%0 Journal Article
%@ 1932-6203
%A Baisley, K
%A Chimbindi, N
%A Mthiyane, N
%A Floyd, S
%A McGrath, N
%A Pillay, D
%A Seeley, J
%A Zuma, T
%A Dreyer, J
%A Gareta, D
%A Smit, T
%A Mutevedzi, T
%A Fenty, J
%A Herbst, K
%A Birdthistle, I
%A Shahmanesh, M
%D 2018
%F discovery:10065030
%J PLoS One
%N 12
%T High HIV incidence and low uptake of HIV prevention services: The context of risk for young male adults prior to DREAMS in rural KwaZulu-Natal, South Africa
%U https://discovery-pp.ucl.ac.uk/id/eprint/10065030/
%V 13
%X BACKGROUND: Young men are less likely than young women to engage with HIV prevention and care, and their HIV-related mortality is higher. We describe HIV incidence and uptake of HIV services in men 20-29 years(y) in rural KwaZulu-Natal, South Africa, before the roll-out of DREAMS. METHODS: We used data from a population-based demographic and HIV surveillance cohort. HIV incidence was estimated from anonymised testing in an annual serosurvey. Service uptake was assessed in 2011 and 2015, through two self-reported outcomes: 1) HIV testing in the past 12 months(m); 2) voluntary medical male circumcision(VMMC). Logistic regression was used to estimate odds ratios(OR) and 95% confidence intervals(CI) for factors associated with each outcome. RESULTS: HIV incidence in 2011-2015 was 2.6/100 person-years (95%CI = 2.0-3.4) and 4.2 (95%CI = 3.1-5.6) among men 20-24y and 25-29y, respectively, with no significant change from 2006-2010. N = 1311 and N = 1221 young men participated in the 2011 and 2015 surveys, respectively. In both years, <50% reported testing for HIV in the past 12m. In 2011, only 5% reported VMMC, but coverage in 2015 increased to 40% and 20% in men 20-24y and 25-29y, respectively. HIV testing was positively associated with higher education and mobility. Testing uptake was higher in men reporting >1 partner in the past 12m, or condom use at last sex, but lower in those reporting a casual partner (adjusted (a)OR = 0.53, 95%CI = 0.37-0.75). VMMC uptake was associated with survey year and higher education. Men aged 25-29y and those who were employed (aOR = 0.66; 95%CI = 0.49-0.89) were less likely to report VMMC. CONCLUSIONS: HIV incidence in men 20-29y was very high, and pre-exposure prophylaxis (PrEP) should be considered in this population. Uptake of services was low. VMMC coverage increased dramatically from 2011 to 2015, especially among younger men, suggesting a demand for this service. Interventions designed with and for young men are urgently needed.
%Z © 2018 Baisley et al. This is an open  access article distributed under the terms of the  Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which  permits unrestricted use, distribution, and  reproduction in any medium, provided the original  author and source are credited.