Migration, hotspots, and dispersal of HIV infection in Rakai, Uganda

Mary Kate Grabowski, Justin Lessler, Jeremiah Bazaale, Dorean Nabukalu, Justine Nankinga, Betty Nantume, Joseph Ssekasanvu, Steven J. Reynolds, Robert Ssekubugu, Fred Nalugoda, Godfrey Kigozi, Joseph Kagaayi, John S. Santelli, Caitlin Kennedy, Maria J. Wawer, David Serwadda, Larry W. Chang, Ronald H. Gray

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


HIV prevalence varies markedly throughout Africa, and it is often presumed areas of higher HIV prevalence (i.e., hotspots) serve as sources of infection to neighboring areas of lower prevalence. However, the small-scale geography of migration networks and movement of HIV-positive individuals between communities is poorly understood. Here, we use population-based data from ~22,000 persons of known HIV status to characterize migratory patterns and their relationship to HIV among 38 communities in Rakai, Uganda with HIV prevalence ranging from 9 to 43%. We find that migrants moving into hotspots had significantly higher HIV prevalence than migrants moving elsewhere, but out-migration from hotspots was geographically dispersed, contributing minimally to HIV burden in destination locations. Our results challenge the assumption that high prevalence hotspots are drivers of transmission in regional epidemics, instead suggesting that migrants with high HIV prevalence, particularly women, selectively migrate to these areas.

Original languageEnglish (US)
Article number976
JournalNature communications
Issue number1
StatePublished - Dec 1 2020

ASJC Scopus subject areas

  • General Physics and Astronomy
  • General Chemistry
  • General Biochemistry, Genetics and Molecular Biology


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