OBJECTIVE : To assess the prevalence of HIV risk behaviour among sexually active HIV sero-negative
individuals in the Tshwane district of South Africa (SA). METHODS : Demographic and HIV risk behaviour data were collected on a questionnaire from participants
of a cross-sectional study that screened for early HIV infection using pooled nucleic
acid amplification testing (NAAT). The study enrolled individuals who tested negative on
rapid HIV tests performed at five HIV counseling and testing (HCT) clinics, which included
four antenatal clinics and one general HCT clinic. RESULTS : The study enrolled 9547 predominantly black participants (96.6%) with a median age of 27
years (interquartile range [IQR]: 23±31). There were 1661 non-pregnant and 7886 pregnant
participants largely enrolled from the general and antenatal HCT clinics, respectively. NAAT
detected HIV infection in 61 participants (0.6%; 95% confidence interval [CI]: 0.4±0.8) in the
whole study. A high proportion of study participants, 62.8% and 63.0%, were unaware of
their partner's HIV status; and also had high prevalence, 88.5% and 99.5%, of recent unprotected
sex in the general and pregnant population, respectively. Consistent use of condoms
was associated with protection against HIV infection in the general population. Trends of higher odds for HIV infection were observed with most demographic and HIV risk factors at
univariate analysis, however, multivariate analysis did not show statistical significance for
almost all these factors. A significantly lower risk of HIV infection was observed in circumcised
men (p <0.001). CONCLUSIONS : These data show that a large segment of sexually active people in the Tshwane district of
SA have high risk exposure to HIV. The detection of newly diagnosed HIV infections in all
study clinics reflects a wide distribution of individuals who are capable of sustaining HIV
transmission in the setting where HIV risk behaviour is highly prevalent. A questionnaire that
captures HIV risk behaviour would be useful during HIV counselling and testing to ensure
that there is a systematic way of identifying HIV risk factors and that counselling is optimised
for each individual. HIV risk behaviour surveillance could be used to inform relevant HIV prevention
interventions that could be implemented at a community or population level.
S1 Fig. Questionnaire. A questionnaire tool that was used to collect demographic and HIV
risk factors from the study participants. Codes (in red) were used to capture questionnaire
data into the Excel spreadsheet. N/AÐnot applicable was used for participants who had no
recent sexually transmitted diseases (number 12) and this also applied for parameters on number
18 and 19. Questionnaire parameters (numbers 5, 6, 8, 15 and 18) that were not applicable
to the whole general or pregnant population group were not included in the group's analysis
but some of them were analysed separately.
S2 Fig. Validation questionnaire. A questionnaire tool that was used to collect data for validation.
This data was collected at a follow up visit.
S1 Table. Validation questionnaire data obtained at a different time point.
S2 Table. Some behavioural and biologic characteristics of participants with newly diagnosed