Barcelona 2013
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| Abstract #413 - Gender in the Equation: Not Just Treatment as Prevention | ||||
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Session: 20.5: Gender in the Equation: Not Just Treatment as Prevention (Workshop) on Monday @ 16.30-18.30 in Auditorium Chaired by Dr Wendee Wechsberg Authors: Presenting Author: Dr Wendee Wechsberg - RTI International, United States |
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| Additional Authors: | ||||
| Aim: Heterosexual transmission fuels South Africa?s HIV epidemic. Many couples stay together for long periods supporting positive cultural traditions of keeping families together. Nonetheless, concurrent partnerships and alcohol and other drug abuse occur, increasing vulnerability to HIV acquisition. In an NIAAA funded trial, 296 couples received a women?s centered intervention, men?s intervention, or couple?s intervention which were designed to reduce alcohol and drug use, reduce victimization and violence, and increase safer sex practices. | ||||
| Method / Issue: We performed geographical mapping of taverns to demarcate 30 neighborhoods in a large black township in Cape Town. Thirty neighborhoods were randomized to the three arms of the study. Couples were recruited from drinking venues within their neighborhood and clustered to that arm of intervention. Between 2010 and 2012, 296 couples aged 18-35 years in long-term relationships were recruited. Participants were screened for recent alcohol and drug use, HIV testing, and were interviewed at the baseline and the 6-month visits; 93.5% of participants returned for follow-up visits. | ||||
| Results / Comments: Substantial gender differences in HIV were observed. At baseline, the HIV prevalence was 19.5%, however, HIV infection was 2.3 (95%CI [1.5, 3.6]) times more likely among women (26.2%) than men (13.2%). By the 6-month visit, 22 participants (5 men and 17 women) seroconverted; an HIV incidence rate of 9.7/100 person-years. HIV incidence among women was 16.2/100 person-years versus 4.1/100 among men (incidence rate ratio = 4.0, 95%CI [1.5, 10.8]). At baseline 62 (20%) couples were serodiscordant; both partners were HIV-infected in 10% of couples and the remaining 70% were uninfected. At the 6-month follow-up, among 268 couples, 67 (25%) were serodiscordant. Five participants who became HIV-infected at follow-up may have acquired HIV from their partner. Both previously uninfected partners seroconverted in two partnerships. The remaining 14 participants who seroconverted may have acquired HIV infection from a casual partner, as their main partner remained uninfected, suggesting that HIV transmission occurs in concurrent partnerships and women are more susceptible. | ||||
| Discussion: The marked differences in HIV prevalence and incidence between men and women in South Africa has many possible explanations. The formative methods used for the adaptions of the interventions revealed many factors of gender disparity. Men are more likely to drink alcohol, have other partners, and unprotected sex. Women drink less, also have other partners, yet are more biologically susceptible. They remain in long term relationships despite the possibility of other partners. Some explanation remains in the lack of gender equity and cultural traditions steeped deep among African men with their sense of domination, and women?s passivity around sexual protection. However, women have admitted needing to trade sex for Sunday family dinner meat to take care of the family. Although there was great attendance and zeal for the interventions, the follow up rate was only at six months. The behavioral outcomes will be beneficial to explain the markedly high incidence. | ||||
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