Clusters of HIV risk and protective sexual behaviors in Agincourt, Rural South Africa; Findings from the Ha Nakekela population-based study of ages 15 and older

Understanding how sexual behaviors cluster in distinct population subgroups along the life course is critical for effective targeting and tailoring of HIV prevention messaging and intervention activities. We examined interrelatedness of sexual behaviors and variation between men and women across a wide age range in a rural South African setting with a high HIV burden. Data come from the Ha Nakekela population-based survey of people aged 15-85-plus drawn from the Agincourt Health and Socio-Demographic Surveillance System. We used latent class analysis of six sexual behavior indicators to identify distinct subgroup sexual behavior clusters. We then examined associations between class membership and sociodemographic and other behavioral risk factors and assessed the accuracy of a reduced set of sexual behavior indicators to classify individuals into latent classes. We identified three sexual behavior classes: (1) single with consistent protective behaviors; (2) risky behaviors; and (3) in union with lack of protective behaviors. Patterns of sexual behaviors varied by gender. Class membership was also associated with age, HIV status, nationality, and alcohol use. With only two sexual behavior indicators (union status and multiple sexual partners), individuals were accurately assigned to their most likely predicted class. There were distinct multidimensional sexual behavior clusters in population subgroups that varied by sex, age, and HIV status. In this population, only two brief questions were needed to classify individuals into risk classes. Replication in other situations is needed to confirm these findings.We are grateful for funding support from: the US National Institute on Aging—R01 AG049634 HIV after 40 in rural South Africa: Aging in the Context of an HIV Epidemic (PI Sanyu Mojola); the National Institutes of Health—R24 AG032112-05 Partnership for Social Science AIDS Research in South Africa’s Era of ART Rollout (PI Jane Menken); the University of Colorado, Innovative Seed Grant HIV after 40 in rural South Africa (PI Sanyu Mojola); the Eunice Kennedy Shriver National Institute of Child Health and Human Development—K01 HD057246 (PI Samuel Clark); and the William and Flora Hewlett Foundation 2009-4060 African Population Research and Training Program (PI Jane Menken). The MRC/Wits Rural Public Health and Health Transitions Research Unit and Agincourt Health and Socio-Demographic Surveillance System, a node of the South African Population Research Infrastructure Network (SAPRIN), is supported by the Department of Science and Innovation, the University of the Witwatersrand, and the Medical Research Council, South Africa, and previously the Wellcome Trust, UK (Grants 058893/Z/99/A; 069683/Z/02/Z; 085477/Z/08/Z; 085477/B/08/Z). This work has also benefted from research, administrative, and computing support from the Eunice Kennedy Shriver National Institute of Child Health and Human Development–funded University of Colorado Population Center (R24HD066613, P2C HD066613)