{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T00:16:59Z","timestamp":1790295419606,"version":"4.1.0"},"reference-count":17,"publisher":"BMJ","issue":"4","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Sex Transm Infect"],"accepted":{"date-parts":[[2025,8,13]]},"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Previous analyses from South Africa have found that the ecological association between the prevalence of HIV and syphilis switched from positive to negative in the wake of the HIV pandemic. This was attributed to the impact of HIV mortality on sexual network connectivity. We conducted an ecological analysis of HIV prevalence and syphilis seropositivity among all districts in South Africa in 2010 and 2022.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We used Spearman\u2019s correlation to compare the weighted prevalence of HIV and syphilis per district using South Africa\u2019s 2022 Antenatal HIV Sentinel Survey. We calculated the change in the weighted syphilis and HIV prevalence per district between 2010 and 2022.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The district-level antenatal prevalence of HIV in 2022 was positively correlated with the prevalence of syphilis (Rho=0.42; p=0.0018). A comparison of the same scatter plot from 2010 revealed that the six districts with the highest HIV prevalence in 2010 had large increases in syphilis prevalence from 2010 (median 0.1%, IQR 0.0%\u20130.4%) to 2022 (median 5.2%, IQR 4.2\u20135.8%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The positive association between HIV and syphilis prevalence is compatible with an increase in sexual network connectivity in the districts with the largest increases in syphilis prevalence.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/sextrans-2025-056650","type":"journal-article","created":{"date-parts":[[2025,9,1]],"date-time":"2025-09-01T07:55:19Z","timestamp":1756713319000},"page":"248-250","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Prevalence of antenatal syphilis remains positively associated with HIV in South African districts"],"prefix":"10.1136","volume":"102","author":[{"given":"Tendesayi","family":"Kufa","sequence":"first","affiliation":[{"name":"National Institute for Communicable Diseases, Johannesburg, South Africa"},{"name":"University of the Witwatersrand, Johannesburg-Braamfontein, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nosipho","family":"Shangase","sequence":"additional","affiliation":[{"name":"National Institute for Communicable Diseases, Johannesburg, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrian","family":"Puren","sequence":"additional","affiliation":[{"name":"National Institute for Communicable Diseases, Johannesburg, South Africa"},{"name":"University of the Witwatersrand, Johannesburg, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2557-8998","authenticated-orcid":false,"given":"Chris","family":"Kenyon","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences, Institute of Tropical Medicine Antwerp, Antwerp, Belgium"},{"name":"Department of Medicine, University of Cape Town, Rondebosch, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,8,31]]},"reference":[{"key":"2026051905450665000_102.4.248.1","doi-asserted-by":"crossref","first-page":"682","DOI":"10.1186\/s12879-017-2794-x","article-title":"Strong associations between national prevalence of various STIs suggests sexual network connectivity is a common underpinning risk factor","volume":"17","author":"Kenyon","year":"2017","journal-title":"BMC Infect Dis"},{"key":"2026051905450665000_102.4.248.2","doi-asserted-by":"crossref","first-page":"1880","DOI":"10.12688\/f1000research.17148.1","article-title":"It\u2019s the network, stupid: a population\u2019s sexual network connectivity determines its STI prevalence","volume":"7","author":"Kenyon","year":"2018","journal-title":"F1000Res"},{"key":"2026051905450665000_102.4.248.3","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1097\/OLQ.0000000000000422","article-title":"The Prevalence of Syphilis from the Early HIV Period is Correlated With Peak HIV Prevalence at a Country Level","volume":"43","author":"Osbak","year":"2016","journal-title":"Sex Transm Dis"},{"key":"2026051905450665000_102.4.248.4","doi-asserted-by":"publisher","DOI":"10.1097\/00007435-200305000-00008"},{"key":"2026051905450665000_102.4.248.5","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1016\/j.ijid.2014.05.014","article-title":"What underpins the decline in syphilis in Southern and Eastern Africa? An exploratory ecological analysis","volume":"29","author":"Kenyon","year":"2014","journal-title":"Int J Infect Dis"},{"key":"2026051905450665000_102.4.248.6","doi-asserted-by":"publisher","DOI":"10.1177\/0956462414546392"},{"key":"2026051905450665000_102.4.248.7","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0b013e31815e4062"},{"key":"2026051905450665000_102.4.248.8","unstructured":"Kufa-Chakezha T , Shangase N , Lombard C , et al . The 2022 antenatal survey: key findings. NICD Johannesburg; 2023."},{"key":"2026051905450665000_102.4.248.9","unstructured":"Microbiology Expert Committee . Syphilis serology requesting and auto-review memo. National Health Laboratory Services; 2022."},{"key":"2026051905450665000_102.4.248.10","unstructured":"National Department of Health . The national antenatal sentinel HIV and syphilis prevalence survey, South Africa. 2011."},{"key":"2026051905450665000_102.4.248.11","unstructured":"Ramlagan S , the SVTeam . The sixth south african national HIV prevalence, incidence, behaviour and communication survey: 20 years of strategic HIV and public health data. HSRC; 2023."},{"key":"2026051905450665000_102.4.248.12","doi-asserted-by":"crossref","DOI":"10.1136\/bmjph-2023-000674","article-title":"HIV prevalence and associated factors among adolescent boys and young men in South Africa: 2017 nationally representative household-based population survey","volume":"2","author":"Makusha","year":"2024","journal-title":"BMJ Public Health"},{"key":"2026051905450665000_102.4.248.13","unstructured":"Morris M , Goodreau S , Moody J . Sexual networks, concurrency and STD\/HIV. In: Holmes KK , ed. Sexually transmitted diseases. New York: McGraw-Hill Medical, 2008.:2166."},{"key":"2026051905450665000_102.4.248.14","unstructured":"Organization WH . Global health sector strategies on, respectively, hiv, viral hepatitis and sexually transmitted infections for the period 2022-2030. World Health Organization; 2022."},{"key":"2026051905450665000_102.4.248.15","doi-asserted-by":"crossref","DOI":"10.1186\/s12879-020-05302-1","article-title":"Risky sexual behaviours among women of reproductive age in a high HIV burdened township in KwaZulu-Natal, South Africa","volume":"20","author":"Hlongwa","year":"2020","journal-title":"BMC Infect Dis"},{"key":"2026051905450665000_102.4.248.16","doi-asserted-by":"crossref","DOI":"10.1038\/s41598-017-16382-6","article-title":"Higher risk sexual behaviour is associated with unawareness of HIV-positivity and lack of viral suppression - implications for Treatment as Prevention","volume":"7","author":"Huerga","year":"2017","journal-title":"Sci Rep"},{"key":"2026051905450665000_102.4.248.17","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1177\/21582440211040114","article-title":"Intersections Between Masculinities and Sexual Behaviors Among Young Men at the University of KwaZulu-Natal, South Africa","volume":"11","author":"Khumalo","year":"2021","journal-title":"Sage Open"}],"container-title":["Sexually Transmitted Infections"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/sextrans-2025-056650","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T12:45:24Z","timestamp":1779194724000},"score":1,"resource":{"primary":{"URL":"https:\/\/sti.bmj.com\/lookup\/doi\/10.1136\/sextrans-2025-056650"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,31]]},"references-count":17,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,5,19]]},"published-print":{"date-parts":[[2026,6]]}},"alternative-id":["10.1136\/sextrans-2025-056650"],"URL":"https:\/\/doi.org\/10.1136\/sextrans-2025-056650","relation":{},"ISSN":["1368-4973","1472-3263"],"issn-type":[{"value":"1368-4973","type":"print"},{"value":"1472-3263","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,31]]}}}