Estimating HIV Prevalence and HIV-Related Risk Behaviors Among Heterosexual Women Who Have Multiple Sex Partners Using Respondent-Driven Sampling in a High-Risk Community in South Africa

BACKGROUND: Repeated surveillance surveys are important for monitoring trends in HIV and risk behaviors over time. In countries most adversely affected by HIV and AIDS, community-level HIV biological and behavioral surveillance surveys are needed among subpopulations who engage in high-risk sexual behaviors. PURPOSE: To describe the effectiveness of respondent-driven sampling (RDS) to recruit heterosexual women who have multiple concurrent sexual partnerships, to report HIV prevalence and describe key characteristics among them, and to assess whether RDS-accessed women not usually recruited during routine sentinel surveillance surveys. METHODS: We conducted a HIV biological and behavioral surveillance surveys using RDS among women. Participants completed an audio-computer-assisted survey interview, voluntarily provided dried blood spots for HIV testing, and were offered rapid HIV testing. RESULTS: The analytical sample comprised 845 women whose mean age was 23.9 years. About 6.4% were married, 49.6% lived in informal dwellings, and 31.8% reported not to have enough money for food. HIV prevalence was 28.8% (95% confidence intervals: 24.3 to 33.4). Being between 20 and 29 years was significantly related to HIV infection. Women who had never attended a public health facility (10.1%) compared with those who had were more likely to be 16-19 years (P = 0.008), reported sexual debut at 10-14 years (P = 0.044), were more likely to have experienced a symptom of a sexually transmitted infection (P = 0.031), and to have taken illegal drugs (P = 0.007). CONCLUSIONS: RDS effectively recruited women who reported 2 or more male sexual partners in the past 3 months. HIV prevalence and HIV-related risk behaviors were high among women who have multiple concurrent partners.