Aging and Frailty; the case of HIV-positive and HIV-negative individuals in Ghana: A case-control study

Aging and Frailty; the case of HIV-positive and HIV-negative individuals in Ghana: A case-control study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Aging and Frailty; the case of HIV-positive and HIV-negative individuals in Ghana: A case-control study Paul Ntiamoah, Max Efui Ananni-Akollor, Magaret T. Frempong, Mohammed Mutocheluh, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4643949/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Physical frailty remains an important health challenge associated with aging. HIV infection may influence the development of physical frailty. This may lead to persons living with HIV experiencing adverse health outcomes that result from physical frailty at earlier ages as compared to persons who are HIV-negative. There is inadequate knowledge of frailty among Ghanaians especially in persons living with HIV. This study sought to investigate the prevalence and factors associated with frailty among elderly persons (older adults) with or without HIV infection in Ghana. Methodology : This case-control study was conducted from January 2020 to December 2020. A total of 181 elderly persons were recruited for this study. Sociodemographic and lifestyle data were obtained with a structured questionnaire. Blood samples were obtained to determine the HIV status of individuals whose HIV status was unknown for exclusion purposes. Frailty was assessed by the Frailty Phenotype Tool. Statistical values with p < 0.05 were considered statistically significant. Results Out of the 181 participants, 42.5% (n = 77) were known HIV-positive individuals on antiretroviral therapy whereas 57.5% of participants in this study were HIV-negative. While the overall prevalence of frailty was 15.5% (n = 28), the prevalence of frailty among HIV-negative adults was 12.5% (n = 13) and that recorded among HIV-positive elderly persons was 19.5% (n = 15). Occupation ( p = 0.020), age ( p = 0.049), smoking status ( p = 0.029 ) , and not having multiple sex partners ( p = 0.031) were associated with frailty among HIV-negative older adults. Conclusion : Frailty is more common among elderly persons with HIV infection than those without HIV infection, with nearly 2 out of 10 elderly HIV-infected persons being frail. No significant association was observed between frailty status and sociodemographics and lifestyle characteristics among the HIV-positive participants. We conclude that frailty is common among Ghanaian older adults and it is a bigger problem in elderly persons living with HIV infection. Frailty elderly older adults older adults with HIV Figures Figure 1 Figure 2 Figure 3 INTRODUCTION The world’s population is aging ( 1 ), with the percentage of elderly persons (individuals who are 60 years and above) increasing globally ( 2 ). By 2030, a quarter of Asia's population is expected to be over 60 years old, while about 25% of the developed world's population will be over 65 years old ( 2 ). The population of the elderly in Ghana increased more than sevenfold between 1960 and 2010 ( 3 ). Although, Sub-Saharan countries have the youngest populations( 3 ), in 2022, 3.6% of the Ghanaian population was over 65 years old, indicating an increase in the elderly population from 3.5% in 2021 ( 4 ). The number of persons living with HIV aged 50 years and above is on the rise. Globally, 4.2 million persons aged 50 years and older were living with HIV in 2013 ( 5 ). In sub-Saharan Africa, which accounts for 60% of all persons living with HIV worldwide, 14.3% of the adult population living with HIV is aged over 60 years( 1 , 6 ). In Ghana, as of March 20, 2023, the Ghana AIDS Commission reported a total of 346,120 people living with HIV infection ( 7 ). HIV-positive older adults have been observed to be more prone to developing dementia, diabetes, osteoporosis, frailty, and some cancers ( 8 ). Similarly, aging has been associated with the development of diseases like cancer, cardiovascular disease, neurodegenerative diseases, liver disease, loss of bone density, and an increased risk of fractures, as well as other conditions including frailty, irrespective of the HIV status ( 9 ). Owing to the success of antiretroviral therapy, the lifespan of people living with HIV has increased considerably, coupled with the incidence of the disease ( 10 ). Clinicians attending to such patients are therefore concerned about the increasing trend of frailty ( 11 ). Frailty is marked by a decline in function across multiple physiological systems, as well as an increased susceptibility to stressors ( 12 , 13 ). Frailty develops with increasing age and is associated with a high risk of multiple undesirable health outcomes, including hospitalization, falls, institutionalization, and death ( 12 – 14 ). Well-functioning neuro-immuno-endocrine system, healthy diet, and regular physical exercise impact positively biological ageing. Nevertheless, in frail older people, low-grade inflammation, excessive and uncontrolled oxidative stress, and immunosenescence make anti-aging mechanisms less effective ( 13 ). There are several causes and contributors to frailty. Increased levels of free radicals, mitochondrial dysfunction, and cytokines may activate inflammatory pathways, eventually resulting in frailty ( 15 ). Similarly, various microorganisms, including HIV, can cause chronic infection regardless of the immune response to clear them. As a result, the immune system remains activated. Prolonged immune activation and persistently high levels of pro-inflammatory cytokines can cause damage throughout the body ( 16 ). Frailty is more common in HIV-positive young people than in HIV-negative young people. Elderly persons living with HIV have been described to be more frail than those without HIV infection ( 17 ) in some parts of the world. Moreover, the prevalence of frailty among people aged 65 years and above has been reported to range from 4.0–17.0% ( 18 ). The prevalence of frailty has been reported to be higher among individuals in hospital settings ranging from 18% to 40 ( 13 , 19 ). In Ghana, there is a paucity of data regarding frailty among adults aged 60 years and above irrespective of their HIV status. Therefore, this study evaluated the prevalence and factors associated with frailty among adults (60 years and above) with or without HIV in infection Ghana. Methods Study design and study population A case-control study design was adopted to recruit potential participants among persons who visited the out-patients department (OPD) and antiretroviral therapy clinics of St. Elizabeth Hospital, Hwidiem, and Holy Family Hospital, Techiman in the Ahafo and Bono-East Regions of Ghana respectively. Written informed consent was sought from individuals who approached the study team after hearing the announcement about the study at the OPD and antiretroviral therapy clinics to participate in the study. Individuals who were eligible according to our inclusion criteria were enrolled as participants in this study. As the world’s population ages, the population of elderly HIV-infected individuals has also increased due to the availability of effective highly active anti-retroviral therapy as well as new infections in persons 60 years and above (1). Aging comes with many health challenges which are further aggravated by HIV infection (20, 21). A deeper understanding of the negative outcomes of aging including frailty will help improve the quality of life of the elderly. Hence this study recruited HIV-infected persons (60 years and above) who were on antiretroviral therapy as well as HIV-negative individuals (60 years and above) as subjects of the study. Study Site The study was conducted at Holy Family Hospital, Techiman, and St. Elizabeth Catholic Hospital, Hwidiem. Techiman Municipality is located in the central part of the Bono-East Region and lies between latitudes 80 00' north and 70 35' south and between longitudes 10 49' east and 20 30' west. The Municipality had a population of 243,335 according to the 2021 population and housing census (22). With three main vegetation zones including a semi-deciduous zone in the south, Guinea-Savanna woodland in the north-west and a Transitional zone covering from the south-east and west to the north, the Techiman Municipality has both tropical conventional and semi-equatorial or savannah climates(23). Techiman is a town with high commercial activities. Holy Family Hospital is a secondary-level facility that offers a wide range of preventive and curative healthcare services including many specialist services. Hwidiem is a town situated in the Asutifi-South District. The Asutifi-South District is located in the western part of the Ahafo Region of Ghana and lies between latitudes 6°40' and 7°15' North and longitudes 2°15' and 2°45' West. According to the 2021 population and housing census by the Ghana Statistical Service, Asutifi-South District has a population of 68,394 (22). The Asutifi-South District is situated within the wet semi-equatorial zone with double maxima rainfall and it is predominantly covered by semi-deciduous forest(24). There are mining activities in the Asutifi-South District. St. Elizabeth Catholic Hospital, Hwidiem is a secondary-level facility that offers a wide range of preventive and curative healthcare services including many specialist services. The nature of these towns grants us the opportunity to encounter both elderly and younger persons with different lifestyles and life experiences that reflect the nature of Ghanaian society. Areas with high commercial activities and mining towns are associated with behaviors such as commercial sex activities, multiple sexual partners, drug abuse, and other practices that may expose a person to HIV infections. There is a well-resourced district hospital in each of these towns. Hence the selection of Hwidiem and Techiman as sites for the present study. Inclusion criteria Participants who were HIV-negative upon screening for the presence of HIV infection and aged 60 years and above were included in the study. For HIV- positive participants, we included only confirmed HIV-positive persons who were on antiretroviral therapy and aged 60 years and above. Exclusion Criteria Individuals who were wheelchair-bound or physically handicapped were excluded from the study as their physical status may affect negatively the measurement of physical frailty. Persons who were below 60 years old were also excluded from the study since persons of this age are generally considered to be physically strong. Sample size With a 95% confidence level and 80% power, using a 6.6% elderly population in Ghana (25) and a 2.7% prevalence of HIV in the Brong-Ahafo Region of Ghana (26) a minimum sample size of 95 elderly persons and 40 HIV-positive persons was required for the study. However, a total of 181 participants, 104 HIV-negative participants (≥ 60 years) and 77 HIV-infected persons (≥ 60 years) were enrolled in the study, to improve statistical power. Sampling and Research Techniques A standardized questionnaire was administered to collect demographic information and information on possible contributory factors of accelerated aging from each participant. The degree of physical frailty was determined using validated clinical criteria (Fried’s Frailty Phenoty) adapted from the Sasaguri Genkimon study (27). This was based on the assessment of unintentional shrinking, slowness, weakness, physical activity, and endurance levels among participants. Participants were grouped into non-frail, pre-frail, and frail. A venous blood sample was collected from each participant into EDTA tubes. Participants whose HIV status was unknown were screened for HIV-1/2 antibodies based on the Ghana National AIDS/STI Control Program’s Protocols using HIV-1/2 first response kits, Oraquick test kits, and SD-Bioline test kits for antibody detection. Ethical Approval The Committee on Human Research, Publications and Ethics, School of Medical Sciences, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana approved the protocol for the study with reference no: CHRPE/AP/626/19. The Management Teams as well as the Research Teams of St. Elizabeth Hospital, Hwidiem, and Holy Family Hospital, Techiman also approved the protocol for the study. Assessment of frailty Fried’s Frailty phenotype tool adapted from the Sasaguri Genkimon Study (27) was used to assess frailty among participants of this study. The frailty phenotype has five components and each component is given a score of one (1). Individuals who scored zero (0) out of the five (5) measured criteria were identified as non-frail, those who had a score of one (1) or two (2) were classified as pre-frail and those with a score of three (3) or more were classified as frail. The definition of the operational frailty phenotype in this study is listed below; Operational definition of frailty phenotype in this study Component Definition Unintentional shrinking Body Mass Index of <18.5 kg/m2 Slowness A six (6) meter fast gait speed using the average of two (gender-specific cutoff: a median height). The criteria for classifying a participant as slow is as follows: HIV-negative elderly Male time: > 8.0s for height 8.0s for height ≥ 165.0cm. Female Time: > 8.0s for height 7.0s for height ≥ 155.0 cm HIV-positive elderly Male time: > 8.9s for height 8.0s for height ≥ 170.0cm. Female Time: > 7.6s for height 10.1s for height ≥ 160.0 cm Exhaustion A positive answer to one of two self-reported questions. In the last month, “Did you feel tired without any reason” and “Did you have the feeling that everything you did was an effort?” Weakness Grip strength outside a cut-off as validated with the equipment according to gender and age. Cut off for classifying frailty according to dynamometer reading (Kg) Age (years) Gender Male Female 60-64 <30.2 <17.2 65-69 <28.2 <15.4 70-99 <21.3 <14.7 Physical activities Individuals with energy expended in kilo calories as recorded by the pedometer within the lowest quintile as stratified by gender were identified as frail by this criterion. Category of participants Criteria for classifying low activity (energy expended in kcal) Male Female HIV negative elderly <43.3 <58.9 HIV positive elderly <72.2 <38.16 Score interpretation 0/5= non-frail, (1-2)/5= pre-frail and ≥3/5= frail Source: Adapted from the Sasaguri Genkimon Study (27). Statistical Analysis The data obtained was cleaned and coded in Microsoft Excel. Categorical variables were presented as frequency and percentages. Statistical analysis was performed with Statistical Package for Social Science (SPSS version 26.0), STATA (Version 14.1), and GraphPad (version 8.0). Non-parametric analysis of variation (Kruskal-Wallis test) was performed to determine the association between study variables and frailty, p < 0.05 was considered statistically significant. Results Sociodemographic characteristics of study participants The majority the 181 participants of this study were females (56.9%). The median age of participants of this study was 64 years (min=60 yrs, max= 90 yrs). The majority of the participants (72.3%) were aged 60-69 years, while 22.1% (41/181) were aged from 70 to 79 years with 5.0% (9/181) aged 80 years and above. On education among participants, 45.8% (83/181) of the participants had obtained only primary education, whilst individuals with tertiary education formed the lowest percentage of participants in this study (14.4%). Considering marital status, about half of the participants were married (51.4%), widows were 28.7% (52/181), those divorced were 17.1% (31/181), 2.2% (4/181) were cohabiting whilst the remaining 0.6% (1/181) were single. Also, most of the participants were informally employed (57.0%), followed by those who were unemployed (32.0%) whilst 11% were formally employed. Most participants were residing in rural areas (72.9%) ( Table 1 ). Table 1: sociodemographic characteristics of study participants Variable N=181 Frequency (n %) Gender Male 78(43.1) Female 103 (56.9) Age Category (Years) 60-69 132 (72.9) 70-79 40 (22.1) 80 and above 9 (5.0) Educational Level No formal education 43 (23.8) Primary 83 (45.8) Secondary 29 (16.0) Tertiary 26 (14.4) Marital Status Married 93 (51.4) Single 1 (0.6) Cohabiting 4 (2.2) Divorced 31 (17.1) Widow/er 52 (28.7) Occupational Status Formal 20 (11.0) Informal 103 (57.0) Unemployed 58 (32.0) Place of Residence Rural 129 (72.9) Urban 48 (27.1) *Data presented as frequency and percentages Lifestyle Characteristics of Study Participants Out of the 181 participants of this study, 57.5% did not engage in any exercise, and 9.5% and 33.1% had a history of smoking and a history of alcohol intake respectively. Investigated lifestyle factors are shown in Table 2 below. Table 2: Lifestyle characteristics of study participants Variable N=181 Frequency (n%) Exercise No 104 (57.5) Yes 77 (42.5) Exercise Frequency Never exercise 102 (56.4) Daily 65 (35.9) Weekly 14 (7.7) Ever Smoked No 162 (90.5) Yes 17 (9.5) Ever Drunk Alcohol No 121 (66.9) Yes 60 (33.1) Currently, Drink Alcohol No 153 (84.5) Yes 28 (15.5) Alcohol Frequency Never 153 (84.5) Daily-Weekly 24 (13.3) Occasionally 4 (2.2) Marriage Type Unmarried 22 (24.7) Monogamous 60 (67.4) Polygamous 7 (7.9) Multiple Sex Partners No 77 (89.5) Yes 9 (10.5) Ever-Patronized Sex Workers No 81 (90.0) Yes 9 (10.0) Ever Shared Sharps No 76 (88.4) Yes 10 (11.6) Prevalence of Frailty among the Elderly Participants Out of 181 elderly participants screened for frailty, 68 (37.5%), 85 (47.0%), and 28 (15.5%) were identified to be non-frail, pre-frail, and frail respectively ( Figure 2 ). Frailty Distribution Stratified by Age Group In this study, the percentage of participants who were non-frail decreased with increasing age whereas the proportion of frail participants increased with increasing age (Figure 2) . Prevalence of Frailty among HIV-Positive and HIV-Negative Participants Out of the 104 HIV-negative participants, 38.5%, 49.0%, and 12.5% were non-frail, pre-frail, and frail respectively. Also, among the 77 HIV-positive participants, 36.4%, 44.1%, and 19.5% were non-frail, pre-frail, and frail respectively. Therefore, this study observed a frailty prevalence of 12.5% and 19.5% among HIV-negative and HIV-positive participants respectively ( Figure 3). Sociodemographic Factors associated with Frailty Syndrome among study Participants Investigation of the association between frailty status and sociodemographic factors such as gender, age, educational level, marital status, occupational status, and place of residence among both HIV-positive and HIV-negative participants observed no significant associations. However, age category ( p =0.049), and occupational status ( p =0.020) of the HIV-negative groups were significantly associated with frailty ( Table 3 ). Table 3: Sociodemographic factors associated with frailty among participants stratified by HIV status HIV POSITIVE HIV NEGATIVE VARIABLE NON FRAIL PRE-FRAIL FRAIL p -value NON FRAIL PRE-FRAIL FRAIL p -value Gender 0.119 0.243 Male 8 (28.6) 12 (35.3) 9 (60.0) 21 (52.5) 20 (39.2) 8 (61.5) Female 20 (71.4) 22 (64.7) 6 (40.0) 19 (47.5) 31 (60.8) 5 (38.5) Age Category (Years) 0.235 0.049 60-69 24 (85.7) 27 (79.4) 13 (86.7) 33 (82.5) 28 (54.9) 7 (53.8) 70-79 2 (7.1) 7 (20.6) 2 (13.3) 6 (15.0) 19 (37.3) 4 (30.8) 80 and above 2 (7.1) 0 (0.0) 0 (0.0) 1 (2.5) 4 (7.8) 2 (15.4) Educational Level 0.636 0.425 No formal education 11 (39.3) 9 (26.5) 5 (33.3) 3 (7.5) 11 (21.6) 4 (30.8) Primary 10 (35.7) 17 (50.0) 4 (26.7) 23 (57.5) 25 (49.0) 4 (30.8) Secondary 6 (21.4) 6 (17.6) 4 (26.7) 5 (12.5) 6 (11.8) 2 (15.4) Tertiary 1 (3.6) 2 (5.9) 2 (13.3) 9 (22.5) 9 (17.5) 3 (23.1) Marital Status 0.338 0.442 Married 8 (28.6) 11 (32.4) 9 (60.0) 26 (65.0) 33 (64.7) 6 (46.2) Single 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 1 (2.0) 0 (0.0) Cohabiting 2 (7.1) 1 (2.9) 0 (0.0) 0 (0.0) 1 (2.0) 0 (0.0) Divorced 8 (28.6) 10 (29.4) 1 (6.7) 3 (7.5) 5 (9.8) 4 (30.8) Widow/er 10 (35.7) 12 (35.3) 5 (33.3) 11 (27.5) 11 (21.6) 3 (23.1) Occupational Status 0.096 0.020 Formal 3 (10.7) 4 (11.8) 5 (33.3) 7 (17.5) 1 (2.0) 0 (0.0) Informal 24 (85.7) 24 (70.6) 8 (53.3) 19 (47.5) 24 (47.1) 4 (30.8) Unemployed 1 (3.6) 6 (17.6) 2 (13.3) 14 (35.0) 26 (51.0) 9 (69.2) Place of Residence 0.371 0.224 Rural 14 (50.0) 22 (64.7) 7 (46.7) 35 (92.1) 40 (80.0) 11 (91.7) Urban 14 (50.0) 12 (35.3) 8 (53.3) 3 (7.9) 10 (20.0) 1 (8.3) *P<0.05 was considered statistically significant Lifestyle factors associated with frailty among participants with and without HIV Among HIV-negative participants of this study, there was a significant association between frailty and individuals who ever smoked ( p = 0.029) as well as between frailty and those who had multiple sex partners ( p = 0.031) (Table 4). Table 4: Lifestyle factors associated with frailty among participants with and without HIV HIV POSITIVE HIV NEGATIVE VARIABLE NON FRAIL PRE-FRAIL FRAIL p -value NON FRAIL PRE-FRAIL FRAIL p -value Exercise 0.642 0.706 No 15 (53.6) 18 (52.9) 10 (66.7) 22 (55.0) 32 (30.8) 7 (53.8) Yes 13 (46.4) 16 (47.1) 5 (33.3) 18 (45.0) 19 (37.3) 6 (46.2) Exercise Frequency 0.394 0.87 Never exercise 14 (50.0) 18 (52.9) 10 (66.7) 21 (52.5) 32 (62.7) 7 (53.8) Daily 11 (39.3) 15 (44.1) 3 (20.0) 15 (37.5) 16 (31.4) 5 (38.5) Weekly 3 (10.7) 1 (2.9) 2 (13.3) 4 (10.0) 3 (5.9) 1 (7.7) Smoking status 0.452 0.029 No 26 (92.9) 29 (85.3) 12 (80.0) 35 (87.5) 49 (100.0) 11 (84.6) Yes 2 (7.1) 5 (14.7) 3 (20.) 5 (12.5) 0 (0.0) 2 (15.1) Ever Drunk Alcohol 0.243 0.429 No 20 (71.4) 23 (67.6) 7 (46.7) 27 (67.5) 37 (72.5) 7 (53.8) Yes 8 (28.6) 11 (32.4) 8 (53.3) 13 (32.5) 14 (27.5) 6 (46.2) Currently, Drink Alcohol 0.237 0.883 No 24 (85.7) 29 (85.3) 10 (66.7) 34 (85.0) 45 (88.2) 11 (84.6) Yes 4 (14.3) 5 (14.7) 5 (33.3) 6 (15.0) 6 (11.8) 2 (15.4) Marriage Type - - 0.686 Unmarried - - - 10 (25.6) 12 (24.0) 5 (41.7) Monogamous - - 25 (64.1) 35 (70.0) 6 (50.0) Polygamous - - 4 (10.3) 3 (6.0) 1 (8.3) Multiple-Sex-Partner status - 0.031 No - - 30 (81.1) 47 (95.9) 12 (100.0) Yes - - 7 (18.9) 2 (4.1) 0 (0.0) Ever-Patronized Sex Workers - 0.733 No - - 35 (94.6) 46 (95.8) 11 (100.0) Yes - - 2 (5.4) 2 (4.2) 0 (0.0) Ever Shared Sharps - 0.433 No - - 33 (89.2) 43 (87.8) 9 (75.0) Yes - - 4 (10.8) 6 (12.2) 3 (25.0) Discussion The provision of improved healthcare for people living with HIV (PLHIV) has resulted in increased life expectancy together with an increased prevalence of chronic illnesses (10). There is the possibility of increased demands for healthcare needs in the coming years for these individuals. In 2020, about 8.1 million older adults were known to be living with HIV (28). In Sub-Saharan Africa, 14.3% of the adult population living with HIV were 50 years or older (6). The population of PLHIV continues to increase considerably with about 25 million cases in sub-Saharan Africa and a prevalence of about 20 % in several countries (29). Aging with HIV infection comes with several health implications including dementia, diabetes, osteoporosis, some forms of cancer, and frailty (30). This study evaluated the prevalence and factors associated with frailty among older adults with or without HIV infection in two district hospitals in Ghana. With an overall 15.5% (28/181) prevalence of frailty, we observed a 12.5% (13/104) prevalence of frailty among the HIV-negative individuals whereas participants with HIV infection recorded a frailty prevalence of 19.5% (15/77). Occupational status, age, smoking status, and multiple-sex partner status were the sociodemographic and lifestyle factors identified to be possibly associated with frailty among participants without HIV infection. This study's overall 15.5% prevalence of frailty syndrome is consistent with a study by (18), where Collard and other’s review of twenty-one (21) community-based studies on the epidemiology of frailty in persons aged 65 years and above revealed prevalence of frailty ranging from 4.0% to 17.0%. Similarly, the prevalence of frailty in this study falls within the range of 4.9% to 27.3% as reported by Choi et al ., 2015, in a study that examined articles on the prevalence of frailty using the Fried scale in community-dwelling adults aged 65years and older in Taiwan and Spain (31). Although Santos-Eggimann et al., reported a lower frailty prevalence rate of 5.8% in Switzerland while the highest prevalence of 27.3% was recorded in Spain, the overall prevalence of frailty in the survey by Santos-Eggimann et al. was 17% (32) which is comparable to the overall prevalence of the current study. On the contrary, the current prevalence of 15.5% is inconsistent with that observed previously in the Ghanaian population. Biritwum and his colleagues reported a frailty prevalence of 37.9% among Ghanaians in 2016 using the frailty index (33). This prevalence is higher than what we observed in this current study. The difference in the definition of frailty used by Biritwum et al (2016) and that used in the present study ( frailty index vs frailty phenotype) explains the difference in frailty prevalence obtained by the two studies. A study that assessed the prevalence of frailty among older Indian adults revealed a prevalence of 29.94% (34). This prevalence is higher than that observed in our study. Also, in a study by Khandelwal et al. (2012), 32.3% of older adults over the age of 60 were physically frail (35). The differences in our findings and these studies could be due to variations in frailty assessment scales or tools used, partly due to geographical variations and the general health status of the participants. Moreover, according to the AGEhIV cohort study, PLHIV had a higher prevalence of frailty than HIV-negative individuals at all ages (36), this observation is similar to that obtained by the present study. In this current study, the prevalence of frailty was higher among older adults living with HIV compared to those without HIV infection. Similarly, in a case-control study in South Africa, PLHIV were more likely to be frail than those without HIV infection with a prevalence of 19.4% against 13.3% accordingly (37). This observation could be attributed to the advancement in the management of HIV infection, which increases the life expectancy of PLHIV but leaves them with chronic illness regardless of the immune response to clear the virus. As a result, the immune system remains activated. Prolonged immune activation and persistently high levels of pro-inflammatory cytokines can cause damage throughout the body and result in frailty (16). In Sub-Saharan Africa, the proportion of elderly people living with HIV is increasing, resulting in an increased prevalence of non-AIDS-related chronic non-communicable conditions (38). Age-related diseases among elderly persons living with HIV infections will almost certainly place a strain on healthcare budgets and resources (37). In this current study, occupation, age, smoking status, and multiple-sex partner status were the sociodemographic and lifestyle factors associated with frailty among the HIV-negative population. Consistently, previous studies have well-documented smoking as a risk factor for frailty(39, 40), while increased exercise has a protective effect on frailty (41). However, our study found no significant association between exercise and frailty among participants. Disparities in results are most likely due to variations in study design and clinical demographics of patients recruited. Although factors including chronic kidney disease (42), cerebrovascular disease (43), and cardiovascular disease (44) are known risk factors for frailty, the current study did not assess any of these factors. One major limitation of this study is the inability to assess the effect of existing chronic diseases on the frailty status of our participants. Again, this study could not determine the CD4 + counts of older adults with HIV to evaluate its association with frailty due to lack of funds. Conclusion Frailty is more common among older adults (elderly) with HIV infection than those without HIV infection, with approximately 2 out of 10 of the older adults with HIV being frail. Occupation, age, smoking status, and not having multiple sex partners have been identified to be associated with frailty among older adults who do not have HIV infection. Declarations Ethics approval and consent to participate The study was conducted by the Declaration of Helsinki, and approved by the Ethics Committee of Kwame Nkrumah University of Science and Technology (ref: CHRPE/AP/626/19). The Management Team of St. Elizabeth Hospital, Hwidiem also approved the protocol for the study Data Availability All data generated or analyzed during this study are included in this article and can be requested from the corresponding author. Competing Interests The authors declare that there are no conflicts of interest. Funding This study did not receive funding from private, government, or not-for-profit organizations. Acknowledgments The authors are grateful to, Alfred Effah, Samuel K. Boakye-Boateng, Bernice Kumih-Achiaw, Felix Gadzeto, Evans O. Agyapong, Ivan Muanah, Bright Attah-Mensah, Anthony Appiah, Kwasi-Tutu Ali, Oscar Olympio, the study participants, the management and staff of St. Elizabeth Catholic Hospital, Hwidiem, and Holy Family Hospital, Techiman for their contributions in diverse ways towards the successful conduct of the study. References UNAIDS. The GAP Report. 2014. Khan HT. Population ageing in a globalized world: Risks and dilemmas? Journal of evaluation in clinical practice. 2019;25(5):754-60. GSS GSS. The Elderly in Ghana. 2010 Population & Housing Census Report. . Accra: Ghana Statistical Service; 2013. Knoema. Ghana - Population ages 65 years and above as a share of total population 2022 [Available from: https://knoema.com. Mahy M, Autenrieth CS, Stanecki K, Wynd S. Increasing trends in HIV prevalence among people aged 50 years and older: evidence from estimates and survey data. AIDS (London, England). 2014;28(4):S453. Pathai S, Bajillan H, Landay AL, High KP. Is HIV a model of accelerated or accentuated aging? Journals of Gerontology Series A: Biomedical Sciences and Medical Sciences. 2014;69(7):833-42. Boakye DS, Adjorlolo S. Achieving the UNAIDS 95-95-95 treatment target by 2025 in Ghana: a myth or a reality? Global Health Action. 2023;16(1):2271708. Karpiak SE, Havlik R. Are HIV-infected older adults aging differently? HIV and Aging. 2017;42:11-27. Niccoli T, Partridge L. Ageing as a risk factor for disease. Current biology. 2012;22(17):R741-R52. Sabin CA, Reiss P. Epidemiology of ageing with HIV: what can we learn from cohorts? Aids. 2017;31:S121-S8. Bloch M. Frailty in people living with HIV. J AIDS research therapy. 2018;15(1):1-5. Hoogendijk EO, Afilalo J, Ensrud KE, Kowal P, Onder G, Fried LP. Frailty: implications for clinical practice and public health. The Lancet. 2019;394(10206):1365-75. Pilotto A, Custodero C, Maggi S, Polidori MC, Veronese N, Ferrucci L. A multidimensional approach to frailty in older people. Ageing research reviews. 2020;60:101047. Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. The lancet. 2013;381(9868):752-62. Cardoso SW, Torres TS, Santini-Oliveira M, Marins LMS, Veloso VG, Grinsztejn B. Aging with HIV: a practical review. Brazilian Journal of Infectious Diseases. 2013;17:464-79. Highleyman L. Inflammation, immune activation, and HIV. BETA: bulletin of experimental treatments for AIDS: a publication of the San Francisco AIDS Foundation. 2010;22(2):12-26. Rees HC, Ianas V, McCracken P, Smith S, Georgescu A, Zangeneh T, et al. Measuring frailty in HIV-infected individuals. Identification of frail patients is the first step to amelioration and reversal of frailty. JoVE. 2013(77):e50537. Collard RM, Boter H, Schoevers RA, Oude Voshaar RC. Prevalence of frailty in community‐dwelling older persons: a systematic review. J Journal of the american geriatrics society. 2012;60(8):1487-92. Cunha AIL, Veronese N, de Melo Borges S, Ricci NA. Frailty as a predictor of adverse outcomes in hospitalized older adults: a systematic review and meta-analysis. Ageing research reviews. 2019;56:100960. Jaul E, Barron J. Characterizing the heterogeneity of aging: a vision for a staging system for aging. Frontiers in Public Health. 2021;9:513557. Thillainadesan J, Scott IA, Le Couteur DG. Frailty, a multisystem ageing syndrome. Age and Ageing. 2020;49(5):758-63. GSS GSS. Population and Housing Census, general report : population of regions and districts Accra: Ghana Statistical Service; 2021. MoFA-Ghana MoFaA. Techiman Municipal. Accra: Ministry of Food and Agriculture; 2024. MoFA-Ghana MoFaA. Asutifi-South District. Accra: Ministry of Food and Agriculture; 2024. GSS GSS. The elderly in Ghana. Accra: Ghana Statistical Service; 2013. NACP NAaSCP. HIV Sentinel Survey Report National AIDS. 2017. Chen S, Honda T, Chen T, Narazaki K, Haeuchi Y, Supartini A, et al. Screening for frailty phenotype with objectively-measured physical activity in a west Japanese suburban community: evidence from the Sasaguri Genkimon Study. BMC geriatrics. 2015;15(1):36. Longev LH. Ageing with HIV. The Lancet Healthy Longevity ;3(3):E119. Siedner MJ. Aging, health, and quality of life for older people living with HIV in Sub-Saharan Africa: a review and proposed conceptual framework. Journal of aging health. 2019;31(1):109-38. Ahmed MH, Ahmed F, Abu-Median A-B, Panourgia M, Owles H, Ochieng B, et al. HIV and an ageing population—what are the medical, psychosocial, and palliative care challenges in healthcare provisions. Microorganisms. 2023;11(10):2426. Choi J, Ahn A, Kim S, Won CW. Global prevalence of physical frailty by Fried's criteria in community-dwelling elderly with national population-based surveys. Journal of the American Medical Directors Association. 2015;16(7):548-50. Santos-Eggimann B, Cuénoud P, Spagnoli J, Junod J. Prevalence of frailty in middle-aged and older community-dwelling Europeans living in 10 countries. The Journals of Gerontology: Series A. 2009;64(6):675-81. Biritwum R, Minicuci N, Yawson A, Theou O, Mensah G, Naidoo N, et al. Prevalence of and factors associated with frailty and disability in older adults from China, Ghana, India, Mexico, Russia and South Africa. Maturitas. 2016;91:8-18. Thakkar S, Srivastava S. Cross-sectional associations of physical frailty with fall, multiple falls and fall-injury among older Indian adults: Findings from LASI, 2018. PLoS one. 2022;17(8):e0272669. Khandelwal D, Goel A, Kumar U, Gulati V, Narang R, Dey A, et al. Frailty is associated with longer hospital stay and increased mortality in hospitalized older patients. The journal of nutrition, health. 2012;16:732-5. Kooij KW, Wit FW, Schouten J, van der Valk M, Godfried MH, Stolte IG, et al. HIV infection is independently associated with frailty in middle-aged HIV type 1-infected individuals compared with similar but uninfected controls. Aids. 2016;30(2):241-50. Pathai S, Gilbert C, Weiss HA, Cook C, Wood R, Bekker L-G, et al. Frailty in HIV-infected adults in South Africa. Journal of acquired immune deficiency syndromes. 2013;62(1):43. Egede LE, Walker RJ, Monroe P, Williams JS, Campbell JA, Dawson AZ. HIV and cardiovascular disease in sub-Saharan Africa: Demographic and Health Survey data for 4 countries. BMC Public Health. 2021;21(1):1122. Hubbard RE, O’Mahony MS, Savva GM, Calver BL, Woodhouse KW. Inflammation and frailty measures in older people. Journal of cellular and molecular medicine. 2009;13(9b):3103-9. Kojima G, Iliffe S, Walters K. Smoking as a predictor of frailty: a systematic review. BMC geriatrics. 2015;15:1-7. Hubbard RE, Fallah N, Searle SD, Mitnitski A, Rockwood K. Impact of exercise in community-dwelling older adults. PloS one. 2009;4(7):e6174. Chowdhury R, Peel NM, Krosch M, Hubbard RE. Frailty and chronic kidney disease: a systematic review. Archives of gerontology geriatrics. 2017;68:135-42. Veronese N, Sigeirsdottir K, Eiriksdottir G, Marques EA, Chalhoub D, Phillips CL, et al. Frailty and risk of cardiovascular diseases in older persons: the age, gene/environment susceptibility-Reykjavik study. Rejuvenation research. 2017;20(6):517-24. Newman AB, Gottdiener JS, McBurnie MA, Hirsch CH, Kop WJ, Tracy R, et al. Associations of subclinical cardiovascular disease with frailty. The Journals of Gerontology Series A: Biological Sciences Medical Sciences. 2001;56(3):M158-M66. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4643949","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":322675984,"identity":"6fb7b8be-a205-4862-adb7-3aaede60f51d","order_by":0,"name":"Paul Ntiamoah","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA0klEQVRIiWNgGAWjYFACxgYQmcDA3sDATJwONpgWngNEa4FQCQwSCURqMZdvbvx0o8Iuz1zyjeHnggobBv727gS8WizbGJulc84kF1vOzjGWnnEmjUHizNkNeLUYHGNskM5tY07ccDvHQJq37TCDgUQuQS3Nv3Pb6hM33Dxj/JtYLW1AWw4nbrjBY0asLYlt1jlnjifu7Ekrs+Y5k8ZD2C+Hjz++nVNRnbid/fDm2zwVNnL87b34tSD0MnAYgGge4pRDtLA/IF71KBgFo2AUjCgAAJJOSDJNNT/0AAAAAElFTkSuQmCC","orcid":"","institution":"Department of Molecular Medicine, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi","correspondingAuthor":true,"prefix":"","firstName":"Paul","middleName":"","lastName":"Ntiamoah","suffix":""},{"id":322675987,"identity":"498fadf8-9ddd-4844-acb5-c339c589d5d8","order_by":1,"name":"Max Efui Ananni-Akollor","email":"","orcid":"","institution":"Department of Molecular Medicine, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi","correspondingAuthor":false,"prefix":"","firstName":"Max","middleName":"Efui","lastName":"Ananni-Akollor","suffix":""},{"id":322675988,"identity":"a2ff7d20-5086-4712-903e-81329bbc605d","order_by":2,"name":"Magaret T. Frempong","email":"","orcid":"","institution":"Department of Molecular Medicine, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi","correspondingAuthor":false,"prefix":"","firstName":"Magaret","middleName":"T.","lastName":"Frempong","suffix":""},{"id":322675989,"identity":"7c2fc554-3822-4db9-9f0c-e3546d2957af","order_by":3,"name":"Mohammed Mutocheluh","email":"","orcid":"","institution":"Department of Clinical Microbiology, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi,","correspondingAuthor":false,"prefix":"","firstName":"Mohammed","middleName":"","lastName":"Mutocheluh","suffix":""},{"id":322675991,"identity":"a682e925-6737-4638-a3e5-048d2ad8bc5b","order_by":4,"name":"Patrick Williams Narkwah","email":"","orcid":"","institution":"Department of Clinical Microbiology, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi,","correspondingAuthor":false,"prefix":"","firstName":"Patrick","middleName":"Williams","lastName":"Narkwah","suffix":""},{"id":322675992,"identity":"78766a4e-0e39-4e09-8962-02adaf9c4111","order_by":5,"name":"Samuel Kekeli Agordzo","email":"","orcid":"","institution":"Department of Molecular Medicine, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi","correspondingAuthor":false,"prefix":"","firstName":"Samuel","middleName":"Kekeli","lastName":"Agordzo","suffix":""},{"id":322675993,"identity":"385d0d3c-78ba-45bd-9074-d31ae29b126a","order_by":6,"name":"Dora Dapaah","email":"","orcid":"","institution":"St. Elizabeth Hospital, Hwidiem, Ahafo Region","correspondingAuthor":false,"prefix":"","firstName":"Dora","middleName":"","lastName":"Dapaah","suffix":""},{"id":322675994,"identity":"81afd78a-f977-4fed-a92e-2246f0d76320","order_by":7,"name":"Dennis Adu-Gyasi","email":"","orcid":"","institution":"Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo North Municipality, Bono East Region","correspondingAuthor":false,"prefix":"","firstName":"Dennis","middleName":"","lastName":"Adu-Gyasi","suffix":""}],"badges":[],"createdAt":"2024-06-26 16:06:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4643949/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4643949/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":61002487,"identity":"cf62c939-3160-4629-a94c-e8a59da71943","added_by":"auto","created_at":"2024-07-24 13:18:24","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":18042,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eDistribution of frailty syndrome among study participants\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4643949/v1/c91addce27b535fbb4002565.png"},{"id":61002485,"identity":"4a5c5bd2-e496-4323-9306-88d58b9be564","added_by":"auto","created_at":"2024-07-24 13:18:23","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":27065,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of frailty status stratified by age group\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-4643949/v1/133d53ee3b4087dd56fd22f1.png"},{"id":61002488,"identity":"7a114f2a-cdeb-407c-a135-2e14ba16847a","added_by":"auto","created_at":"2024-07-24 13:18:24","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":28227,"visible":true,"origin":"","legend":"\u003cp\u003eshows the distribution of frailty among both HIV-negative and HIV-positive participants\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-4643949/v1/a92c896505d5008e987bd6c1.png"},{"id":85301164,"identity":"8d5e66aa-0cd2-41c9-a8e0-478d0961a5c4","added_by":"auto","created_at":"2025-06-24 12:02:05","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1568850,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4643949/v1/7fb88bb5-786f-4984-bfbc-6288b4d8658e.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Aging and Frailty; the case of HIV-positive and HIV-negative individuals in Ghana: A case-control study","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eThe world\u0026rsquo;s population is aging (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e), with the percentage of elderly persons (individuals who are 60 years and above) increasing globally (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). By 2030, a quarter of Asia's population is expected to be over 60 years old, while about 25% of the developed world's population will be over 65 years old (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). The population of the elderly in Ghana increased more than sevenfold between 1960 and 2010 (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Although, Sub-Saharan countries have the youngest populations(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e), in 2022, 3.6% of the Ghanaian population was over 65 years old, indicating an increase in the elderly population from 3.5% in 2021 (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe number of persons living with HIV aged 50 years and above is on the rise. Globally, 4.2\u0026nbsp;million persons aged 50 years and older were living with HIV in 2013 (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). In sub-Saharan Africa, which accounts for 60% of all persons living with HIV worldwide, 14.3% of the adult population living with HIV is aged over 60 years(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). In Ghana, as of March 20, 2023, the Ghana AIDS Commission reported a total of 346,120 people living with HIV infection (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). HIV-positive older adults have been observed to be more prone to developing dementia, diabetes, osteoporosis, frailty, and some cancers (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Similarly, aging has been associated with the development of diseases like cancer, cardiovascular disease, neurodegenerative diseases, liver disease, loss of bone density, and an increased risk of fractures, as well as other conditions including frailty, irrespective of the HIV status (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Owing to the success of antiretroviral therapy, the lifespan of people living with HIV has increased considerably, coupled with the incidence of the disease (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Clinicians attending to such patients are therefore concerned about the increasing trend of frailty (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFrailty is marked by a decline in function across multiple physiological systems, as well as an increased susceptibility to stressors (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Frailty develops with increasing age and is associated with a high risk of multiple undesirable health outcomes, including hospitalization, falls, institutionalization, and death (\u003cspan additionalcitationids=\"CR13\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Well-functioning neuro-immuno-endocrine system, healthy diet, and regular physical exercise impact positively biological ageing. Nevertheless, in frail older people, low-grade inflammation, excessive and uncontrolled oxidative stress, and immunosenescence make anti-aging mechanisms less effective (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). There are several causes and contributors to frailty. Increased levels of free radicals, mitochondrial dysfunction, and cytokines may activate inflammatory pathways, eventually resulting in frailty (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Similarly, various microorganisms, including HIV, can cause chronic infection regardless of the immune response to clear them. As a result, the immune system remains activated. Prolonged immune activation and persistently high levels of pro-inflammatory cytokines can cause damage throughout the body (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFrailty is more common in HIV-positive young people than in HIV-negative young people. Elderly persons living with HIV have been described to be more frail than those without HIV infection (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e) in some parts of the world. Moreover, the prevalence of frailty among people aged 65 years and above has been reported to range from 4.0\u0026ndash;17.0% (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). The prevalence of frailty has been reported to be higher among individuals in hospital settings ranging from 18% to 40 (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). In Ghana, there is a paucity of data regarding frailty among adults aged 60 years and above irrespective of their HIV status. Therefore, this study evaluated the prevalence and factors associated with frailty among adults (60 years and above) with or without HIV in infection Ghana.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy design and study population\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA case-control study\u0026nbsp;design was adopted to recruit potential participants among persons who visited the out-patients department (OPD) and antiretroviral therapy clinics of St. Elizabeth Hospital, Hwidiem, and Holy Family Hospital, Techiman in the Ahafo and Bono-East Regions of Ghana respectively. Written informed consent was sought from individuals who approached the study team after hearing the announcement about the study at the OPD and antiretroviral therapy clinics to participate in the study. Individuals who were eligible according to our inclusion criteria were enrolled as participants in this study. As the world\u0026rsquo;s population ages, the population of elderly HIV-infected individuals has also increased due to the availability of effective highly active anti-retroviral therapy as well as new infections in persons 60 years and above\u0026nbsp;(1). Aging comes with many health challenges which are further aggravated by HIV infection\u0026nbsp;(20, 21). A deeper understanding of the negative outcomes of aging including frailty will help improve the quality of life of the elderly. Hence this study recruited HIV-infected persons (60 years and above) who were on antiretroviral therapy as well as HIV-negative individuals (60 years and above) as subjects of the study.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy Site\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe study was conducted at Holy Family Hospital, Techiman, and St. Elizabeth Catholic Hospital, Hwidiem. Techiman Municipality is located in the central part of the Bono-East Region and lies between\u0026nbsp;latitudes 80\u0026nbsp;00\u0026apos;\u0026nbsp;north and 70\u0026nbsp;35\u0026apos;\u0026nbsp;south and between longitudes 10\u0026nbsp;49\u0026apos;\u0026nbsp;east and 20\u0026nbsp;30\u0026apos;\u0026nbsp;west. The Municipality had a population of 243,335 according to the 2021 population and housing census\u0026nbsp;(22). With three main vegetation zones including a semi-deciduous zone in the south, Guinea-Savanna woodland in the north-west and a Transitional zone covering from the south-east and west to the north, the Techiman Municipality has both tropical conventional and semi-equatorial or savannah climates(23). Techiman is a town with high commercial activities. Holy Family Hospital is a secondary-level facility that offers a wide range of preventive and curative healthcare services including many specialist services.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Hwidiem is a town situated in the Asutifi-South District. The Asutifi-South District is located in the western part of the Ahafo Region of Ghana and lies between latitudes 6\u0026deg;40\u0026apos; and 7\u0026deg;15\u0026apos; North and longitudes 2\u0026deg;15\u0026apos; and 2\u0026deg;45\u0026apos; West. According to the 2021 population and housing census by the Ghana Statistical Service, Asutifi-South District has a population of 68,394 (22). The Asutifi-South District is situated within the wet semi-equatorial zone with double maxima rainfall and it is predominantly covered by semi-deciduous forest(24). There are mining activities in the Asutifi-South District. St. Elizabeth Catholic \u0026nbsp;Hospital, Hwidiem is a secondary-level facility that offers a wide range of preventive and curative healthcare services including many specialist services.\u003c/p\u003e\n\u003cp\u003eThe nature of these towns grants us the opportunity to encounter both elderly and younger persons with different lifestyles and life experiences that reflect the nature of Ghanaian society. Areas with high commercial activities and mining towns are associated with behaviors such as commercial sex activities, multiple sexual partners, drug abuse, and other practices that may expose a person to HIV infections. There is a well-resourced district hospital in each of these towns. Hence the selection of Hwidiem and Techiman as sites for the present study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInclusion criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants who were HIV-negative upon screening for the presence of HIV infection and aged \u0026nbsp;60 years and above were included in the study. For HIV- positive participants, we included only confirmed HIV-positive persons who were on antiretroviral therapy and aged \u0026nbsp;60 years and above. \u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eExclusion Criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIndividuals who were wheelchair-bound or physically handicapped were excluded from the study as their physical status may affect negatively the measurement of physical frailty. Persons who were below 60 years old were also excluded from the study since persons of this age are generally considered to be physically strong.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSample size\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWith a 95% confidence level and 80% power, using a 6.6% elderly population in Ghana\u0026nbsp;(25)\u0026nbsp;and a 2.7% prevalence of HIV in the Brong-Ahafo Region of Ghana\u0026nbsp;(26)\u0026nbsp;a minimum sample size of 95 elderly persons and 40 HIV-positive persons was required for the study. However, a total of 181 participants, 104 HIV-negative participants (\u0026ge; 60 years) and 77 HIV-infected persons (\u0026ge; 60 years) were enrolled in the study, to improve statistical power.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSampling and Research Techniques\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA standardized questionnaire was administered to collect demographic information and information on possible contributory factors of accelerated aging from each participant. The degree of physical frailty was determined using validated clinical criteria (Fried\u0026rsquo;s Frailty Phenoty) adapted from the \u0026nbsp;Sasaguri Genkimon study\u0026nbsp;(27). This was based on the assessment of unintentional shrinking, slowness, weakness, physical activity, and endurance levels among participants. Participants were grouped into non-frail, pre-frail, and frail.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA venous blood sample was collected from each participant into EDTA tubes. Participants whose HIV status was unknown were screened for HIV-1/2 antibodies based on the \u0026nbsp;Ghana National AIDS/STI Control Program\u0026rsquo;s Protocols using HIV-1/2 first response kits, Oraquick test kits, and SD-Bioline test kits for antibody detection.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Committee on Human Research, Publications and Ethics, School of Medical Sciences, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana approved the protocol for the study with reference no: CHRPE/AP/626/19.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;The Management Teams as well as the Research Teams of St. Elizabeth Hospital, Hwidiem, and Holy Family Hospital, Techiman also approved the protocol for the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAssessment of frailty\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFried\u0026rsquo;s Frailty phenotype tool adapted from the Sasaguri Genkimon Study\u0026nbsp;(27)\u0026nbsp;was used to assess frailty among participants of this study.\u003c/p\u003e\n\u003cp\u003eThe frailty phenotype has five components and each component is given a score of one (1). Individuals who scored zero (0) out of the five (5) measured criteria were identified as non-frail, those who had a score of one (1) or two (2) were classified as pre-frail and those with a score of three (3) or more were classified as frail.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe definition of the operational frailty phenotype in this study is listed below;\u003c/p\u003e\n\u003cp\u003eOperational definition of frailty phenotype in this study\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.307692307692307%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eComponent\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"82.6923076923077%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eDefinition\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.307692307692307%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eUnintentional shrinking\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"82.6923076923077%\" valign=\"top\"\u003e\n \u003cp\u003eBody Mass Index of \u0026lt;18.5 kg/m2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.307692307692307%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSlowness\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"82.6923076923077%\" valign=\"top\"\u003e\n \u003cp\u003eA six (6) meter fast gait speed using the average of two (gender-specific cutoff: a median height). The criteria for classifying a participant as slow is as follows:\u003c/p\u003e\n \u003cp\u003eHIV-negative elderly\u003c/p\u003e\n \u003cp\u003eMale time: \u0026gt; 8.0s for height \u0026lt; 165.0cm or Time \u0026gt;8.0s for height \u0026ge; 165.0cm. Female Time: \u0026gt; 8.0s for height \u0026lt; 155.0cm or Time \u0026gt; 7.0s for height \u0026ge; 155.0 cm\u003c/p\u003e\n \u003cp\u003eHIV-positive elderly\u003c/p\u003e\n \u003cp\u003eMale time: \u0026gt; 8.9s for height \u0026lt; 170.0cm or Time \u0026gt;8.0s for height \u0026ge; 170.0cm. Female Time: \u0026gt; 7.6s for height \u0026lt; 160.0cm or Time \u0026gt; 10.1s for height \u0026ge; 160.0 cm\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.307692307692307%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eExhaustion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"82.6923076923077%\" valign=\"top\"\u003e\n \u003cp\u003eA positive answer to one of two self-reported questions. In the last month, \u0026ldquo;Did you feel tired without any reason\u0026rdquo; and \u0026ldquo;Did you have the feeling that everything you did was an effort?\u0026rdquo;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.307692307692307%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eWeakness\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"82.6923076923077%\" valign=\"top\"\u003e\n \u003cp\u003eGrip strength outside a cut-off as validated with the equipment according to gender and age.\u003c/p\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"537\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.476722532588454%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"71.3221601489758%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eCut off for classifying frailty according to dynamometer reading (Kg)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.201117318435752%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.476722532588454%\" rowspan=\"2\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"87.52327746741155%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"81.48936170212765%\" valign=\"bottom\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.51063829787234%\" valign=\"bottom\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.476722532588454%\" valign=\"bottom\"\u003e\n \u003cp\u003e60-64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"71.3221601489758%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026lt;30.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.201117318435752%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026lt;17.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.476722532588454%\" valign=\"bottom\"\u003e\n \u003cp\u003e65-69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"71.3221601489758%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026lt;28.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.201117318435752%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026lt;15.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.476722532588454%\" valign=\"bottom\"\u003e\n \u003cp\u003e70-99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"71.3221601489758%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026lt;21.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.201117318435752%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026lt;14.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.307692307692307%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ePhysical activities\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"82.6923076923077%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eIndividuals with energy expended in kilo calories as recorded by the pedometer within the lowest quintile as stratified by gender were identified as frail by this criterion.\u0026nbsp;\u003c/p\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"462\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.25108225108225%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eCategory of participants\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"67.74891774891775%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eCriteria for classifying low activity (energy expended in kcal)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.452229299363054%\" valign=\"top\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"52.547770700636946%\" valign=\"top\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.18142548596112%\" valign=\"top\"\u003e\n \u003cp\u003eHIV negative elderly\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.18142548596112%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;43.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.63714902807775%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;58.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.18142548596112%\" valign=\"top\"\u003e\n \u003cp\u003eHIV positive elderly\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.18142548596112%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;72.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.63714902807775%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;38.16\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.307692307692307%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eScore interpretation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"82.6923076923077%\" valign=\"top\"\u003e\n \u003cp\u003e0/5= non-frail, (1-2)/5= pre-frail and \u0026ge;3/5= frail\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eSource: Adapted from the Sasaguri Genkimon Study (27). \u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data obtained was cleaned and coded in Microsoft Excel. \u0026nbsp;Categorical variables were presented as frequency and percentages.\u0026nbsp;Statistical analysis was performed with Statistical Package for Social Science (SPSS version 26.0), STATA (Version 14.1), and GraphPad (version 8.0). Non-parametric analysis of variation (Kruskal-Wallis test) was performed to determine the association between study variables and frailty, \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.05 was considered statistically significant.\u0026nbsp;\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eSociodemographic characteristics of study participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe majority the 181 participants of this study were females (56.9%). The median age of participants of this study was 64 years (min=60 yrs, max= 90 yrs). The majority of the participants (72.3%) were aged 60-69 years, while 22.1% (41/181) were aged from 70 to 79 years with 5.0% (9/181) aged 80 years and above. On education among participants, 45.8% (83/181) \u0026nbsp;of the participants had obtained only primary education, whilst individuals with tertiary education formed the lowest percentage of participants in this study (14.4%). Considering marital status, about half of the participants were married (51.4%), widows were 28.7% (52/181), \u0026nbsp;those divorced were 17.1% (31/181), 2.2% (4/181) were cohabiting whilst the remaining 0.6% (1/181) were single. Also, most of the participants were informally employed (57.0%), followed by those who were unemployed (32.0%) whilst 11% were formally employed. Most participants were residing in rural areas (72.9%) (\u003cstrong\u003eTable 1\u003c/strong\u003e).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1: sociodemographic characteristics of study participants\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"541\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.380776340110906%\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.08687615526802%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;N=181\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.53234750462107%\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; Frequency (n %)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.380776340110906%\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.08687615526802%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.53234750462107%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.380776340110906%\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.08687615526802%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.53234750462107%\"\u003e\n \u003cp\u003e78(43.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.380776340110906%\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.08687615526802%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.53234750462107%\"\u003e\n \u003cp\u003e103 (56.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.380776340110906%\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge Category (Years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.08687615526802%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.53234750462107%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.380776340110906%\"\u003e\n \u003cp\u003e60-69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.08687615526802%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.53234750462107%\"\u003e\n \u003cp\u003e132 (72.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.380776340110906%\"\u003e\n \u003cp\u003e70-79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.08687615526802%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.53234750462107%\"\u003e\n \u003cp\u003e40 (22.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.380776340110906%\"\u003e\n \u003cp\u003e80 and above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.08687615526802%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.53234750462107%\"\u003e\n \u003cp\u003e9 (5.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.380776340110906%\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducational Level\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.08687615526802%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.53234750462107%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.4074074074074%\" colspan=\"2\"\u003e\n \u003cp\u003eNo formal education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.592592592592595%\"\u003e\n \u003cp\u003e43 (23.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.4074074074074%\" colspan=\"2\"\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.592592592592595%\"\u003e\n \u003cp\u003e83 (45.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.4074074074074%\" colspan=\"2\"\u003e\n \u003cp\u003eSecondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.592592592592595%\"\u003e\n \u003cp\u003e29 (16.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.4074074074074%\" colspan=\"2\"\u003e\n \u003cp\u003eTertiary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.592592592592595%\"\u003e\n \u003cp\u003e26 (14.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.4074074074074%\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital Status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.592592592592595%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.4074074074074%\" colspan=\"2\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.592592592592595%\"\u003e\n \u003cp\u003e93 (51.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.4074074074074%\" colspan=\"2\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.592592592592595%\"\u003e\n \u003cp\u003e1 (0.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.4074074074074%\" colspan=\"2\"\u003e\n \u003cp\u003eCohabiting\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.592592592592595%\"\u003e\n \u003cp\u003e4 (2.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.4074074074074%\" colspan=\"2\"\u003e\n \u003cp\u003eDivorced\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.592592592592595%\"\u003e\n \u003cp\u003e31 (17.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.4074074074074%\" colspan=\"2\"\u003e\n \u003cp\u003eWidow/er\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.592592592592595%\"\u003e\n \u003cp\u003e52 (28.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.4074074074074%\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eOccupational Status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.592592592592595%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.4074074074074%\" colspan=\"2\"\u003e\n \u003cp\u003eFormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.592592592592595%\"\u003e\n \u003cp\u003e20 (11.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.4074074074074%\" colspan=\"2\"\u003e\n \u003cp\u003eInformal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.592592592592595%\"\u003e\n \u003cp\u003e103 (57.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.4074074074074%\" colspan=\"2\"\u003e\n \u003cp\u003eUnemployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.592592592592595%\"\u003e\n \u003cp\u003e58 (32.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.4074074074074%\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003ePlace of Residence\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.592592592592595%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.4074074074074%\" colspan=\"2\"\u003e\n \u003cp\u003eRural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.592592592592595%\"\u003e\n \u003cp\u003e129 (72.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.4074074074074%\" colspan=\"2\"\u003e\n \u003cp\u003eUrban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.592592592592595%\"\u003e\n \u003cp\u003e48 (27.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e*Data presented as frequency and percentages\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLifestyle Characteristics of Study Participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOut of the 181 participants of this study, 57.5% did not engage in any exercise, and 9.5% and 33.1% \u0026nbsp;had a history of smoking and a history of alcohol intake respectively. Investigated lifestyle factors are shown in Table 2 below.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2: Lifestyle characteristics of study participants\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"624\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; N=181\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.57692307692308%\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; Frequency (n%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\"\u003e\n \u003cp\u003e\u003cstrong\u003eExercise\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.57692307692308%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.57692307692308%\"\u003e\n \u003cp\u003e104 (57.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.57692307692308%\"\u003e\n \u003cp\u003e77 (42.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\"\u003e\n \u003cp\u003e\u003cstrong\u003eExercise Frequency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.57692307692308%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\"\u003e\n \u003cp\u003eNever exercise\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.57692307692308%\"\u003e\n \u003cp\u003e102 (56.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\"\u003e\n \u003cp\u003eDaily\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.57692307692308%\"\u003e\n \u003cp\u003e65 (35.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\"\u003e\n \u003cp\u003eWeekly\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.57692307692308%\"\u003e\n \u003cp\u003e14 (7.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\"\u003e\n \u003cp\u003e\u003cstrong\u003eEver Smoked\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.57692307692308%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.57692307692308%\"\u003e\n \u003cp\u003e162 (90.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.57692307692308%\"\u003e\n \u003cp\u003e17 (9.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\"\u003e\n \u003cp\u003e\u003cstrong\u003eEver Drunk Alcohol\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.57692307692308%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.57692307692308%\"\u003e\n \u003cp\u003e121 (66.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.57692307692308%\"\u003e\n \u003cp\u003e60 (33.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\"\u003e\n \u003cp\u003e\u003cstrong\u003eCurrently, Drink Alcohol\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.57692307692308%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.57692307692308%\"\u003e\n \u003cp\u003e153 (84.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.57692307692308%\"\u003e\n \u003cp\u003e28 (15.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\"\u003e\n \u003cp\u003e\u003cstrong\u003eAlcohol Frequency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.57692307692308%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\"\u003e\n \u003cp\u003eNever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.57692307692308%\"\u003e\n \u003cp\u003e153 (84.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\"\u003e\n \u003cp\u003eDaily-Weekly\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.57692307692308%\"\u003e\n \u003cp\u003e24 (13.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\"\u003e\n \u003cp\u003eOccasionally\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.57692307692308%\"\u003e\n \u003cp\u003e4 (2.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarriage Type\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.57692307692308%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\"\u003e\n \u003cp\u003eUnmarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.57692307692308%\"\u003e\n \u003cp\u003e22 (24.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\"\u003e\n \u003cp\u003eMonogamous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.57692307692308%\"\u003e\n \u003cp\u003e60 (67.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\"\u003e\n \u003cp\u003ePolygamous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.57692307692308%\"\u003e\n \u003cp\u003e7 (7.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMultiple Sex Partners\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.57692307692308%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.57692307692308%\"\u003e\n \u003cp\u003e77 (89.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.57692307692308%\"\u003e\n \u003cp\u003e9 (10.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\"\u003e\n \u003cp\u003e\u003cstrong\u003eEver-Patronized Sex Workers\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.57692307692308%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.57692307692308%\"\u003e\n \u003cp\u003e81 (90.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.57692307692308%\"\u003e\n \u003cp\u003e9 (10.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\"\u003e\n \u003cp\u003e\u003cstrong\u003eEver Shared Sharps\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.57692307692308%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.57692307692308%\"\u003e\n \u003cp\u003e76 (88.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.57692307692308%\"\u003e\n \u003cp\u003e10 (11.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003ePrevalence of Frailty among the Elderly Participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOut of 181 elderly participants screened for frailty, 68 (37.5%), 85 (47.0%), and 28 (15.5%) were identified to be non-frail, pre-frail, and frail respectively (\u003cstrong\u003eFigure 2\u003c/strong\u003e).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFrailty Distribution Stratified by Age Group\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn this study, the percentage of participants who were non-frail decreased with increasing age whereas the proportion of frail participants increased with increasing age \u003cstrong\u003e(Figure 2)\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePrevalence of Frailty among HIV-Positive and HIV-Negative Participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOut of the 104 HIV-negative participants, 38.5%, 49.0%, and 12.5% were non-frail, pre-frail, and frail respectively. Also, among the 77 HIV-positive participants, 36.4%, 44.1%, and 19.5% were non-frail, pre-frail, and frail respectively. Therefore, this study observed a frailty prevalence of 12.5% and 19.5% among HIV-negative and HIV-positive participants respectively \u003cstrong\u003e(\u003c/strong\u003e\u003cstrong\u003eFigure 3). \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSociodemographic Factors associated with Frailty Syndrome among study Participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInvestigation of the association between frailty status and sociodemographic factors such as gender, age, educational level, marital status, occupational status, and place of residence among both HIV-positive and HIV-negative participants observed no significant associations. However, age category (\u003cem\u003ep\u003c/em\u003e=0.049), and occupational status (\u003cem\u003ep\u003c/em\u003e=0.020) of the HIV-negative groups were significantly associated with frailty (\u003cstrong\u003eTable 3\u003c/strong\u003e).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3:\u0026nbsp;\u003c/strong\u003eSociodemographic factors associated with frailty among participants stratified by HIV status \u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv align=\"center\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"786\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.338422391857506%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"31.806615776081426%\" colspan=\"3\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eHIV POSITIVE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.760814249363868%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"33.20610687022901%\" colspan=\"3\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eHIV NEGATIVE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.888040712468193%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.338422391857506%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eVARIABLE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.94147582697201%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eNON FRAIL\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.468193384223918%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003ePRE-FRAIL\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.396946564885496%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eFRAIL\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.760814249363868%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.94147582697201%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eNON FRAIL\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.595419847328245%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003ePRE-FRAIL\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.669211195928753%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eFRAIL\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.888040712468193%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.338422391857506%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.94147582697201%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"12.468193384223918%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"8.396946564885496%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.760814249363868%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.119\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.94147582697201%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"12.595419847328245%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"9.669211195928753%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.888040712468193%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.243\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.338422391857506%\" valign=\"bottom\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.94147582697201%\" valign=\"bottom\"\u003e\n \u003cp\u003e8 (28.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.468193384223918%\" valign=\"bottom\"\u003e\n \u003cp\u003e12 (35.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.396946564885496%\" valign=\"bottom\"\u003e\n \u003cp\u003e9 (60.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.760814249363868%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10.94147582697201%\" valign=\"bottom\"\u003e\n \u003cp\u003e21 (52.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.595419847328245%\" valign=\"bottom\"\u003e\n \u003cp\u003e20 (39.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.669211195928753%\" valign=\"bottom\"\u003e\n \u003cp\u003e8 (61.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.888040712468193%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.338422391857506%\" valign=\"bottom\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.94147582697201%\" valign=\"bottom\"\u003e\n \u003cp\u003e20 (71.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.468193384223918%\" valign=\"bottom\"\u003e\n \u003cp\u003e22 (64.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.396946564885496%\" valign=\"bottom\"\u003e\n \u003cp\u003e6 (40.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.760814249363868%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10.94147582697201%\" valign=\"bottom\"\u003e\n \u003cp\u003e19 (47.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.595419847328245%\" valign=\"bottom\"\u003e\n \u003cp\u003e31 (60.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.669211195928753%\" valign=\"bottom\"\u003e\n \u003cp\u003e5 (38.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.888040712468193%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.338422391857506%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge Category (Years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.94147582697201%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"12.468193384223918%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"8.396946564885496%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.760814249363868%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.235\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.94147582697201%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"12.595419847328245%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"9.669211195928753%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.888040712468193%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.049\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.338422391857506%\" valign=\"bottom\"\u003e\n \u003cp\u003e60-69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.94147582697201%\" valign=\"bottom\"\u003e\n \u003cp\u003e24 (85.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.468193384223918%\" valign=\"bottom\"\u003e\n \u003cp\u003e27 (79.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.396946564885496%\" valign=\"bottom\"\u003e\n \u003cp\u003e13 (86.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.760814249363868%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10.94147582697201%\" valign=\"bottom\"\u003e\n \u003cp\u003e33 (82.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.595419847328245%\" valign=\"bottom\"\u003e\n \u003cp\u003e28 (54.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.669211195928753%\" valign=\"bottom\"\u003e\n \u003cp\u003e7 (53.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.888040712468193%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.338422391857506%\" valign=\"bottom\"\u003e\n \u003cp\u003e70-79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.94147582697201%\" valign=\"bottom\"\u003e\n \u003cp\u003e2 (7.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.468193384223918%\" valign=\"bottom\"\u003e\n \u003cp\u003e7 (20.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.396946564885496%\" valign=\"bottom\"\u003e\n \u003cp\u003e2 (13.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.760814249363868%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10.94147582697201%\" valign=\"bottom\"\u003e\n \u003cp\u003e6 (15.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.595419847328245%\" valign=\"bottom\"\u003e\n \u003cp\u003e19 (37.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.669211195928753%\" valign=\"bottom\"\u003e\n \u003cp\u003e4 (30.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.888040712468193%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.338422391857506%\" valign=\"bottom\"\u003e\n \u003cp\u003e80 and above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.94147582697201%\" valign=\"bottom\"\u003e\n \u003cp\u003e2 (7.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.468193384223918%\" valign=\"bottom\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.396946564885496%\" valign=\"bottom\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.760814249363868%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10.94147582697201%\" valign=\"bottom\"\u003e\n \u003cp\u003e1 (2.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.595419847328245%\" valign=\"bottom\"\u003e\n \u003cp\u003e4 (7.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.669211195928753%\" valign=\"bottom\"\u003e\n \u003cp\u003e2 (15.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.888040712468193%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.338422391857506%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducational Level\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.94147582697201%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"12.468193384223918%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"8.396946564885496%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.760814249363868%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.636\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.94147582697201%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"12.595419847328245%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"9.669211195928753%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.888040712468193%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.425\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.338422391857506%\" valign=\"bottom\"\u003e\n \u003cp\u003eNo formal education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.94147582697201%\" valign=\"bottom\"\u003e\n \u003cp\u003e11 (39.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.468193384223918%\" valign=\"bottom\"\u003e\n \u003cp\u003e9 (26.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.396946564885496%\" valign=\"bottom\"\u003e\n \u003cp\u003e5 (33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.760814249363868%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10.94147582697201%\" valign=\"bottom\"\u003e\n \u003cp\u003e3 (7.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.595419847328245%\" valign=\"bottom\"\u003e\n \u003cp\u003e11 (21.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.669211195928753%\" valign=\"bottom\"\u003e\n \u003cp\u003e4 (30.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.888040712468193%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.338422391857506%\" valign=\"bottom\"\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.94147582697201%\" valign=\"bottom\"\u003e\n \u003cp\u003e10 (35.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.468193384223918%\" valign=\"bottom\"\u003e\n \u003cp\u003e17 (50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.396946564885496%\" valign=\"bottom\"\u003e\n \u003cp\u003e4 (26.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.760814249363868%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10.94147582697201%\" valign=\"bottom\"\u003e\n \u003cp\u003e23 (57.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.595419847328245%\" valign=\"bottom\"\u003e\n \u003cp\u003e25 (49.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.669211195928753%\" valign=\"bottom\"\u003e\n \u003cp\u003e4 (30.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.888040712468193%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.338422391857506%\" valign=\"bottom\"\u003e\n \u003cp\u003eSecondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.94147582697201%\" valign=\"bottom\"\u003e\n \u003cp\u003e6 (21.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.468193384223918%\" valign=\"bottom\"\u003e\n \u003cp\u003e6 (17.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.396946564885496%\" valign=\"bottom\"\u003e\n \u003cp\u003e4 (26.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.760814249363868%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10.94147582697201%\" valign=\"bottom\"\u003e\n \u003cp\u003e5 (12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.595419847328245%\" valign=\"bottom\"\u003e\n \u003cp\u003e6 (11.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.669211195928753%\" valign=\"bottom\"\u003e\n \u003cp\u003e2 (15.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.888040712468193%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.338422391857506%\" valign=\"bottom\"\u003e\n \u003cp\u003eTertiary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.94147582697201%\" valign=\"bottom\"\u003e\n \u003cp\u003e1 (3.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.468193384223918%\" valign=\"bottom\"\u003e\n \u003cp\u003e2 (5.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.396946564885496%\" valign=\"bottom\"\u003e\n \u003cp\u003e2 (13.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.760814249363868%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10.94147582697201%\" valign=\"bottom\"\u003e\n \u003cp\u003e9 (22.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.595419847328245%\" valign=\"bottom\"\u003e\n \u003cp\u003e9 (17.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.669211195928753%\" valign=\"bottom\"\u003e\n \u003cp\u003e3 (23.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.888040712468193%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.338422391857506%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital Status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.94147582697201%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"12.468193384223918%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"8.396946564885496%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.760814249363868%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.338\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.94147582697201%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"12.595419847328245%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"9.669211195928753%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.888040712468193%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.442\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.338422391857506%\" valign=\"bottom\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.94147582697201%\" valign=\"bottom\"\u003e\n \u003cp\u003e8 (28.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.468193384223918%\" valign=\"bottom\"\u003e\n \u003cp\u003e11 (32.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.396946564885496%\" valign=\"bottom\"\u003e\n \u003cp\u003e9 (60.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.760814249363868%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10.94147582697201%\" valign=\"bottom\"\u003e\n \u003cp\u003e26 (65.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.595419847328245%\" valign=\"bottom\"\u003e\n \u003cp\u003e33 (64.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.669211195928753%\" valign=\"bottom\"\u003e\n \u003cp\u003e6 (46.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.888040712468193%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.338422391857506%\" valign=\"bottom\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.94147582697201%\" valign=\"bottom\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.468193384223918%\" valign=\"bottom\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.396946564885496%\" valign=\"bottom\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.760814249363868%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10.94147582697201%\" valign=\"bottom\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.595419847328245%\" valign=\"bottom\"\u003e\n \u003cp\u003e1 (2.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.669211195928753%\" valign=\"bottom\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.888040712468193%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.338422391857506%\" valign=\"bottom\"\u003e\n \u003cp\u003eCohabiting\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.94147582697201%\" valign=\"bottom\"\u003e\n \u003cp\u003e2 (7.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.468193384223918%\" valign=\"bottom\"\u003e\n \u003cp\u003e1 (2.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.396946564885496%\" valign=\"bottom\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.760814249363868%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10.94147582697201%\" valign=\"bottom\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.595419847328245%\" valign=\"bottom\"\u003e\n \u003cp\u003e1 (2.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.669211195928753%\" valign=\"bottom\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.888040712468193%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.338422391857506%\" valign=\"bottom\"\u003e\n \u003cp\u003eDivorced\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.94147582697201%\" valign=\"bottom\"\u003e\n \u003cp\u003e8 (28.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.468193384223918%\" valign=\"bottom\"\u003e\n \u003cp\u003e10 (29.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.396946564885496%\" valign=\"bottom\"\u003e\n \u003cp\u003e1 (6.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.760814249363868%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10.94147582697201%\" valign=\"bottom\"\u003e\n \u003cp\u003e3 (7.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.595419847328245%\" valign=\"bottom\"\u003e\n \u003cp\u003e5 (9.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.669211195928753%\" valign=\"bottom\"\u003e\n \u003cp\u003e4 (30.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.888040712468193%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.338422391857506%\" valign=\"bottom\"\u003e\n \u003cp\u003eWidow/er\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.94147582697201%\" valign=\"bottom\"\u003e\n \u003cp\u003e10 (35.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.468193384223918%\" valign=\"bottom\"\u003e\n \u003cp\u003e12 (35.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.396946564885496%\" valign=\"bottom\"\u003e\n \u003cp\u003e5 (33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.760814249363868%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10.94147582697201%\" valign=\"bottom\"\u003e\n \u003cp\u003e11 (27.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.595419847328245%\" valign=\"bottom\"\u003e\n \u003cp\u003e11 (21.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.669211195928753%\" valign=\"bottom\"\u003e\n \u003cp\u003e3 (23.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.888040712468193%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.338422391857506%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eOccupational Status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.94147582697201%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"12.468193384223918%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"8.396946564885496%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.760814249363868%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.096\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.94147582697201%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"12.595419847328245%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"9.669211195928753%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.888040712468193%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.020\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.338422391857506%\" valign=\"bottom\"\u003e\n \u003cp\u003eFormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.94147582697201%\" valign=\"bottom\"\u003e\n \u003cp\u003e3 (10.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.468193384223918%\" valign=\"bottom\"\u003e\n \u003cp\u003e4 (11.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.396946564885496%\" valign=\"bottom\"\u003e\n \u003cp\u003e5 (33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.760814249363868%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10.94147582697201%\" valign=\"bottom\"\u003e\n \u003cp\u003e7 (17.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.595419847328245%\" valign=\"bottom\"\u003e\n \u003cp\u003e1 (2.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.669211195928753%\" valign=\"bottom\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.888040712468193%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.338422391857506%\" valign=\"bottom\"\u003e\n \u003cp\u003eInformal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.94147582697201%\" valign=\"bottom\"\u003e\n \u003cp\u003e24 (85.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.468193384223918%\" valign=\"bottom\"\u003e\n \u003cp\u003e24 (70.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.396946564885496%\" valign=\"bottom\"\u003e\n \u003cp\u003e8 (53.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.760814249363868%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10.94147582697201%\" valign=\"bottom\"\u003e\n \u003cp\u003e19 (47.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.595419847328245%\" valign=\"bottom\"\u003e\n \u003cp\u003e24 (47.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.669211195928753%\" valign=\"bottom\"\u003e\n \u003cp\u003e4 (30.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.888040712468193%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.338422391857506%\" valign=\"bottom\"\u003e\n \u003cp\u003eUnemployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.94147582697201%\" valign=\"bottom\"\u003e\n \u003cp\u003e1 (3.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.468193384223918%\" valign=\"bottom\"\u003e\n \u003cp\u003e6 (17.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.396946564885496%\" valign=\"bottom\"\u003e\n \u003cp\u003e2 (13.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.760814249363868%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10.94147582697201%\" valign=\"bottom\"\u003e\n \u003cp\u003e14 (35.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.595419847328245%\" valign=\"bottom\"\u003e\n \u003cp\u003e26 (51.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.669211195928753%\" valign=\"bottom\"\u003e\n \u003cp\u003e9 (69.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.888040712468193%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.338422391857506%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003ePlace of Residence\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.94147582697201%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"12.468193384223918%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"8.396946564885496%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.760814249363868%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.371\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.94147582697201%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"12.595419847328245%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"9.669211195928753%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.888040712468193%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.224\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.338422391857506%\" valign=\"bottom\"\u003e\n \u003cp\u003eRural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.94147582697201%\" valign=\"bottom\"\u003e\n \u003cp\u003e14 (50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.468193384223918%\" valign=\"bottom\"\u003e\n \u003cp\u003e22 (64.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.396946564885496%\" valign=\"bottom\"\u003e\n \u003cp\u003e7 (46.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.760814249363868%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10.94147582697201%\" valign=\"bottom\"\u003e\n \u003cp\u003e35 (92.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.595419847328245%\" valign=\"bottom\"\u003e\n \u003cp\u003e40 (80.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.669211195928753%\" valign=\"bottom\"\u003e\n \u003cp\u003e11 (91.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.888040712468193%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.338422391857506%\" valign=\"bottom\"\u003e\n \u003cp\u003eUrban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.94147582697201%\" valign=\"bottom\"\u003e\n \u003cp\u003e14 (50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.468193384223918%\" valign=\"bottom\"\u003e\n \u003cp\u003e12 (35.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.396946564885496%\" valign=\"bottom\"\u003e\n \u003cp\u003e8 (53.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.760814249363868%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10.94147582697201%\" valign=\"bottom\"\u003e\n \u003cp\u003e3 (7.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.595419847328245%\" valign=\"bottom\"\u003e\n \u003cp\u003e10 (20.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.669211195928753%\" valign=\"bottom\"\u003e\n \u003cp\u003e1 (8.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.888040712468193%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e*P\u0026lt;0.05 was considered statistically significant\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLifestyle factors associated with frailty among participants with and without HIV\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAmong HIV-negative participants of this study, \u0026nbsp;there was a significant association between frailty and individuals who ever smoked (\u003cem\u003ep\u003c/em\u003e = 0.029) as well as between frailty and those who had multiple sex partners (\u003cem\u003ep\u003c/em\u003e = 0.031) (Table 4).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4: Lifestyle factors associated with frailty among participants with and without HIV\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"780\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"33.07692307692308%\" colspan=\"3\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eHIV POSITIVE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.461538461538462%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"35.12820512820513%\" colspan=\"3\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eHIV NEGATIVE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.948717948717949%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eVARIABLE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.538461538461538%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eNON FRAIL\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.307692307692308%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003ePRE-FRAIL\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.23076923076923%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eFRAIL\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.461538461538462%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.051282051282051%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eNON FRAIL\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.564102564102564%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003ePRE-FRAIL\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.512820512820513%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eFRAIL\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.948717948717949%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eExercise\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.538461538461538%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"12.307692307692308%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"9.23076923076923%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"8.461538461538462%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.642\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.051282051282051%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"12.564102564102564%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10.512820512820513%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.948717948717949%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.706\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"bottom\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.538461538461538%\" valign=\"bottom\"\u003e\n \u003cp\u003e15 (53.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.307692307692308%\" valign=\"bottom\"\u003e\n \u003cp\u003e18 (52.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.23076923076923%\" valign=\"bottom\"\u003e\n \u003cp\u003e10 (66.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.461538461538462%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"12.051282051282051%\" valign=\"bottom\"\u003e\n \u003cp\u003e22 (55.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.564102564102564%\" valign=\"bottom\"\u003e\n \u003cp\u003e32 (30.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.512820512820513%\" valign=\"bottom\"\u003e\n \u003cp\u003e7 (53.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.948717948717949%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"bottom\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.538461538461538%\" valign=\"bottom\"\u003e\n \u003cp\u003e13 (46.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.307692307692308%\" valign=\"bottom\"\u003e\n \u003cp\u003e16 (47.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.23076923076923%\" valign=\"bottom\"\u003e\n \u003cp\u003e5 (33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.461538461538462%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"12.051282051282051%\" valign=\"bottom\"\u003e\n \u003cp\u003e18 (45.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.564102564102564%\" valign=\"bottom\"\u003e\n \u003cp\u003e19 (37.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.512820512820513%\" valign=\"bottom\"\u003e\n \u003cp\u003e6 (46.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.948717948717949%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eExercise Frequency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.538461538461538%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"12.307692307692308%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"9.23076923076923%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"8.461538461538462%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.394\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.051282051282051%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"12.564102564102564%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10.512820512820513%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.948717948717949%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.87\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"bottom\"\u003e\n \u003cp\u003eNever exercise\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.538461538461538%\" valign=\"bottom\"\u003e\n \u003cp\u003e14 (50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.307692307692308%\" valign=\"bottom\"\u003e\n \u003cp\u003e18 (52.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.23076923076923%\" valign=\"bottom\"\u003e\n \u003cp\u003e10 (66.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.461538461538462%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"12.051282051282051%\" valign=\"bottom\"\u003e\n \u003cp\u003e21 (52.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.564102564102564%\" valign=\"bottom\"\u003e\n \u003cp\u003e32 (62.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.512820512820513%\" valign=\"bottom\"\u003e\n \u003cp\u003e7 (53.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.948717948717949%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"bottom\"\u003e\n \u003cp\u003eDaily\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.538461538461538%\" valign=\"bottom\"\u003e\n \u003cp\u003e11 (39.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.307692307692308%\" valign=\"bottom\"\u003e\n \u003cp\u003e15 (44.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.23076923076923%\" valign=\"bottom\"\u003e\n \u003cp\u003e3 (20.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.461538461538462%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"12.051282051282051%\" valign=\"bottom\"\u003e\n \u003cp\u003e15 (37.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.564102564102564%\" valign=\"bottom\"\u003e\n \u003cp\u003e16 (31.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.512820512820513%\" valign=\"bottom\"\u003e\n \u003cp\u003e5 (38.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.948717948717949%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"bottom\"\u003e\n \u003cp\u003eWeekly\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.538461538461538%\" valign=\"bottom\"\u003e\n \u003cp\u003e3 (10.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.307692307692308%\" valign=\"bottom\"\u003e\n \u003cp\u003e1 (2.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.23076923076923%\" valign=\"bottom\"\u003e\n \u003cp\u003e2 (13.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.461538461538462%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"12.051282051282051%\" valign=\"bottom\"\u003e\n \u003cp\u003e4 (10.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.564102564102564%\" valign=\"bottom\"\u003e\n \u003cp\u003e3 (5.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.512820512820513%\" valign=\"bottom\"\u003e\n \u003cp\u003e1 (7.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.948717948717949%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eSmoking status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.538461538461538%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"12.307692307692308%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"9.23076923076923%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"8.461538461538462%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.452\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.051282051282051%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"12.564102564102564%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10.512820512820513%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.948717948717949%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.029\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"bottom\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.538461538461538%\" valign=\"bottom\"\u003e\n \u003cp\u003e26 (92.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.307692307692308%\" valign=\"bottom\"\u003e\n \u003cp\u003e29 (85.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.23076923076923%\" valign=\"bottom\"\u003e\n \u003cp\u003e12 (80.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.461538461538462%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"12.051282051282051%\" valign=\"bottom\"\u003e\n \u003cp\u003e35 (87.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.564102564102564%\" valign=\"bottom\"\u003e\n \u003cp\u003e49 (100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.512820512820513%\" valign=\"bottom\"\u003e\n \u003cp\u003e11 (84.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.948717948717949%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"bottom\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.538461538461538%\" valign=\"bottom\"\u003e\n \u003cp\u003e2 (7.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.307692307692308%\" valign=\"bottom\"\u003e\n \u003cp\u003e5 (14.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.23076923076923%\" valign=\"bottom\"\u003e\n \u003cp\u003e3 (20.)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.461538461538462%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"12.051282051282051%\" valign=\"bottom\"\u003e\n \u003cp\u003e5 (12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.564102564102564%\" valign=\"bottom\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.512820512820513%\" valign=\"bottom\"\u003e\n \u003cp\u003e2 (15.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.948717948717949%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eEver Drunk Alcohol\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.538461538461538%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"12.307692307692308%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"9.23076923076923%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"8.461538461538462%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.243\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.051282051282051%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"12.564102564102564%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10.512820512820513%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.948717948717949%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.429\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"bottom\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.538461538461538%\" valign=\"bottom\"\u003e\n \u003cp\u003e20 (71.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.307692307692308%\" valign=\"bottom\"\u003e\n \u003cp\u003e23 (67.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.23076923076923%\" valign=\"bottom\"\u003e\n \u003cp\u003e7 (46.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.461538461538462%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"12.051282051282051%\" valign=\"bottom\"\u003e\n \u003cp\u003e27 (67.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.564102564102564%\" valign=\"bottom\"\u003e\n \u003cp\u003e37 (72.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.512820512820513%\" valign=\"bottom\"\u003e\n \u003cp\u003e7 (53.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.948717948717949%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"bottom\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.538461538461538%\" valign=\"bottom\"\u003e\n \u003cp\u003e8 (28.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.307692307692308%\" valign=\"bottom\"\u003e\n \u003cp\u003e11 (32.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.23076923076923%\" valign=\"bottom\"\u003e\n \u003cp\u003e8 (53.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.461538461538462%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"12.051282051282051%\" valign=\"bottom\"\u003e\n \u003cp\u003e13 (32.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.564102564102564%\" valign=\"bottom\"\u003e\n \u003cp\u003e14 (27.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.512820512820513%\" valign=\"bottom\"\u003e\n \u003cp\u003e6 (46.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.948717948717949%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eCurrently, Drink Alcohol\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.538461538461538%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"12.307692307692308%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"9.23076923076923%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"8.461538461538462%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.237\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.051282051282051%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"12.564102564102564%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10.512820512820513%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.948717948717949%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.883\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"bottom\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.538461538461538%\" valign=\"bottom\"\u003e\n \u003cp\u003e24 (85.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.307692307692308%\" valign=\"bottom\"\u003e\n \u003cp\u003e29 (85.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.23076923076923%\" valign=\"bottom\"\u003e\n \u003cp\u003e10 (66.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.461538461538462%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"12.051282051282051%\" valign=\"bottom\"\u003e\n \u003cp\u003e34 (85.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.564102564102564%\" valign=\"bottom\"\u003e\n \u003cp\u003e45 (88.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.512820512820513%\" valign=\"bottom\"\u003e\n \u003cp\u003e11 (84.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.948717948717949%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"bottom\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.538461538461538%\" valign=\"bottom\"\u003e\n \u003cp\u003e4 (14.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.307692307692308%\" valign=\"bottom\"\u003e\n \u003cp\u003e5 (14.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.23076923076923%\" valign=\"bottom\"\u003e\n \u003cp\u003e5 (33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.461538461538462%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"12.051282051282051%\" valign=\"bottom\"\u003e\n \u003cp\u003e6 (15.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.564102564102564%\" valign=\"bottom\"\u003e\n \u003cp\u003e6 (11.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.512820512820513%\" valign=\"bottom\"\u003e\n \u003cp\u003e2 (15.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.948717948717949%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarriage Type\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.538461538461538%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"12.307692307692308%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"9.23076923076923%\" valign=\"bottom\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.461538461538462%\" valign=\"bottom\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.051282051282051%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"12.564102564102564%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10.512820512820513%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.948717948717949%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.686\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"bottom\"\u003e\n \u003cp\u003eUnmarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.538461538461538%\" valign=\"bottom\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.307692307692308%\" valign=\"bottom\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.23076923076923%\" valign=\"bottom\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.461538461538462%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"12.051282051282051%\" valign=\"bottom\"\u003e\n \u003cp\u003e10 (25.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.564102564102564%\" valign=\"bottom\"\u003e\n \u003cp\u003e12 (24.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.512820512820513%\" valign=\"bottom\"\u003e\n \u003cp\u003e5 (41.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.948717948717949%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"bottom\"\u003e\n \u003cp\u003eMonogamous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.538461538461538%\" valign=\"bottom\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.307692307692308%\" valign=\"bottom\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.23076923076923%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"8.461538461538462%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"12.051282051282051%\" valign=\"bottom\"\u003e\n \u003cp\u003e25 (64.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.564102564102564%\" valign=\"bottom\"\u003e\n \u003cp\u003e35 (70.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.512820512820513%\" valign=\"bottom\"\u003e\n \u003cp\u003e6 (50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.948717948717949%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"bottom\"\u003e\n \u003cp\u003ePolygamous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.538461538461538%\" valign=\"bottom\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.307692307692308%\" valign=\"bottom\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.23076923076923%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"8.461538461538462%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"12.051282051282051%\" valign=\"bottom\"\u003e\n \u003cp\u003e4 (10.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.564102564102564%\" valign=\"bottom\"\u003e\n \u003cp\u003e3 (6.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.512820512820513%\" valign=\"bottom\"\u003e\n \u003cp\u003e1 (8.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.948717948717949%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eMultiple-Sex-Partner status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.538461538461538%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"12.307692307692308%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"9.23076923076923%\" valign=\"bottom\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.461538461538462%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"12.051282051282051%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"12.564102564102564%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10.512820512820513%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.948717948717949%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.031\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"bottom\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.538461538461538%\" valign=\"bottom\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.307692307692308%\" valign=\"bottom\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.23076923076923%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"8.461538461538462%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"12.051282051282051%\" valign=\"bottom\"\u003e\n \u003cp\u003e30 (81.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.564102564102564%\" valign=\"bottom\"\u003e\n \u003cp\u003e47 (95.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.512820512820513%\" valign=\"bottom\"\u003e\n \u003cp\u003e12 (100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.948717948717949%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"bottom\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.538461538461538%\" valign=\"bottom\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.307692307692308%\" valign=\"bottom\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.23076923076923%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"8.461538461538462%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"12.051282051282051%\" valign=\"bottom\"\u003e\n \u003cp\u003e7 (18.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.564102564102564%\" valign=\"bottom\"\u003e\n \u003cp\u003e2 (4.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.512820512820513%\" valign=\"bottom\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.948717948717949%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eEver-Patronized Sex Workers\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.538461538461538%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"12.307692307692308%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"9.23076923076923%\" valign=\"bottom\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.461538461538462%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"12.051282051282051%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"12.564102564102564%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10.512820512820513%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.948717948717949%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.733\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"bottom\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.538461538461538%\" valign=\"bottom\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.307692307692308%\" valign=\"bottom\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.23076923076923%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"8.461538461538462%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"12.051282051282051%\" valign=\"bottom\"\u003e\n \u003cp\u003e35 (94.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.564102564102564%\" valign=\"bottom\"\u003e\n \u003cp\u003e46 (95.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.512820512820513%\" valign=\"bottom\"\u003e\n \u003cp\u003e11 (100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.948717948717949%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"bottom\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.538461538461538%\" valign=\"bottom\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.307692307692308%\" valign=\"bottom\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.23076923076923%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"8.461538461538462%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"12.051282051282051%\" valign=\"bottom\"\u003e\n \u003cp\u003e2 (5.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.564102564102564%\" valign=\"bottom\"\u003e\n \u003cp\u003e2 (4.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.512820512820513%\" valign=\"bottom\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.948717948717949%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eEver Shared Sharps\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.538461538461538%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"12.307692307692308%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"9.23076923076923%\" valign=\"bottom\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.461538461538462%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"12.051282051282051%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"12.564102564102564%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10.512820512820513%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.948717948717949%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.433\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"bottom\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.538461538461538%\" valign=\"bottom\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.307692307692308%\" valign=\"bottom\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.23076923076923%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"8.461538461538462%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"12.051282051282051%\" valign=\"bottom\"\u003e\n \u003cp\u003e33 (89.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.564102564102564%\" valign=\"bottom\"\u003e\n \u003cp\u003e43 (87.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.512820512820513%\" valign=\"bottom\"\u003e\n \u003cp\u003e9 (75.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.948717948717949%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"bottom\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.538461538461538%\" valign=\"bottom\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.307692307692308%\" valign=\"bottom\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.23076923076923%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"8.461538461538462%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"12.051282051282051%\" valign=\"bottom\"\u003e\n \u003cp\u003e4 (10.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.564102564102564%\" valign=\"bottom\"\u003e\n \u003cp\u003e6 (12.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.512820512820513%\" valign=\"bottom\"\u003e\n \u003cp\u003e3 (25.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.948717948717949%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe provision of improved healthcare for people living with HIV (PLHIV) has resulted in increased life expectancy together with an increased prevalence of chronic illnesses\u0026nbsp;(10). There is the possibility of increased demands for healthcare needs in the coming years for these individuals. In 2020, about 8.1 million older adults were known to be living with HIV\u0026nbsp;(28). In Sub-Saharan Africa, 14.3%\u0026nbsp;of the adult population living with HIV were 50 years or older\u0026nbsp;(6). The population of PLHIV continues to increase considerably with about 25 million cases in sub-Saharan Africa and a prevalence of about 20 % in several countries\u0026nbsp;(29). Aging with HIV infection comes with several health implications including dementia, diabetes, osteoporosis, some forms of cancer, and frailty\u0026nbsp;(30).\u0026nbsp;This study evaluated the prevalence and factors associated with frailty among older adults with or without HIV infection in two district hospitals in Ghana. With an overall 15.5% (28/181) prevalence of frailty, we observed a 12.5% (13/104) prevalence of frailty among the HIV-negative individuals whereas participants with HIV infection recorded a frailty prevalence of 19.5% (15/77). Occupational status, age, smoking status, and multiple-sex partner status were the sociodemographic and lifestyle factors identified to be possibly associated with frailty among participants without HIV infection.\u003c/p\u003e\n\u003cp\u003eThis study\u0026apos;s overall 15.5% prevalence of frailty syndrome is consistent with a study by\u0026nbsp;(18),\u0026nbsp;where Collard and other\u0026rsquo;s\u0026nbsp;review of twenty-one (21) community-based studies on the epidemiology of frailty in persons aged 65 years and above revealed prevalence of frailty ranging from 4.0% to 17.0%. \u0026nbsp;Similarly, the prevalence of frailty in this study falls within the range of 4.9% to 27.3% as reported by Choi \u003cem\u003eet al\u003c/em\u003e., 2015, in a study that examined articles on the prevalence\u0026nbsp;of frailty using the Fried scale in community-dwelling adults aged 65years and older in Taiwan and Spain\u0026nbsp;(31). Although Santos-Eggimann \u003cem\u003eet al.,\u0026nbsp;\u003c/em\u003ereported a lower\u0026nbsp;frailty\u0026nbsp;prevalence\u0026nbsp;rate of 5.8% in Switzerland while the highest prevalence of 27.3% was recorded in Spain, the overall prevalence of frailty in the survey by Santos-Eggimann \u003cem\u003eet al.\u003c/em\u003e was 17%\u0026nbsp;(32)\u0026nbsp;which is comparable to the overall prevalence of the current study.\u0026nbsp;On the contrary, the current prevalence of 15.5% is inconsistent with that observed previously in the Ghanaian population. Biritwum and his colleagues reported a frailty prevalence of 37.9% among Ghanaians in 2016 using the frailty index\u0026nbsp;(33). This prevalence is higher than what we observed in this current study. \u0026nbsp;The difference in the definition of frailty used by Biritwum et al (2016) and that used in the present study ( frailty index vs frailty phenotype) explains the difference in frailty prevalence obtained by the two studies. A study that assessed the prevalence of frailty among older Indian adults revealed a prevalence of 29.94%\u0026nbsp;(34). This prevalence is higher than that observed in our study. Also, in a study by Khandelwal et al. (2012), 32.3% of older adults over the age of 60 were physically frail\u0026nbsp;(35). The differences in our findings and these studies could be due to variations in frailty assessment scales or tools used, partly due to geographical variations and the general health status of the participants. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMoreover, according to the AGEhIV cohort study, \u0026nbsp;PLHIV had a higher prevalence of frailty than HIV-negative individuals at all ages\u0026nbsp;(36), this observation is similar to that obtained by the present study. In this current study, the prevalence of frailty was higher among older adults living with HIV compared to those without HIV infection. Similarly, in a case-control study in South Africa, PLHIV were more likely to be frail than those without HIV infection with a prevalence of 19.4% against 13.3% accordingly\u0026nbsp;(37). This observation could be attributed to the advancement in the management of HIV infection, which increases the life expectancy of \u0026nbsp; PLHIV but leaves them with chronic illness regardless of the immune response to clear the virus. As a result, the immune system remains activated. Prolonged immune activation and persistently high levels of pro-inflammatory cytokines can cause damage throughout the body and result in frailty\u0026nbsp;(16). In Sub-Saharan Africa, the proportion of elderly people living with HIV is increasing, resulting in an increased prevalence of non-AIDS-related chronic non-communicable conditions\u0026nbsp;(38). Age-related diseases among elderly persons living with HIV infections will almost certainly place a strain on healthcare budgets and resources\u0026nbsp;(37).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn this current study, occupation, age, smoking status, and multiple-sex partner status were the sociodemographic and lifestyle factors associated with frailty among the HIV-negative population. Consistently, previous studies have well-documented smoking as a risk factor for frailty(39, 40), while increased exercise has a protective effect on frailty\u0026nbsp;(41). However, our study found no significant association between exercise and frailty among participants. Disparities in results are most likely due to variations in study design and clinical demographics of patients recruited. Although factors including chronic kidney disease\u0026nbsp;(42), cerebrovascular disease\u0026nbsp;(43), and cardiovascular disease\u0026nbsp;(44)\u0026nbsp;are known risk factors for frailty, the current study did not assess any of these factors. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOne major limitation of this study is the inability to assess the effect of existing chronic diseases on the frailty status of our participants. Again, this study could not determine the CD4\u003csup\u003e+\u0026nbsp;\u003c/sup\u003ecounts of older adults with HIV to evaluate its association with frailty due to lack of funds.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eFrailty is more common among older adults (elderly) with HIV infection than those without HIV infection, with approximately 2 out of 10 of the older adults with HIV being frail. Occupation, age, smoking status, and not having multiple sex partners have been identified to be associated with frailty among older adults who do not have HIV infection.\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted by the Declaration of Helsinki, and approved by the Ethics Committee of Kwame Nkrumah University of Science and Technology (ref: CHRPE/AP/626/19). The Management Team of St. Elizabeth Hospital, Hwidiem also approved the protocol for the study\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analyzed during this study are included in this article and can be requested from the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that there are no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study did not receive funding from private, government, or not-for-profit organizations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors are grateful to, Alfred Effah, Samuel K. Boakye-Boateng, Bernice Kumih-Achiaw, Felix \u0026nbsp;Gadzeto, Evans O. Agyapong, Ivan Muanah, Bright Attah-Mensah, Anthony Appiah, Kwasi-Tutu Ali, Oscar Olympio, the study participants, the management and staff of St. Elizabeth Catholic Hospital, Hwidiem, and Holy Family Hospital, Techiman for their contributions in diverse ways towards the successful conduct of the study.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eUNAIDS. The GAP Report. 2014.\u003c/li\u003e\n\u003cli\u003eKhan HT. Population ageing in a globalized world: Risks and dilemmas? Journal of evaluation in clinical practice. 2019;25(5):754-60.\u003c/li\u003e\n\u003cli\u003eGSS GSS. The Elderly in Ghana. 2010 Population \u0026amp; Housing Census Report. . Accra: Ghana Statistical Service; 2013.\u003c/li\u003e\n\u003cli\u003eKnoema. Ghana - Population ages 65 years and above as a share of total population 2022 [Available from: https://knoema.com.\u003c/li\u003e\n\u003cli\u003eMahy M, Autenrieth CS, Stanecki K, Wynd S. 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Screening for frailty phenotype with objectively-measured physical activity in a west Japanese suburban community: evidence from the Sasaguri Genkimon Study. BMC geriatrics. 2015;15(1):36.\u003c/li\u003e\n\u003cli\u003eLongev LH. Ageing with HIV. The Lancet Healthy Longevity\u003c/li\u003e\n\u003cli\u003e;3(3):E119.\u003c/li\u003e\n\u003cli\u003eSiedner MJ. Aging, health, and quality of life for older people living with HIV in Sub-Saharan Africa: a review and proposed conceptual framework. Journal of aging\u003c/li\u003e\n\u003cli\u003ehealth. 2019;31(1):109-38.\u003c/li\u003e\n\u003cli\u003eAhmed MH, Ahmed F, Abu-Median A-B, Panourgia M, Owles H, Ochieng B, et al. HIV and an ageing population\u0026mdash;what are the medical, psychosocial, and palliative care challenges in healthcare provisions. Microorganisms. 2023;11(10):2426.\u003c/li\u003e\n\u003cli\u003eChoi J, Ahn A, Kim S, Won CW. 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The Journals of Gerontology Series A: Biological Sciences Medical Sciences. 2001;56(3):M158-M66.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Frailty, elderly, older adults, older adults with HIV","lastPublishedDoi":"10.21203/rs.3.rs-4643949/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4643949/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePhysical frailty remains an important health challenge associated with aging. HIV infection may influence the development of physical frailty. This may lead to persons living with HIV experiencing adverse health outcomes that result from physical frailty at earlier ages as compared to persons who are HIV-negative. There is inadequate knowledge of frailty among Ghanaians especially in persons living with HIV. This study sought to investigate the prevalence and factors associated with frailty among elderly persons (older adults) with or without HIV infection in Ghana.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethodology\u003c/strong\u003e: This case-control study was conducted from January 2020 to December 2020. A total of 181 elderly persons were recruited for this study. Sociodemographic and lifestyle data were obtained with a structured questionnaire. Blood samples were obtained to determine the HIV status of individuals whose HIV status was unknown for exclusion purposes. Frailty was assessed by the Frailty Phenotype Tool. Statistical values with \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.05 were considered statistically significant.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOut of the 181 participants, 42.5% (n = 77) were known HIV-positive individuals on antiretroviral therapy whereas 57.5% of participants in this study were HIV-negative. While the overall prevalence of frailty was 15.5% (n = 28), the prevalence of frailty among HIV-negative adults was 12.5% (n = 13) and that recorded among HIV-positive elderly persons was 19.5% (n = 15). Occupation (\u003cem\u003ep\u003c/em\u003e = 0.020), age (\u003cem\u003ep\u003c/em\u003e = 0.049), smoking status (\u003cem\u003ep\u003c/em\u003e = 0.029\u003cstrong\u003e)\u003c/strong\u003e, and not having multiple sex partners (\u003cem\u003ep\u003c/em\u003e = 0.031) were associated with frailty among HIV-negative older adults. \u003cstrong\u003eConclusion\u003c/strong\u003e: Frailty is more common among elderly persons with HIV infection than those without HIV infection, with nearly 2 out of 10 elderly HIV-infected persons being frail. No significant association was observed between frailty status and sociodemographics and lifestyle characteristics among the HIV-positive participants. We conclude that frailty is common among Ghanaian older adults and it is a bigger problem in elderly persons living with HIV infection.\u003c/p\u003e","manuscriptTitle":"Aging and Frailty; the case of HIV-positive and HIV-negative individuals in Ghana: A case-control study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-24 13:18:18","doi":"10.21203/rs.3.rs-4643949/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9d1342e7-cf22-4fba-aede-1f6ba8250850","owner":[],"postedDate":"July 24th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-06-24T11:53:46+00:00","versionOfRecord":[],"versionCreatedAt":"2024-07-24 13:18:18","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4643949","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4643949","identity":"rs-4643949","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}