A previous study found there is an 11% greater prevalence of HIV in HIV-endemic rural areas during local rainfall shocks. Following a severe drought in Lesotho in 2014–2016, the authors were interested in whether this had an impact on HIV prevalence. They selected a nationally representative sample between 2016-2017; all adults aged 15–59 years in randomly selected households were invited to complete an interview and HIV testing, and one woman per household was eligible to answer questions on their experience of sexual violence. The authors estimated deviations in rainfall for 2014–2016 using precipitation data, with drought defined as <15% average rainfall 1981–2016. They found that all of Lesotho suffered from reduced rainfall, with regions receiving 1%–36% of their historical rainfall. Of 12,887 interviewed participants, 93.5% lived in the areas that experienced drought, with the majority in rural areas (7281 vs. 4771 in urban areas). Of the 835 adults living in areas without drought, 520 were in rural areas and 315 in urban. Among females aged 15–19 years, living in a rural drought area was associated with early sexual debut (odds ratio [OR] 3.11, 95%CI 1.43–6.74) and higher HIV prevalence (OR 2.77, 95%CI 1.19–6.47). It was also associated with lower educational attainment in rural females aged 15–24 years (OR 0.44, 95%CI 0.25–0.78). Multivariate analyses adjusting for household wealth and sexual behaviour also found that experiencing drought may increase the odds of HIV infection among females aged 15–24 years (adjusted OR [aOR] 1.80, 95%CI 0.96–3.39), but this did not reach significance. Migration was associated with twofold higher odds of HIV infection in young people (aOR 2.06, 95%CI 1.25–3.40). Therefore drought in Lesotho is associated with higher HIV prevalence in girls aged 15–19 years in rural areas and with lower educational attainment, and riskier sexual behaviour in rural females aged 15–24 years.
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