High HIV prevalence in a southern semi-rural area of Mozambique: a community-based survey

Background Southern African countries have borne the brunt of the HIV/AIDS pandemic. Monitoring epidemiological dynamics is critical to identify the populations at greatest risk of infection and to guide control strategies. Methods A cross-sectional community-based study to determine age- and sex-specific HIV prevalence among individuals aged 1847 years was carried out in Manhica, southern Mozambique. Participants were randomly selected from the demographic surveillance system in place in the area and voluntary HIV counselling and testing were offered at home. In addition, HIV prevalence estimates from the antenatal clinic (ANC) were collected prospectively. Results A total of 839 individuals were invited to participate in the study. Of these, 722 were recruited (50.7% women). The overall HIV prevalence in the community was 39.9% [95% confidence interval (CI) 35.9-43.8%]. By age, the prevalence was 23.2% (95% CI 17.9-28.6%) in individuals aged 18-27 years, 41.2% (95% CI 35.6-48.3%) in those aged 28-37 years and 44.8% (95% CI 38.4-51.2%) in those aged 38-47 years. HIV prevalence was higher among women than men in all age groups. The overall HIV prevalence estimate for women in the community (43.1%; 95% CI 37.6-48.5%) was 1.4 times higher than that for those attending the ANC (29.4%; 95% CI 26.7-32.0%). Conclusions The high HIV prevalence found in this region suggests that the epidemic is in a mature stable phase. The lower rates in the ANC than in the community suggest that ANC evaluations may underestimate community HIV prevalence. Resources to monitor HIV infection dynamics are needed to guide targeted control strategies in countries in which the epidemic exacts the greatest toll.