Distinct HIV discordancy patterns by epidemic size in stable sexual partnerships in sub-Saharan Africa
- 1Infectious Disease Epidemiology Group, Weill Cornell Medical College–Qatar, Cornell University, Qatar Foundation–Education City, Doha, Qatar
- 2Department of Infectious Disease Epidemiology, Imperial College London, London, UK
- 3Bureau for Global Health, United States Agency for International Development, Washington, DC, USA
- 4Department of Public Health, Weill Cornell Medical College, Cornell University, New York, New York, USA
- 5Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Correspondence to Dr Laith J Abu-Raddad, Weill Cornell Medical College–Qatar, Qatar Foundation–Education City, P.O. Box 24144, Doha, Qatar;
Contributors HC managed the databases, conducted the data analyses and wrote the first draft of the paper. LJA-R conceived and led the design and conduct of the study and contributed to the data analyses. All authors contributed to the interpretation of the results and drafting of the manuscript. All authors were involved in the finalisation of the manuscript and approved the final version.
- Accepted 16 October 2011
Objective To describe patterns of HIV infection among stable sexual partnerships across sub-Saharan Africa (SSA).
Methods The authors defined measures of HIV discordancy and conducted a comprehensive quantitative assessment of discordancy among stable partnerships in 20 countries in SSA through an analysis of the Demographic and Health Survey data.
Results HIV prevalence explained at least 50% of the variation in HIV discordancy, with two distinct patterns of discordancy emerging based on HIV prevalence being roughly smaller or larger than 10%. In low-prevalence countries, approximately 75% of partnerships affected by HIV are discordant, while only about half of these are discordant in high-prevalence countries. Out of each 10 HIV infected persons, two to five are engaged in discordant partnerships in low-prevalence countries compared with one to three in high-prevalence countries. Among every 100 partnerships in the population, one to nine are affected by HIV and zero to six are discordant in low-prevalence countries compared with 16–45 and 9–17, respectively, in high-prevalence countries. Finally, zero to four of every 100 sexually active adults are engaged in a discordant partnership in low-prevalence countries compared with six to eight in high-prevalence countries.
Conclusions In high-prevalence countries, a large fraction of stable partnerships were affected by HIV and half were discordant, whereas in low-prevalence countries, fewer stable partnerships were affected by HIV but a higher proportion of them were discordant. The findings provide a global view of HIV infection among stable partnerships in SSA but imply complex considerations for rolling out prevention interventions targeting discordant partnerships.
- demographic and health survey
- sexual partnerships
- sub-Saharan Africa
- behavioural intervention
- sexual behaviour
- epidemiology (general)
Funding Qatar National Research Fund (QNRF) (NPRP 08-068-3-024), the Biostatistics, Epidemiology, and Biomathematics Research Core at the Weill Cornell Medical College in Qatar (WCMC-Q), The Wellcome Trust, and the National Institutes of Health (R01 AI083034).
Competing interests None.
Provenance and peer review Not commissioned; externally peer reviewed.
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