Prevalence of HIV among those 15 and older in rural South Africa
Identifieur interne : 002069 ( Pmc/Corpus ); précédent : 002068; suivant : 002070Prevalence of HIV among those 15 and older in rural South Africa
Auteurs : Francesc Xavier G Mez-Olivé ; Nicole Angotti ; Brian Houle ; Kerstin Klipstein-Grobusch ; Chodziwadziwa Kabudula ; Jane Menken ; Jill Williams ; Stephen Tollman ; Samuel J. ClarkSource :
- AIDS Care [ 0954-0121 ] ; 2013.
Abstract
A greater knowledge of the burden of HIV in rural areas of Southern Africa is needed, especially among older adults. We conducted a cross-sectional biomarker survey in the rural South African Agincourt Health and Sociodemographic Surveillance site in 2010–2011 and estimated HIV prevalence and risk factors. Using an age–sex stratified random sample of ages 15 +, a total of 5037 (65.7%) of a possible 7662 individuals were located and 4362 (86.6%) consented to HIV testing. HIV prevalence was high (19.4%) and characterized by a large gender gap (10.6% for men and 23.9% for women). Rates peaked at 45.3% among men and 46.1% among women – both at ages 35–39. Compared with a similar study in the rural KwaZulu-Natal Province, South Africa, peak prevalence occurred at later ages, and HIV prevalence was higher among older adults – with rates above 15% for men and 10% for women through to age 70. High prevalence continues to characterize Southern Africa, and recent evidence confirms that older adults cannot be excluded from policy considerations. The high prevalence among older adults suggests likely HIV infection at older ages. Prevention activities need to expand to older adults to reduce new infections. Treatment will be complicated by increased risk of noncommunicable diseases and by increasing numbers of older people living with HIV.
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DOI: 10.1080/09540121.2012.750710
PubMed: 23311396
PubMed Central: 3778517
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Prevalence of HIV among those 15 and older in rural South Africa</title><author><name sortKey="G Mez Olive, Francesc Xavier" sort="G Mez Olive, Francesc Xavier" uniqKey="G Mez Olive F" first="Francesc Xavier" last="G Mez-Olivé">Francesc Xavier G Mez-Olivé</name><affiliation><nlm:aff id="A1"> School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa</nlm:aff></affiliation></author><author><name sortKey="Angotti, Nicole" sort="Angotti, Nicole" uniqKey="Angotti N" first="Nicole" last="Angotti">Nicole Angotti</name><affiliation><nlm:aff id="A1"> School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa</nlm:aff></affiliation><affiliation><nlm:aff id="A2"> Institute of Behavioral Science, University of Colorado, Boulder, CO, USA</nlm:aff></affiliation></author><author><name sortKey="Houle, Brian" sort="Houle, Brian" uniqKey="Houle B" first="Brian" last="Houle">Brian Houle</name><affiliation><nlm:aff id="A2"> Institute of Behavioral Science, University of Colorado, Boulder, CO, USA</nlm:aff></affiliation></author><author><name sortKey="Klipstein Grobusch, Kerstin" sort="Klipstein Grobusch, Kerstin" uniqKey="Klipstein Grobusch K" first="Kerstin" last="Klipstein-Grobusch">Kerstin Klipstein-Grobusch</name><affiliation><nlm:aff id="A1"> School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa</nlm:aff></affiliation><affiliation><nlm:aff id="A3"> Julius Center for Health Sciences and Primary Care, Utrecht University, Utrecht, The Netherlands</nlm:aff></affiliation></author><author><name sortKey="Kabudula, Chodziwadziwa" sort="Kabudula, Chodziwadziwa" uniqKey="Kabudula C" first="Chodziwadziwa" last="Kabudula">Chodziwadziwa Kabudula</name><affiliation><nlm:aff id="A1"> School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa</nlm:aff></affiliation></author><author><name sortKey="Menken, Jane" sort="Menken, Jane" uniqKey="Menken J" first="Jane" last="Menken">Jane Menken</name><affiliation><nlm:aff id="A1"> School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa</nlm:aff></affiliation><affiliation><nlm:aff id="A2"> Institute of Behavioral Science, University of Colorado, Boulder, CO, USA</nlm:aff></affiliation></author><author><name sortKey="Williams, Jill" sort="Williams, Jill" uniqKey="Williams J" first="Jill" last="Williams">Jill Williams</name><affiliation><nlm:aff id="A1"> School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa</nlm:aff></affiliation><affiliation><nlm:aff id="A2"> Institute of Behavioral Science, University of Colorado, Boulder, CO, USA</nlm:aff></affiliation></author><author><name sortKey="Tollman, Stephen" sort="Tollman, Stephen" uniqKey="Tollman S" first="Stephen" last="Tollman">Stephen Tollman</name><affiliation><nlm:aff id="A1"> School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa</nlm:aff></affiliation><affiliation><nlm:aff id="A4"> Centre for Global Health Research, Umeå University, Umeå, Sweden</nlm:aff></affiliation><affiliation><nlm:aff id="A5"> INDEPTH Network, Accra, Ghana</nlm:aff></affiliation></author><author><name sortKey="Clark, Samuel J" sort="Clark, Samuel J" uniqKey="Clark S" first="Samuel J." last="Clark">Samuel J. Clark</name><affiliation><nlm:aff id="A1"> School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa</nlm:aff></affiliation><affiliation><nlm:aff id="A5"> INDEPTH Network, Accra, Ghana</nlm:aff></affiliation><affiliation><nlm:aff id="A6"> Department of Sociology, University of Washington, Seattle, WA, USA</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">23311396</idno><idno type="pmc">3778517</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3778517</idno><idno type="RBID">PMC:3778517</idno><idno type="doi">10.1080/09540121.2012.750710</idno><date when="2013">2013</date><idno type="wicri:Area/Pmc/Corpus">002069</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">002069</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Prevalence of HIV among those 15 and older in rural South Africa</title><author><name sortKey="G Mez Olive, Francesc Xavier" sort="G Mez Olive, Francesc Xavier" uniqKey="G Mez Olive F" first="Francesc Xavier" last="G Mez-Olivé">Francesc Xavier G Mez-Olivé</name><affiliation><nlm:aff id="A1"> School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa</nlm:aff></affiliation></author><author><name sortKey="Angotti, Nicole" sort="Angotti, Nicole" uniqKey="Angotti N" first="Nicole" last="Angotti">Nicole Angotti</name><affiliation><nlm:aff id="A1"> School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa</nlm:aff></affiliation><affiliation><nlm:aff id="A2"> Institute of Behavioral Science, University of Colorado, Boulder, CO, USA</nlm:aff></affiliation></author><author><name sortKey="Houle, Brian" sort="Houle, Brian" uniqKey="Houle B" first="Brian" last="Houle">Brian Houle</name><affiliation><nlm:aff id="A2"> Institute of Behavioral Science, University of Colorado, Boulder, CO, USA</nlm:aff></affiliation></author><author><name sortKey="Klipstein Grobusch, Kerstin" sort="Klipstein Grobusch, Kerstin" uniqKey="Klipstein Grobusch K" first="Kerstin" last="Klipstein-Grobusch">Kerstin Klipstein-Grobusch</name><affiliation><nlm:aff id="A1"> School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa</nlm:aff></affiliation><affiliation><nlm:aff id="A3"> Julius Center for Health Sciences and Primary Care, Utrecht University, Utrecht, The Netherlands</nlm:aff></affiliation></author><author><name sortKey="Kabudula, Chodziwadziwa" sort="Kabudula, Chodziwadziwa" uniqKey="Kabudula C" first="Chodziwadziwa" last="Kabudula">Chodziwadziwa Kabudula</name><affiliation><nlm:aff id="A1"> School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa</nlm:aff></affiliation></author><author><name sortKey="Menken, Jane" sort="Menken, Jane" uniqKey="Menken J" first="Jane" last="Menken">Jane Menken</name><affiliation><nlm:aff id="A1"> School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa</nlm:aff></affiliation><affiliation><nlm:aff id="A2"> Institute of Behavioral Science, University of Colorado, Boulder, CO, USA</nlm:aff></affiliation></author><author><name sortKey="Williams, Jill" sort="Williams, Jill" uniqKey="Williams J" first="Jill" last="Williams">Jill Williams</name><affiliation><nlm:aff id="A1"> School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa</nlm:aff></affiliation><affiliation><nlm:aff id="A2"> Institute of Behavioral Science, University of Colorado, Boulder, CO, USA</nlm:aff></affiliation></author><author><name sortKey="Tollman, Stephen" sort="Tollman, Stephen" uniqKey="Tollman S" first="Stephen" last="Tollman">Stephen Tollman</name><affiliation><nlm:aff id="A1"> School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa</nlm:aff></affiliation><affiliation><nlm:aff id="A4"> Centre for Global Health Research, Umeå University, Umeå, Sweden</nlm:aff></affiliation><affiliation><nlm:aff id="A5"> INDEPTH Network, Accra, Ghana</nlm:aff></affiliation></author><author><name sortKey="Clark, Samuel J" sort="Clark, Samuel J" uniqKey="Clark S" first="Samuel J." last="Clark">Samuel J. Clark</name><affiliation><nlm:aff id="A1"> School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa</nlm:aff></affiliation><affiliation><nlm:aff id="A5"> INDEPTH Network, Accra, Ghana</nlm:aff></affiliation><affiliation><nlm:aff id="A6"> Department of Sociology, University of Washington, Seattle, WA, USA</nlm:aff></affiliation></author></analytic><series><title level="j">AIDS Care</title><idno type="ISSN">0954-0121</idno><idno type="eISSN">1360-0451</idno><imprint><date when="2013">2013</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>A greater knowledge of the burden of HIV in rural areas of Southern Africa is needed, especially among older adults. We conducted a cross-sectional biomarker survey in the rural South African Agincourt Health and Sociodemographic Surveillance site in 2010–2011 and estimated HIV prevalence and risk factors. Using an age–sex stratified random sample of ages 15 +, a total of 5037 (65.7%) of a possible 7662 individuals were located and 4362 (86.6%) consented to HIV testing. HIV prevalence was high (19.4%) and characterized by a large gender gap (10.6% for men and 23.9% for women). Rates peaked at 45.3% among men and 46.1% among women – both at ages 35–39. Compared with a similar study in the rural KwaZulu-Natal Province, South Africa, peak prevalence occurred at later ages, and HIV prevalence was higher among older adults – with rates above 15% for men and 10% for women through to age 70. High prevalence continues to characterize Southern Africa, and recent evidence confirms that older adults cannot be excluded from policy considerations. The high prevalence among older adults suggests likely HIV infection at older ages. Prevention activities need to expand to older adults to reduce new infections. Treatment will be complicated by increased risk of noncommunicable diseases and by increasing numbers of older people living with HIV.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Kahn, K" uniqKey="Kahn K">K. Kahn</name></author><author><name sortKey="Collinson, M A" uniqKey="Collinson M">M. A. Collinson</name></author><author><name sortKey="Gomez Olive, F X" uniqKey="Gomez Olive F">F. X. Gomez-Olive</name></author><author><name sortKey="Mokoena, O" uniqKey="Mokoena O">O. Mokoena</name></author><author><name sortKey="Twine, R" uniqKey="Twine R">R. Twine</name></author><author><name sortKey="Mee, P" uniqKey="Mee P">P. Mee</name></author><author><name sortKey="Tollman, S M" uniqKey="Tollman S">S. M. Tollman</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kautz, T" uniqKey="Kautz T">T. Kautz</name></author><author><name sortKey="Bendavid, E" uniqKey="Bendavid E">E. Bendavid</name></author><author><name sortKey="Bhattacharya, J" uniqKey="Bhattacharya J">J. Bhattacharya</name></author><author><name sortKey="Miller, G" uniqKey="Miller G">G. Miller</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Levitt, N S" uniqKey="Levitt N">N. S. Levitt</name></author><author><name sortKey="Steyn, K" uniqKey="Steyn K">K. Steyn</name></author><author><name sortKey="Dave, J" uniqKey="Dave J">J. Dave</name></author><author><name sortKey="Bradshaw, D" uniqKey="Bradshaw D">D. Bradshaw</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mills, E J" uniqKey="Mills E">E. J. Mills</name></author><author><name sortKey="Rammohan, A" uniqKey="Rammohan A">A. Rammohan</name></author><author><name sortKey="Awofeso, N" uniqKey="Awofeso N">N. Awofeso</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Shisana, O" uniqKey="Shisana O">O. Shisana</name></author><author><name sortKey="Rehle, T" uniqKey="Rehle T">T. Rehle</name></author><author><name sortKey="Simbayi, L C" uniqKey="Simbayi L">L. C. Simbayi</name></author><author><name sortKey="Zuma, K" uniqKey="Zuma K">K. Zuma</name></author><author><name sortKey="Jooste, S" uniqKey="Jooste S">S. Jooste</name></author><author><name sortKey="Pillay Van Wyk, V" uniqKey="Pillay Van Wyk V">V. Pillay-van-Wyk</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Wallrauch, C" uniqKey="Wallrauch C">C. Wallrauch</name></author><author><name sortKey="Barnighausen, T" uniqKey="Barnighausen T">T. Barnighausen</name></author><author><name sortKey="Newell, M L" uniqKey="Newell M">M. L. Newell</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Welz, T" uniqKey="Welz T">T. Welz</name></author><author><name sortKey="Hosegood, V" uniqKey="Hosegood V">V. Hosegood</name></author><author><name sortKey="Jaffar, S" uniqKey="Jaffar S">S. Jaffar</name></author><author><name sortKey="Batzing Feigenbaum, J" uniqKey="Batzing Feigenbaum J">J. Batzing-Feigenbaum</name></author><author><name sortKey="Herbst, K" uniqKey="Herbst K">K. Herbst</name></author><author><name sortKey="Newell, M L" uniqKey="Newell M">M. L. Newell</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">AIDS Care</journal-id><journal-id journal-id-type="iso-abbrev">AIDS Care</journal-id><journal-id journal-id-type="publisher-id">caic</journal-id><journal-title-group><journal-title>AIDS Care</journal-title></journal-title-group><issn pub-type="ppub">0954-0121</issn><issn pub-type="epub">1360-0451</issn><publisher><publisher-name>Taylor & Francis</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">23311396</article-id><article-id pub-id-type="pmc">3778517</article-id><article-id pub-id-type="doi">10.1080/09540121.2012.750710</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group></article-categories><title-group><article-title>Prevalence of HIV among those 15 and older in rural South Africa</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Gómez-Olivé</surname><given-names>Francesc Xavier</given-names></name><xref ref-type="aff" rid="A1"><sup>a</sup></xref></contrib><contrib contrib-type="author"><name><surname>Angotti</surname><given-names>Nicole</given-names></name><xref ref-type="aff" rid="A1"><sup>a</sup></xref><xref ref-type="aff" rid="A2"><sup>b</sup></xref></contrib><contrib contrib-type="author"><name><surname>Houle</surname><given-names>Brian</given-names></name><xref ref-type="aff" rid="A2"><sup>b</sup></xref></contrib><contrib contrib-type="author"><name><surname>Klipstein-Grobusch</surname><given-names>Kerstin</given-names></name><xref ref-type="aff" rid="A1"><sup>a</sup></xref><xref ref-type="aff" rid="A3"><sup>c</sup></xref></contrib><contrib contrib-type="author"><name><surname>Kabudula</surname><given-names>Chodziwadziwa</given-names></name><xref ref-type="aff" rid="A1"><sup>a</sup></xref></contrib><contrib contrib-type="author"><name><surname>Menken</surname><given-names>Jane</given-names></name><xref ref-type="aff" rid="A1"><sup>a</sup></xref><xref ref-type="aff" rid="A2"><sup>b</sup></xref></contrib><contrib contrib-type="author"><name><surname>Williams</surname><given-names>Jill</given-names></name><xref ref-type="aff" rid="A1"><sup>a</sup></xref><xref ref-type="aff" rid="A2"><sup>b</sup></xref></contrib><contrib contrib-type="author"><name><surname>Tollman</surname><given-names>Stephen</given-names></name><xref ref-type="aff" rid="A1"><sup>a</sup></xref><xref ref-type="aff" rid="A4"><sup>d</sup></xref><xref ref-type="aff" rid="A5"><sup>e</sup></xref></contrib><contrib contrib-type="author"><name><surname>Clark</surname><given-names>Samuel J.</given-names></name><xref ref-type="aff" rid="A1"><sup>a</sup></xref><xref ref-type="aff" rid="A5"><sup>e</sup></xref><xref ref-type="aff" rid="A6"><sup>f</sup></xref><xref ref-type="corresp" rid="COR1">∗</xref></contrib><aff id="A1"><label>a</label> School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa</aff><aff id="A2"><label>b</label> Institute of Behavioral Science, University of Colorado, Boulder, CO, USA</aff><aff id="A3"><label>c</label> Julius Center for Health Sciences and Primary Care, Utrecht University, Utrecht, The Netherlands</aff><aff id="A4"><label>d</label> Centre for Global Health Research, Umeå University, Umeå, Sweden</aff><aff id="A5"><label>e</label> INDEPTH Network, Accra, Ghana</aff><aff id="A6"><label>f</label> Department of Sociology, University of Washington, Seattle, WA, USA</aff></contrib-group><author-notes><corresp id="COR1"><label>∗</label> Corresponding author. Email: <email>work@samclark.net</email></corresp><fn><p>This is an Open Access article distributed under the terms of the Creative Commons Attribution License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/3.0">http://creativecommons.org/licenses/by/3.0</ext-link>), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The moral rights of the named author(s) have been asserted.</p></fn></author-notes><pub-date pub-type="epub"><day>11</day><month>1</month><year>2013</year></pub-date><pub-date pub-type="ppub"><month>9</month><year>2013</year></pub-date><volume>25</volume><issue>9</issue><fpage>1122</fpage><lpage>1128</lpage><history><date date-type="received"><day>13</day><month>8</month><year>2012</year></date><date date-type="rev-recd"><day>14</day><month>11</month><year>2012</year></date></history><permissions><copyright-statement>© 2013 The Author(s). Published by Routledge.</copyright-statement><copyright-year>2013</copyright-year><license license-type="open-access" xlink:href="http://www.informaworld.com/mpp/uploads/iopenaccess_tcs.pdf"><license-p>This is an open access article distributed under the <ext-link ext-link-type="uri" xlink:href="http://www.informaworld.com/mpp/uploads/iopenaccess_tcs.pdf">Supplemental Terms and Conditions for iOpenAccess articles published in Taylor & Francis journals</ext-link>, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p></license></permissions><abstract><p>A greater knowledge of the burden of HIV in rural areas of Southern Africa is needed, especially among older adults. We conducted a cross-sectional biomarker survey in the rural South African Agincourt Health and Sociodemographic Surveillance site in 2010–2011 and estimated HIV prevalence and risk factors. Using an age–sex stratified random sample of ages 15 +, a total of 5037 (65.7%) of a possible 7662 individuals were located and 4362 (86.6%) consented to HIV testing. HIV prevalence was high (19.4%) and characterized by a large gender gap (10.6% for men and 23.9% for women). Rates peaked at 45.3% among men and 46.1% among women – both at ages 35–39. Compared with a similar study in the rural KwaZulu-Natal Province, South Africa, peak prevalence occurred at later ages, and HIV prevalence was higher among older adults – with rates above 15% for men and 10% for women through to age 70. High prevalence continues to characterize Southern Africa, and recent evidence confirms that older adults cannot be excluded from policy considerations. The high prevalence among older adults suggests likely HIV infection at older ages. Prevention activities need to expand to older adults to reduce new infections. Treatment will be complicated by increased risk of noncommunicable diseases and by increasing numbers of older people living with HIV.</p></abstract><kwd-group><kwd>HIV</kwd><kwd>South Africa</kwd><kwd>rural health</kwd></kwd-group></article-meta></front><body><sec id="s1"><title>Introduction</title><p>Among world regions, sub-Saharan Africa continues to have the highest burden of HIV/AIDS (<xref ref-type="bibr" rid="R8">UN Joint Programme on HIV/AIDS, 2010</xref>). Within sub-Saharan Africa, the epidemic in South Africa remains one of the largest in the world (<xref ref-type="bibr" rid="R6">Shisana et al., 2009</xref>). Evidence from 2002 to 2008 suggests that in South Africa HIV prevalence has stabilized, with a reduction among adolescents from 2005 to 2008. However, national estimates mask regional heterogeneity, with KwaZulu-Natal having the highest estimated regional prevalence of 21.5% (<xref ref-type="bibr" rid="R10">Welz et al., 2007</xref>).</p><p>Gaps remain in understanding the HIV epidemic in South Africa, and detailed information from rural areas remains scarce (<xref ref-type="bibr" rid="R10">Welz et al., 2007</xref>). Surveys often ignore HIV burden among those older than 50 (<xref ref-type="bibr" rid="R5">Mills, Rammohan, & Awofeso, 2010</xref>). A study at the Africa Centre health and demographic surveillance system (HDSS) site in KwaZulu-Natal in 2007 expanded HIV surveillance to include all eligible individuals aged 15 +. It found high HIV prevalence among older adults and indicated the need for greater understanding of the burden, treatment, and prevention needs of this population (<xref ref-type="bibr" rid="R9">Wallrauch, Barnighausen, & Newell, 2010</xref>).</p><p>To address these gaps, we estimated HIV prevalence and its association with several sociodemographic factors in a rural population in South Africa near the Mozambique border. We compare our results with two studies from the Africa Centre HDSS (<xref ref-type="bibr" rid="R9">Wallrauch et al., 2010</xref>; <xref ref-type="bibr" rid="R10">Welz et al., 2007</xref>) and the 2006–2007 Swaziland Demographic and Health Survey.</p></sec><sec sec-type="methods" id="s2"><title>Method</title><p>The rural study site is situated in northeast South Africa in the Bushbuckridge subdistrict of Ehlanseni district, Mpumalanga Province (<xref ref-type="fig" rid="F1">Figures 1</xref> and <xref ref-type="fig" rid="F2">2</xref>). By mid-2011, the population under surveillance comprised some 90,000 people in 27 villages. The MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt) annually monitors deaths, births, and migration in this population since 1992 (<xref ref-type="bibr" rid="R2">Kahn et al., 2012</xref>). For this cross-sectional study, we randomly selected 7662 individuals, stratified by age and sex, from an eligible population of 34,413 using the 2009 HDSS census round as the sampling frame. Inclusion criteria were men and women aged 15 + who were permanent residents prior to the 2009 census round. We incorporated an oversample of 284 adults over age 50 from a prior study of older people (The 2006 Study on Global Ageing and Adult Health (SAGE) studied the health and well-being of a sample of 425 adults aged 50 +). Recruitment occurred during August 2010–May 2011.</p><fig id="F1" position="float"><label>Figure 1.</label><caption><p>Location of the Agincourt HDSS in Southern Africa.</p></caption><graphic xlink:href="caic25_1122_f1"></graphic></fig><fig id="F2" position="float"><label>Figure 2.</label><caption><p>Boundary of the Agincourt HDSS study site in the subdistrict.</p></caption><graphic xlink:href="caic25_1122_f2"></graphic></fig><p>All sampled persons were visited in their homes up to three times. The field team included 10 fieldworkers, 1 field supervisor, and 1 project site manager, all trained in the field research protocol, HIV counseling, and collection of dried blood spots. The interview (approximately 45 minutes) included the following: informed consent (assent for minors); sexual behavior and chronic disease risk factors questionnaires; anthropometric measurements; and collection of biomarkers for diabetes, cholesterol, and dried blood spots for HIV. No material incentives were provided to participate in the study. Test results were made available to participants one month after enrollment at the two health facilities in the area offering antiretroviral treatment. Blood spots were tested using screening assay Vironostika Uniform 11 (Biomerieux, France), and positives were confirmed by the SD Bioline HIV ELISA test (Standard Diagnostics Inc., Korea). If screening and confirmatory assays did not agree, a third assay was done. Following WHO criteria, this third assay determined the final result. We used a probit regression to model sociodemographic risk factors for HIV status among those who were tested. Predictors included sex, five-year age group, quintiles using 2009 household socioeconomic status, previous migration status, village, gender of household head, nationality, education in years, and union status.</p><p>We performed all analyses using Stata 11.2 (<xref ref-type="bibr" rid="R7">StataCorp, 2009</xref>). Models incorporated probability weights to produce population estimates.</p><p>The study received ethical approvals from the University of the Witwatersrand Human Research Ethics Committee and the Mpumalanga Provincial Research and Ethics Committee.</p></sec><sec sec-type="results" id="s3"><title>Results</title><p><xref ref-type="fig" rid="F3">Figure 3</xref> shows the recruitment flowchart. Of the 7662 randomly selected participants, 469 (6%) were found ineligible. Of the remaining 7193 eligible participants, 5037 (70%) were located. Of these, 353 refused to participate (7%), 322 consented to interview, but not HIV testing (6%), and 4362 consented to both interview and HIV testing (87%). <xref ref-type="table" rid="T1">Table 1</xref> presents sociodemographic characteristics of males and females from the eligible sample.</p><fig id="F3" position="float"><label>Figure 3.</label><caption><p>Flowchart of age-sex stratified random sample of 2009 Agincourt population, based on eligibility, being located for potential interview, consenting to interview, and consenting to HIV testing.</p></caption><graphic xlink:href="caic25_1122_f3"></graphic></fig><table-wrap id="T1" position="float"><label>Table 1.</label><caption><p>Sociodemographic characteristics by sex: age-sex stratified random sample of ages 15 + from the 2009 Agincourt population (<italic>N</italic> = 34,413).</p></caption><table frame="hsides" rules="groups" width="100%"><thead><tr><th align="left" rowspan="1" colspan="1"></th><th align="center" rowspan="1" colspan="1">Female (%) <italic>n</italic> = 3892</th><th align="center" rowspan="1" colspan="1">Male (%) <italic>n</italic> = 3770</th><th align="center" rowspan="1" colspan="1">Total (%) <italic>n</italic> = 7662</th></tr></thead><tbody><tr><td align="left" colspan="4" rowspan="1">Sex</td></tr><tr><td align="left" rowspan="1" colspan="1"> Female</td><td align="left" rowspan="1" colspan="1">100</td><td align="left" rowspan="1" colspan="1">0</td><td align="left" rowspan="1" colspan="1">52</td></tr><tr><td align="left" rowspan="1" colspan="1"> Male</td><td align="left" rowspan="1" colspan="1">0</td><td align="left" rowspan="1" colspan="1">100</td><td align="left" rowspan="1" colspan="1">48</td></tr><tr><td align="left" colspan="4" rowspan="1"> Age group</td></tr><tr><td align="left" rowspan="1" colspan="1"> 15–19</td><td align="left" rowspan="1" colspan="1">8</td><td align="left" rowspan="1" colspan="1">8</td><td align="left" rowspan="1" colspan="1">8</td></tr><tr><td align="left" rowspan="1" colspan="1"> 20–24</td><td align="left" rowspan="1" colspan="1">12</td><td align="left" rowspan="1" colspan="1">13</td><td align="left" rowspan="1" colspan="1">12</td></tr><tr><td align="left" rowspan="1" colspan="1"> 25–29</td><td align="left" rowspan="1" colspan="1">12</td><td align="left" rowspan="1" colspan="1">13</td><td align="left" rowspan="1" colspan="1">13</td></tr><tr><td align="left" rowspan="1" colspan="1"> 30–34</td><td align="left" rowspan="1" colspan="1">12</td><td align="left" rowspan="1" colspan="1">13</td><td align="left" rowspan="1" colspan="1">12</td></tr><tr><td align="left" rowspan="1" colspan="1"> 35–39</td><td align="left" rowspan="1" colspan="1">12</td><td align="left" rowspan="1" colspan="1">13</td><td align="left" rowspan="1" colspan="1">12</td></tr><tr><td align="left" rowspan="1" colspan="1"> 40–44</td><td align="left" rowspan="1" colspan="1">9</td><td align="left" rowspan="1" colspan="1">8</td><td align="left" rowspan="1" colspan="1">9</td></tr><tr><td align="left" rowspan="1" colspan="1"> 45–49</td><td align="left" rowspan="1" colspan="1">8</td><td align="left" rowspan="1" colspan="1">8</td><td align="left" rowspan="1" colspan="1">8</td></tr><tr><td align="left" rowspan="1" colspan="1"> 50–54</td><td align="left" rowspan="1" colspan="1">4</td><td align="left" rowspan="1" colspan="1">5</td><td align="left" rowspan="1" colspan="1">5</td></tr><tr><td align="left" rowspan="1" colspan="1"> 55–59</td><td align="left" rowspan="1" colspan="1">5</td><td align="left" rowspan="1" colspan="1">4</td><td align="left" rowspan="1" colspan="1">5</td></tr><tr><td align="left" rowspan="1" colspan="1"> 60–64</td><td align="left" rowspan="1" colspan="1">5</td><td align="left" rowspan="1" colspan="1">5</td><td align="left" rowspan="1" colspan="1">5</td></tr><tr><td align="left" rowspan="1" colspan="1"> 65–69</td><td align="left" rowspan="1" colspan="1">4</td><td align="left" rowspan="1" colspan="1">4</td><td align="left" rowspan="1" colspan="1">4</td></tr><tr><td align="left" rowspan="1" colspan="1"> 70–74</td><td align="left" rowspan="1" colspan="1">3</td><td align="left" rowspan="1" colspan="1">3</td><td align="left" rowspan="1" colspan="1">3</td></tr><tr><td align="left" rowspan="1" colspan="1"> 75–79</td><td align="left" rowspan="1" colspan="1">3</td><td align="left" rowspan="1" colspan="1">1</td><td align="left" rowspan="1" colspan="1">2</td></tr><tr><td align="left" rowspan="1" colspan="1"> 80–84</td><td align="left" rowspan="1" colspan="1">3</td><td align="left" rowspan="1" colspan="1">2</td><td align="left" rowspan="1" colspan="1">2</td></tr><tr><td align="left" colspan="4" rowspan="1">SES quintile</td></tr><tr><td align="left" rowspan="1" colspan="1"> Low</td><td align="left" rowspan="1" colspan="1">15</td><td align="left" rowspan="1" colspan="1">15</td><td align="left" rowspan="1" colspan="1">15</td></tr><tr><td align="left" rowspan="1" colspan="1"> Middle-low</td><td align="left" rowspan="1" colspan="1">19</td><td align="left" rowspan="1" colspan="1">19</td><td align="left" rowspan="1" colspan="1">19</td></tr><tr><td align="left" rowspan="1" colspan="1"> Middle</td><td align="left" rowspan="1" colspan="1">21</td><td align="left" rowspan="1" colspan="1">20</td><td align="left" rowspan="1" colspan="1">21</td></tr><tr><td align="left" rowspan="1" colspan="1"> Middle-high</td><td align="left" rowspan="1" colspan="1">21</td><td align="left" rowspan="1" colspan="1">21</td><td align="left" rowspan="1" colspan="1">21</td></tr><tr><td align="left" rowspan="1" colspan="1"> High</td><td align="left" rowspan="1" colspan="1">24</td><td align="left" rowspan="1" colspan="1">26</td><td align="left" rowspan="1" colspan="1">25</td></tr><tr><td align="left" colspan="4" rowspan="1">Previous migration history</td></tr><tr><td align="left" rowspan="1" colspan="1"> No</td><td align="left" rowspan="1" colspan="1">35</td><td align="left" rowspan="1" colspan="1">45</td><td align="left" rowspan="1" colspan="1">40</td></tr><tr><td align="left" rowspan="1" colspan="1"> Yes</td><td align="left" rowspan="1" colspan="1">65</td><td align="left" rowspan="1" colspan="1">55</td><td align="left" rowspan="1" colspan="1">60</td></tr><tr><td align="left" rowspan="1" colspan="1">Male-headed household</td><td align="left" rowspan="1" colspan="1">54</td><td align="left" rowspan="1" colspan="1">73</td><td align="left" rowspan="1" colspan="1">63</td></tr><tr><td align="left" rowspan="1" colspan="1">South African</td><td align="left" rowspan="1" colspan="1">69</td><td align="left" rowspan="1" colspan="1">71</td><td align="left" rowspan="1" colspan="1">70</td></tr><tr><td align="left" colspan="4" rowspan="1">Education</td></tr><tr><td align="left" rowspan="1" colspan="1"> 0</td><td align="left" rowspan="1" colspan="1">23</td><td align="left" rowspan="1" colspan="1">15</td><td align="left" rowspan="1" colspan="1">19</td></tr><tr><td align="left" rowspan="1" colspan="1"> 1–11</td><td align="left" rowspan="1" colspan="1">56</td><td align="left" rowspan="1" colspan="1">61</td><td align="left" rowspan="1" colspan="1">58</td></tr><tr><td align="left" rowspan="1" colspan="1"> 12</td><td align="left" rowspan="1" colspan="1">15</td><td align="left" rowspan="1" colspan="1">17</td><td align="left" rowspan="1" colspan="1">16</td></tr><tr><td align="left" rowspan="1" colspan="1"> 13 +</td><td align="left" rowspan="1" colspan="1">6</td><td align="left" rowspan="1" colspan="1">7</td><td align="left" rowspan="1" colspan="1">7</td></tr><tr><td align="left" colspan="4" rowspan="1">Union status</td></tr><tr><td align="left" rowspan="1" colspan="1"> None</td><td align="left" rowspan="1" colspan="1">36</td><td align="left" rowspan="1" colspan="1">45</td><td align="left" rowspan="1" colspan="1">40</td></tr><tr><td align="left" rowspan="1" colspan="1"> Current</td><td align="left" rowspan="1" colspan="1">37</td><td align="left" rowspan="1" colspan="1">42</td><td align="left" rowspan="1" colspan="1">40</td></tr><tr><td align="left" rowspan="1" colspan="1"> Previous</td><td align="left" rowspan="1" colspan="1">27</td><td align="left" rowspan="1" colspan="1">13</td><td align="left" rowspan="1" colspan="1">20</td></tr></tbody></table></table-wrap><p><xref ref-type="table" rid="T2">Table 2</xref> presents sex- and age-specific HIV prevalence rates estimated from those who were tested.</p><table-wrap id="T2" position="float"><label>Table 2.</label><caption><p>Measured Agincourt HIV prevalence (%) by sex and age.</p></caption><table frame="hsides" rules="groups" width="100%"><thead><tr><th align="left" rowspan="1" colspan="1"></th><th align="center" colspan="4" rowspan="1">Measured (95% CI)<hr></hr></th></tr><tr><th align="left" rowspan="1" colspan="1">Age</th><th align="center" colspan="2" rowspan="1">Female</th><th align="center" colspan="2" rowspan="1">Male</th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">15–19</td><td align="left" rowspan="1" colspan="1">5.5</td><td align="left" rowspan="1" colspan="1">(2.6–8.4)</td><td align="left" rowspan="1" colspan="1">0.4</td><td align="left" rowspan="1" colspan="1">(0.0–1.3)</td></tr><tr><td align="left" rowspan="1" colspan="1">20–24</td><td align="left" rowspan="1" colspan="1">27.0</td><td align="left" rowspan="1" colspan="1">(21.9–32.2)</td><td align="left" rowspan="1" colspan="1">6.1</td><td align="left" rowspan="1" colspan="1">(2.9–9.4)</td></tr><tr><td align="left" rowspan="1" colspan="1">25–29</td><td align="left" rowspan="1" colspan="1">37.8</td><td align="left" rowspan="1" colspan="1">(32.1–43.4)</td><td align="left" rowspan="1" colspan="1">21.7</td><td align="left" rowspan="1" colspan="1">(15.2–28.3)</td></tr><tr><td align="left" rowspan="1" colspan="1">30–34</td><td align="left" rowspan="1" colspan="1">41.8</td><td align="left" rowspan="1" colspan="1">(36.2–47.3)</td><td align="left" rowspan="1" colspan="1">41.8</td><td align="left" rowspan="1" colspan="1">(33.7–50.0)</td></tr><tr><td align="left" rowspan="1" colspan="1">35–39</td><td align="left" rowspan="1" colspan="1">46.1</td><td align="left" rowspan="1" colspan="1">(40.7–51.6)</td><td align="left" rowspan="1" colspan="1">45.3</td><td align="left" rowspan="1" colspan="1">(38.1–52.6)</td></tr><tr><td align="left" rowspan="1" colspan="1">40–44</td><td align="left" rowspan="1" colspan="1">34.4</td><td align="left" rowspan="1" colspan="1">(28.1–40.8)</td><td align="left" rowspan="1" colspan="1">41.0</td><td align="left" rowspan="1" colspan="1">(31.4–50.6)</td></tr><tr><td align="left" rowspan="1" colspan="1">45–49</td><td align="left" rowspan="1" colspan="1">34.2</td><td align="left" rowspan="1" colspan="1">(28.0–40.4)</td><td align="left" rowspan="1" colspan="1">28.8</td><td align="left" rowspan="1" colspan="1">(20.9–36.7)</td></tr><tr><td align="left" rowspan="1" colspan="1">50–54</td><td align="left" rowspan="1" colspan="1">26.9</td><td align="left" rowspan="1" colspan="1">(19.4–34.4)</td><td align="left" rowspan="1" colspan="1">30.6</td><td align="left" rowspan="1" colspan="1">(19.9–41.2)</td></tr><tr><td align="left" rowspan="1" colspan="1">55–59</td><td align="left" rowspan="1" colspan="1">26.8</td><td align="left" rowspan="1" colspan="1">(19.5–34.0)</td><td align="left" rowspan="1" colspan="1">34.6</td><td align="left" rowspan="1" colspan="1">(24.2–44.9)</td></tr><tr><td align="left" rowspan="1" colspan="1">60–64</td><td align="left" rowspan="1" colspan="1">13.1</td><td align="left" rowspan="1" colspan="1">(7.6–18.6)</td><td align="left" rowspan="1" colspan="1">19.8</td><td align="left" rowspan="1" colspan="1">(12.4–27.2)</td></tr><tr><td align="left" rowspan="1" colspan="1">65–69</td><td align="left" rowspan="1" colspan="1">10.3</td><td align="left" rowspan="1" colspan="1">(5.2–15.4)</td><td align="left" rowspan="1" colspan="1">16.5</td><td align="left" rowspan="1" colspan="1">(8.9–24.1)</td></tr><tr><td align="left" rowspan="1" colspan="1">70–74</td><td align="left" rowspan="1" colspan="1">11.0</td><td align="left" rowspan="1" colspan="1">(4.6–17.4)</td><td align="left" rowspan="1" colspan="1">5.7</td><td align="left" rowspan="1" colspan="1">(0.8–10.5)</td></tr><tr><td align="left" rowspan="1" colspan="1">75–79</td><td align="left" rowspan="1" colspan="1">6.2</td><td align="left" rowspan="1" colspan="1">(0.9–11.4)</td><td align="left" rowspan="1" colspan="1">5.3</td><td align="left" rowspan="1" colspan="1">(0.0–12.4)</td></tr><tr><td align="left" rowspan="1" colspan="1">80–84</td><td align="left" rowspan="1" colspan="1">1.3</td><td align="left" rowspan="1" colspan="1">(0.0–3.8)</td><td align="left" rowspan="1" colspan="1">1.8</td><td align="left" rowspan="1" colspan="1">(0.0–5.3)</td></tr><tr><td align="left" rowspan="1" colspan="1">15–84</td><td align="left" rowspan="1" colspan="1">23.9</td><td align="left" rowspan="1" colspan="1">(22.2–25.6)</td><td align="left" rowspan="1" colspan="1">10.6</td><td align="left" rowspan="1" colspan="1">(9.3–12.0)</td></tr></tbody></table></table-wrap><p>A probit regression estimated HIV sociodemographic risk factors for the tested sample (<xref ref-type="table" rid="T3">Table 3</xref>). An interaction between sex and age improved model fit (<italic>p</italic> < 0.001). Those in the high SES quintile had lower probability of being HIV + relative to those in the low quintile (<italic>p</italic> < 0.001). Men aged 15–19 (<italic>p</italic> = 0.001), 20–24 (<italic>p</italic> < 0.001) and 25–29 (<italic>p</italic> < 0.001) had lower probabilities of being HIV + relative to same-age women. Men aged 55–59 (<italic>p</italic> = 0.020), 60–64 (<italic>p</italic> = 0.110), and 65–69 (<italic>p</italic> = 0.013) had higher probabilities of being HIV + relative to same-age women. Those in a male-headed household had lower probability of being HIV +(<italic>p</italic> = 0.010), while South Africans had higher probability of being HIV + relative to non-South Africans (i.e., those not of South African origin, namely former Mozambican refugees) (<italic>p</italic> = 0.031). Those with the most education had lower probability of being HIV + relative to those with no education (<italic>p</italic> = 0.028). Those in union currently had a lower probability of being HIV + (<italic>p</italic> = 0.001), while those who were in union previously had a higher probability of being HIV + (<italic>p</italic> = 0.049) relative to those who had never been in union.</p><table-wrap id="T3" position="float"><label>Table 3.</label><caption><p>Probit regression of HIV status on sociodemographic characteristics: respondents tested for HIV (<italic>n</italic> = 4197).</p></caption><table frame="hsides" rules="groups" width="100%"><thead><tr><th align="left" rowspan="1" colspan="1"></th><th align="center" rowspan="1" colspan="1">Beta</th><th align="center" rowspan="1" colspan="1">Lower 95% CI</th><th align="center" rowspan="1" colspan="1">Upper 95% CI</th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">Male</td><td align="left" rowspan="1" colspan="1">− 1.085</td><td align="left" rowspan="1" colspan="1">− 1.774</td><td align="left" rowspan="1" colspan="1">− 0.396</td></tr><tr><td align="left" colspan="4" rowspan="1">Age</td></tr><tr><td align="left" rowspan="1" colspan="1"> 15–19</td><td align="left" rowspan="1" colspan="1">–</td><td align="left" rowspan="1" colspan="1">–</td><td align="left" rowspan="1" colspan="1">–</td></tr><tr><td align="left" rowspan="1" colspan="1"> 20–24</td><td align="left" rowspan="1" colspan="1">1.060</td><td align="left" rowspan="1" colspan="1">0.748</td><td align="left" rowspan="1" colspan="1">1.373</td></tr><tr><td align="left" rowspan="1" colspan="1"> 25–29</td><td align="left" rowspan="1" colspan="1">1.454</td><td align="left" rowspan="1" colspan="1">1.135</td><td align="left" rowspan="1" colspan="1">1.774</td></tr><tr><td align="left" rowspan="1" colspan="1"> 30–34</td><td align="left" rowspan="1" colspan="1">1.541</td><td align="left" rowspan="1" colspan="1">1.219</td><td align="left" rowspan="1" colspan="1">1.862</td></tr><tr><td align="left" rowspan="1" colspan="1"> 35–39</td><td align="left" rowspan="1" colspan="1">1.694</td><td align="left" rowspan="1" colspan="1">1.368</td><td align="left" rowspan="1" colspan="1">2.02</td></tr><tr><td align="left" rowspan="1" colspan="1"> 40–44</td><td align="left" rowspan="1" colspan="1">1.345</td><td align="left" rowspan="1" colspan="1">0.999</td><td align="left" rowspan="1" colspan="1">1.691</td></tr><tr><td align="left" rowspan="1" colspan="1"> 45–49</td><td align="left" rowspan="1" colspan="1">1.336</td><td align="left" rowspan="1" colspan="1">0.981</td><td align="left" rowspan="1" colspan="1">1.692</td></tr><tr><td align="left" rowspan="1" colspan="1"> 50–54</td><td align="left" rowspan="1" colspan="1">1.120</td><td align="left" rowspan="1" colspan="1">0.725</td><td align="left" rowspan="1" colspan="1">1.515</td></tr><tr><td align="left" rowspan="1" colspan="1"> 55–59</td><td align="left" rowspan="1" colspan="1">0.994</td><td align="left" rowspan="1" colspan="1">0.596</td><td align="left" rowspan="1" colspan="1">1.392</td></tr><tr><td align="left" rowspan="1" colspan="1"> 60–64</td><td align="left" rowspan="1" colspan="1">0.447</td><td align="left" rowspan="1" colspan="1">0.027</td><td align="left" rowspan="1" colspan="1">0.868</td></tr><tr><td align="left" rowspan="1" colspan="1"> 65–69</td><td align="left" rowspan="1" colspan="1">0.261</td><td align="left" rowspan="1" colspan="1">− 0.19</td><td align="left" rowspan="1" colspan="1">0.712</td></tr><tr><td align="left" rowspan="1" colspan="1"> 70–74</td><td align="left" rowspan="1" colspan="1">0.242</td><td align="left" rowspan="1" colspan="1">− 0.243</td><td align="left" rowspan="1" colspan="1">0.727</td></tr><tr><td align="left" rowspan="1" colspan="1"> 75–79</td><td align="left" rowspan="1" colspan="1">− 0.097</td><td align="left" rowspan="1" colspan="1">− 0.657</td><td align="left" rowspan="1" colspan="1">0.464</td></tr><tr><td align="left" rowspan="1" colspan="1"> 80–84</td><td align="left" rowspan="1" colspan="1">− 0.773</td><td align="left" rowspan="1" colspan="1">− 1.637</td><td align="left" rowspan="1" colspan="1">0.092</td></tr><tr><td align="left" colspan="4" rowspan="1">Sex × Age</td></tr><tr><td align="left" rowspan="1" colspan="1"> Male × 20–24</td><td align="left" rowspan="1" colspan="1">0.049</td><td align="left" rowspan="1" colspan="1">− 0.704</td><td align="left" rowspan="1" colspan="1">0.802</td></tr><tr><td align="left" rowspan="1" colspan="1"> Male × 25–29</td><td align="left" rowspan="1" colspan="1">0.575</td><td align="left" rowspan="1" colspan="1">− 0.162</td><td align="left" rowspan="1" colspan="1">1.312</td></tr><tr><td align="left" rowspan="1" colspan="1"> Male × 30–34</td><td align="left" rowspan="1" colspan="1">1.048</td><td align="left" rowspan="1" colspan="1">0.325</td><td align="left" rowspan="1" colspan="1">1.772</td></tr><tr><td align="left" rowspan="1" colspan="1"> Male × 35–39</td><td align="left" rowspan="1" colspan="1">1.030</td><td align="left" rowspan="1" colspan="1">0.311</td><td align="left" rowspan="1" colspan="1">1.75</td></tr><tr><td align="left" rowspan="1" colspan="1"> Male × 40–44</td><td align="left" rowspan="1" colspan="1">1.226</td><td align="left" rowspan="1" colspan="1">0.484</td><td align="left" rowspan="1" colspan="1">1.968</td></tr><tr><td align="left" rowspan="1" colspan="1"> Male × 45–49</td><td align="left" rowspan="1" colspan="1">1.047</td><td align="left" rowspan="1" colspan="1">0.296</td><td align="left" rowspan="1" colspan="1">1.799</td></tr><tr><td align="left" rowspan="1" colspan="1"> Male × 50–54</td><td align="left" rowspan="1" colspan="1">1.306</td><td align="left" rowspan="1" colspan="1">0.521</td><td align="left" rowspan="1" colspan="1">2.092</td></tr><tr><td align="left" rowspan="1" colspan="1"> Male × 55–59</td><td align="left" rowspan="1" colspan="1">1.554</td><td align="left" rowspan="1" colspan="1">0.783</td><td align="left" rowspan="1" colspan="1">2.326</td></tr><tr><td align="left" rowspan="1" colspan="1"> Male × 60–64</td><td align="left" rowspan="1" colspan="1">1.623</td><td align="left" rowspan="1" colspan="1">0.841</td><td align="left" rowspan="1" colspan="1">2.405</td></tr><tr><td align="left" rowspan="1" colspan="1"> Male × 65–69</td><td align="left" rowspan="1" colspan="1">1.669</td><td align="left" rowspan="1" colspan="1">0.857</td><td align="left" rowspan="1" colspan="1">2.481</td></tr><tr><td align="left" rowspan="1" colspan="1"> Male × 70–74</td><td align="left" rowspan="1" colspan="1">1.094</td><td align="left" rowspan="1" colspan="1">0.21</td><td align="left" rowspan="1" colspan="1">1.977</td></tr><tr><td align="left" rowspan="1" colspan="1"> Male × 75–79</td><td align="left" rowspan="1" colspan="1">1.331</td><td align="left" rowspan="1" colspan="1">0.275</td><td align="left" rowspan="1" colspan="1">2.387</td></tr><tr><td align="left" rowspan="1" colspan="1"> Male × 80–84</td><td align="left" rowspan="1" colspan="1">1.503</td><td align="left" rowspan="1" colspan="1">0.187</td><td align="left" rowspan="1" colspan="1">2.819</td></tr><tr><td align="left" colspan="4" rowspan="1">Village</td></tr><tr><td align="left" rowspan="1" colspan="1"> 1</td><td align="left" rowspan="1" colspan="1">–</td><td align="left" rowspan="1" colspan="1">–</td><td align="left" rowspan="1" colspan="1">–</td></tr><tr><td align="left" rowspan="1" colspan="1"> 2</td><td align="left" rowspan="1" colspan="1">0.123</td><td align="left" rowspan="1" colspan="1">− 0.267</td><td align="left" rowspan="1" colspan="1">0.513</td></tr><tr><td align="left" rowspan="1" colspan="1"> 3</td><td align="left" rowspan="1" colspan="1">0.059</td><td align="left" rowspan="1" colspan="1">− 0.185</td><td align="left" rowspan="1" colspan="1">0.303</td></tr><tr><td align="left" rowspan="1" colspan="1"> 4</td><td align="left" rowspan="1" colspan="1">− 0.087</td><td align="left" rowspan="1" colspan="1">− 0.397</td><td align="left" rowspan="1" colspan="1">0.223</td></tr><tr><td align="left" rowspan="1" colspan="1"> 5</td><td align="left" rowspan="1" colspan="1">− 0.131</td><td align="left" rowspan="1" colspan="1">− 0.407</td><td align="left" rowspan="1" colspan="1">0.145</td></tr><tr><td align="left" rowspan="1" colspan="1"> 6</td><td align="left" rowspan="1" colspan="1">− 0.003</td><td align="left" rowspan="1" colspan="1">− 0.292</td><td align="left" rowspan="1" colspan="1">0.285</td></tr><tr><td align="left" rowspan="1" colspan="1"> 7</td><td align="left" rowspan="1" colspan="1">− 0.064</td><td align="left" rowspan="1" colspan="1">− 0.375</td><td align="left" rowspan="1" colspan="1">0.248</td></tr><tr><td align="left" rowspan="1" colspan="1"> 8</td><td align="left" rowspan="1" colspan="1">− 0.076</td><td align="left" rowspan="1" colspan="1">− 0.337</td><td align="left" rowspan="1" colspan="1">0.184</td></tr><tr><td align="left" rowspan="1" colspan="1"> 9</td><td align="left" rowspan="1" colspan="1">− 0.113</td><td align="left" rowspan="1" colspan="1">− 0.368</td><td align="left" rowspan="1" colspan="1">0.142</td></tr><tr><td align="left" rowspan="1" colspan="1"> 10</td><td align="left" rowspan="1" colspan="1">− 0.188</td><td align="left" rowspan="1" colspan="1">− 0.445</td><td align="left" rowspan="1" colspan="1">0.069</td></tr><tr><td align="left" rowspan="1" colspan="1"> 11</td><td align="left" rowspan="1" colspan="1">0.023</td><td align="left" rowspan="1" colspan="1">− 0.209</td><td align="left" rowspan="1" colspan="1">0.256</td></tr><tr><td align="left" rowspan="1" colspan="1"> 12</td><td align="left" rowspan="1" colspan="1">0.179</td><td align="left" rowspan="1" colspan="1">− 0.131</td><td align="left" rowspan="1" colspan="1">0.489</td></tr><tr><td align="left" rowspan="1" colspan="1"> 13</td><td align="left" rowspan="1" colspan="1">− 0.098</td><td align="left" rowspan="1" colspan="1">− 0.388</td><td align="left" rowspan="1" colspan="1">0.193</td></tr><tr><td align="left" rowspan="1" colspan="1"> 14</td><td align="left" rowspan="1" colspan="1">− 0.038</td><td align="left" rowspan="1" colspan="1">− 0.404</td><td align="left" rowspan="1" colspan="1">0.327</td></tr><tr><td align="left" rowspan="1" colspan="1"> 15</td><td align="left" rowspan="1" colspan="1">0.128</td><td align="left" rowspan="1" colspan="1">− 0.157</td><td align="left" rowspan="1" colspan="1">0.414</td></tr><tr><td align="left" rowspan="1" colspan="1"> 16</td><td align="left" rowspan="1" colspan="1">− 0.473</td><td align="left" rowspan="1" colspan="1">− 0.768</td><td align="left" rowspan="1" colspan="1">− 0.178</td></tr><tr><td align="left" rowspan="1" colspan="1"> 17</td><td align="left" rowspan="1" colspan="1">0.263</td><td align="left" rowspan="1" colspan="1">− 0.071</td><td align="left" rowspan="1" colspan="1">0.597</td></tr><tr><td align="left" rowspan="1" colspan="1"> 18</td><td align="left" rowspan="1" colspan="1">0.348</td><td align="left" rowspan="1" colspan="1">− 0.063</td><td align="left" rowspan="1" colspan="1">0.76</td></tr><tr><td align="left" rowspan="1" colspan="1"> 19</td><td align="left" rowspan="1" colspan="1">0.318</td><td align="left" rowspan="1" colspan="1">− 0.137</td><td align="left" rowspan="1" colspan="1">0.772</td></tr><tr><td align="left" rowspan="1" colspan="1"> 20</td><td align="left" rowspan="1" colspan="1">− 0.069</td><td align="left" rowspan="1" colspan="1">− 0.513</td><td align="left" rowspan="1" colspan="1">0.375</td></tr><tr><td align="left" rowspan="1" colspan="1"> 21</td><td align="left" rowspan="1" colspan="1">0.566</td><td align="left" rowspan="1" colspan="1">0.165</td><td align="left" rowspan="1" colspan="1">0.967</td></tr><tr><td align="left" rowspan="1" colspan="1">Prior migration history</td><td align="left" rowspan="1" colspan="1">0.004</td><td align="left" rowspan="1" colspan="1">− 0.118</td><td align="left" rowspan="1" colspan="1">0.125</td></tr><tr><td align="left" colspan="4" rowspan="1">SES quintiles</td></tr><tr><td align="left" rowspan="1" colspan="1"> Low</td><td align="left" rowspan="1" colspan="1">–</td><td align="left" rowspan="1" colspan="1">–</td><td align="left" rowspan="1" colspan="1">–</td></tr><tr><td align="left" rowspan="1" colspan="1"> Middle-low</td><td align="left" rowspan="1" colspan="1">− 0.160</td><td align="left" rowspan="1" colspan="1">− 0.328</td><td align="left" rowspan="1" colspan="1">0.009</td></tr><tr><td align="left" rowspan="1" colspan="1"> Middle</td><td align="left" rowspan="1" colspan="1">− 0.048</td><td align="left" rowspan="1" colspan="1">− 0.223</td><td align="left" rowspan="1" colspan="1">0.127</td></tr><tr><td align="left" rowspan="1" colspan="1"> Middle-high</td><td align="left" rowspan="1" colspan="1">− 0.052</td><td align="left" rowspan="1" colspan="1">− 0.237</td><td align="left" rowspan="1" colspan="1">0.134</td></tr><tr><td align="left" rowspan="1" colspan="1"> High</td><td align="left" rowspan="1" colspan="1">− 0.332</td><td align="left" rowspan="1" colspan="1">− 0.515</td><td align="left" rowspan="1" colspan="1">− 0.15</td></tr><tr><td align="left" rowspan="1" colspan="1">Male-headed household</td><td align="left" rowspan="1" colspan="1">− 0.170</td><td align="left" rowspan="1" colspan="1">− 0.301</td><td align="left" rowspan="1" colspan="1">− 0.04</td></tr><tr><td align="left" rowspan="1" colspan="1">South African</td><td align="left" rowspan="1" colspan="1">0.158</td><td align="left" rowspan="1" colspan="1">0.015</td><td align="left" rowspan="1" colspan="1">0.301</td></tr><tr><td align="left" colspan="4" rowspan="1">Education (years)</td></tr><tr><td align="left" rowspan="1" colspan="1"> 0</td><td align="left" rowspan="1" colspan="1">–</td><td align="left" rowspan="1" colspan="1">–</td><td align="left" rowspan="1" colspan="1">–</td></tr><tr><td align="left" rowspan="1" colspan="1"> 1 − 11</td><td align="left" rowspan="1" colspan="1">0.013</td><td align="left" rowspan="1" colspan="1">− 0.148</td><td align="left" rowspan="1" colspan="1">0.174</td></tr><tr><td align="left" rowspan="1" colspan="1"> 12</td><td align="left" rowspan="1" colspan="1">− 0.077</td><td align="left" rowspan="1" colspan="1">− 0.299</td><td align="left" rowspan="1" colspan="1">0.145</td></tr><tr><td align="left" rowspan="1" colspan="1"> 13 +</td><td align="left" rowspan="1" colspan="1">− 0.323</td><td align="left" rowspan="1" colspan="1">− 0.611</td><td align="left" rowspan="1" colspan="1">− 0.035</td></tr><tr><td align="left" colspan="4" rowspan="1">Union status</td></tr><tr><td align="left" rowspan="1" colspan="1"> None</td><td align="left" rowspan="1" colspan="1">–</td><td align="left" rowspan="1" colspan="1">–</td><td align="left" rowspan="1" colspan="1">–</td></tr><tr><td align="left" rowspan="1" colspan="1"> Current</td><td align="left" rowspan="1" colspan="1">− 0.263</td><td align="left" rowspan="1" colspan="1">− 0.42</td><td align="left" rowspan="1" colspan="1">− 0.106</td></tr><tr><td align="left" rowspan="1" colspan="1"> Previous</td><td align="left" rowspan="1" colspan="1">0.170</td><td align="left" rowspan="1" colspan="1">0</td><td align="left" rowspan="1" colspan="1">0.34</td></tr><tr><td align="left" rowspan="1" colspan="1"> Constant</td><td align="left" rowspan="1" colspan="1">− 1.505</td><td align="left" rowspan="1" colspan="1">− 1.914</td><td align="left" rowspan="1" colspan="1">− 1.097</td></tr></tbody></table></table-wrap><p><xref ref-type="fig" rid="F4">Figure 4(A)</xref> presents Agincourt HIV prevalence estimates by sex and age. The estimate for all ages was 19.4% (23.9% for females and 10.6% for males). Males had peak prevalence of 45.3% at ages 35–39 and prevalence remained over 15% until age 70. Females had peak prevalence of 46.1%, also at ages 35–39, with prevalence remaining over 10% until age 70. HIV prevalence among those 50 + was 16.5% (16.1% females and 17.7% males).</p><fig id="F4" position="float"><label>Figure 4.</label><caption><p>HIV prevalence by sex and age of: (A) Agincourt 2010 estimates; (B) KwaZulu-Natal estimates; and (C) Swaziland DHS estimates from 2006 to 2007. ∗Age group 60–64 includes everyone aged 60 +.</p></caption><graphic xlink:href="caic25_1122_f4"></graphic></fig><p><xref ref-type="fig" rid="F4">Figure 4(B)</xref> presents sex- and age-specific prevalence estimates based on two studies from KwaZulu-Natal Province (<xref ref-type="bibr" rid="R9">Wallrauch et al., 2010</xref>; <xref ref-type="bibr" rid="R10">Welz et al., 2007</xref>), and <xref ref-type="fig" rid="F4">Figure 4(C)</xref> contains results from the 2006–2007 Swaziland DHS survey (Central Statistical Office (CSO) [<xref ref-type="bibr" rid="R1">Swaziland] and Macro International, 2008</xref>). Geographically, Swaziland sits between the Agincourt and KwaZulu-Natal study sites. HIV prevalence estimates are comparable between studies but age patterns somewhat differ. In KwaZulu-Natal and Swaziland, prevalence is skewed to the left, with high prevalence among younger ages that steadily declines with age. In Agincourt, HIV prevalence peaks at slightly older ages, with slower decline with age. Similar to its geography, the Swaziland results are intermediate between KwaZulu-Natal and Agincourt.</p></sec><sec sec-type="discussion" id="s4"><title>Discussion</title><p>Using a cross-sectional biomarker survey, we estimated HIV prevalence in rural South Africa for adults aged 15 + in 2010–2011. We found high prevalence comparable with KwaZulu-Natal, the region recognized to have highest prevalence in South Africa (<xref ref-type="bibr" rid="R9">Wallrauch et al., 2010</xref>; <xref ref-type="bibr" rid="R10">Welz et al., 2007</xref>) and nearby Swaziland. As in the South-African sites, prevalence for those aged 50–54, 55–59, and 60–64 from the 2006–2007 DHS of Swaziland are relatively high and show no sign of quickly approaching 0 as age increases; prevalence among the oldest age group in that survey, 60–64, is 13% for males and 6.8% for females. Compared with both KwaZulu-Natal and Swaziland, Agincourt HIV prevalence peaks over 35% in the fifties for males and over 25% in females. Agincourt is the highest of the three at ages 35 +.</p><p>A relatively large HIV burden among those who were 50 + raises several questions. First, it is unknown whether older individuals contracted HIV at earlier ages and survived for long periods, or whether they acquired HIV at older ages; additional analyses of sexual risk behavior among older adults are needed. Antiretroviral therapy rollout in the study site only began in 2007 – future studies are needed to determine uptake and coverage. Second, high prevalence among older people may affect their capacity to care for grandchildren, creating an epidemic that affects both older people themselves and those under their care (<xref ref-type="bibr" rid="R3">Kautz, Bendavid, Bhattacharya, & Miller, 2010</xref>). Third, older people who also suffer from chronic noncommunicable diseases (NCDs) will need to use health facilities more frequently, seeking chronic care for both NCDs and HIV.</p><p>The Agincourt and Africa Centre HDSS sites are widely separated, with Swaziland in between. The similarity of HIV prevalence estimates in all three areas and the gradient they form suggest that HIV prevalence of this general sex-age-specific magnitude (through to older ages well beyond 50) is typical in rural South Africa.</p><p>Two conclusions are clear: (1) consideration must be given to expanding prevention activities to older adults and (2) health care systems need to include HIV + older adults in treatment plans. Effective treatment will be complicated by increased prevalence of NCD in older people, requiring coordination of care and follow-up, and by increasing numbers of older people living with HIV (<xref ref-type="bibr" rid="R4">Levitt, Steyn, Dave, & Bradshaw, 2011</xref>).</p><p>We contemplate two longitudinal follow-up studies of HIV – participants to estimate incidence and of HIV + participants to investigate entry into treatment, adherence, resistance, and other outcomes important to people living with HIV.</p></sec></body><back><ack><title>Acknowledgements</title><p>This study was supported by the grant R24AG032112 from the National Institute on Aging (NIA), Partnership for Social Science AIDS Research in South Africa's Era of ART Rollout; grants K01 HD057246 and R01 HD054511 from the National Institute of Child Health and Human Development (NICHD) of the National Institutes of Health (NIH); William and Flora Hewlett Foundation Grants 2006–8377 and 2009–4069; Wellcome Trust; Anglo-American Chairman's Fund. 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