Published in PLOS One on 2026-04-24, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Enyew Getaneh Mekonen
Source: PLOS One • DOI 10.1371/journal.pone.0347752
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
Anemia affects over 30% of women of reproductive age globally, with the highest burden in low‑ and middle‑income countries, and it poses additional risks for women living with human immunodeficiency virus (HIV), including disease progression and reduced survival. Although previous studies report prevalence among HIV‑positive women ranging from 37.8% to 55.8%, most evidence comes from hospital‑based or high‑income settings, leaving a gap in population‑level data. Addressing this gap is critical, as women in low- and middle-income countries (LMICs) often face overlapping vulnerabilities such as nutritional deficiencies, limited healthcare access, and high HIV burden. Using nationally representative Demographic and Health Surveys, this study aims to estimate anemia prevalence and identify associated factors among HIV‑positive women to inform targeted interventions and integrated management strategies.
A cross‑sectional study was conducted using Demographic and Health Survey data collected between 2022 and 2024 from nine countries in sub-Saharan Africa and Asia, including 1,446 HIV‑positive women aged 15–49 years. Hemoglobin concentration was used to classify anemia based on World Health Organization (WHO) thresholds. Individual and community‑level factors were examined, and weighted data were analyzed using multilevel logistic regression to account for clustering. Associations were reported as adjusted odds ratios with 95% confidence intervals.
Among HIV‑positive women in Africa and Asia, the prevalence of anemia was 50.62% (95% confidence interval (CI): 48.04–53.20%), with 19.29% classified as mild, 26.28% as moderate, and 5.05% as severe. Prevalence varied widely across countries, ranging from 71.43% in Mali to 12.00% in Tajikistan. Educational status [adjusted odds ration (AOR) = 0.43; 95% CI: 0.22–0.81], media exposure [AOR = 0.41; 95% CI: 0.19–0.87], contraceptive use [AOR = 2.37; 95% CI: 1.35–4.17], and iron supplementation during pregnancy [AOR = 2.17; 95% CI: 1.04–4.55] were significantly associated with anemia.
Anemia remains a major public health concern among HIV‑positive women, driven by reproductive, nutritional, and socio‑behavioral factors. Strengthening antenatal and HIV care programs, integrating family planning services, and promoting adherence to iron supplementation are critical strategies to reduce anemia risk. Tailored health communication and nutritional interventions, alongside future longitudinal studies, are essential to establish causal pathways and inform targeted interventions.
1. Introduction
Anemia remains a major public health concern globally, affecting over 30% of women of reproductive age, with the highest burden observed in low- and middle-income countries (LMICs) [1]. It is linked to increased morbidity and all-cause mortality, decreased economic productivity, and diminished cognitive and physical abilities [2–4]. Anemia during pregnancy has been proposed as a potential marker of increased risk of major hemorrhage and a risk factor for maternal death [5,6]. Maternal iron deficiency can result in unfavorable pregnancy and neonatal outcomes, such as stillbirth, low birth weight, and infant mortality [7,8].
Reading this evidence
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This briefing makes the source accessible within the wider public health desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2026 Enyew Getaneh Mekonen. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
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