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Volume 29, Number 11—November 2023
Research

Risk Factors for Recent HIV Infections among Adults in 14 Countries in Africa Identified by Population-Based HIV Impact Assessment Surveys, 2015–2019

Dustin W. CurrieComments to Author , Christine A. West, Hetal K. Patel, Jennifer Favaloro, Fred Asiimwe, Felix Ndagije, Rachel Silver, Owen Mugurungi, Judith Shang, Clement B. Ndongmo, Daniel B. Williams, Edington Dzinotyiweyi, Anthony Waruru, Munyaradzi Pasipamire, Harriet Nuwagaba-Biribonwoha, Sindisiwe Dlamini, Natasha McLeod, Eugenie Kayirangwa, Gallican Rwibasira, Peter A. Minchella, Andrew F. Auld, Rose Nyirenda, Yimam Getaneh, Ashenafi Haile Hailemariam, Isabelle Tondoh-Koui, Natacha Kohemun, George S. Mgomella, Prosper Faustine Njau, Wilford L. Kirungi, Ibrahim Dalhatu, Kristen A. Stafford, Stephane M. Bodika, Faith Ussery, Stephen McCracken, Paul Stupp, Kristin Brown, Yen T. Duong, Bharat S. Parekh, and Andrew C. Voetsch
Author affiliations: Centers for Disease Control and Prevention, Atlanta, Georgia, USA (D.W. Currie, C.A. West, H.K. Patel, J. Favaloro, R. Silver, S.M. Bodika, F. Ussery, S. McCracken, P. Stupp, K. Brown, B.S. Parekh, A.C. Voetsch); Centers for Disease Control and Prevention, Maseru, Lesotho (F. Asiimwe); Columbia University, Maseru (F. Ndagije); Zimbabwe Ministry of Health and Child Care, Harare, Zimbabwe (O. Mugurungi); Centers for Disease Control and Prevention, Yaoundé, Cameroon (J. Shang, C.B. Ndongmo); Centers for Disease Control and Prevention, Windhoek, Namibia (D.B. Williams); Republic of Namibia Ministry of Health and Social Services, Windhoek (E. Dzinotyiweyi); Centers for Disease Control and Prevention, Nairobi, Kenya (A. Waruru); Centers for Disease Control and Prevention, Mbabane, Eswatini (M. Pasipamire); Columbia University, Mbabane (H. Nuwagaba-Biribonwoha); Ministry of Health Mbabane, Mbabane (S. Dlamini); Columbia University, New York, New York, USA (N. McLeod, Y.T. Duong); Centers for Disease Control and Prevention, Kigali, Rwanda (E. Kayirangwa); Republic of Rwanda Ministry of Health, Kigali (G. Rwibasira); Centers for Disease Control and Prevention, Lusaka, Zambia (P.A. Minchella, A.F. Auld); Ministry of Health, Lilongwe, Malawi (R. Nyrenda); Ethiopian Public Health Institute, Addis Ababa, Ethiopia (Y. Getaneh); Zhejiang University, Hangzhou, China (Y. Getaneh); Centers for Disease Control and Prevention, Addis Ababa (A.H. Hailemariam); Cote d’Ivoire Ministry of Health, Abidjan, Côte d’Ivoire (I. Tondoh-Koui); Centers for Disease Control and Prevention, Abidjan (N. Kohemun); Centers for Disease Control and Prevention, Dar es Salaam, Tanzania (G.S. Mgomella); United Republic of Tanzania Ministry of Health, Dodoma, Tanzania (P.F. Njau); Republic of Uganda Ministry of Health, Kampala, Uganda (W.L. Kirungi); Centers for Disease Control and Prevention, Abuja, Nigeria (I. Dalhatu); University of Maryland, Baltimore, Maryland, USA (K.A. Stafford)

Main Article

Table 2

Bivariate comparisons of risk factors for HIV infections among adults in 14 countries in Africa identified by Population-Based HIV Impact Assessment surveys, 2015–2019

Risk factor Recent HIV infection
 HIV negative
 Long-term HIV infections
No. Weighted
 No. Weighted
 p value* No. Weighted
 p value†
No. % No. % No. %
Region‡ <0.0001 0.01
Western Africa 53 31,539 27.1 121,330 72,879,939 51.5 2,412 1,348,293 21.1
Eastern Africa 72 53,892 46.3 73,843 53,868,359 38.1 3,906 2,756,375 43.1
Southeastern Africa 70 24,950 21.4 29,160 13,091,358 9.3 4,890 1,856,636 29
Southern Africa
 69
 6,069
 5.2
17,576
 1,615,316
 1.1
5,359
 436,423
 6.8
Sex 0.005 0.92
M 78 40,782 35 99,363 66,646,015 47.1 5,000 2,261,024 35.3
F
 186
 75,668
 65
142,546
 74,808,958
 52.9
11,567
 4,136,702
 64.7
Age group, y 0.03 <0.0001
15–24 91 36,543 31.4 67,966 41,540,180 29.4 1,893 755,870 11.8
25–34 111 53,441 45.9 91,808 53,077,420 37.5 6,178 2,371,780 37.1
35–49
 62
 26,466
 22.7
82,135
 46,837,373
 33.1
8,496
 3,270,077
 51.1
Household wealth 0.41 0.70
Lowest 40% 96 40,848 35.1 97,567 54,229,216 38.3 6,224 2,161,490 33.8
Upper 60%
 168
 75,602
 64.9
144,255
 87,186,311
 61.7
10,326
 4,231,165
 66.2
Household location§ 0.34
Urban 126 46,670 40.1 96,798 63,325,186 44.8 0.25 6,924 2,784,412 43.5
Rural
 138
 69,780
 59.9
145,111
 78,129,786
 55.2
9,643
 3,613,314
 56.5
Education level 0.04 0.07
None 25 11,533 10.1 44,294 25,840,908 18.5 1,413 696,206 10.9
Primary 100 49,596 43.6 86,089 52,676,177 37.7 7,676 3,299,037 51.8
Postprimary
 138
 52,660
 46.3
109,771
 61,061,737
 43.7
7,431
 2,370,552
 37.3
Worked in previous 12 mo 0.94 0.58
Yes 127 62,728 53.9 123,378 76,651,794 54.2 7,911 3,318,448 51.9
No
 137
 53,722
 46.1
118,448
 64,758,011
 45.8
8,651
 3,076,646
 48.1
Marital status <0.0001 <0.0001
Married/like married 151 69,813 60.2 175,295 101,169,547 71.6 10,908 4,436,093 69.5
Divorced/separated 41 22,659 19.5 10,826 6,561,523 4.6 1,952 836,072 13.1
Widowed 3 388 0.3 2,054 1,092,655 0.8 968 362,925 5.7
Never married
 68
 23,204
 20
53,335
 32,405,793
 22.9
2,700
 751,311
 11.8
Age of sexual debut, y 0.001 0.006
<18 157 66,675 59.9 106,632 63,470,656 46.3 7,653 3,134,550 50.2
≥18
 98
 44,632
 40.1
127,738
 73,588,418
 53.7
8,493
 3,111,333
 49.8
No. sexual partners in previous 12 mo 0.0003 <0.0001
1 partner 200 82,904 71.2 204,635 116,558,470 82.4 13,953 5,238,471 81.9
>2 partners
 64
 33,546
 28.8
37,274
 24,896,503
 17.6
2,614
 1,159,256
 18.1
Relationship with last sexual partner 0.05 0.005
Husband/wife or live-in partner 121 47,756 57.4 97,489 54,972,899 59.1 9,562 3,636,435 69.3
Partner, not living with 56 16,609 20.0 19,979 9,938,239 12.5 2,924 742,195 14.1
Ex-spouse or ex-partner 10 4,193 5.0 5,036 2,610,448 3.3 640 221,601 4.2
Friend or acquaintance 25 13,507 16.2 15,229 10,823,253 13.6 1,117 556,196 10.6
Other relationship
 4
 1,168
 1.4
1,936
 1,186,842
 1.5
206
 89,099
 1.7
Sexual partner outside marriage/live-in partner, previous 12 mo <0.0001 <0.0001
All partners spouse/live-in 123 52,369 45.0 167,344 95,343,903 67.4 10,146 3,999,570 62.6
Not all partners spouse/live-in
 140
 64,057
 55.0
74,407
 46,022,631
 32.6
6,412
 2,393,107
 37.4
Condom use at last sexual intercourse 0.18 0.0004
Used condom 71 21,302 19.0 37,519 20,655,616 15.1 6,554 1,940,679 31.5
Did not use condom
 186
 90,769
 81.0
197,907
 116,224,955
 84.9
9,595
 4,223,093
 68.5
Condom use at last sexual intercourse with a non–spouse/live-in partner¶ 0.02 0.001
Used condom 44 14,409 24.1 27,045 15,467,358 36.8 2,918 834,620 38.4
Did not use condom
 89
 45,270
 75.9
41,936
 26,610,675
 63.2
3,121
 1,337,601
 61.6
HIV status of sexual partners in previous 12 mo <0.0001 <0.0001
>1 partner thought/told/tested HIV+ 17 9,272 8.0 2,460 1,223,899 0.9 5,415 2,050,692 32.4
>1 partner with unknown HIV status 160 73,747 63.4 125,184 74,688,294 52.8 6,180 2,642,358 41.8
All partners thought/told/tested HIV–
 84
 33,217
 28.6
113,852
 65,396,552
 46.3
3,984
 1,628,233
 25.8
Age difference with sexual partners 0.08 0.37
All partners <5 years older than participant 145 68,659 59.6 148,663 91,313,569 65.3 9,487 3,765,009 60.2
>1 partner 5–9 years older than participant 68 26,805 23.3 44,307 23,554,393 16.8 3,476 1,254,666 20.1
>1 partner >10 years older than participant
 44
 19,708
 17.1
45,609
 24,970,655
 17.9
3,197
 1,235,268
 19.7
Community HIV viremia# <0.0001 0.03
Lowest quartile 18 14,601 12.5 63,635 45,382,548 32.1 1,022 533,366 8.3
Second quartile 29 13,682 11.7 61,878 31,538,699 22.3 1,297 588,249 9.2
Third quartile 65 36,361 31.2 63,050 38,179,235 27.0 3,452 1,786,811 27.9
Highest quartile 152 51,806 44.5 53,346 26,354,490 18.6 10,796 3,489,301 54.5

*p value comparing the distribution of the variable of interest among participants with recent HIV infection and those who were HIV-negative. †p value comparing the distribution of the variable of interest among participants with recent HIV infection and those with long-term HIV infections. ‡Western: Cameroon, Cote d’Ivoire, Nigeria; Eastern: Ethiopia, Kenya, Rwanda, Tanzania, Uganda; Southeastern: Malawi, Zambia, Zimbabwe; Southern: Eswatini, Lesotho, Namibia. §In Ethiopia, only the urban population was sampled. ¶Only calculated among participants with >1 sexual partner who was not a spouse or live-in partner. #Lowest quartile (0–25%), <39.38 viremic persons/10,000 population; second quartile (25%–50%), 39.38–122.51 viremic persons/10,000 population; third quartile (50%–75%), 122.52–297.03 viremic persons/10,000 population; highest quartile (76%–100%), >297.03 viremic persons/10,000 population.

Main Article

Page created: October 02, 2023
Page updated: October 23, 2023
Page reviewed: October 23, 2023
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
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