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The HIV Epidemic in Sub-Saharan Africa is Aging: Evidence from the Demographic and Health Surveys in Sub-Saharan Africa

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Abstract

We use the individual-level data from all available Demographic and Health Surveys (DHS) from 27 sub-Saharan African countries conducted between 2003 and 2012 (40 population-based and nationally representative surveys in total) to calculate HIV testing consent rates and HIV prevalence for each country separately, as well as for the pooled sample. The pooled sample comprised of 427,130 individuals. In most countries HIV prevalence in adults aged 45 years and above is higher than in the total population. We further show that over the past decade HIV prevalence has increased in older age groups, while it has decreased in younger ones. While the age patterns of HIV consent rates vary across the 27 countries included in our sample, analysis of the pooled sample across all countries reveals a u-shaped relationship with lowest consent rates around age 35 years and higher consent rates among younger and older people. We argue that future DHS and other population-based HIV surveys should offer HIV testing to all adults without age limits.

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Acknowledgements

SV, KH and TB received funding for this work from UNAIDS. TB received funding from the Alexander von Humboldt Foundation through the Alexander von Humboldt professor award, and from NICHD of NIH (R01-HD084233) and NIAID of NIH (R01-AI124389 and R01-AI112339).

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Authors and Affiliations

  1. Department of Economics, University of Göttingen, Göttingen, Germany

    Sebastian Vollmer

  2. Department of Global Health and Population, Harvard T.H. Chan School of Public Health Harvard University 665 Huntington Avenue, Boston, USA

    Sebastian Vollmer & Till Bärnighausen

  3. ETH Zürich, Zurich, Switzerland

    Kenneth Harttgen

  4. UNAIDS, Geneva, Switzerland

    Tobias Alfven, Jude Padayachy & Peter Ghys

  5. Wellcome Trust Africa Centre for Heath and Population Studies, University of KwaZulu-Natal, Kwazulu-Natal, South Africa

    Till Bärnighausen

  6. Institute of Public Health, University of Heidelberg, Heidelberg, Germany

    Till Bärnighausen

Authors
  1. Sebastian Vollmer
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  2. Kenneth Harttgen
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  3. Tobias Alfven
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  4. Jude Padayachy
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  5. Peter Ghys
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  6. Till Bärnighausen
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Corresponding author

Correspondence to Till Bärnighausen.

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Conflicts of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

This article does not contain any studies with human participants performed by any of the authors. The DHS data-collection procedures were approved by the ICF International (Calverton, MD, USA) institutional review board and by the relevant human subjects committees in each country.

Appendix

Appendix

See Tables 3, 4, 5 and Fig. 4.

Table 3 Annual growth in HIV prevalence between first and last survey
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Table 4 Consent rates for HIV tests by age group—males
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Table 5 Consent rates for HIV-tests by age group—Females
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Fig. 4
figure 4

Predicted probability of consent rates for HIV tests by age and sex. The figure shows the consent rates for HIV tests by age pooled across all survey. The solid line is the predicted probability of consenting to the HIV test by age and it is estimated by fitting a fractional polynomial. The grey area is the 95 % confidence interval of the fitted curve

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Vollmer, S., Harttgen, K., Alfven, T. et al. The HIV Epidemic in Sub-Saharan Africa is Aging: Evidence from the Demographic and Health Surveys in Sub-Saharan Africa. AIDS Behav 21 (Suppl 1), 101–113 (2017). https://doi.org/10.1007/s10461-016-1591-7

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  • DOI: https://doi.org/10.1007/s10461-016-1591-7

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