Individual and population-level risk factors for new HIV infections among adults in Eastern and Southern Africa

Despite substantial recent declines, general population HIV incidence in sub-Saharan Africa remains above international targets. Better description of risk factors for new infections would improve prioritisation of interventions. Using data from population-based cohorts in Kenya, Malawi, Tanzania, South Africa, Uganda, Zimbabwe we described the prevalence of risk factors for men and women aged 15-24 and 25-49 and estimated the association between individual and community-level risk factors and HIV acquisition between 2005 and 2016. Among 43,434 men and 55,919 women aged 15 to 49 there were 4,612 seroconversions. Education, marital status, male circumcision, new sexual partners, types of partner, prevalence of untreated HIV infection in the community and community partner acquisition rates were associated with HIV incidence. Only the prevalence of untreated HIV was a risk for both sexes and apparent at all ages. The prevalence of risk factors varied by age, sex and study. HIV incidence was higher in people aged 25-49 living in communities where men had high partner acquisition rates. Our results show potential for improved prevention through changed timing of prevention interventions relative to behaviour and the utility of using community characteristics to target prevention.

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Publication Details

Journal
Nature Communications
Published
2026-01-06
DOI
https://doi.org/10.1038/s41467-025-67966-0
Primary Topic
Genital Health and Disease
Type
article
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0.00
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article

Individual and population-level risk factors for new HIV infections among adults in Eastern and Southern Africa

Estelle McLean, Coleman Kishamawe, Eveline Geubbels, Milly Marston et al.
Nature Communications
Genital Health and Disease
article

Individual and population-level risk factors for new HIV infections among adults in Eastern and Southern Africa

Estelle McLean, Coleman Kishamawe, Eveline Geubbels, Milly Marston, Tawanda Dadirai, Chifundo Kanjala, Keith Tomlin, Albert Dube, Alison Wringe, David Obor, Jeffrey W. Eaton, Charles Festo, Constance Nyamukapa, Malebogo Tlhajoane, Kathryn Risher, Clara Calvert, Emma Slaymaker, Simon Gregson, Sylvia Kusemererwa, Anthony Ndyanabo, Julie Ambia, Rob Newton, Ramadhani Abdul, Alison Price, Gertrude Mutonyi, Louisa Moorhouse, George Olilo, Georges Reniers, T. Accelerating Medicines Partnership in RA SLE Network, T Lutalo, Kobus Herbst, Albert Takaruza, Mark Urassa, Jim Todd, Amelia Crampin, Denna Michael, Njabulo Myeza, Dickman Gareta, Daniel Kwaro, Dorean Nabukalu, Nuala McGrath, Emmanuel Mtuli, Kathy Baisley
article en

Abstract

Despite substantial recent declines, general population HIV incidence in sub-Saharan Africa remains above international targets. Better description of risk factors for new infections would improve prioritisation of interventions. Using data from population-based cohorts in Kenya, Malawi, Tanzania, South Africa, Uganda, Zimbabwe we described the prevalence of risk factors for men and women aged 15-24 and 25-49 and estimated the association between individual and community-level risk factors and HIV acquisition between 2005 and 2016. Among 43,434 men and 55,919 women aged 15 to 49 there were 4,612 seroconversions. Education, marital status, male circumcision, new sexual partners, types of partner, prevalence of untreated HIV infection in the community and community partner acquisition rates were associated with HIV incidence. Only the prevalence of untreated HIV was a risk for both sexes and apparent at all ages. The prevalence of risk factors varied by age, sex and study. HIV incidence was higher in people aged 25-49 living in communities where men had high partner acquisition rates. Our results show potential for improved prevention through changed timing of prevention interventions relative to behaviour and the utility of using community characteristics to target prevention.

Nature CommunicationsVol. 17(1)
Ifakara Health Institute (TZ), Pennsylvania State University (US), Center for Disease Dynamics, Economics & Policy (US), Catholic University of Health and Allied Sciences (TZ), Kenya Medical Research Institute (KE), University of Bristol (GB), Health & Medical Publishing Group (ZA), London School of Hygiene & Tropical Medicine (GB), Biomedical Research and Training Institute (ZW), Rakai Health Sciences Program (UG), Africa Health Research Institute (ZA), Malawi Epidemiology and Intervention Research Unit (MW), National Institute for Medical Research (TZ), University of Southampton (GB), Imperial College London (GB), University of York (GB), University of Glasgow (GB), Uganda Virus Research Institute (UG), University of KwaZulu-Natal (ZA), University of Edinburgh (GB)
Good health and well-being
Openalex Percentile: Top 96%
Genital Health and Disease
DOIOpen Access PDFOpenAlex
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