Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2013 Jul 1;63(3):393-400.
doi: 10.1097/QAI.0b013e3182926795.

Behavioral, biological, and demographic risk and protective factors for new HIV infections among youth in Rakai, Uganda

John S Santelli  1 , Zoe R Edelstein, Sanyukta Mathur, Ying Wei, Wenfei Zhang, Mark G Orr, Jenny A Higgins, Fred Nalugoda, Ron H Gray, Maria J Wawer, David M Serwadda
Affiliations

Behavioral, biological, and demographic risk and protective factors for new HIV infections among youth in Rakai, Uganda

John S Santelli et al. J Acquir Immune Defic Syndr. .

Abstract

Background: Prevalence of HIV infection is considerable among youth, although data on risk factors for new (incident) infections are limited. We examined incidence of HIV infection and risk and protective factors among youth in rural Uganda, including the role of gender and social transitions.

Methods: Participants were sexually experienced youth (15-24 years old) enrolled in the Rakai Community Cohort Study, 1999-2008 (n = 6741). Poisson regression with robust standard errors was used to estimate incident rate ratios (IRR) and 95% confidence intervals (CI) of incident HIV infection.

Results: HIV incidence was greater among young women than young men (14.1 vs. 8.3 per 1000 person-years, respectively); this gender disparity was greater among teenagers (14.9 vs. 3.6). Beyond behavioral (multiple partners and concurrency) and biological factors (sexually transmitted infection symptoms), social transitions such as marriage and staying in school influenced HIV risk. In multivariate analyses among women, HIV incidence was associated with living in a trading village (adjusted IRR (aIRR) = 1.48; 95% CI: 1.04 to 2.11), being a student (aIRR = 0.22; 95% CI: 0.07 to 0.72), current marriage (aIRR = 0.55; 95% CI: 0.37 to 0.81), former marriage (aIRR = 1.73; 95% CI: 1.01 to 2.96), having multiple partners, and sexually transmitted infection symptoms. Among men, new infections were associated with former marriage (aIRR = 5.57; 95% CI: 2.51 to 12.36), genital ulceration (aIRR = 3.56; 95% CI: 1.97 to 6.41), and alcohol use (aIRR = 2.08; 95% CI: 1.15 to 3.77).

Conclusions: During the third decade of the HIV epidemic in Uganda, HIV incidence remains considerable among youth, with young women particularly at risk. The risk for new infections was strongly shaped by social transitions such as leaving school, entrance into marriage, and marital dissolution; the impact of marriage was different for young men than women.

PubMed Disclaimer

References

    1. UNAIDS. 2008 Report on the global AIDS epidemic. Geneva, Switzerland: UNAIDS; 2008.
    1. Kirby D. Success in Uganda: An Overview of Uganda’s Campaign to Change Sexual Behaviors and Decrease HIV Prevalence, 1986–1995. Santa Cruz, California, USA: ETR Associates; 2008.
    1. Mmari K, Blum RW. Risk and protective factors that affect adolescent reproductive health in developing countries: A structured literature review. Global Public Health: An International Journal for Research, Policy and Practice. 2009;4:350–366. - PubMed
    1. Kirby D. Changes in sexual behavior leading to the decline in prevalence of HIV in Uganda: confirmation from multiple sources of evidence. Sexually Transmitted Infections. 2008;84:ii35–ii41. - PMC - PubMed
    1. Napierala Mavedzenge S, Olson R, Doyle AM, Changalucha J, Ross DA. The Epidemiology of HIV Among Young People in Sub-Saharan Africa: Know Your Local Epidemic and Its Implications for Prevention. Journal of Adolescent Health. 2011;49:559–567. - PubMed

Publication types