Simela Sethunya R, Kelepile Matlhogonolo, Sebobi Thabo I
Department of Environmental Science, Faculty of Science, University of Botswana, Gaborone, Botswana.
Department of Geography, Binghamton University, New York, USA.
BMC Infect Dis. 2025 Jan 16;25(1):69. doi: 10.1186/s12879-025-10464-x.
The global burden of HIV and AIDS continues to significantly impact public health, particularly in Sub-Saharan Africa. This study investigates the spatial distribution and associated risk factors of HIV prevalence in Botswana using data from the 2021 Botswana AIDS Impact Survey (BAIS V).
The analysis included 12,653 adults aged 15-64 years and employed chi-square tests, multilevel mixed-effects regression, and spatial analysis techniques. HIV prevalence estimates were visualized through choropleth maps, and spatial autocorrelation was analyzed using Anselin Local Moran's I in ArcGIS 10.8.2 software.
Findings revealed that 18% (ARR 95% CI: 0.15-0.23) of the surveyed population were people living with HIV (PLWH), with females disproportionately affected (66.8%). Females were 1.63 times more likely to be living with HIV compared to males (ARR 1.63, 95% CI: 1.52-1.76), and individuals aged 35-44 years (ARR 10.59 95% CI 8.96-12.52) were at the highest risk compared to the 15-24 year group. Lower education levels, rural residency, marital status (single), age (middle to late adulthood 35-54 years) and females were identified as key determinants of HIV infection. Spatial analysis showed Central Mahalapye as the district with the highest HIV prevalence rate (33.7%). Further, a high HIV prevalence cluster was found in the northeastern region of Botswana, while urban districts like Gaborone had significantly lower rates (11.2%).
These findings emphasize the role of socio-demographic and spatial factors in shaping HIV risk. Intensified targeted interventions, particularly for females, individuals with lower education, and rural populations, are recommended to reduce HIV transmission and mitigate the epidemic's impact in Botswana.
艾滋病毒和艾滋病的全球负担继续对公共卫生产生重大影响，特别是在撒哈拉以南非洲。本研究利用2021年博茨瓦纳艾滋病影响调查（BAIS V）的数据，调查了博茨瓦纳艾滋病毒流行率的空间分布及相关风险因素。
分析纳入了12653名15至64岁的成年人，并采用卡方检验、多水平混合效应回归和空间分析技术。通过分级统计图直观呈现艾滋病毒流行率估计值，并使用ArcGIS 10.8.2软件中的安塞尔林局部莫兰指数分析空间自相关。
研究结果显示，18%（调整风险比95%置信区间：0.15 - 0.23）的受调查人群为艾滋病毒感染者（PLWH），女性受影响比例过高（66.8%）。与男性相比，女性感染艾滋病毒的可能性高1.63倍（调整风险比1.63，95%置信区间：1.52 - 1.76），与15至24岁年龄组相比，35至44岁的个体风险最高（调整风险比10.59，95%置信区间8.96 - 12.52）。较低的教育水平、农村居住情况、婚姻状况（单身）、年龄（成年中期至晚期35至54岁）以及女性被确定为艾滋病毒感染的关键决定因素。空间分析显示，马哈拉皮耶中部是艾滋病毒流行率最高的地区（33.7%）。此外，在博茨瓦纳东北部地区发现了一个艾滋病毒高流行率聚集区，而像哈博罗内这样的城市地区流行率则显著较低（11.2%）。
这些发现强调了社会人口学和空间因素在塑造艾滋病毒风险方面的作用。建议加强有针对性的干预措施，特别是针对女性、教育程度较低者和农村人口，以减少艾滋病毒传播并减轻该流行病在博茨瓦纳的影响。
