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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

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Abstract

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 https://dhsprogram.com. CHIRPS precipitation data are publicly available at https://chc.ucsb.edu/data/chirps.

Code Availability

Code is available upon request.

References

  1. Costello A, Abbas M, Allen A, Ball S, Bell S, Bellamy R, et al. Managing the health effects of climate change. Lancet and University College London Institute for Global Health Commission. Lancet. 2009;373:1693–733.

    Article  PubMed  Google Scholar 

  2. Feria-Arroyo TP, Castro-Arellano I, Gordillo-Perez G, Cavazos AL, Vargas-Sandoval M, Grover A, et al. Implications of climate change on the distribution of the tick vector Ixodes scapularis and risk for Lyme disease in the Texas-Mexico transboundary region. Parasites and Vectors. 2014;7:1–16.

    Article  Google Scholar 

  3. Erickson RA, Hayhoe K, Presley SM, Allen LJS, Long KR, Cox SB. Potential impacts of climate change on the ecology of dengue and its mosquito vector the Asian tiger mosquito (Aedes albopictus). Environ Res Lett. 2012;7:034003.

    Article  Google Scholar 

  4. Epstein A, Benmarhnia T, Weiser SD. Drought and illness among young children in Uganda, 2009–2012. Am J Trop Med Hyg. 2020;102:644–8.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Tong DQ, Wang JXL, Gill TE, Lei H, Wang B. Intensified dust storm activity and Valley fever infection in the southwestern United States. Geophys Res Lett. 2017;44:4304–12.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Burke M, Gong E, Jones K. Income Shocks and HIV in Africa. Econ J. 2015;125:1157–89.

    Article  Google Scholar 

  7. Armstrong A, Nagata JM, Vicari M, Irvine C, Cluver L, Sohn AH, et al. A Global Research Agenda for Adolescents Living With HIV. J Acquir Immune Defic Syndr. 2018;78(Suppl 1):16–21.

    Article  Google Scholar 

  8. Low AJ, Frederix K, McCracken S, Manyau S, Gummerson E, Radin E, et al. Association between severe drought and HIV prevention and care behaviors in Lesotho: A population-based survey 2016–2017. PLoS Med 2019; 16. doi:https://doi.org/10.1371/journal.pmed.1002727.

  9. Sawyer SM, Azzopardi PS, Wickremarathne D, Patton GC. The age of adolescence. Lancet Child Adolesc Heal. 2018;2:223–8.

    Article  Google Scholar 

  10. Hlongwa M, Mashamba-Thompson T, Makhunga S, Hlongwana K. Barriers to HIV testing uptake among men in sub-Saharan Africa: a sco** review. Afr J AIDS Res. 2020;19:13–23.

    Article  PubMed  Google Scholar 

  11. Camlin CS, Ssemmondo E, Chamie G, El Ayadi AM, Kwarisiima D, Sang N, et al. Men “missing” from population-based HIV testing: insights from qualitative research. AIDS Care - Psychol Socio-Medical Asp AIDS/HIV. 2016;28:67–73.

    Article  Google Scholar 

  12. Wheeler T, Von Braun J. Climate change impacts on global food security. Sci (80- ). 2013;341:508–13.

    Article  CAS  Google Scholar 

  13. Stain HJ, Kelly B, Lewin TJ, Higginbotham N, Beard JR, Hourihan F. Social networks and mental health among a farming population. Soc Psychiatry Psychiatr Epidemiol. 2008;43:843–9.

    Article  PubMed  Google Scholar 

  14. Staniford AK, Dollard MF, Guerin B. Stress and help-seeking for drought-stricken citrus growers in the Riverland of South Australia. Aust J Rural Health. 2009;17:147–54.

    Article  PubMed  Google Scholar 

  15. Carnie TL, Berry HL, Blinkhorn SA, Hart CR. In their own words: Young people’s mental health in drought-affected rural and remote NSW. Aust J Rural Health. 2011;19:244–8.

    Article  PubMed  Google Scholar 

  16. Epstein A, Bendavid E, Nash D, Charlebois ED, Weiser SD. Drought and intimate partner violence towards women in 19 countries in sub-saharan Africa during 2011–2018: A population-based study. PLoS Med 2020; 17. doi:https://doi.org/10.1371/JOURNAL.PMED.1003064.

  17. ICF International. Demographic and Health Survey Sampling and Household Listing Manual. 2012.https://dhsprogram.com/pubs/pdf/DHSM4/DHS6_Sampling_Manual_Sept2012_DHSM4.pdf (accessed 19 Apr2021).

  18. UNAIDS. Seizing the moment: Tackling entrenched inequalities to end epidemics. Geneva: ; 2020.

  19. UNAIDS. UNAIDS Report on the Global AIDS Epidemic. Geneva: World Health Organization; 2010. https://www.unaids.org/globalreport/Global_report.htm.

    Google Scholar 

  20. Funk C, Peterson P, Landsfeld M, Pedreros D, Verdin J, Shukla S, et al. The climate hazards infrared precipitation with stations - A new environmental record for monitoring extremes. Sci Data 2015; 2. doi:https://doi.org/10.1038/sdata.2015.66.

  21. Stalter R, Chen M, Uwizeye G, Mutunge E, Ahayo A, Mugwaneza P, et al. Association of sexual risk behaviour with previous HIV testing among voluntary HIV counselling and testing clients in Kigali, Rwanda. Int J STD AIDS. 2016;27:1317–25.

    Article  PubMed  Google Scholar 

  22. George G, Beckett S, Cawood C, Khanyile D, Govender K, Kharsany ABM. Impact of HIV testing and treatment services on risky sexual behaviour in the uMgungundlovu District, KwaZulu-Natal, South Africa: A cross-sectional study. AIDS Res Ther 2019; 16. doi:https://doi.org/10.1186/s12981-019-0237-z.

  23. Rutstein SO, Johnson K. The DHS wealth index. DHS Comp. Reports No. 6. 2004.http://dhsprogram.com/pubs/pdf/CR6/CR6.pdf (accessed 25 May2021).

  24. Norton EC, Miller MM, Kleinman LC. Computing Adjusted Risk Ratios and Risk Differences in Stata. Stata J Promot Commun Stat Stata. 2013;13:492–509.

    Article  Google Scholar 

  25. StataCorp. Stata Statistical Software: Release 14. 2015.

  26. R Core Team. R: A language and environment for statistical computing. 2017.http://www.r-project.org/.

  27. Food and Agriculture Organization. The impact of disasters on agriculture and food security: FAO in Emergencies. Rome, Italy: ; 2015.

  28. Smirnov O, Zhang M, **ao T, Orbell J, Lobben A, Gordon J. The relative importance of climate change and population growth for exposure to future extreme droughts. Clim Change. 2016;138:41–53.

    Article  CAS  Google Scholar 

  29. Chikwari CD, Dringus S, Ferrand RA. Barriers to, and emerging strategies for, HIV testing among adolescents in sub-Saharan Africa. Curr Opin HIV AIDS. 2018;13:257–64.

    Article  PubMed  Google Scholar 

  30. Awopegba OE, Kalu A, Ahinkorah BO, Seidu AA, Ajayi AI. Prenatal care coverage and correlates of HIV testing in sub-Saharan Africa: Insight from demographic and health surveys of 16 countries. PLoS ONE 2020; 15. doi:https://doi.org/10.1371/journal.pone.0242001.

  31. Weiser SD, Tsai AC, Gupta R, Frongillo EA, Kawuma A, Senkungu J, et al. Food insecurity is associated with morbidity and patterns of healthcare utilization among HIV-infected individuals in a resource-poor setting. AIDS. 2012;26:67–75.

    Article  PubMed  Google Scholar 

  32. Young S, Wheeler AC, McCoy SI, Weiser SD. A Review of the Role of Food Insecurity in Adherence to Care and Treatment Among Adult and Pediatric Populations Living with HIV and AIDS. AIDS Behav. 2014;18:505–15.

    Article  PubMed Central  Google Scholar 

  33. Leddy AM, Roque A, Sheira LA, Frongillo EA, Landay AL, Adedimeji AA, et al. Food Insecurity Is Associated With Inflammation Among Women Living With HIV. J Infect Dis. 2019;219:429–36.

    Article  PubMed  Google Scholar 

  34. Weiser SD, Yuan C, Guzman D, Frongillo EA, Riley ED, Bangsberg DR, et al. Food insecurity and HIV clinical outcomes in a longitudinal study of urban homeless and marginally housed HIV-infected individuals. AIDS. 2013;27:2953–8.

    Article  PubMed  Google Scholar 

  35. Weiser SD, Palar K, Frongillo EA, Tsai AC, Kumbakumba E, dePee S, et al. Longitudinal assessment of associations between food insecurity, antiretroviral adherence and HIV treatment outcomes in rural Uganda. AIDS. 2014;28:115–20.

    Article  CAS  PubMed  Google Scholar 

  36. Kalichman SC, Cherry C, Amaral C, White D, Kalichman MO, Pope H, et al. Health and Treatment Implications of Food Insufficiency among People Living with HIV/AIDS, Atlanta, Georgia. J Urban Heal Bull New York Acad Med; 87. doi:https://doi.org/10.1007/s11524-010-9446-4.

  37. Weiser SD, Fernandes KA, Brandson EK, Lima VD, Anema A, Bangsberg DR, et al. The association between food insecurity and mortality among HIV-infected individuals on HAART. J Acquir Immune Defic Syndr. 2009;52:342–9.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Wutich A, Brewis A, Tsai A. Water and mental health. WIREs Water. 2020;7:e1461.

    Article  Google Scholar 

  39. Tsai AC, Tomlinson M, Comulada WS, Rotheram-Borus MJ. Food insufficiency, depression, and the modifying role of social support: Evidence from a population-based, prospective cohort of pregnant women in peri-urban South Africa. Soc Sci Med. 2016;151:69–77.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Peltz A, Garg A. Food insecurity and health care use. Pediatrics 2019; 144. doi:https://doi.org/10.1542/peds.2019-0347.

  41. Melo A, Matias MA, Dias SS, Gregório MJ, Rodrigues AM, De Sousa RD, et al. Is food insecurity related to health-care use, access and absenteeism? Public Health Nutr. 2019;22:3211–9.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Thomas MMC, Miller DP, Morrissey TW. Food insecurity and child health. Pediatrics 2019; 144. doi:https://doi.org/10.1542/peds.2019-0397.

  43. Mahmood A, Kim H, Kabir U, Kedia S, Ray M. Food Insecurity and Influenza and Pneumonia Vaccines Uptake Among Community-Dwelling Older Adults in the United States. J Community Health. 2020;45:943–53.

    Article  PubMed  Google Scholar 

  44. Lankowski AJ, Siedner MJ, Bangsberg DR, Tsai AC. Impact of geographic and transportation-related barriers on HIV outcomes in sub-saharan Africa: A systematic review. AIDS Behav. 2014;18:1199–223.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Stanke C, Kerac M, Prudhomme C, Medlock J, Murray V. Health effects of drought: a systematic review of the evidence. PLoS Curr 2013; 5. doi:https://doi.org/10.1371/currents.dis.7a2cee9e980f91ad7697b570bcc4b004.

  46. Kloos H. Health aspects of resettlement in Ethiopia. Soc Sci Med. 1990;30:643–56.

    Article  CAS  PubMed  Google Scholar 

  47. Lindvall K, Kinsman J, Abraha A, Dalmar A, Abdullahi MF, Godefay H, et al. Health status and health care needs of drought-related migrants in the horn of africa—a qualitative investigation. Int J Environ Res Public Health. 2020;17:1–18.

    Article  Google Scholar 

  48. Finlay SE, Moffat A, Gazzard R, Baker D, Murray V. Health impacts of wildfires. PLoS Curr 2012; 4. doi:https://doi.org/10.1371/4f959951cce2c.

  49. Mechtenberg A, McLaughlin B, DiGaetano M, Awodele A, Omeeboh L, Etwalu E, et al. Health care during electricity failure: The hidden costs. PLoS ONE. 2020;15:e0235760.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Funding

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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Authors and Affiliations

  1. Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States

    Adrienne Epstein

  2. Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, UK

    Adrienne Epstein

  3. Department of Pediatrics, University of California, San Francisco, San Francisco, CA, United States

    Jason M. Nagata

  4. Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada

    Kyle T. Ganson

  5. Institute for Implementation Science in Population Health, City University of New York (CUNY), New York City, NY, United States

    Denis Nash

  6. Department of Medicine, University of California, San Francisco, San Francisco, CA, United States

    Parya Saberi, Edwin D. Charlebois & Sheri D. Weiser

  7. Division of Global Psychiatry, Massachusetts General Hospital, Boston, MA, USA

    Alexander C. Tsai

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  1. Adrienne Epstein
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Contributions

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). https://doi.org/10.1007/s10461-022-03820-4

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