The epidemiology of HIV-1 infection in northern Tanzania: results from a community-based study.

We conducted a community-based study to determine the predictors of HIV-1 among women aged 20-44 years (N = 1,418) and their regular male partners (N = 566) from randomly selected households in Moshi, Tanzania. The weighted prevalence of HIV-1 was 10.3% in women and 7% in men. The highest risk of HIV-1 was in subjects whose partners were HIV-1 seropositive in both women (adjusted odds ratio (AOR) = 26.63; 95% confidence interval (CI): 10.74-66.02) and men (AOR = 22.25; 95%CI: 7.06-70.15). Herpes simplex virus type 2 (HSV-2) and Mycoplasma genitalium were also significantly associated with HIV-1. Women with male partners >or=12 years older than themselves had increased risk of HIV-1 (AOR = 1.99; 95%CI: 1.01-7.85). Other predictors of HIV-1 were history of infertility and the number of sex partners in the last three years in women and the age at time of circumcision and history of past sexually transmitted diseases (STDs) in male partners. These findings show that HIV-1/STDs were major public health problems among women and their long-term partners in this population. HIV-1 prevention efforts should include promotion of couple's HIV-1 counseling and testing services, control of HSV-2, promotion of safer sexual practices and strategies to reduce the age difference between women and their partners.

Infertility in a community and clinic-based sample of couples in Moshi, Northern Tanzania.

BACKGROUND: Previous research on the aetiology of infertility in sub-Saharan Africa was generally clinic based and it is not known whether findings from this work are representative of the general population. A better understanding of the medical causes of infertility is crucial for reducing the incidence of infertility and for improving the clinical management. OBJECTIVE: To determine the type and aetiology of infertility in a community and clinic-based sample. DESIGN: Couples identified as infertile in a representative cross-sectional survey from a community-based sample of 2019 women aged 20-44 years and couples seeking care for infertility at a tertiary health facility. SETTING: The community-based sample was drawn from Moshi Urban District and the clinic-based sample from patients seeking care at Kilimanjaro Christian Medical Centre (KCMC) in 2002 and 2003. PARTICIPANTS: Sixty six couples identified as infertile in the community-based sample and 112 couples seeking care for infertility. RESULTS: The percentage of primary infertility was 37.1% and secondary infertility was 62.9%. Female only factor infertility was identified in 65.9% of the couples, male only factor in 6.8%, male and female factors in 15.2% and unexplained infertility in 12.1%. CONCLUSION: The type and aetiology of infertility were the same in the community and clinic-based sample suggesting that the couples seeking infertility health care were representative of the general infertile population. Tubal factor infertility was the commonest cause.