'Behind walls': a study of HIV risk behaviours and seroprevalence in prisons in Zambia.

Inmate populations include a large number of individuals at risk of HIV infection. However, there is insufficient data about HIV/AIDS epidemiology in prisons. Our study, conducted in Zambia, a sub-Saharan African nation with an estimated HIV prevalence of 19% in adults, was designed to address this shortfall.

Micronutrient supplementation in the AIDS diarrhoea-wasting syndrome in Zambia: a randomized controlled trial.

OBJECTIVE: As HIV has spread through sub-Saharan Africa, persistent diarrhoea has emerged as a major problem in hospitals and in the community in severely affected areas. We have previously demonstrated that antiprotozoal therapy with albendazole reduces diarrhoea in AIDS patients in urban Zambia. This trial was designed to test the hypothesis that the clinical response to albendazole might be improved by oral micronutrient supplementation. DESIGN: Randomized, placebo-controlled trial. SETTING: Home care service of Ndola Central Hospital, Zambia. PATIENTS: HIV-seropositive patients with persistent diarrhoea. INTERVENTION: Patients were randomized to albendazole plus vitamins A, C and E, selenium and zinc orally or albendazole plus placebo, for 2 weeks. MAIN OUTCOME MEASURES: Time with diarrhoea following completion of treatment; mortality; adverse events. RESULTS: Serum vitamin A and E concentrations before treatment were powerful predictors of early mortality, but supplementation did not reduce time with diarrhoea or mortality during the first month, even after taking into account initial vitamin A or E concentrations, CD4 cell count or clinical markers of illness severity. Serum concentrations of vitamins A and E did not increase significantly in supplemented patients compared with those given placebo, and there were no changes in CD4 cell count or haematological parameters. No adverse events were detected except those attributable to underlying disease. CONCLUSIONS: Although micronutrient deficiency is predictive of early death in Zambian patients with the diarrhoea-wasting syndrome, short-term oral supplementation does not overcome it nor influence morbidity or mortality.

The HIV epidemic in Zambia: socio-demographic prevalence patterns and indications of trends among childbearing women.

OBJECTIVE: To examine socio-demographic HIV prevalence patterns and trends among childbearing women in Zambia. DESIGN: Repeated cross-sectional surveys. METHODS: Personal interviews and unlinked anonymous testing of blood samples of women attending antenatal care in selected areas. RESULTS: The 1994 data includes information from 27 areas and a total of 11,517 women. The HIV prevalence among urban residents appeared with moderate variation at a very high level (range 25-32%, comparing provinces). The geographical variation was more prominent in rural populations (range 8-16%) and was approximately half the prevalence level of the urban populations. With the exception of the 15-19 years age-group, HIV infection was found to rise sharply with increasing educational attainment (odds ratio, 3.1; confidence interval, 2.6-3.8) when contrasting extreme educational levels. Although the assessment of trends is somewhat restricted, the available information indicates stable prevalence levels in most populations over the last 2-4 years. CONCLUSIONS: The data showed extremely high HIV prevalence levels among childbearing women. Longer time-intervals between surveys are needed, however, in order to verify the stability in prevalence identified by this study. The tendency to changing differentials by social status is suggested as a possible sign of an ongoing process of significant behavioural change.

PIP: A series of cross-sectional surveys conducted in Zambia revealed extremely high HIV prevalence among childbearing women. The analysis was based on data derived from an HIV sentinel surveillance system established among childbearing-age women in Zambia in 1990 and expanded in 1994 to improve geographic coverage and obtain data on socio-demographic characteristics. In 1994, when complete data on HIV status was obtained on 11,517 women from 27 areas, overall HIV prevalence was 19.8%. This rate ranged from 22% to 35% in Lusaka and provincial headquarters, from 25% to 32% in urban areas, and from 8% to 16% in rural areas. In both urban and rural areas, HIV prevalence was highest in the 25-29 year age group (34% and 17%, respectively). With the exception of the 15-19 year group, seroprevalence also rose significantly with increasing educational attainment; the odds ratio was 3.13 for the most educated compared to the least educated women. The lack of HIV prevalence socioeconomic differentials among 15-19 year olds, who became sexually active at a time when information about AIDS prevention was available, may be indicative of a process of behavioral change. Only 1 area (Kalabo) showed a trend of increase in the past 2-3 years; in other areas, HIV infection rates appear to have stabilized.