Social determinants of HIV infection, hotspot areas and subpopulation groups in Ethiopia: evidence from the National Demographic and Health Survey

Correspondence to Yihunie Lakew; [email protected] ABSTRACT Objective: This study identifies social determinants of HIV infection, hotspot areas and subpopulation groups in Ethiopia. Design: The study used data from the 2011 Ethiopian Demographic and Health Survey (EDHS). Sample blood tests from the finger pricks collected on filter paper cards were labelled with a barcode unique to each respondent. Spatial scan statistics and geographic information system tools were used to map hotspot areas of HIV prevalence. Bivariate and multivariable logistic regression models were used to identify social determinants of HIV infection. Population: A total of 30 625 adults (16 515 women and 14 110 men) were included from 11 administrative states of Ethiopia. Main outcome measures: Laboratory-confirmed HIV serostatus is the main outcome variable. Results: HIV prevalence reached 10–21% in the central, eastern and western geographic clusters of Ethiopia. Multivariable analysis showed that individuals who were in the middle, richer and richest wealth quintiles had increased odds of having HIV over those in the poorest quintile. Adults who had primary, secondary and higher educational levels had higher odds of being HIV positive than non-educated individuals. The odds of having HIV were higher among adults who had multiple lifetime sexual partners than those with a single partner. An increasing odds of HIV infection were observed among adults in the age groups of 25–29, 30–34, 35–39 and 40–45 years compared with adults in the age group of 45–49 years. Merchants had higher odds of being HIV positive than those who were not employed. The odds of having HIV were higher among urban residents and females than among rural residents and males, respectively. Conclusions: This study found statistically significant HIV concentrations in administrative zones of central, eastern and western Ethiopia. Geospatial monitoring and targeting of prevention strategies for specific population groups is recommended. INTRODUCTION HIV/AIDS has been documented as one of the major public health challenges in the world. Globally, there were approximately 35.0 million people living with HIV at the end of 2013 with 2.1 million people newly infected. The sub-Saharan region of Africa is the most affected in the world with 24.7 million people living with HIV in 2013. This region accounts for almost 70% of the global total of new HIV infections despite of having only a 13% share of the world’s population. Ethiopia is one of the sub-Sahara African countries shared the burden of HIV epidemics. There were totally 759 268 people living with HIV and 80 000 HIV-infected children in Ethiopia in the year 2012. The national HIV prevalence among adults in Ethiopia has declined from 4.5% between 1998 and 1999 to 1.5% in 2011, which is an encouraging achievement for the country. Strengths and limitations of this study