Community effects on the risk of HIV infection in rural Tanzania.
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Author(s): Bloom SS, Urassa M, Ng'weshemi J, Boerma JT
This study investigated the effect of community characteristics on HIV prevalence and incidence. Data from an open cohort study with demographic surveillance, epidemiological surveys and qualitative research were used to examine the association between individual and community risk factors with HIV prevalence in 1994-5 and incidence between 1994-5 and 1996-7 among men and women living in a rural area in Northwest Tanzania. Authors investigated the following community factors: level of social and economic activity, ratio of bar workers per male population aged 18-59, level of community mobility, and distance to the nearest town. All four community factors had strong effects on HIV transmission. Men living in subvillages with the highest level of social and economic activity were about five times more likely to have HIV than those in places of low levels of activity. Women in these subvillages were about twice as likely. After controlling for community effects, the effects of some individual factors on the risk of HIV--education, male circumcision, type of work, and number of household assets--changed notably. Results suggest that community characteristics play an important part in the spread of HIV in rural Tanzania. Community effects need both to be considered in individual risk factor analyses and be given more attention in intervention programs.
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