There are several reasons why the shift in the rural/urban nature of HIV in the DRC may have taken place. The focus of many HIV prevention and treatment programs is in urban areas, given their historically higher HIV prevalence. PEPFAR, for instance, concentrates its efforts in Kinshasa, Lubumbashi and Kisangani, cities of over 1 million people. Indeed, the 2013 prevalence of HIV in urban women in the DRC was nearly double that of rural women, though it Tirapazamine had decreased since 2007 while rural women\'s HIV had increased. Changes in the economy and connectivity of the DRC between 2007 and 2013 may also play a role: the road network of the DRC has increased dramatically to facilitate logging and other natural resource extraction. A decline in civil war and violence in the eastern portion of the country may also lead individuals to have higher mobility than they otherwise would, exposing them to greater HIV risk.
Whatever the driving force, it seems that the DRC may now be experiencing the diffusion of HIV outwards from cities into rural areas that has previously been observed in other sub-Saharan countries and globally. Women in the DRC have higher HIV rates than men regardless of rural/urban residence, wealth, education and age. Our findings suggest that HIV prevention programs need to expand their reach into rural areas of the DRC in order to maintain the low levels of HIV prevalence that currently occur there. The large size of the country and the relative inaccessibility of many rural regions makes this difficult, but the expanding nature of economically important transportation networks into previously isolated areas means that patterns of HIV will change as well.
Whatever the driving force, it seems that the DRC may now be experiencing the diffusion of HIV outwards from cities into rural areas that has previously been observed in other sub-Saharan countries and globally. Women in the DRC have higher HIV rates than men regardless of rural/urban residence, wealth, education and age. Our findings suggest that HIV prevention programs need to expand their reach into rural areas of the DRC in order to maintain the low levels of HIV prevalence that currently occur there. The large size of the country and the relative inaccessibility of many rural regions makes this difficult, but the expanding nature of economically important transportation networks into previously isolated areas means that patterns of HIV will change as well.