Who infects whom? XXXX concordance and discordance among migrant and non-migrant couples in South Africa.

@entity2858 @entity1 @entity645 @entity281
OBJECTIVES: To measure @entity2858 discordance among migrant and non-migrant @entity1 and their rural partners, and to estimate the relative risk of @entity281 from inside versus outside primary relationships. DESIGN: A cross-sectional behavioural and @entity2858 seroprevalence survey among 168 couples in which the male partner either a migrant, or not. METHODS: A detailed questionnaire was administered and blood was collected for laboratory analysis. A mathematical model was developed to estimate the relative risk of @entity281 from inside versus from outside regular relationships. RESULTS: A total of 70% (117 of 168) of couples were negatively concordant for @entity645 , 9% (16 of 168) were positively concordant and 21% (35 of 168) were discordant. Migrant couples were more likely than non-migrant couples to have one or both partners infected [35 versus 19%; P = 0.026; odds ratio (OR) = 2.28] and to be @entity2858 discordant (27 versus 15%; P = 0.066; OR = 2.06). In 71.4% of discordant couples, the male was the infected partner; this did not differ by migration status. In the mathematical model, migrant @entity1 were 26 times more likely to be infected from outside their regular relationships than from inside [relative risk (RR) = 26.3; P = 0.000]; non-migrant @entity1 were 10 times more likely to be infected from outside their regular relationships than inside (RR = 10.5; P = 0.00003). CONCLUSIONS: Migration continues to play an important role in the spread of @entity2858 in South Africa. The direction of spread of the epidemic is not only from returning migrant @entity1 to their rural partners, but also from @entity1 to their migrant partners. Prevention efforts will need to target both migrant @entity1 and @entity1 who remain at home.
