HIV-1 and HIV-2 prevalence and associated risk factors among postnatal women in Harare, Zimbabwe.

Studies of antenatal women form the predominant source of data on HIV-1 prevalence in Africa. Identifying factors associated with prevalent HIV is important in targeting diagnostic services and care. Between November 1997 and January 2000, 14,110 postnatal women from Harare, Zimbabwe were tested by ELISAs reactive to both HIV-1 and HIV-2; a subset of positive samples was confirmed with assays specific for HIV-1 and HIV-2. Baseline characteristics were elicited and modelled to identify risk factors for prevalent HIV infection. HIV-1 and HIV-2 prevalences were 32.0% (95% CI 31.2-32.8) and 1.3% (95% CI 1.1-1.5), respectively; 4% of HIV-1-positive and 99% of HIV-2-positive women were co-infected. HIV-1 prevalence increased from 0% among 14-year-olds to >45% among women aged 29-31 years, then fell to <20% among those aged>40 years. In multivariate analyses, prevalence increased with parity, was lower in married women than in single women, divorcees and widows, and higher in women with the lowest incomes and those professing no religion. Adjusted HIV-1 prevalence increased during 1998 and decreased during 1999. Age modified the effects of parity, home ownership and parental education. Among older women, prevalence was greater for women who were not homeowners. Among younger women, prevalence increased with parity and low parental education. None of these factors distinguished women co-infected with HIV-2 from those infected with HIV-1 alone. Prevalent HIV-1 infection is associated with financial insecurity and weak psychosocial support. The ZVITAMBO study apparently spanned the peak of the HIV-1 epidemic among reproductive women in Harare.

Supplementing lactating women with puréed papaya and grated carrots improved vitamin A status in a placebo-controlled trial.

Doubts have been raised about the effectiveness of carotene-containing foods in improving the vitamin A status of populations at risk. We investigated the effect of papaya and carrots on the vitamin A status of lactating women with 2- to 12-mo-old infants in ZIMBABWE: The women were randomly assigned to three supplementation groups and a placebo group, and received 6 mg of beta-carotene capsules, 650 g puréed papaya, 100 g grated carrots or a placebo, daily for 60 d. All groups were given a meal containing 10 g of vegetable oil daily. Serum retinol, relative dose response, serum ferritin, hemoglobin and C-reactive protein were measured before and after the supplementation period. Mean serum retinol increased significantly after supplementation in the beta-carotene group (P < 0.001), the papaya group (P < 0.001) and the carrot group (P < 0.001), but not in the placebo group (P > 0.05). The relative dose response decreased significantly (P < 0.05) in the beta-carotene and papaya groups, but not in the carrot or placebo groups (P > 0.05). There was an increase in mean serum ferritin in all groups but the increase did not differ among groups. The hemoglobin increases in the beta-carotene and papaya groups were greater than that in the placebo group. We conclude that puréed papaya and grated carrots can improve the vitamin A and iron nutriture of lactating women. These findings reinforce the importance of plant food-based approaches in the control of vitamin A deficiency in low income countries.