HIV This Week

Zungu-Dirwayi N, Shisana O, Louw J, Dana P. Social determinants for HIV prevalence among South African educators. AIDS Care. 2007; 19(10):1296-303.

HIV prevalence among women in South Africa continues to be high despite the availability of a comprehensive plan for the control of HIV and a plethora of prevention programmes. Any explanation for the ongoing high HIV prevalence continues to be elusive. The objective of this study was to understand the relationship between HIV, gender, race, and socioeconomic status among South African public sector educators in order to inform prevention programmes. A cross-sectional survey involving a probability sample of 1,766 schools out of 26,713 in the Department of Education Register of School Needs was selected. A sample of 24,200 respondents out of 356,749 public sector educators participated in the study. Nurses registered with the South African Nursing Council were recruited, trained to conduct interviews and to collect specimens for HIV testing. The study found an association between HIV, gender, race, and socioeconomic status among educators. African educators showed a higher HIV prevalence than other race groups. Among females, the highest HIV prevalence was among educators aged 25-35 years and in males aged 36-49 years. Further, educators with a high income and educational qualifications had a lower HIV prevalence compared to educators with low income and low educational qualifications, regardless of sex. Migration and marital factors were also found to play a role in HIV infection. The results suggest that HIV prevention needs to take into account critical issues around empowerment of vulnerable groups such as women and certain race groups to be able to implement safe sexual practices and therefore reduce HIV infections.

Editors’ note: Nearly 13% of all educators were HIV-positive in this study, a tremendous toll for any educational system. HIV prevalence in women who began teaching being married (14.7%) or engaged (11.4%) was lower than that among those who began their career being single (25.4%). Prevention programmes for young, single, female educators who are mobile are urgently needed. Educators of both sexes who were placed away from their families on completion of their studies had a significantly higher HIV prevalence. School boards need to consider the advantages of keeping teachers’ families with them to preserve mid-to-long term teaching capacity.

This study examined the role of hunger and food insecurity in the sexual behaviour of female sex workers in Lagos metropolis, Nigeria within the context of HIV. In addition, the study investigated the prevalence of sexually transmitted infections and induced abortion among the respondents. Cross-sectional survey and in-depth interview research methods were adopted to generate both quantitative and qualitative data from the respondents. The study showed that 35.0% of the respondents joined the sex industry because of poverty and lack of other means of getting daily food. While all the respondents had knowledge about the existence of HIV and AIDS, 82.0% of them identified sexual intercourse as a major route of HIV transmission. There was a significant relationship between poverty, food insecurity, and consistent use of condoms by female sex workers at P<0.01. Specifically, only 24.7% of the respondents used condoms regularly in every sexual act. Consequently, 51.6% had previous cases of sexually transmitted infections. The most prevalent sexually transmitted infection among the respondents was gonorrhoea, with 76.4% prevalence among ever infected female sex workers. This was followed by syphilis with a prevalence of 21.1%. In addition, 59.1% of the sample had become pregnant while on the job and 93.1% of these pregnancies were aborted through induced abortion. In conclusion, hunger and malnutrition were the factors that pushed young women into prostitution in Nigeria and these same factors hindered them from practicing safe sex within the sex industry. Thus, it is recommended that the Nigerian government should develop programmes that will reduce hunger and food insecurity, in order to reduce rapid transmission of HIV infection in the country.

Editors’ note: The links between hunger, food insecurity, and vulnerability to HIV described by this article are brought into sharp relief by the current global food crisis. Improving local food production to meet basic food needs not only helps reduce poverty levels; it pulls the rug out from under food insecurity as a driver of the HIV epidemic.