HIV risk factors in three geographic strata of rural Rakai District; Uganda

ABSTRACT

OBJECTIVES: To examine risk factors for HIV-1 infection in three geographic strata (main road trading centers that service local and international traffic; small trading villages on secondary dirt roads that serve as foci for local communications; and agricultural villages off main and secondary roads) in Rakai District; Uganda. DESIGN AND METHODS: Serological; sociodemographic; knowledge/behaviors and health survey conducted in 21 randomly selected community clusters; complete data were collected for 1292 consenting adults. RESULTS: Fifteen per cent of the men and 24pc of the women were HIV-1-positive. On univariate analysis; several sociodemographic and behavioral factors were significantly associated with risk of HIV infection; including age; place of residence; travel; occupation; marital status; number of sex partners; sex for money or gifts; history of sexually transmitted disease (STD); and history of injections. On multivariate analysis; age; residence and number of sex partners remained significantly associated with HIV infection in both sexes; a history of STD and not having been circumcised were significant in men. There was a significant interaction between place of residence and reported number of sex partners for any given level of sexual activity; the risk of HIV infection was markedly increased if the background community prevalence was high. CONCLUSION: Sexual transmission appears to be the primary behavioral risk factor for infection; but the risks associated with this factor vary substantially between the three geographic strata. These data can be used to design targeted interventions: