ArticleJournal of acquired immune deficiency syndromes (1999)2017
Social Disequilibrium and the Risk of HIV Acquisition: A Multilevel Study in Rural KwaZulu-Natal Province, South Africa.
Article in Journal of acquired immune deficiency syndromes (1999), 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers, 1 of them a synthesis that pooled it.
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Who cites it
17 citing papers in PubMed, 1 synthesis or guideline pooled it, 25 citations in OpenAlex.
- Social, Behavioral, and Cultural factors of HIV in Malawi: Semi-Automated Systematic Review.Journal of medical Internet research · 2020Pooled it
- A method for statistical analysis of repeated residential movements to link human mobility and HIV acquisition.PloS one · 2019Trial
- Leveraging Smartphone Mobility Data to Understand HIV Risk Among Rural South African Young Adults: Feasibility Study.JMIR mHealth and uHealth · 2025Article
- Advancing Adolescent and Young Adult HIV Prevention and Care and Treatment Through Use of Multi-level Theories and Frameworks: A Scoping Review and Adapted HIV Ecological Framework.AIDS and behavior · 2024Article
- Predictors of migration in an HIV hyper-endemic rural South African community: evidence from a population-based cohort (2005-2017).BMC public health · 2022Article
- Multilevel model in the identification of behavioral and structural risk factors for HIV: integrative review.Revista brasileira de enfermagem · 2022Review
- SAHCS 2021 Conference Summary.Southern African journal of HIV medicine · 2022Article
- Cohort Profile Update: Africa Centre Demographic Information System (ACDIS) and population-based HIV survey.International journal of epidemiology · 2021Article
- HIV incidence declines in a rural South African population: a G-imputation approach for inference.BMC public health · 2020Article
- Discrete Survival Time Constructions for Studying Marital Formation and Dissolution in Rural South Africa.Frontiers in psychology · 2020Article
- Declines in HIV incidence among men and women in a South African population-based cohort.Nature communications · 2019Article
- Space-time clustering of recently-diagnosed tuberculosis and impact of ART scale-up: Evidence from an HIV hyper-endemic rural South African population.Scientific reports · 2019Article
- Sociobehavioral and community predictors of unsuppressed HIV viral load: multilevel results from a hyperendemic rural South African population.AIDS (London, England) · 2019Article
- Effect of ART scale-up and female migration intensity on risk of HIV acquisition: results from a population-based cohort in KwaZulu-Natal, South Africa.BMC public health · 2019Observational
- Identifying 'corridors of HIV transmission' in a severely affected rural South African population: a case for a shift toward targeted prevention strategies.International journal of epidemiology · 2018Article
- High percentage of undiagnosed HIV cases within a hyperendemic South African community: a population-based study.Journal of epidemiology and community health · 2018Article
- Sexual partnership age pairings and risk of HIV acquisition in rural South Africa.AIDS (London, England) · 2017Article
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Authors and funding
5 authors at 4 institutions in 3 countries.
Funding
Abstract
backgroundFew population-based multilevel studies have quantified the risks that social context poses in rural communities with high HIV incidence across South Africa. We investigated the individual, social, and community challenges to HIV acquisition risk in areas with high and low incidence of HIV infection (hotspots/coldspots).
methodsThe cohort (N = 17,376) included all HIV-negative adults enrolled in a population-based HIV surveillance study from 2004 to 2015 in a rural South African community with large labor migrancy. Multilevel survival models were fitted to examine the social determinants (ie, neighborhood migration intensity), community traits (ie, HIV prevalence), and individual determinants of HIV acquisition risk in identified hotspots/coldspots.
resultsThe HIV acquisition risk (adjusted hazard ratio [aHR] = 1.05, 95% confidence interval [CI]: 1.01 to 1.09) was greater in hotspots with higher neighborhood migration intensity among men. In women, higher neighborhood migration intensity (aHR = 1.02, 95% CI: 1.01 to 1.02) was associated with a greater HIV acquisition risk, irrespective of whether they lived in hotspot/coldspot communities. HIV acquisition risk was greater in communities with a higher prevalence of HIV in both men (aHR = 1.07, 95% CI: 1.03 to 1.12) and women (aHR = 1.03, 95% CI: 1.01 to 1.05), irrespective of hotspot/coldspot locations.
conclusionHIV acquisition risk was strongly influenced by gender (ie, young women), behavior (ie, sexual debut, contraception, circumcision), and social determinants. Certain challenges (ie, community disease prevalence) for HIV acquisition risk impacted both sexes, regardless of residence in hotspot/coldspot communities, whereas social determinants (ie, neighborhood migration intensity) were pronounced in hotspots among men. Future intervention scale-up requires addressing the social context that contributes to HIV acquisition risk in rural areas with high migration.
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