The demographic and socioeconomic correlates of behavior and HIV infection status across sub-Saharan Africa

BACKGROUND: Predisposition to become HIV positive (HIV + ) is influenced by a wide range of correlated economic, environmental, demographic, social, and behavioral factors. While evidence among a candidate handful have strong evidence, there is lack of a consensus among the vast array of variables measured in large surveys. METHODS: We performed a comprehensive data-driven search for correlates of HIV positivity in >600,000 participants of the Demographic and Health Survey across 29 sub-Saharan African countries from 2003 to 2017. We associated a total of 7251 and of 6,288 unique variables with HIV positivity in females and males respectively in each of the 50 surveys. We performed a meta-analysis within countries to attain 29 country-specific associations. RESULTS: Here we identify 344 (5.4% out possible) and 373 (5.1%) associations with HIV + in males and females, respectively, with robust statistical support. The associations are consistent in directionality across countries and sexes. The association sizes among individual correlates and their predictive capability were low to modest, but comparable to established factors. Among the identified associations, variables identifying being head of household among females was identified in 17 countries with a mean odds ratio (OR) of 2.5 (OR range: 1.1–3.5, R(2) = 0.01). Other common associations were identified, including marital status, education, age, and ownership of land or livestock. CONCLUSIONS: Our continent-wide search for variables has identified under-recognized variables associated with being HIV + that are consistent across the continent and sex. Many of the association sizes are as high as established risk factors for HIV positivity, including male circumcision.