Growing gender disparity in HIV infection in Africa: sources and policy implications
Growing gender disparity in HIV infection in Africa: sources and policy implications
Abstract HIV incidence in eastern and southern Africa has historically been concentrated among girls and women aged 15-24 years, but as new cases decline with HIV interventions, population-level infection dynamics may shift by age and gender. Here, we integrated population-based surveillance and longitudinal deep-sequence viral phylogenetics to assess how HIV incidence and the population groups driving transmission have evolved over a 15 year period from 2003 to 2018 in Uganda. HIV viral suppression increased more rapidly in women than men, resulting in 1.5-2 fold higher suppression rates in women with HIV by 2018 across age groups. Incidence declined more slowly in women than men, increasing pre-existing gender imbalance in HIV burden. Age-specific transmission flows shifted; the share of transmission to girls and women aged 15-24 years from older men declined by approximately one third, whereas the contribution of transmission to women aged 25-34 years from men aged 0-6 years older doubled from 2003 to 2018. We estimated closing the gender gap in viral suppression could have reduced HIV incidence in women by half in 2018 and ended gender disparities in incidence. This study suggests that male-targeted HIV programs to increase HIV suppression are critical to reduce incidence in women, close gender gaps in infection burden and improve men’s health in Africa.
Ssekasanvu Joseph、Ratmann Oliver、Golubchik Tanya、Quinn Thomas C.、Santelli John、Spencer Simon EF、Wawer Maria J、Grabowski M Kate、Monod M¨|lodie、Serwadda David、Ssempijja Victor、Akullian Adam、Blenkinsop Alexandra、Gray Ronald H、Hall Matthew、Dan Shozen、Reynolds Steven J.、Fraser Christophe、Xi Xiaoyue、Sewankambo Nelson K.、Jackson Jade C、Godfrey-Faussett Peter、Brizzi Andrea、Galiwango Ronald M、Chang Larry W、Mills Lisa A.、Bonsall David、D?rner Lucie Abeler、Laeyendecker Oliver、Kankaka Edward Nelson、Chen Yu、Kigozi Godfrey、Ssekubugu Robert、Kagaayi Joseph、Thomson Laura
Department of Epidemiology, Johns Hopkins Bloomberg School of Public HealthDepartment of Mathematics, Imperial College LondonSydney Infectious Diseases Institute, School of Medical Sciences, Faculty of Medicine and Health, University of Sydney||Big Data Institute, Nuffield Department of Medicine, University of OxfordDepartment of Pathology, Johns Hopkins School of Medicine||Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health||Department of Medicine, Johns Hopkins School of MedicinePopulation and Family Health and Pediatrics, Columbia Mailman School of Public HealthDepartment of Statistics, University of WarwickRakai Health Sciences Program||Department of Epidemiology, Johns Hopkins Bloomberg School of Public HealthRakai Health Sciences Program||Department of Pathology, Johns Hopkins School of Medicine||Department of Infectious and Tropical Diseases, London School of Hygiene & Tropical MedicineDepartment of Mathematics, Imperial College LondonRakai Health Sciences Program||College of Health Sciences, School of Medicine, Makerere UniversityClinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research||Statistics Department, Rakai Health Sciences ProgramBill and Melinda Gates FoundationDepartment of Mathematics, Imperial College LondonProfessor Emeritus, Department of Epidemiology, Johns Hopkins University, Bloomberg School of Public HealthBig Data Institute, University of OxfordDepartment of Mathematics, Imperial College LondonRakai Health Sciences Program||Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health||Department of Medicine, Johns Hopkins School of MedicineBig Data Institute, University of Oxford||Pandemic Sciences Institute, Univeristy of OxfordDepartment of Mathematics, Imperial College LondonCollege of Health Sciences, School of Medicine, Makerere UniversityDepartment of Pathology, Johns Hopkins School of MedicineDepartment of Infectious and Tropical Diseases, London School of Hygiene & Tropical MedicineDepartment of Mathematics, Imperial College LondonRakai Health Sciences ProgramDivision of Infectious diseases, Johns Hopkins School of MedicineDivision of Global HIV and TB, U. S. Centers for Disease Control and PreventionWellcome Centre for Human Genomics, Nuffield Department of Medicine, Univeristy of Oxford||Pandemic Sciences Institute, Univeristy of OxfordBig Data Institute, University of OxfordDivision of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health||Department of Medicine, Johns Hopkins School of MedicineDivision of Infectious diseases, Johns Hopkins School of Medicine||Research Department, Rakai Health Sciences ProgramDepartment of Mathematics, Imperial College LondonRakai Health Sciences ProgramRakai Health Sciences ProgramRakai Health Sciences ProgramBig Data Institute, University of Oxford
医学研究方法预防医学医药卫生理论
Ssekasanvu Joseph,Ratmann Oliver,Golubchik Tanya,Quinn Thomas C.,Santelli John,Spencer Simon EF,Wawer Maria J,Grabowski M Kate,Monod M¨|lodie,Serwadda David,Ssempijja Victor,Akullian Adam,Blenkinsop Alexandra,Gray Ronald H,Hall Matthew,Dan Shozen,Reynolds Steven J.,Fraser Christophe,Xi Xiaoyue,Sewankambo Nelson K.,Jackson Jade C,Godfrey-Faussett Peter,Brizzi Andrea,Galiwango Ronald M,Chang Larry W,Mills Lisa A.,Bonsall David,D?rner Lucie Abeler,Laeyendecker Oliver,Kankaka Edward Nelson,Chen Yu,Kigozi Godfrey,Ssekubugu Robert,Kagaayi Joseph,Thomson Laura.Growing gender disparity in HIV infection in Africa: sources and policy implications[EB/OL].(2025-03-28)[2025-06-21].https://www.medrxiv.org/content/10.1101/2023.03.16.23287351.点此复制
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