Trends in HIV prevalence and incidence sex ratios in ALPHA demographic surveillance sites, 1990-2010

Antiretroviral Therapy (ART) has two well-described beneficial effects. First, it drastically prolongs the life expectancy of those receiving treatment, and second, it reduces HIV transmission to uninfected partners. The expansion of ART programs is thus expected to elevate HIV prevalence rates and reduce HIV incidence at the same time. These expectations are largely confirmed in a pooled dataset of five African demographic surveillance sites with HIV status information. Further, we find that the F/M sex ratio of prevalent infections increases over time and that suggests that ART coverage is better among women than men. This is corroborated by an increasing F/M sex ratio of incidence, suggesting that although the pool of HIV infected women is increased, less are infectious compared to the pool of HIV positive men. Our results thus indicate that higher ART coverage rates benefit HIV positive women (more than men) in term of increased survival, but benefit HIV negative men (more than women) because of a greater reduction in new infections.