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Migration, hotspots, and dispersal of HIV infection in Rakai, Uganda

Author

Listed:
  • Mary Kate Grabowski

    (Johns Hopkins School of Medicine
    Johns Hopkins Bloomberg School of Public Health
    Rakai Health Sciences Program)

  • Justin Lessler

    (Johns Hopkins Bloomberg School of Public Health)

  • Jeremiah Bazaale

    (Rakai Health Sciences Program)

  • Dorean Nabukalu

    (Rakai Health Sciences Program)

  • Justine Nankinga

    (Rakai Health Sciences Program)

  • Betty Nantume

    (Rakai Health Sciences Program)

  • Joseph Ssekasanvu

    (Johns Hopkins Bloomberg School of Public Health)

  • Steven J. Reynolds

    (Rakai Health Sciences Program
    National Institutes of Health
    Johns Hopkins School of Medicine)

  • Robert Ssekubugu

    (Rakai Health Sciences Program)

  • Fred Nalugoda

    (Rakai Health Sciences Program)

  • Godfrey Kigozi

    (Rakai Health Sciences Program)

  • Joseph Kagaayi

    (Rakai Health Sciences Program)

  • John S. Santelli

    (Columbia University)

  • Caitlin Kennedy

    (Johns Hopkins Bloomberg School of Public Health)

  • Maria J. Wawer

    (Johns Hopkins Bloomberg School of Public Health
    Rakai Health Sciences Program)

  • David Serwadda

    (Rakai Health Sciences Program
    Makerere University School of Public Health)

  • Larry W. Chang

    (Johns Hopkins Bloomberg School of Public Health
    Rakai Health Sciences Program
    Johns Hopkins School of Medicine
    Johns Hopkins Bloomberg School of Public Health)

  • Ronald H. Gray

    (Johns Hopkins Bloomberg School of Public Health
    Rakai Health Sciences Program)

Abstract

HIV prevalence varies markedly throughout Africa, and it is often presumed areas of higher HIV prevalence (i.e., hotspots) serve as sources of infection to neighboring areas of lower prevalence. However, the small-scale geography of migration networks and movement of HIV-positive individuals between communities is poorly understood. Here, we use population-based data from ~22,000 persons of known HIV status to characterize migratory patterns and their relationship to HIV among 38 communities in Rakai, Uganda with HIV prevalence ranging from 9 to 43%. We find that migrants moving into hotspots had significantly higher HIV prevalence than migrants moving elsewhere, but out-migration from hotspots was geographically dispersed, contributing minimally to HIV burden in destination locations. Our results challenge the assumption that high prevalence hotspots are drivers of transmission in regional epidemics, instead suggesting that migrants with high HIV prevalence, particularly women, selectively migrate to these areas.

Suggested Citation

  • Mary Kate Grabowski & Justin Lessler & Jeremiah Bazaale & Dorean Nabukalu & Justine Nankinga & Betty Nantume & Joseph Ssekasanvu & Steven J. Reynolds & Robert Ssekubugu & Fred Nalugoda & Godfrey Kigoz, 2020. "Migration, hotspots, and dispersal of HIV infection in Rakai, Uganda," Nature Communications, Nature, vol. 11(1), pages 1-12, December.
    • Handle: RePEc:nat:natcom:v:11:y:2020:i:1:d:10.1038_s41467-020-14636-y
    DOI: 10.1038/s41467-020-14636-y
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    Cited by:

    1. Bell, Griffin J. & Ncayiyana, Jabulani & Sholomon, Ari & Goel, Varun & Zuma, Khangelani & Emch, Michael, 2022. "Race, place, and HIV: The legacies of apartheid and racist policy in South Africa," Social Science & Medicine, Elsevier, vol. 296(C).

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