Continued Very High Prevalence of HIV Infection in Rural KwaZulu-Natal, South Africa: A Population-Based Longitudinal Study

The objective of the current study was to estimate the prevalence of HIV, associated sociodemographic factors including migration and mobility, in a rural population in KwaZulu-Natal, South Africa.

A household-based HIV serosurvey of a population that has been under longitudinal demographic surveillance since 2000 was used for the analysis. Researchers identified and approached for finger-prick HIV testing all residents (women ages 15-40; men ages 15-54) and a sample of non-residents ("migrants") who periodically returned to area households.

A total of 8,325/11,505 male and 11,542/14,396 female residents were traced. Of these, HIV testing consent was obtained from 4,692 men and 6,859 women. Overall, 27 percent of female and 13.5 percent of male residents were HIV-infected. Prevalence peaked at 51 percent among resident women ages 25-29 and 44 percent among resident men ages 30-34; the highest rate of 57.5 percent was among 26-year-old women. The female-to-male infection ratio for residents ages 15-19 was 13.0. Many factors, such as increased mobility, associated with an increased infection risk among residents, were also associated with non-participation. Among non-residents, 41 percent of women ages 15-49 and 34 percent of men ages 15-54 were HIV-infected.

"The extremely high prevalence of HIV suggests an urgent need to allocate adequate resources for HIV prevention and treatment in rural areas. Effective monitoring of the epidemic in Africa needs to include efforts to strengthen sentinel surveillance in rural areas and strategies for the surveillance of migrants and mobile individuals," the researchers concluded.

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