Journal Article

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

Chimbindi, Natsayi, Shahmanesh, Maryam, Floyd, Sian, Seeley, Janet, Mutevedzi, Tinofa, Fenty, Justin, Zuma, Thembelihle, Pillay, Deenan, Gareta, Dickman, Baisley, Kathy, Dreyer, Jaco, Herbst, Kobus, Birdthistle, Isolde, McGrath, Nuala, Smit, Theresa, Mthiyane, Nondumiso

2018

Overview

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. 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. 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. 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.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Acquired immune deficiency syndrome / Adult / Adults / AIDS / Antiretroviral drugs / Biology and Life Sciences / Circumcision / Circumcision, Male / Cohort Studies / Condoms / Confidence intervals / Demographics / Disease prevention / Education / Educational Status / Elective Surgical Procedures / Health aspects / Health risks / HIV / HIV infections / HIV Infections - diagnosis / HIV Infections - epidemiology / HIV Infections - prevention & control / HIV tests / Human immunodeficiency virus / Humans / Incidence / Male / Medicine and Health Sciences / Men / Methods / No confidence motions & votes / Patient Acceptance of Health Care / People and Places / Polls & surveys / Prevalence / Prevention / Prophylaxis / Research and Analysis Methods / Risk factors / Rural Population / Sexual Behavior / Sexually transmitted disease prevention / Sexually transmitted diseases / South Africa / Statistical analysis / Statistics / STD / Teenagers / Time Factors / Womens health / Young Adult / Young adults / Young men