HIV risk in partners of migrants and residents in Rakai, Uganda: an observational cohort study

Abstract

Background: Migration status has been linked to a higher burden of untreated HIV infection throughout sub-Saharan Africa. In Rakai District, Uganda, we have previously shown that migrants have an increased risk of HIV acquisition during the first two years following migration into a new community. However, little is known about these in-migrants’ sexual partners. Here, we characterized in-migrants’ sexual partner pool and examined their risk for pairing with an untreated HIV-positive individual.

Methods: From 1999 through 2016, we continuously surveyed 30 communities in Rakai District, Uganda as part of the Rakai Community Cohort Study (RCCS). In this open population-based cohort study, participants aged 15 to 49 reported on their four most recent sexual partners in the last year at each survey visit. We compared the self-reported characteristics of sexual partners of recent in-migrants (arrival < 2 years) and residents stratified by gender. Within a subset of linked cohabitating couples of known HIV serostatus, we also measured the prevalence of untreated HIV infection among partners comparing recent in-migrants to residents using log-binomial regression. Data were analyzed at each survey visit (12 surveys total) to assess calendar trends before and after the availability of antiretroviral therapy (ART).

Results: In total, 116,749 sexual partners were self-reported by 29,423 RCCS participants. Within both genders, we observed increased sexual risk behaviors in the partnerships of in-migrants compared to those of residents. Among 7,558 cohabitating couples of known HIV serostatus (21,140 couple-visits), migrants were significantly more likely to partner with other migrants. The prevalence of untreated HIV infection was significantly higher among cohabitating partners of HIV-negative in-migrants compared to residents irrespective of gender. HIV-negative in-migrant women and men were more likely to partner with untreated HIV-positive individuals compared to residents before and after the availability of ART (Female PRR=1.55, 95% CI: 1.30-1.85; Male PRR=1.74, 95% CI: 1.40-2.17).

Conclusion: HIV-negative in-migrants are more likely than HIV-negative residents to partner with untreated HIV-positive individuals. These findings highlight the need for HIV prevention programs that target in-migrants either before or promptly following their relocation.