Pathways to HIV Infection and Pregnancy: Differences in Predictive Factors among Young People in Rural Kwazulu/Natal, South Africa

Abigail Harrison, Brown University
John G. Cleland, London School of Hygiene and Tropical Medicine
Eleanor Gouws, UNAIDS
Janet Frohlich, University of Natal at Durban

The pathways to HIV infection and pregnancy may be very different, although both result from unprotected sexual activity. What are these differences, and how are they reflected in factors associated with the two outcomes? In this study from rural South Africa, data were collected in a household survey that included 820 women aged 15-24. In multivariate analysis, older age (OR=4.16), not being in school (OR=2.88), early sexual debut (OR=4.87), living with neither parent (R=1.69), and non-participation in community groups (OR=1.96) were significantly associated with having ever been pregnant. Women from poorer households were more likely to be HIV infected (OR=2.27), as were younger women (OR=2.01) and those not in school (OR=3.14), although this association was attenuated after controlling for sexual risk factors. These findings suggest divergent pathways to infection and pregnancy, and raise questions about the relative contribution of partner choice versus unprotected sex to each outcome.