Ann Community Med Public Health | Volume 2, Issue 1 | Research Article | Open Access

First Community - Based HIV Prevalence Estimate in Zambezi, Namibia: A Pathfinder Study

Kimberly C Brouwer1 , Caitlin E O’Connell2,3*, Meghan D Morris4 , Melanie L Rusch5 , Ismelda Pietersen6 , Francina Tjituka6 , Rachel Chen7 , Margaret Jacobsohn8 and Timothy C Rodwell1,3

1University of California San Diego, San Diego, CA, USA 2 Harvard University Center for the Environment, Cambridge, MA, USA 3 Utopia Scientific, San Diego, CA, USA 4 University of California San Francisco, San Francisco, CA, USA 5 Population Health and Epidemiology, Vancouver Island Health Authority, British Columbia, Canada 6 Ministry of Health and Social Services, Windhoek, Namibia 7 Harvard University, Cambridge, MA, USA 8 Integrated Development & Nature Conservation of Namibia, Windhoek, Namibia

*Correspondance to: Caitlin E O’Connell 

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Background: While great strides have been made in combating HIV, the epidemic remains a formidable challenge in populations that are difficult to reach. As a rural area that has seen improvements in HIV prevention and treatment over the past decade, the Zambezi region of Namibia may serve as a helpful model for other remote regions around the world. Quantitative studies from the region are still scarce, however, and data is needed to characterize the epidemiology and track trends in this highly impacted area. Objectives: In 2012, we performed the first ever community-based HIV prevalence estimate in the Zambezi region. Method: We examined correlates of HIV infection and barriers to care among 203 adults from villages near and distant from the Trans-Zambezi highway. Participants underwent testing for HIV and interviewer-administered surveys eliciting information on demographics, HIV knowledge and attitudes, HIV risk behaviors, medical history, mobility, and health care access. Correlates of HIV infection were determined using univariate and multivariate logistic regression. Results: HIV prevalence was significantly higher in females (23% vs. 10%) and varied by age but not by village. Most participants (81%) reported difficulty obtaining condoms and 57% had never been tested for HIV previously - citing transportation and cost barriers. While a preponderance of participants (90%) understood main transmission routes of HIV, misconceptions and stigma were common. Among females, univariate associations with HIV infection included: Spouse/ partner mobility, substance use by friends, and concerns about Sexually Transmitted Infections (STIs) in their community. Among males, correlates included: Having symptoms of an STI, higher socioeconomic status, and concern about community substance use. Conclusion: While further research is warranted, our results suggest the potential for mobile healthcare strategies and preventive interventions targeting younger women. This study offers critical baseline data and a historical perspective of social correlates of HIV that may inform future intervention efforts in this region and similar remote settings.


Barriers to care; Epidemiology; HIV prevalence


Brouwer KC, O’Connell CE, Morris MD, Rusch ML, Pietersen I, Tjituka F, et al. First Community - Based HIV Prevalence Estimate in Zambezi, Namibia: A Pathfinder Study. Ann Community Med Public Health. 2022; 2(1): 1009..

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