Incidence of HIV-1 infection in a rural region of Uganda.

OBJECTIVE: To determine the incidence of infection with HIV-1 and the risk factors associated with seroconversion in three geographical strata of a rural Ugandan district. DESIGN: Serological, sociodemographic, and behavioural surveys of everyone aged 13 or more in 21 randomly selected communities at baseline and one year later. SETTING: Rural population of Rakai district, southwestern Uganda, residing in main road trading centres, secondary trading villages, and agricultural villages. SUBJECTS: In 1989, 1292 adults provided a blood sample and interview data; one year later, 778 survivors (77%) who had been seronegative at baseline provided follow up data. MAIN OUTCOME MEASURES: Incidence of HIV infection in relation to individual characteristics and risk factors, including place of residence. RESULTS: Incidence of HIV infection in all adults was 2.1/100 person years of observation (SE 0.5 (95% confidence interval 1.1 to 3.1)); in people aged 15-39 the incidence was 3.2/100 person years. Incidence was highest in men and women aged 20-24 (9.2/100 person years (3.9) and 6.8/100 person years (2.9) respectively). Risk factors significantly associated with seroconversion were age 24 and under and two or more sexual partners. Between the surveys the proportion of all respondents reporting high risk behaviour (two or more partners) significantly increased from 8.9% to 12.3%. CONCLUSIONS: Despite preventive programmes and substantial knowledge about AIDS the incidence of HIV infection remains high in this rural population. Prevention aimed at vulnerable rural communities is urgently needed to contain the HIV epidemic.

PIP: In 1990, researchers followed up on as many of the 1292 adults they surveyed in 1989 as they who lived in rural Rakai district in southwestern Uganda to determine HIV-1 incidence and the risk factors associated with seroconversion. They were only able to follow up on 774 of the 1037 adults who were HIV-1 seronegative in 1989. In 1989, knowledge about AIDS and about sexual intercourse as a mode of HIV transmission was high (94% and 86%, respectively). The 1989 HIV-1 seroprevalence rate ranged from 38.5% in trading centers to 8.6% in agricultural villages off main and secondary roads. 21 (2.7%) had seroconverted (incidence = 2.1/100 person years). Since the researchers oversampled in trading centers, they estimated the weighted seroincidence to be 1.9%. HIV-1 seroconversion peaked in the 20-24 year old age group with it being greater in men than in women (9.2% vs. 6.8%). The most significant risk factor for seroconversion was number of sexual partners (8.3% for 2 or more partners vs. 2.5% for 0-1 partners; rate ratio = 3.4; p .01 for trend). The risk of seroconversion for someone with just 1 sexual partner was high (2.8%), reflecting the high HIV-1 seroprevalence in Rakai district. The percentage of subjects with at least 2 sexual partners rose from 8.9% in 1989 to 12.3% in 1990. Seroconversion was not associated with injections. No one had had a blood transfusion. Attendance at a 1989 AIDS education rally did not affect HIV seroconversion. In fact, it was greater among people attending the rally (3.5% vs. 2.1%). Logistic regression revealed that age and numbers of partners were the only significant factors affecting seroconversion (odds ration [OR] for 15-24 years compared to 25-39 years was 3.9 and OR for 2 or more sexual partners was 6.5). These findings indicated that existing HIV/AIDS education programs do not reduce HIV transmission and that better strategies are needed.

Focus group interviews about AIDS in Rakai District of Uganda.

Focus group interviews about AIDS were held in Rakai district, Uganda during early 1990 with groups from various sections of the community. It was found that the knowledge of AIDS symptoms and its transmission were widespread. Attitudes regarding many aspects of sexual behavior, AIDS patients, condoms, injections, hospital treatment, sexually transmitted diseases and an AIDS cure were investigated. We found that most people no longer fear casual contact with AIDS patients but they blame spouses of people with AIDS for spreading the infection. Condoms are generally not trusted. Many people feel that condoms cannot prevent transmission of the AIDS virus and some fear that they may get torn and cause complications in women. Most people now do not like injections for treatment and when necessary, prefer disposable needles and syringes. Hospital treatment for AIDS patients is not trusted very much, and many people believe that AIDS patients are intentionally killed off by doctors. Sexual behavior was extensively discussed and it was found that there is generally a reduced level of multiple sexual partners. The reduction is more marked in rural areas but the urban areas are still having higher levels of multiple sexual partners.

Dynamics of spread of HIV-I infection in a rural district of Uganda.

OBJECTIVE: To define the geographical distribution of HIV infection and the community characteristics associated with HIV prevalence in a rural population of Uganda. DESIGN: Seroprevalence survey and interviews of the population aged 13 years and older in 21 randomly selected clusters. SETTING: Rural population of Rakai district, south west Uganda. SUBJECTS: 1292 adults, of whom 594 men and 698 women gave a blood sample and answered the questionnaire. MAIN OUTCOME MEASURES: HIV status determined by ELISA and western blotting in relation to community characteristics. RESULTS: The weighted seroprevalence of HIV for the district was 12.6% with prevalence by cluster varying from 1.2% to 52.8%. Seroprevalence was highest in main road trading centres (men 26%, women 47%), intermediate in rural trading villages on secondary roads (men 22%, women 29%), and lowest in rural agricultural villages (men 8%, women 9%). For both men and women, multiple regression showed a strong negative association between cluster seroprevalence and the proportion of the population employed in agriculture (beta = -0.677 for men, -0.807 for women). Among women, cluster seroprevalence increased with a higher proportion of the population reporting multiple sex partners (beta = 0.814), external travel (beta = 0.579), and injections (beta = 0.483). CONCLUSIONS: Community characteristics, particularly the proportion of the population in agriculture, are associated with HIV prevalence and can be used for targeting interventions. The seroprevalences of HIV suggest spread of infection from main road trading centres, through intermediate trading villages, to rural agricultural villages.