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

BMJ 1994;308:171-173 (15 January)

Papers

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

M J Wawer, N K Sewankambo, S Berkley, D Serwadda, S D Musgrave, H R Gray, M Musagara, Y R Stallings, K J Konde-Lule

Center for Population and Family Health, Columbia University School of Public Health, 60 Haven Avenue, New York, NY 10032, USA Department of Medicine and Institute of Public Health, Makere University, Kampala, Uganda Health Sciences Division, Rockefeller Foundation, New York Rakai Project - Columbia University Office, Uganda Virus Research Institute, Entebbe, Uganda Departments of Population Dynamics and International Health, Johns Hopkins University School of Public Health, Baltimore, Maryland, USA Correspondence to: Dr Wawer.

Abstract

Objective : To determine the incidence of infection with HIV-1and the risk factors associated with seroconversion in threegeographical strata of a rural Ugandan district.
Design : Serological, sociodemographic, and behavioural surveysof everyone aged 13 or more in 21 randomly selected communitiesat baseline and 20 one year later.
Setting : Rural population of Rakai district, south-westernUganda, residing in main road trading centres, secondary tradingvillages, and agricultural villages.
Subjects : In 1989, 1292 adults provided a blood sample andinterview data; one year later, 778 survivors (77%) who hadbeen seronegative at baseline provided follow up data.
Main outcome measures : Incidence of HIV infection in relationto individual characteristics and risk factors, including placeof residence.
Results : Incidence of HIV infection in all adults was 2.1/100person years of observation (SE 0.5 (95% confidence interval1.1 to 3.1)); in people aged 15-39 the incidence was 3.2/100person 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 wereage 24 and under and two or more sexual partners. Between thesurveys the proportion of all respondents reporting high riskbehaviour (two or more partners) significantly increased from8.9% to 12.3%.
Conclusions : Despite preventive programmes and substantialknowledge about AIDS the incidence of HIV infection remainshigh in this rural population. Prevention aimed at vulnerablerural communities is urgently needed to contain the HIV epidemic.

Public health implications

Public health implications
An AIDS control programme was established in Uganda in 1989 in response to high rates of HIV infection
In 1990 most subjects in Rakai district had attended an AIDS rally in the past year and were aware of the risk factors for HIV infection
The proportion of subjects having two or more sexual partners in the past year increased from 8.9% in 1989 to 12.3% in 1990
The incidence of HIV infection was 2.1/100 person years
The control programme has so far not reduced transmission of HIV in Rakai. More priority should be given to educating people in rural areas

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HIV infection in Uganda: G Bantebya and E Konings
BMJ 1994 308: 789. [Extract] [Full Text]

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