High HIV incidence in a community with high HIV prevalence in rural South Africa: findings from a prospective population-based study

AIDS. 2008 Jan 2;22(1):139-44. doi: 10.1097/QAD.0b013e3282f2ef43.


Objectives: To measure HIV incidence in a rural area of South Africa with high HIV prevalence and to analyze risk factors for acquisition of HIV using a prospective population-based cohort study.

Methods: Data from two rounds (2003-2005) of a large prospective population-based HIV survey in rural KwaZulu-Natal were used to calculate HIV incidence by sex and 5-year age group. Multiple imputations (MI) were used to adjust for selection effects and risk factors for acquiring HIV were examined in Weibull multiple regression.

Results: During 5253 person-years at risk, 170 individuals became seropositive. The crude HIV incidence rate per 100 person-years was 3.8 [95% confidence interval (CI), 3.2-4.6] in women aged 15-49 years and 2.3 (95% CI, 1.8-3.1) in men aged 15-54 years. MI significantly increased the HIV incidence rates both in women and men [7.9/100 person-years (95% CI, 7.4-8.4) and 5.1/100 person-years (95% CI 4.1-6.2), respectively]. When holding other factors constant in Weibull multiple regression, the hazard of HIV seroconversion was approximately twice as high in people who were currently unmarried but had a partner than among people who were currently married (P < 0.001) and increased with increasing distance from a government health clinic (P = 0.051) and decreasing distance from a primary road (P = 0.002).

Conclusion: In this high HIV prevalence community in rural South Africa HIV incidence is very high. The present focus on antiretroviral treatment needs to be balanced with a renewed emphasis on HIV prevention for both sexes.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Female
  • HIV Antibodies / blood*
  • HIV Infections / blood
  • HIV Infections / epidemiology*
  • HIV Seroprevalence
  • HIV-1*
  • Humans
  • Incidence
  • Male
  • Marital Status
  • Middle Aged
  • Patient Acceptance of Health Care
  • Prospective Studies
  • Residence Characteristics
  • Rural Population
  • Sentinel Surveillance
  • South Africa / epidemiology


  • HIV Antibodies