Study of HIV risk in Africa shows women have very low risk behaviors
Even married women were at risk
A recent study of HIV risk among people in Moshi, Tanzania, found that women who had one sex partner had a five-fold increased risk of HIV infection when compared with similar men.1
"This analysis derives from a survey conducted among people presenting for HIV testing at the HIV voluntary and testing service organization called Kiwakkuki in Moshi," says Nathan M. Thielman, MD, MPH, associate professor in the department of infectious diseases at Duke University in Durham, NC.
"We simply asked a very straightforward question among 1,974 clients: we asked them how many sexual partners they had in their lifetime," Thielman says. "So, 72 of them reported they had none; they'd had lifetime abstinence, and 585 reported one sexual partner for their lifetime, which we took to mean faithfulness, and 1,317 had more than one partner."
As was expected, among the men and women who reported abstinence, the HIV seroprevalence was lowest at about 3 percent, Thielman says.
And among men who reported having only one lifetime partner, only 4 percent were HIV positive, Thielman notes.
However, women who reported having only one lifetime partner had a 22 percent infection rate, which made them five times more likely than men who reported similar behavior to be HIV infected, he says.
For women who reported more than one lifetime partner, the HIV seroprevalence rate was 33 percent, and for men who had more than one lifetime partner, it was 12 percent.1
Also, the median number of partners among women who had more than one lifetime partner was two, while the median number of partners among men who had more than one lifetime partner was four.1
"What is most concerning in this study is the difference in HIV seroprevalence among women who report being faithful and men who report being faithful," Thielman says.
"As such the key policy implication I draw from this is we need to advocate for prevention methods that empower women to negotiate safer sex even in the context of monogamous relationships," Thielman adds.
One possible limitation to the study is previous research that suggests that women in sub-Saharan Africa may under-report their sexual activity relative to men, Thielman says.
"It's somewhat controversial," he says. "So there are limitations in this study because it relies on self-reporting of sexual activity."
However, the overriding message is that men and women who are abstinent had the lowest absolute risk of HIV infection, and men with a single lifetime partner had a very low risk of HIV infection, Thielman says.
Governmental and non-governmental health organizations serving this population face considerable challenges in HIV prevention work, he notes.
"The greatest challenge is getting the money directly to the organizations that do the good work," Thielman says.
"I think there is an appropriate amount of emphasis on provision of treatment for those who are HIV infected," Thielman says. "And I'm a huge advocate of providing antiretrovirals to those in need, but we don't want to lose sight of providing prevention messages, as well."
One cost model of HIV prevention work suggests that for every $92 spent to offer free voluntary counseling and testing, one HIV infection could be averted, Thielman says.
"Compare that to the cost of treatment, and it's illustrative of the importance of a prevention message coupled with treatment in sub-Saharan Africa," Thielman says. "Those are the data we've modeled out through this program."
Reference:
- Landman KZ, et al. Differences in the risk of HIV infection among persons reporting abstinence, faithfulness, and multiple sexual partners in Moshi, Tanzania. Presented at the 43rd Annual Meeting of the Infectious Diseases Society of America, Oct. 6-9, 2005, in San Francisco, CA. Abstract:768.
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