Analysis of Heavy Rainfall in Sub-Saharan Africa and HIV Transmission Risk, HIV Prevalence, and Sexually Transmitted Infections, 2005-2017.

Journal: JAMA network open

Volume: 5

Issue: 9

Year of Publication: 2022

Affiliated Institutions:  Department of Pediatrics, University of California, San Francisco. Department of Medicine, University of California, San Francisco. Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom. Department of Epidemiology and Biostatistics, University of California, San Francisco. Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston. Institute for Implementation Science in Population Health, City University of New York, New York.

Abstract summary 

Extreme precipitation, including heavy rains and flooding, is associated with poor health outcomes mediated in part by decreases in income and food production. However, the association between heavy rains and HIV burden is unknown.To investigate the association between heavy rainfall, HIV prevalence, and HIV transmission risk over a 12-year span in sub-Saharan Africa.A cross-sectional population-based study, using data collected from the 2005-2017 Demographic and Health Surveys, was conducted in 21 countries in sub-Saharan Africa and analyzed from July 29, 2021, to June 14, 2022.Heavy rainfall was defined based on the extent to which annual rainfall deviated from the historical average (standardized precipitation index ≥1.5) at the enumeration area level.HIV, self-reported sexually transmitted infections (STIs), and number of sexual partners.The study included 288 333 participants aged 15 to 59 years; 172 344 were women (59.8%), and 183 378 were married (63.6%). Mean (SD) age was 31.9 (10.0) years. Overall, 42.4% of participants were exposed to at least 1 year of heavy rainfall in the past 10 years. Each year of heavy rainfall was associated with 1.14 (95% CI, 1.11-1.18) times the odds of HIV infection and 1.11 (95% CI, 1.07-1.15) times the odds of an STI in the past 12 months. There was also an association between heavy rainfall and the reported number of sexual partners (incident rate ratio, 1.12; 95% CI, 1.10-1.15). The odds were greater for the association between heavy rainfall and HIV prevalence and STIs among participants aged older than 20 years and participants in rural areas.The findings of this study suggest that heavy rainfall was associated with a higher HIV burden in sub-Saharan Africa. The association between heavy rainfall and STIs and number of sexual partners suggests that an increase in the risk of sexual transmission is a plausible mechanism for the observed findings around HIV prevalence. Heavy rainfall could also worsen food insecurity, increasing the risk of transactional sex, or cause damage to public health infrastructure, reducing access to STI education, HIV testing, and treatment.

Authors & Co-authors:  Nagata Jason M JM Hampshire Karly K Epstein Adrienne A Lin Feng F Zakaras Jennifer J Murnane Pamela P Charlebois Edwin D ED Tsai Alexander C AC Nash Denis D Weiser Sheri D SD

Study Outcome 

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Statistics
Citations :  Watts N, Amann M, Arnell N, et al. . The 2020 report of The Lancet Countdown on health and climate change: responding to converging crises. Lancet. 2021;397(10269):129-170. doi:10.1016/S0140-6736(20)32290-X
Authors :  10
Identifiers
Doi : e2230282
SSN : 2574-3805
Study Population
Women
Mesh Terms
Africa South of the Sahara
Other Terms
Study Design
Cross Sectional Study
Study Approach
Country of Study
Publication Country
United States