Background: Despite increased antiretroviral therapy (ART) coverage, the incidence of HIV infection among women\nin rural South Africa remains high. While many socio-demographic and behavioral factors have been identified, the\neffect of female migration intensity on the risk of HIV acquisition before and after ART scale-up has not been\nevaluated in the country.\nMethods: We followed 13,315 female participants aged 15-49 who were HIV-uninfected at baseline and recorded\ntheir migration events between 2004 and 2015. Using a Cox proportional hazard model, we estimated the time to\nHIV acquisition among the women, adjusting for annual migration intensity (high: Less than equal to 2 events/year, moderate = 1\nevent/year, and low = 0 event/year) before and after ART scale-up in 2010.\nResults: 1998 (15%) new HIV-infection events were recorded during the observation period. Overall, high migration\nintensity was associated with an increased HIV acquisition risk among women when compared with low migration\nintensity (HR = 2.88, 95% CI: 1.56-5.53). Among those with high migration intensity, the risk of HIV acquisition was\nsignificantly lower in the post-ART period compared to the pre-ART period, after controlling for key sociodemographic\nand behavioural covariates (aHR = 0.18, 95% CI 0.04-0.83).\nConclusions: Women who migrated frequently after ART scale-up had a significantly reduced HIV acquisition risk\ncompared to those before its implementation. While this reduction is encouraging, women who migrate frequently\nremain at high risk of HIV acquisition. In the era of ART, there remains a critical need for public health interventions\nto reduce the risk of HIV acquisition in this highly vulnerable population.
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