Syphilis and other sexually transmitted infections (STIs) are highly prevalent in most regions experiencing severe human immunodeficiency virus (HIV) epidemics. In sub-Saharan Africa, the region most heavily affected by HIV, the prevalence of syphilis among people living with HIV (PLWH) is notably high. This region accounts for 40% of global STIs and 70% of HIV cases. Despite the high prevalence of syphilis and other STIs among PLWH in the region, there are limited studies on the interplay between the two infections from the region. Most studies on the association between syphilis and HIV transmission/progression from the region are limited to specific groups of people, such as female sex workers or pregnant women. In this manuscript, we evaluated the association between the two infections using population-based surveys conducted in the region. Statistical methods (such as logistic regression models and propensity score matching) were employed to assess the interplay between the two infections. Our findings indicated that syphilis infection was associated with higher odds of HIV acquisition. Moreover, co-infection with syphilis was associated with higher odds of HIV disease progression among antiretroviral therapy (ART)-treated PLWH, though the association did not reach statistical significance. Our findings suggest that the recognition and treatment of syphilis to reduce the risk of HIV acquisition/progression should be a public health priority in sub-Saharan Africa, where ART may not be readily available.

HIV remains a significant health issue, especially in sub-Saharan Africa. There are 39 million people living with HIV (PLWH) globally. Treatment with ART improves patient outcomes by suppressing the HIV RNA viral load. However, not all patients treated with ART suppress the HIV RNA viral load. This research paper explores the potential predictors of VL suppression in ART-treated PLWH. We used retrospective data from the 4820 ART-treated participants enrolled through population-based surveys conducted in Zambia and Malawi. We applied several machine learning (ML) classifiers and used the top classifiers to identify the predictors of VL suppression. The age of participants ranged from 15 to 64 years, with a majority being females. The predictive performance of the various ML classifiers ranged from 64% to 92%. In our data from both countries, the logistic classifier was among the top classifiers and was as follows: Malawi (AUC = 0.9255) and Zambia (AUC = 0.8095). Thus, logistic regression was used to identify the predictors of viral suppression. Our findings indicated that besides ART treatment status, older age, higher CD4 T-cell count, and longer duration of ART were identified as significant predictors of viral suppression. Though not statistically significant, ART initiation 12 months or more before the survey, urban residence, and wealth index were also associated with VL suppression. Our findings indicate that HIV prevention programs in the region should integrate education on early ART initiation and adherence in PLWH.

Sexual violence is a major public health concern, particularly in sub-Saharan Africa (SSA), where women living with HIV (WLWHs) experience substantial vulnerability. This study aimed to (1) estimate the weighted prevalence of reported lifetime sexual violence, (2) identify factors associated with sexual violence among WLWHs, and (3) understand its association with viral load (VL) suppression. We conducted a secondary analysis of cross-sectional data from Population-based HIV Impact Assessment (PHIA) surveys conducted between 2015 and 2019 in eleven SSA countries. Logistic regression models were used to identify factors associated with sexual violence and to assess its association with VL suppression. Our analysis included 9923 WLWHs, with a median age of 36 years. The weighted prevalence of reported lifetime sexual violence among the analytical population was 19.23% (n = 1515). Higher education (aOR = 1.32, 95% CI: 1.09–1.61), employment (aOR = 1.27, 95% CI: 1.04–1.56), and multiple sexual partners (aOR = 1.32, 95% CI: 1.14–1.52) were associated with higher odds of reported sexual violence. Sexual violence was not significantly associated with VL suppression in the adjusted analysis (aOR = 0.92, 95% CI: 0.67–1.27). Our findings highlight the burden of sexual violence among WLWHs and suggest that attention to sexual violence within HIV care may warrant consideration.

Most people living with HIV (PLWH) are co-infected with syphilis or other sexually transmitted infections (STIs) and experience frequent reactivations of syphilis. Thus, syphilis or other STIs are highly prevalent in most regions experiencing severe HIV epidemics. In sub-Saharan Africa, the region most heavily affected by HIV, the prevalence of syphilis among PLWH is approximately 7.3%. This region accounts for 40% of global STIs and 70% of HIV cases, highlighting the need for targeted research. Despite the high prevalence of syphilis among PLWH in the region, the impact of syphilis on HIV transmission and HIV disease progression has not been well-studied. In this manuscript, we evaluated if syphilis facilitates HIV acquisition and HIV disease progression in the region. We used retrospective data from 53,915 adult participants enrolled through Population-based HIV Impact Assessment (PHIA) surveys conducted in Zambia and Tanzania. Logistic regression models were used to assess the impact of syphilis on HIV acquisition and disease progression. Our findings indicated that syphilis infection was associated with higher odds of HIV acquisition. Moreover, co-infection with syphilis was associated with higher odds of HIV disease progression among PLWH treated with antiretroviral therapy (ART). Our findings suggested that the recognition, treatment, and prevention of syphilis to reduce the risk of HIV transmission and HIV disease progression should be a public health priority in sub-Saharan Africa, where ART may not be readily available.