HIV infection among STD patients--Kigali, Rwanda, 1988 to 1991.

To follow the progression of HIV seropositivity among heterosexual adults at risk for HIV infection in the country of Rwanda prospectively, up to 100 patients with sexually transmitted diseases (STD) were tested each month from 1988 to 1991 at the health centre of Biryogo, which is located in a very crowded sector of the capital city, Kigali. Each patient had a blood sample tested anonymously for the presence of HIV antibodies. HIV seropositivity was defined as a reactive ELISA test combined to a reactive Western blot test. The overall HIV seropositivity among the 2058 subjects tested was 61%. It was higher (73%) among the 688 women tested as compared to the 1362 men tested (55%; P < 0.001). The per cent HIV seropositivity did not increase between 1988 and 1991, neither among the male nor among the female clinic attenders. However, the per cent seropositivity was higher in the older age groups, especially among the males. This exceedingly high proportion of HIV-infected STD patients in Kigali re-emphasizes the urgent need to include STD treatment, prevention and control among the priority actions for decreasing HIV transmission in African towns. Also, as the per cent seropositivities did not show any trend to increase over the 4-year period considered, we propose that our intensive HIV serosurveillance strategy among STD patients in Kigali be modified, since the plateau of HIV infection appears to have been attained in this particular high-risk population.

Estimating the seroincidence of HIV-1 in the general adult population in Kigali, Rwanda.

OBJECTIVE: To estimate the seroincidence of HIV-1 infection in the general adult population of Kigali, Rwanda. DESIGN: Repeated standardized cross-sectional studies. SETTING: Two urban prenatal clinics. PATIENTS: A total of 4486 consecutive pregnant women consulting in 1989 and 1990. MAIN OUTCOME MEASURES: Prevalence of HIV-1 antibodies. RESULTS: HIV seropositivity increased by 3-5% annually over this period, indicating that it has not reached a plateau in this sentinel population. The percentage infection rates, calculated using two complementary methods, were 26.2-30.7% in 1990. Extrapolating these results to the general population of Kigali, we estimate that 2300-3800 new infections in young women and 3600-6100 new infections in young men occur annually among the total population of 350,000 in Kigali. CONCLUSIONS: A new HIV infection occurred in an adult every 50-90 min, on average, in Kigali during 1989-1990, while every 6-7 h a baby with maternally acquired HIV infection was born. Our HIV surveillance system, which is based on prenatal sentinel posts, is a useful tool for monitoring the progression of the HIV epidemic in Kigali.

PIP: This study aimed to estimate the seroincidence of HIV-1 infection in the general adult population of Kigali, Rwanda, by examining a total of 4486 consecutive pregnant women consulting in 1989 and 1990 at 2 urban prenatal clinics. Via repeated standardized cross-sectional studies the authors aimed to measure prevalence of HIV-1 antibodies. HIV seropositivity increased by 3-5% annually over this sentinel population. The percentage infection rates, calculated using 2 complementary methods, were 26.2-30.7 in 1990. Extrapolating these results to the general population of Kigali, the authors estimate that 2300-3800 new infections in young women and 3600-6100 infections in young men occur annually among the total population of 350,000 in Kigali. A new HIV infection occurred in an adult every 50 through 90 minutes, on average, in Kigali, during 1989 and 1990, while every 6 to 7 hours a baby with maternally acquired HIV infection was born. This HIV surveillance system, which is based on prenatal sentinel posts, is a useful tool for monitoring the progression of the HIV epidemic in Kigali.