Population-based study of fertility in women with HIV-1 infection in Uganda

To assess the effects of HIV-1 and other sexually transmitted infections on pregnancy; we undertook cross-sectional and prospective studies of a rural population in Rakai district; Uganda. Methods: 4813 sexually active women aged 15-49 years were surveyed to find out the prevalence of pregnancy by interview and selective urinary human chorionic gonadotropin tests. The incidence of recognised conception and frequency of pregnancy loss were assessed by follow-up. Samples were taken to test for HIV-1 infection; syphilis; and other sexually transmitted diseases. Findings: At time of survey 757(21.4) of 3544 women without HIV-1 infection or syphilis were pregnant; compared with 46 (14.6) or 316 HIV-1 negative women with active syphilis; 117 (14.2) or 823 HIV-1 positive women with no concurrent syphilis; and 11(8.5) of 130 women with both syphilis and HIV-1 infected women was 0.45 (95CI0.35-0.57); the odds of pregnancy were low both in HIV-1-infected women without symptoms (0.49 [0.39-0.62]) and in women with symptoms of HIV-1-associated and syphilis the odds of pregnancy were low both in HIV-1-infected women without symptoms (0.49[0.39-0.62] and in women with symptoms of HIV-1-associated disease (0.23[0.11-0.48]). In women with concurrent HIV-1 infection and syphilis the odds ratio was 0.28(0.14-0.55). The incidence rate recognised pregnancy during the prospective follow-up study was lower in HIV-1 positive than in HIV-1 negative women (23.5 vs 30. 1 per 100 woman-years; adjusted risk ration 0.73[0.57-0.93]). Rates of pregnancy loss were higher among HIV-1-infected than uninfected women (18.5 vs 12.2; odds ratio 1.50 [1.01-2.27]). The prevalence of HIV-1 infection was significantly lower in pregnant than in non-pregnant women (13.9 vs 21. 3). Interpretation: Pregnancy prevalence is greatly reduced in HIV-1-infected women; owing to lower rates of conception and increased rates of pregnancy loss. HIV-1 surveillance confined to pregnant women underestimates the magnitude of the HIV-1 epidemic in the general population

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

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