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Factors Associated with Variations in Population HIV Prevalence across West Africa: Findings from an Ecological Analysis

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  • Holly J Prudden
  • Tara S Beattie
  • Natalia Bobrova
  • Jasmina Panovska-Griffiths
  • Zindoga Mukandavire
  • Marelize Gorgens
  • David Wilson
  • Charlotte H Watts

Abstract

Background: Population HIV prevalence across West Africa varies substantially. We assess the national epidemiological and behavioural factors associated with this. Methods: National, urban and rural data on HIV prevalence, the percentage of younger (15–24) and older (25–49) women and men reporting multiple (2+) partners in the past year, HIV prevalence among female sex workers (FSWs), men who have bought sex in the past year (clients), and ART coverage, were compiled for 13 countries. An Ecological analysis using linear regression assessed which factors are associated with national variations in population female and male HIV prevalence, and with each other. Findings: National population HIV prevalence varies between 0 4–2 9% for men and 0 4–5.6% for women. ART coverage ranges from 6–23%. National variations in HIV prevalence are not shown to be associated with variations in HIV prevalence among FSWs or clients. Instead they are associated with variations in the percentage of younger and older males and females reporting multiple partners. HIV prevalence is weakly negatively associated with ART coverage, implying it is not increased survival that is the cause of variations in HIV prevalence. FSWs and younger female HIV prevalence are associated with client population sizes, especially older men. Younger female HIV prevalence is strongly associated with older male and female HIV prevalence. Interpretation: In West Africa, population HIV prevalence is not significantly higher in countries with high FSW HIV prevalence. Our analysis suggests, higher prevalence occurs where more men buy sex, and where a higher percentage of younger women, and older men and women have multiple partnerships. If a sexual network between clients and young females exists, clients may potentially bridge infection to younger females. HIV prevention should focus both on commercial sex and transmission between clients and younger females with multiple partners.

Suggested Citation

  • Holly J Prudden & Tara S Beattie & Natalia Bobrova & Jasmina Panovska-Griffiths & Zindoga Mukandavire & Marelize Gorgens & David Wilson & Charlotte H Watts, 2015. "Factors Associated with Variations in Population HIV Prevalence across West Africa: Findings from an Ecological Analysis," PLOS ONE, Public Library of Science, vol. 10(12), pages 1-15, December.
    • Handle: RePEc:plo:pone00:0142601
    DOI: 10.1371/journal.pone.0142601
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    References listed on IDEAS

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    1. Pascaline Dupas, 2011. "Do Teenagers Respond to HIV Risk Information? Evidence from a Field Experiment in Kenya," American Economic Journal: Applied Economics, American Economic Association, vol. 3(1), pages 1-34, January.
    2. World Bank, 2008. "West Africa HIV/AIDS Epidemiology and Response Synthesis : Implications for Prevention," World Bank Publications - Reports 12537, The World Bank Group.
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