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High HIV incidence and low uptake of HIV prevention services: the context of risk for young male adults prior to DREAMS in rural KwaZulu-Natal, South Africa

High HIV incidence and low uptake of HIV prevention services: the context of risk for young male adults prior to DREAMS in rural KwaZulu-Natal, South Africa
High HIV incidence and low uptake of HIV prevention services: the context of risk for young male adults prior to DREAMS in rural KwaZulu-Natal, South Africa
Background: young men are less likely than young women to engage with HIV prevention and care, and their HIV-related mortality is higher. We describe HIV incidence and uptake of HIV services in men 20-29 years(y) in rural KwaZulu-Natal, South Africa, before the roll-out of DREAMS.Methods: we used data from a population-based demographic and HIV surveillance cohort. HIV incidence was estimated from anonymised testing in an annual serosurvey. Service uptake was assessed in 2011 and 2015, through two self-reported outcomes: 1) HIV testing in the past 12 months(m); 2) voluntary medical male circumcision(VMMC). Logistic regression was used to estimate odds ratios(OR) and 95% confidence intervals(CI) for factors associated with each outcome.Results: HIV incidence in 2011-2015 was 2.6/100 person-years (95%CI=2.0-3.4) and 4.2 (95%CI=3.1-5.6) among men 20-24y and 25-29y, respectively, with no significant change from 2006-2010. N=1311 and N=1221 young men participated in the 2011 and 2015 surveys, respectively. In both years, <50% reported testing for HIV in the past 12m. In 2011, only 5% reported VMMC, but coverage in 2015 increased to 40% and 20% in men 20-24y and 25-29y, respectively. HIV testing was positively associated with higher education and mobility. Testing uptake was higher in men reporting >1 partner in the past 12m, or condom use at last sex, but lower in those reporting a casual partner (adjusted (a)OR=0.53, 95%CI=0.37-0.75). VMMC uptake was associated with survey year and higher education. Men aged 25-29y and those who were employed (aOR=0.66; 95%CI=0.49-0.89) were less likely to report VMMC.Conclusions: HIV incidence in men 20-29y was very high, and pre-exposure prophylaxis (PrEP) should be considered in this population. Uptake of services was low. VMMC coverage increased dramatically from 2011 to 2015, especially among younger men, suggesting a demand for this service. Interventions designed with and for young men are urgently needed.
1932-6203
Baisley, Kathy
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Chimbindi, Natsayi
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Mthiyane, Nondumiso
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Floyd, Sian
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Mcgrath, Nuala
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Pillay, Deenan
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Seeley, Janet
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Zuma, Thembelihle
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Dreyer, Jaco
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Gareta, Dickman
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Smit, Teresa
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Mutevedzi, Tinofa
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Fenty, Justin
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Herbst, Kobus
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Birdthistle, Isolde
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Shahmanesh, Maryam
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Baisley, Kathy
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Chimbindi, Natsayi
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Mthiyane, Nondumiso
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Floyd, Sian
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Mcgrath, Nuala
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Pillay, Deenan
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Seeley, Janet
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Zuma, Thembelihle
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Dreyer, Jaco
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Gareta, Dickman
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Smit, Teresa
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Mutevedzi, Tinofa
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Fenty, Justin
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Herbst, Kobus
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Birdthistle, Isolde
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Shahmanesh, Maryam
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Baisley, Kathy, Chimbindi, Natsayi, Mthiyane, Nondumiso, Floyd, Sian, Mcgrath, Nuala, Pillay, Deenan, Seeley, Janet, Zuma, Thembelihle, Dreyer, Jaco, Gareta, Dickman, Smit, Teresa, Mutevedzi, Tinofa, Fenty, Justin, Herbst, Kobus, Birdthistle, Isolde and Shahmanesh, Maryam (2018) High HIV incidence and low uptake of HIV prevention services: the context of risk for young male adults prior to DREAMS in rural KwaZulu-Natal, South Africa. PLoS ONE, 13 (12). (doi:10.1371/journal.pone.0208689).

Record type: Article

Abstract

Background: young men are less likely than young women to engage with HIV prevention and care, and their HIV-related mortality is higher. We describe HIV incidence and uptake of HIV services in men 20-29 years(y) in rural KwaZulu-Natal, South Africa, before the roll-out of DREAMS.Methods: we used data from a population-based demographic and HIV surveillance cohort. HIV incidence was estimated from anonymised testing in an annual serosurvey. Service uptake was assessed in 2011 and 2015, through two self-reported outcomes: 1) HIV testing in the past 12 months(m); 2) voluntary medical male circumcision(VMMC). Logistic regression was used to estimate odds ratios(OR) and 95% confidence intervals(CI) for factors associated with each outcome.Results: HIV incidence in 2011-2015 was 2.6/100 person-years (95%CI=2.0-3.4) and 4.2 (95%CI=3.1-5.6) among men 20-24y and 25-29y, respectively, with no significant change from 2006-2010. N=1311 and N=1221 young men participated in the 2011 and 2015 surveys, respectively. In both years, <50% reported testing for HIV in the past 12m. In 2011, only 5% reported VMMC, but coverage in 2015 increased to 40% and 20% in men 20-24y and 25-29y, respectively. HIV testing was positively associated with higher education and mobility. Testing uptake was higher in men reporting >1 partner in the past 12m, or condom use at last sex, but lower in those reporting a casual partner (adjusted (a)OR=0.53, 95%CI=0.37-0.75). VMMC uptake was associated with survey year and higher education. Men aged 25-29y and those who were employed (aOR=0.66; 95%CI=0.49-0.89) were less likely to report VMMC.Conclusions: HIV incidence in men 20-29y was very high, and pre-exposure prophylaxis (PrEP) should be considered in this population. Uptake of services was low. VMMC coverage increased dramatically from 2011 to 2015, especially among younger men, suggesting a demand for this service. Interventions designed with and for young men are urgently needed.

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High HIV incidence and low uptake of HIV prevention services the context of risk for young male adults prior to DREAMS in rural KwaZulu-Natal - Accepted Manuscript
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Accepted/In Press date: 3 December 2018
e-pub ahead of print date: 26 December 2018

Identifiers

Local EPrints ID: 426787
URI: http://eprints.soton.ac.uk/id/eprint/426787
ISSN: 1932-6203
PURE UUID: 7fb100fd-c532-42e6-bdcb-d7e7aaa1125b
ORCID for Nuala Mcgrath: ORCID iD orcid.org/0000-0002-1039-0159

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Date deposited: 12 Dec 2018 17:30
Last modified: 17 Dec 2019 01:37

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Contributors

Author: Kathy Baisley
Author: Natsayi Chimbindi
Author: Nondumiso Mthiyane
Author: Sian Floyd
Author: Nuala Mcgrath ORCID iD
Author: Deenan Pillay
Author: Janet Seeley
Author: Thembelihle Zuma
Author: Jaco Dreyer
Author: Dickman Gareta
Author: Teresa Smit
Author: Tinofa Mutevedzi
Author: Justin Fenty
Author: Kobus Herbst
Author: Isolde Birdthistle
Author: Maryam Shahmanesh

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