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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.
HIV prevalence varies throughout Africa, but the contribution of migration remains unclear. Using population-based data from ~22,000 persons, Grabowski et al. show that HIV-positive migrants selectively migrate to high prevalence areas and that out-migrants from these areas geographically disperse.
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1 Johns Hopkins School of Medicine, Department of Pathology, Baltimore, USA (GRID:grid.21107.35) (ISNI:0000 0001 2171 9311); Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, USA (GRID:grid.21107.35) (ISNI:0000 0001 2171 9311); Rakai Health Sciences Program, Kalisizo, Uganda (GRID:grid.452655.5)
2 Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, USA (GRID:grid.21107.35) (ISNI:0000 0001 2171 9311)
3 Rakai Health Sciences Program, Kalisizo, Uganda (GRID:grid.452655.5)
4 Rakai Health Sciences Program, Kalisizo, Uganda (GRID:grid.452655.5); National Institutes of Health, Laboratory of Immunoregulation, Division of Intramural Research, National Institute for Allergy and Infectious Diseases, Bethesda, USA (GRID:grid.94365.3d) (ISNI:0000 0001 2297 5165); Johns Hopkins School of Medicine, Division of Infectious Diseases, Department of Medicine, Baltimore, USA (GRID:grid.21107.35) (ISNI:0000 0001 2171 9311)
5 Columbia University, Heilbrunn Department of Population and Family Health, New York, USA (GRID:grid.21729.3f) (ISNI:0000000419368729)
6 Johns Hopkins Bloomberg School of Public Health, Department of International Health, Baltimore, USA (GRID:grid.21107.35) (ISNI:0000 0001 2171 9311)
7 Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, USA (GRID:grid.21107.35) (ISNI:0000 0001 2171 9311); Rakai Health Sciences Program, Kalisizo, Uganda (GRID:grid.452655.5)
8 Rakai Health Sciences Program, Kalisizo, Uganda (GRID:grid.452655.5); Makerere University School of Public Health, Kampala, Uganda (GRID:grid.11194.3c) (ISNI:0000 0004 0620 0548)
9 Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, USA (GRID:grid.21107.35) (ISNI:0000 0001 2171 9311); Rakai Health Sciences Program, Kalisizo, Uganda (GRID:grid.452655.5); Johns Hopkins School of Medicine, Division of Infectious Diseases, Department of Medicine, Baltimore, USA (GRID:grid.21107.35) (ISNI:0000 0001 2171 9311); Johns Hopkins Bloomberg School of Public Health, Department of International Health, Baltimore, USA (GRID:grid.21107.35) (ISNI:0000 0001 2171 9311)