What question did this study set out to answer?

This research aims to assess if HIV prevalence trends in pregnant women are representative of trends in the overall female population in sub-Saharan Africa.

May 25, 2026Open Access

Recent HIV prevalence trends among pregnant women and all women in sub-Saharan Africa: implications for HIV estimates

Key Points

This research aims to assess if HIV prevalence trends in pregnant women are representative of trends in the overall female population in sub-Saharan Africa.
Conducted serial population-based surveys in 13 countries in sub-Saharan Africa between 2003-2012.
Calculated and compared HIV prevalence trends among women aged 15-49 years, focusing on pregnant women versus all women.
Utilized log-binomial regression to analyze differences in trends between the two groups.
HIV prevalence among pregnant women declined from 6.5% to 5.3% between 2003-2008 and 2009-2012, respectively.
Prevalence among all women remained relatively unchanged at 8.4% in period 1 and 8.3% in period 2.
Significant decline (18%) in prevalence among pregnant women compared to nonpregnant women, with changes in age-specific trends noted.

Abstract

National population-wide HIV prevalence and incidence trends in sub-Saharan Africa (SSA) are indirectly estimated using HIV prevalence measured among pregnant women attending antenatal clinics (ANC), among other data. We evaluated whether recent HIV prevalence trends among pregnant women are representative of general population trends. Serial population-based household surveys in 13 SSA countries. We calculated HIV prevalence trends among all women aged 15-49 years and currently pregnant women between surveys conducted from 2003 to 2008 (period 1) and 2009 to 2012 (period 2). Log-binomial regression was used to test for a difference in prevalence trend between the two groups. Prevalence among pregnant women was age-standardized to represent the age distribution of all women. Pooling data for all countries, HIV prevalence declined among pregnant women from 6.5 95% confidence interval (CI) 5.3-7.9% to 5.3% between periods 1 and 2, whereas it remained unchanged among all women at 8.4% (95% CI 8.0-8.9%) in period 1 and 8.3% (95% CI 7.9-8.8%) in period 2. Prevalence declined by 18% more in pregnant women than nonpregnant women. Estimates were similar in Western, Eastern, and Southern regions of SSA; none were statistically significant (P>0.05). HIV prevalence decreased significantly among women aged 15-24 years while increasing significantly among women 35-49 years, who represented 29% of women but only 15% of pregnant women. Age-standardization of prevalence in pregnant women did not reconcile the discrepant trends because at older ages prevalence was lower among pregnant women than nonpregnant women. As HIV prevalence in SSA has shifted toward older, less-fertile women, HIV prevalence among pregnant women has declined more rapidly than prevalence in women overall. Interpretation of ANC prevalence data to inform national HIV estimates should account for both age-specific fertility patterns and HIV-related sub-fertility.

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