Research Article

The Prevalence of HIV by Ethnic Group Is Correlated with HSV-2 and Syphilis Prevalence in Kenya, South Africa, the United Kingdom, and the United States

Table 1

Description of sources of data for prevalence of STIs, multiple partners, concurrency, and circumcision.

Year in which data were collected, referenceStudy type, selection procedure, sample size, response rate, and testing protocol for syphilis

South Africa
HIV2005 [12]A two-stage, nationally representative sample of 23,275 persons 2 years old or older. We limited our analysis to the 13,884 individuals aged 15 to 49 years old. The survey had an overall response rate of 80.7%
HSV-22012 [43]A sample of 18,732, 15–49-year-old women attending antenatal clinics for the first time in four provinces (Western Cape, Northern Cape, Gauteng, and Kwazulu Natal) were tested for HSV-2. Response rate not reported
Syphilis1991 [14]A sample of 17,318, 15–49-year-old women attending antenatal clinics for their first visit were tested for syphilis via the Rapid Plasma Reagin or the Venereal Diseases Research Laboratory test. Response rate not reported. The unadjusted prevalence estimates were used
Urethral discharge 1998 [44]South Africa’s first Demographic and Health Survey employed a 2-stage sampling strategy in South Africa’s nine provinces and stratified results into urban and nonurban groups. It was designed to be representative of all provinces and the four major racial groups. 6,578 men were asked if they had experienced symptoms of a urethral discharge in the last 3 months. The overall response rate for men was 89.7%. Men were not asked questions about their sexual behavior in this survey
Concurrency, multiple partners,
and circumcision
2003 [45]The 2003 Demographic Health Survey (DHS) used a similar study design to the 1998 DHS. The survey sampled 7,966 women and 3,930 men. All were 15–49 years old [45]. The overall response rate for men was 67.8%

USA
HIV2006 [46]HIV prevalence at the end of 2006 was estimated using information from the national HIV/AIDS reporting system
HSV-21988–94 [15]In NHANES III, a national stratified probability sample of 13,094 individuals over the age of 12 were tested for HSV-2. These persons comprised 60.5% of all respondents in NHANES III
2005–09 [23]During NHANES 2005–2008, a total of 8,283 persons aged 14–49 years were interviewed. Of these, 7,293 participants (88% of those interviewed) were tested for HSV-2 antibodies
Syphilis1976–80 [13]In NHANES II a national stratified probability sample of 12,989 individuals over the age of 12 were tested for syphilis. 92% of those who were examined provided blood for syphilis testing. The initial test was with an RPR and confirmation with a microhemagglutination assay for Treponema pallidum (MHA-TP) or the fluorescent treponemal antibody absorption test (FTA-ABS)
2001–2004 [47]Sera from 5,767, 18- to 49-year-old participants in the NHANES 2001–2004, were tested for syphilis IgG antibody using an enzyme immunoassay (EIA). Specimens with positive or indeterminate EIAs underwent rapid plasma
reagin (RPR) testing
Concurrency and multiple partners 1992 [48]The USA sexual behaviour data and gonorrhoea incidence data were taken from the 1992 National Health and Social Life Survey (NHSLS). This was a cross-sectional study that used a nationally representative stratified random sample of 3,432 women and men between the ages of 18 and 59. The overall response rate was 78.6%
Circumcision1999–2004 [49]As part of National Health and Nutrition Examination Surveys from 1999 to 2004, 6,174 men were interviewed about circumcision status. The response rate was 86%

Kenya
HIV, MUDS, and circumcision2008 [20] The 2008 Kenya Demographic and Health Survey used a household-based, two-stage stratified sampling approach to recruit 12,677 participants. The overall household response rate was 97.7%
HSV-2 and syphilis2007 [22]The 2007 Kenya AIDS Indicator Survey used a stratified two-stage sampling strategy to test a nationally and provincially representative sample of 15,853, 15–64-year olds. Syphilis was screened for via a Treponema pallidum particle agglutination assay (TPPA)
(Serodia-TPPA, Fujirebio Diagnostics Inc.). All TPPA positive specimens were tested using the rapid plasma regain (RPR) (Macro-Vue RPR Card Test, BD, USA) on undiluted serum. Only those positive on both TPPA and RPR were classified as syphilis
Concurrency and multiple partners2011 [50] The Population Services International (PSI) Survey/Kenya 6th HIV Survey conducted in 2011 used a two-stage cluster sampling to obtain a provincially representative sample of households from seven of Kenya’s eight provinces (the North East was excluded). A total of 3,051 men and women, 15–49 years old, were included. Response rate not reported

United Kingdom
HIV and MUDS2010–2012 [51]National Surveys of Sexual Attitudes and Lifestyles 3 recruited a probability sample of 15,162 women and men aged 16–74 years in Britain. Participants were interviewed with computer-assisted face-to-face and self-completion questionnaires. Urine from a sample of participants aged 16–44 years who reported at least one sexual partner over the lifetime was tested for HIV antibodies
Concurrency, multiple partners, STI, and circumcision 2000 [24, 52]The second British National Survey of Sexual Attitudes and Lifestyles (NATSAL 2) was a nationally representative sample of 11,161 men and women aged 16–44 years [52]. We extracted the relevant variables from a study which broke down the various sexual behavior variables by ethnic group and sex [52]. Men were asked if they had ever been diagnosed with an STI

DHS: Demographic and Health Survey, NATSAL: National Survey of Sexual Attitudes and Lifestyles, NHANES: National Health and Nutrition Examination Surveys.