Association between severe drought and HIV prevention and care behaviors in Lesotho: A population-based survey 2016-2017

Background A previous analysis of the impact of drought in Africa on HIV demonstrated an 11% greater prevalence in HIV-endemic rural areas attributable to local rainfall shocks. The Lesotho Population-Based HIV Impact Assessment (LePHIA) was conducted after the severe drought of 2014–2016, allowing for reevaluation of this relationship in a setting of expanded antiretroviral coverage. Methods and findings LePHIA selected a nationally representative sample between November 2016 and May 2017. All adults aged 15–59 years in randomly selected households were invited to complete an interview and HIV testing, with one woman per household eligible to answer questions on their experience of sexual violence. Deviations in rainfall for May 2014–June 2016 were estimated using precipitation data from Climate Hazards Group InfraRed Precipitation with Station Data (CHIRPS), with drought defined as
Andrea Low and colleagues present findings from their study in which a link between drought and increased HIV incidence in young girls in Lesotho is observed.
Author summary Why was this study done? Periods of climate extremes have been shown to lead to increases in high-risk behaviors, particularly in agricultural communities dependent on rainfall for their livelihoods. Prior studies have linked these increases in riskier sexual behaviors, such as extramarital partnerships and transactional sex, to increases in HIV acquisition. The Lesotho Population-Based HIV Impact Assessment, a national HIV survey conducted from November 2016 to May 2017 following a 2-year severe drought in southern Africa, allowed us to reevaluate this relationship in the setting of expanded antiretroviral use. What did the researchers do and find? We paired geospatial data on accumulated rainfall from 2014 to 2016 with data from the survey to determine if there were any associations between drought and HIV outcomes. A total of 12,887 adults ages 15–59 years completed a detailed questionnaire, and 11,682 underwent an HIV test. Adolescent girls and young women ages 15–24 years in rural areas of drought had higher rates of high-risk behaviors, such as early sexual debut and transactional sex, and had lower educational attainment. Living in a drought area appeared to be associated with greater HIV prevalence in young females and was associated with a lower HIV prevalence in young males. However, external migration, commonly seen during these periods, was associated with a greater prevalence of HIV in men and women. What do these findings mean? Future policy on mitigation of climate change in southern Africa may consider including HIV prevention interventions in populations at high risk. This could include preexposure prophylaxis (PrEP) for migrants and young women in areas of severe food insecurity. Likewise, HIV programs that provide social and economic support to young women as part of an HIV prevention strategy should consider targeting areas affected by drought. Further studies should be done in other settings to investigate the external validity of these findings, particularly in terms of the impact on HIV in young women.