Risk factors for HIV acquisition in high risk women in a generalised epidemic

3 February 2015

South Africa continues to experience one of the largest HIV epidemics in the world, with women bearing a disproportionate burden of HIV infection. Factors associated with HIV risk are incompletely elucidated in this setting. This study by Naicker et al published in the journal AIDS and Bahavior explored demographic, clinical and behavioural characteristics associated with HIV acquisition among 245 high risk women enrolled in the CAPRISA 002 cohort study.

     HIV negative women, considered to be high risk if they self–identified as sex workers or had at least three sexual partners in the 3 months prior to recruitment, were enrolled and followed up for a period of 24 months or until the study endpoint of HIV infection.
     Twenty-eight women acquired HIV with an overall HIV incidence of 7.20 per 100 women years [95% Confidence Interval (CI) 4.50–9.80]. The highest HIV incidence was observed among women aged 18–24 years [IR 13.20 per 100 wy, 95% CI 6.59–23.62]. In multivariable analysis, after adjusting for demographic, behavioural and clinical factors including laboratory diagnosed STIs, younger women were almost three times more likely to acquire HIV compared to women aged 25 years and older [adjusted Hazard Ratio (aHR) 2.61, 95% CI 1.05–6.47]. Women in relationships with multiple sex partners had more than twice the risk of acquiring HIV when compared to women who had no
partner or who had a husband or stable partner (aHR 2.47, 95% CI 0.98–6.26). These trends remained when the analysis was restricted to women reporting sex for compensation.

     This study reiterates the vulnerability of young women in this setting. Furthermore, women with multiple partners were more likely to acquire HIV compared to women reporting stable relationships. HIV prevention programmes must address young women’s vulnerability and sex partner reduction in this setting.