AIDS
Volume 17, Issue 15, 2003, Pages 2245-2252

Who infects whom? HIV-1 concordance and discordance among migrant and non-migrant couples in South Africa (Article)

Lurie M.N.* , Williams B.G. , Zuma K. , Mkaya-Mwamburi D. , Garnett G.P. , Sweat M.D. , Gittelsohn J. , Abdool Karim S.S.
  • a S. African Medical Research Council, HIV Prev. and Vaccine Research Unit, Durban, South Africa, Department of Infectious Disease, Brown University School of Medicine, Miriam Hospital, Providence, RI, United States, Dept. of Med. and Community Health, Brown University School of Medicine, Miriam Hospital, 164 Summit Avenue, Providence, RI 02906, United States
  • b 16 rue de la Canonniere, Geneva, Switzerland
  • c S. African Medical Research Council, HIV Prev. and Vaccine Research Unit, Durban, South Africa, Department of Statistics, University of Waikato, Hamilton, New Zealand
  • d S. African Medical Research Council, HIV Prev. and Vaccine Research Unit, Durban, South Africa
  • e Dept. of Infect. Dis. Epidemiology, Imp. Coll. Sch. Med. at St. Mary's, London, United Kingdom
  • f Department of International Health, Johns Hopkins University, School of Public Health, Baltimore, MD, United States
  • g Department of International Health, Johns Hopkins University, School of Public Health, Baltimore, MD, United States
  • h University of Natal, Durban, South Africa

Abstract

Objectives: To measure HIV-1 discordance among migrant and non-migrant men and their rural partners, and to estimate the relative risk of infection from inside versus outside primary relationships. Design: A cross-sectional behavioural and HIV-1 seroprevalence survey among 168 couples in which the male partner either a migrant, or not. Methods: A detailed questionnaire was administered and blood was collected for laboratory analysis. A mathematical model was developed to estimate the relative risk of infection from inside versus from outside regular relationships. Results: A total of 70% (117 of 168) of couples were negatively concordant for HIV, 9% (16 of 168) were positively concordant and 21% (35 of 168) were discordant. Migrant couples were more likely than non-migrant couples to have one or both partners infected [35 versus 19%; P = 0.026; odds ratio (OR) = 2.28] and to be HIV-1 discordant (27 versus 15%; P = 0.066; OR = 2.06). In 71.4% of discordant couples, the male was the infected partner; this did not differ by migration status. In the mathematical model, migrant men were 26 times more likely to be infected from outside their regular relationships than from inside [relative risk (RR) = 26. 3; P = 0.000]; non-migrant men were 10 times more likely to be infected from outside their regular relationships than inside (RR = 10.5; P = 0.00003). Conclusions: Migration continues to play an important role in the spread of HIV-1 in South Africa. The direction of spread of the epidemic is not only from returning migrant men to their rural partners, but also from women to their migrant partners. Prevention efforts will need to target both migrant men and women who remain at home. © 2003 Lippincott Williams & Wilkins.

Author Keywords

Migration South Africa Mathematical model Epidemiology Partners Discordance Couples HIV-1

Index Keywords

Models, Biological rural area HIV Infections sexual behavior Human immunodeficiency virus infection multivariate logistic regression analysis human Health Behavior risk assessment Sexual Partners rural population controlled study priority journal mathematical model Cross-Sectional Studies South Africa Humans male spouse female Risk Factors high risk population prevalence Disease Outbreaks Article epidemic major clinical study adult infection risk HIV-1 Age Factors Human immunodeficiency virus 1 Emigration and Immigration virus transmission seroprevalence Seroepidemiologic Studies population migration
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-0242301660&doi=10.1097%2f00002030-200310170-00013&partnerID=40&md5=72d157e09daf9d97ead5ac99b4663637
DOI: 10.1097/00002030-200310170-00013
ISSN: 02699370
Cited by: 217
Original Language: English