Factors associated with variations in population HIV prevalence across West Africa: Findings from an ecological analysis

Prudden, H; Beattie, T; Bobrova, N; Panovska-Griffiths, J; Mukandavire, Z; Gorgens, M; Wilson, D; Watts, C PloS One, 2015; journals.plos.org/plosone/article?id=10.1371/journal.pone.0142601

This paper examines the national epidemiological and behavioural factors associated with population HIV prevalence across West Africa. An ecological analysis using linear regression assessed which factors are affiliated with national variations in population female and male HIV prevalence, and with each other.

Findings

  • National population HIV prevalence varies between 0.4 – 2.9% for men and 0.4 – 5.6% for women
  • Antiretroviral Therapy (ART) coverage ranges from 6 – 23%
  • National variations in HIV prevalence are not shown to be associated with variations in HIV prevalence among female sex workers (FSWs) or clients. Instead they are associated with variations in the percentage of younger and older males and females reporting multiple partners
  • FSWs and younger female HIV prevalence are associated with client population sizes, especially older men

These findings highlight that sexual activity between high-risk men and young girls is an important additional route through which HIV infection may spread to the general population. This poses major challenges for HIV programmes, as girls with multiple partners who may be involved in transactional exchanges (both monetary and material) but who do not identify themselves as sex workers, can be difficult to identify and reach. 

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