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  • Title: HIV and reproductive tract infections in a total village population in rural Kilimanjaro, Tanzania: women at increased risk.
    Author: Klouman E, Masenga EJ, Klepp KI, Sam NE, Nkya W, Nkya C.
    Journal: J Acquir Immune Defic Syndr Hum Retrovirol; 1997 Feb 01; 14(2):163-8. PubMed ID: 9052726.
    Abstract:
    The aim of this study was to determine the prevalence of HIV infection, other sexually transmitted diseases (STDs), and biological risk factors associated with HIV infection in a rural population in Tanzania. A population-based study of a village population was carried out from July 1991 through January 1992. A total of 3,239 people (83.7%) participated in an HIV serosurvey. The total HIV prevalence was 0.7 and 1.9% among males and females, respectively (odds ratio, OR = 2.5; 95% confidence interval, CI: 1.2-5.1), and 4.3% in women and 1.6% in men in participants aged 15 to 44 (OR = 2.6; CI: 1.2-5.8). The same age group was interviewed and offered screening for STDs. Trichomonas vaginalis vaginitis (24.7%) was the most common reproductive tract infection (RTI); 10.3% of women were infertile and 10.6% suffered from pelvic inflammatory disease (PID). Comparing women and men, we found that 2.2 versus 20.4% had been treated for genital discharge (OR = 12.6; CI: 7.1-22.5); 2.6 versus 1.2% suffered from active syphilis (OR = 1.5; CI: 0.9-2.3); 6.9 versus 9.6% had chlamydial infection; and 46.9 versus 14.6% had an ongoing RTI/STD (OR = 5.0; CI: 3.6-6.9). A significant association was found between HIV infection and STD cases (in women) and between HIV infection and a history of STDs (in men). The heavy burden of untreated RTIs in females calls for a more gender-specific approach to HIV and STD prevention. During July 1991 to January 1992, in northern Tanzania, health workers conducted a physical examination of, interviewed, and screened 865 villagers aged 15-44 years for HIV-1 infection, sexually transmitted diseases (STDs), and other reproductive tract infections (RTIs) from Oria village at the foot of Mount Kilimanjaro to determine the spectrum and prevalence rates of STDs, other RTIs, and HIV as well as possible biological risk factors associated with HIV infection. Females were more likely to be HIV-infected than males (1.9% vs. 0.7%; odds ratio [OR] = 2.5). Women aged 25-29 years had the highest HIV infection rate (8.7%). Women were much more likely to have an STD (including HIV or other RTIs) than men (46.9% vs. 14.6%; OR = 5). Yet women were less likely than men to be ever treated for genital discharge (OR = 12.6). A history of syphilis, chlamydial infection, and pelvic inflammatory disease (PID) were more common in HIV-infected than HIV-negative women (ORs = 2.1, 2.4, and 1.9, respectively). Chlamydial infection and/or serological signs of past or current syphilis significantly increased the risk for HIV infection in females (OR = 2.7). Among men, risk factors for HIV infection included genital discharge and genital ulcer disease (ORs = 5.1 and 7.1, respectively). Among males, but not females, a medical history of previous treatment for genital discharge or for genital ulcer disease was a predictor of a current RTI (OR = 2 and 3.6, respectively). Among women, there was an association between syphilis and genital ulcer disease (OR = 4.5) and between PID and secondary fertility (OR = 2.1). 9.6% of men and 6.9% of women had chlamydial infection. 7.2% of women suffered from secondary infertility; 3.1% from primary infertility. These findings indicate a need for a more gender-specific approach to HIV and STD prevention, since women had a heavy burden of untreated RTIs.
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