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  • Title: Proportion of HIV infections attributable to other sexually transmitted diseases in a rural Ugandan population: simulation model estimates.
    Author: Robinson NJ, Mulder DW, Auvert B, Hayes RJ.
    Journal: Int J Epidemiol; 1997 Feb; 26(1):180-9. PubMed ID: 9126519.
    Abstract:
    BACKGROUND: Unprotected heterosexual contact in the presence of other sexually transmitted diseases (STD) enhances the probability of HIV transmission. The objective of this study was to estimate the proportion of HIV infections attributable to STD in rural Uganda. METHODS: Simulation modelling scenarios of the transmission dynamics of HIV infection and of ulcerative and non-ulcerative STD were employed to address this objective, drawing on data from a specific rural population cohort of 10,000 in south-west Uganda. RESULTS: In simulations of the initial 10-year period of the HIV epidemic (1980-1990), over 90% of HIV infections were attributed to STD. Even given conservative assumptions about the prevalence of STD and about their enhancing effects on HIV transmission, STD played a critical role in the rapid and extensive spread of HIV infection. The role of STD decreased with progression of the HIV epidemic. CONCLUSIONS: In developing countries, control of the spread of HIV infection may benefit substantially from successful STD intervention programmes, and particularly in areas where HIV infection is not already well established. Unprotected heterosexual contact in the presence of other sexually transmitted diseases (STDs) increases the likelihood of HIV transmission. A detailed simulation model of HIV transmission dynamics and of ulcerative and nonulcerative STDs was fit to a rural population in southwest Uganda in an attempt to estimate the proportion of HIV infections attributable to STDs in the area. The study population includes the total population of approximately 10,000 in a cluster of 15 villages in Masaka district where population surveys have been conducted annually since mid-1990. In simulations of the initial 10-year period of the HIV epidemic of 1980-90, more than 90% of HIV infections were attributed to STDs. Even making conservative assumptions about the prevalence of STDs and their enhancing effects upon HIV transmission, STDs played an important role in the rapid and extensive spread of HIV infection. The role of STDs decreased with the progression of the HIV epidemic.
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