Despite increased antiretroviral therapy (ART) coverage, the incidence of HIV infection among women in rural South Africa remains high. While many socio-demographic and behavioral factors have been identified, the effect of female migration intensity on the risk of HIV acquisition before and after ART scale-up has not been evaluated in the country.
We followed 13,315 female participants aged 15–49 who were HIV-uninfected at baseline and recorded their migration events between 2004 and 2015. Using a Cox proportional hazard model, we estimated the time to HIV acquisition among the women, adjusting for annual migration intensity (high: ≥2 events/year, moderate = 1 event/year, and low = 0 event/year) before and after ART scale-up in 2010.
1998 (15%) new HIV-infection events were recorded during the observation period. Overall, high migration intensity was associated with an increased HIV acquisition risk among women when compared with low migration intensity (HR = 2.88, 95% CI: 1.56–5.53). Among those with high migration intensity, the risk of HIV acquisition was significantly lower in the post-ART period compared to the pre-ART period, after controlling for key socio-demographic and behavioural covariates (aHR = 0.18, 95% CI 0.04–0.83).
Women who migrated frequently after ART scale-up had a significantly reduced HIV acquisition risk compared to those before its implementation. While this reduction is encouraging, women who migrate frequently remain at high risk of HIV acquisition. In the era of ART, there remains a critical need for public health interventions to reduce the risk of HIV acquisition in this highly vulnerable population.
University of Lincoln, College of Social Science Research
Armtsrong Dzomba, KwaZulu-Natal, South Africa, School of Nursing and Public Health, Africa Health Research Institute (AHRI), Research Innovation and Sequencing Platform (KRISP)
Andrew Tomita, KwaZulu-Natal, South Africa, Africa Health Research Institute (AHRI), KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), Centre for Rural Health, School of Nursing and Public Health
Alain Vandormael, KwaZulu-Natal, South Africa, Africa Health Research Institute (AHRI), School of Nursing and Public Health, KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP)
Kaymarlin Govender, University of KwaZulu-Natal, Health Economics and HIV and AIDS Research Division (HEARD)
Frank Tanser, KwaZulu-Natal, South Africa, Africa Health Research Institute (AHRI), School of Nursing and Public Health, Centre for the AIDS Programme of Research in South Africa (CAPRISA), University College London, Research Department of Infection & Population Health, and University of Lincoln, Lincoln Institute for Health