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Migration, hotspots, and dispersal of HIV infection in Rakai, Uganda

by Lessler, Justin , Nankinga, Justine , Kennedy, Caitlin , Serwadda, David , Ssekubugu, Robert , Kigozi, Godfrey , Ssekasanvu, Joseph , Santelli, John S. , Wawer, Maria J. , Reynolds, Steven J. , Chang, Larry W. , Nalugoda, Fred , Nantume, Betty , Kagaayi, Joseph , Bazaale, Jeremiah , Nabukalu, Dorean , Gray, Ronald H. , Kate Grabowski, Mary

in 631/158/1745 / 692/308/174 / 692/699/255/1901 / Adolescent / Adult / Cohort Studies / Disease hot spots / Dispersal / Dispersion / Emigration and Immigration / Epidemics / Female / Geography / Health risk assessment / HIV / HIV Infections - epidemiology / HIV Infections - transmission / Human immunodeficiency virus / Humanities and Social Sciences / Humans / Hypodermic needles / Male / Middle Aged / Migrants / Migration / multidisciplinary / Prevalence / Rural Population / Science / Science (multidisciplinary) / Transients and Migrants / Uganda - epidemiology / Young Adult

2020

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Migration, hotspots, and dispersal of HIV infection in Rakai, Uganda

2020

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2020

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Journal Article

Migration, hotspots, and dispersal of HIV infection in Rakai, Uganda

Lessler, Justin,

Nankinga, Justine,

Kennedy, Caitlin,

Serwadda, David,

Ssekubugu, Robert,

Kigozi, Godfrey,

Ssekasanvu, Joseph,

Santelli, John S.,

Wawer, Maria J.,

Reynolds, Steven J.,

Chang, Larry W.,

Nalugoda, Fred,

Nantume, Betty,

Kagaayi, Joseph,

Bazaale, Jeremiah,

Nabukalu, Dorean,

Gray, Ronald H.,

Kate Grabowski, Mary

2020

Overview

HIV prevalence varies markedly throughout Africa, and it is often presumed areas of higher HIV prevalence (i.e., hotspots) serve as sources of infection to neighboring areas of lower prevalence. However, the small-scale geography of migration networks and movement of HIV-positive individuals between communities is poorly understood. Here, we use population-based data from ~22,000 persons of known HIV status to characterize migratory patterns and their relationship to HIV among 38 communities in Rakai, Uganda with HIV prevalence ranging from 9 to 43%. We find that migrants moving into hotspots had significantly higher HIV prevalence than migrants moving elsewhere, but out-migration from hotspots was geographically dispersed, contributing minimally to HIV burden in destination locations. Our results challenge the assumption that high prevalence hotspots are drivers of transmission in regional epidemics, instead suggesting that migrants with high HIV prevalence, particularly women, selectively migrate to these areas. HIV prevalence varies throughout Africa, but the contribution of migration remains unclear. Using population-based data from ~22,000 persons, Grabowski et al. show that HIV-positive migrants selectively migrate to high prevalence areas and that out-migrants from these areas geographically disperse.

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Publisher

Nature Publishing Group UK,Nature Publishing Group,Nature Portfolio

Subject

/ Adult