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Drought, HIV Testing, and HIV Transmission Risk Behaviors: A Population-Based Study in 10 High HIV Prevalence Countries in Sub-Saharan Africa


Droughts are associated with poor health outcomes and disruption of public health programming. Data on the association between drought and HIV testing and transmission risk behaviors are limited. We combined data from Demographic and Health Surveys from 10 high HIV prevalence sub-Saharan African countries with a high-resolution measure of drought. We estimated the association between drought and recent HIV testing, report of condomless sex, and number of sexual partners in the last year. Respondents exposed to drought were less likely to have an HIV test and more likely to have condomless sex, although effect sizes were small. We found evidence for effect modification by sex and age for the association between drought and HIV testing, such that the negative association between drought and HIV testing was strongest among men (marginal risk ratio [mRR] 0.92, 95% CI 0.89–0.95) and adolescents (mRR 0.90, 95% CI 0.86–0.93). Drought may hinder HIV testing programs in countries with high HIV prevalence.

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Data Availability

Demographic and Health Survey data are publicly available at CHIRPS precipitation data are publicly available at

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Code is available upon request.


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JMN is supported by the American Heart Association (CDA34760281). AE is supported by the National Institute of Allergy and Infectious Diseases (F31AI150029). SDW is supported by the National Institute of Allergy and Infectious Diseases (K24AI134326).

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AE, JMN, and SDW conceived of the study. AE conducted the data analysis, with input from JMN, EDC and SDW. AE and JMN drafted the manuscript, with support from SDW. All authors contributed to the interpretation of results. All authors have read and approved the final manuscript.

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Correspondence to Adrienne Epstein.

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Demographic and Health Surveys obtain informed consent from survey participants and permission to use DHS data was obtained from the DHS program. Specific approval for this de-identified data analysis was not required.

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Adrienne Epstein and Jason M. Nagata contributed equally to this work.

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Epstein, A., Nagata, J.M., Ganson, K.T. et al. Drought, HIV Testing, and HIV Transmission Risk Behaviors: A Population-Based Study in 10 High HIV Prevalence Countries in Sub-Saharan Africa. AIDS Behav 27, 855–863 (2023).

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