To examine the association between structural factors and variations in HIV prevalence at the community level in a rural South African setting. Cross-sectional associations of individual and community level factors with community level HIV prevalence data. Randomly selected 14-35 year olds from 24 village subsections provided individual socio-demographic, mobility, sexual behaviour and HIV data. Structural variables were constructed from composites of these data, a second survey of adult women, and a community profiling exercise. For males and females separately, logistic regression was used to explore associations between structural factors and HIV prevalence, adjusting for individual age and sexual behaviour. Survey data from 2488 14-35 year olds and 825 poorer women were included in the analysis. HIV data came from 2373 14-35 year olds. HIV prevalence was 10.8% overall, ranging from 1.3% to 46.2% in 24 village subsections. Individual risk factors for HIV included older age for both sexes, sex before age 16 for males, and higher lifetime
numbers of partners for females. At a community level, easier access to the main town, higher proportions of short term residents, and lower levels of social capital were significantly associated with higher HIV prevalence in both sexes. Among males only,
higher HIV prevalence was significantly associated with easier access to a local mine, higher density and activity of local bars, higher numbers of sex workers per village, and lower proportions of out-migrants. Structural factors interact to shape risk-environments for HIV and are strongly associated with variations in prevalence at the community level. Interventions that address local structural factors are an important adjunct to existing prevention efforts.