Abstract
HIV prevalence varies markedly throughout Africa, and it is often presumed areas of higher HIV prevalence (i.e., hotspots) serve as sources of infection to neighboring areas of lower prevalence. However, the small-scale geography of migration networks and movement of HIV-positive individuals between communities is poorly understood. Here, we use population-based data from ~22,000 persons of known HIV status to characterize migratory patterns and their relationship to HIV among 38 communities in Rakai, Uganda with HIV prevalence ranging from 9 to 43%. We find that migrants moving into hotspots had significantly higher HIV prevalence than migrants moving elsewhere, but out-migration from hotspots was geographically dispersed, contributing minimally to HIV burden in destination locations. Our results challenge the assumption that high prevalence hotspots are drivers of transmission in regional epidemics, instead suggesting that migrants with high HIV prevalence, particularly women, selectively migrate to these areas.
Highlights
human immunodeficiency virus (HIV) prevalence varies markedly throughout Africa, and it is often presumed areas of higher HIV prevalence serve as sources of infection to neighboring areas of lower prevalence
Modeling studies of national and sub-national HIV epidemics on the African continent have found that targeting of high prevalence areas is an efficient use of public health resources, these studies were conducted in settings where high prevalence areas corresponded to areas with the largest numbers of people living with HIV29–31
In previous work conducted in rural Rakai District, Uganda and surrounding areas, we showed that sexual partnerships with people outside a community of residence were especially risky for women and were likely responsible for ~25% of incident HIV infections among non-migrants[38]
Summary
HIV prevalence varies markedly throughout Africa, and it is often presumed areas of higher HIV prevalence (i.e., hotspots) serve as sources of infection to neighboring areas of lower prevalence. Modeling studies of national and sub-national HIV epidemics on the African continent have found that targeting of high prevalence areas (i.e., hotspots) is an efficient use of public health resources, these studies were conducted in settings where high prevalence areas corresponded to areas with the largest numbers of people living with HIV29–31. It is unknown whether targeting of high prevalence areas with a low density of HIV-positive people relative to the surrounding region would have similar impact. HIV can be seeded from hotspots into other communities through two mechanisms: cross-community sexual partnerships or migration of HIV-positive individuals between communities
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