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Risk Factors for Recent HIV Infection in Uganda
Jonathan Mermin, MD, MPH;
Joshua Musinguzi, MBChB, MSc;
Alex Opio, MBChB, PhD;
Wilford Kirungi, MBChB, MSc;
John Paul Ekwaru, MSc;
Wolfgang Hladik, MD, MSc;
Frank Kaharuza, MBChB, PhD;
Robert Downing, PhD;
Rebecca Bunnell, ScD, MEd
JAMA. 2008;300(5):540-549.
Context Studies of factors associated with acquiring human immunodeficiency virus (HIV) are often based on prevalence data that might not reflect recent infections.
Objective To determine demographic, biological, and behavioral factors for recent HIV infection in Uganda.
Design and Setting Nationally representative household survey of cross-sectional design conducted in Uganda from August 2004 through January 2005; data were analyzed until November 2007.
Participants There were 11 454 women and 9905 men aged 15 to 59 years who were eligible. Questionnaires were completed for 10 826 women (95%) and 8830 men (89%); of those interviewed, blood specimens were collected for 10 227 women (94%) and 8298 men (94%).
Main Outcome Measure Specimens seropositive for HIV were tested with the BED IgG capture-based enzyme immunosorbent assay to identify recent seroconversions (median, 155 days) using normalized optical density of 0.8 and adjustments.
Results Of the 1023 HIV infections with BED results, 172 (17%) tested as recent. In multivariate analysis, risk factors associated with recent HIV infection included female sex (adjusted odds ratio [aOR], 2.4; 95% confidence interval [CI], 1.1-5.2); current marital status (widowed vs never married, aOR, 6.1; 95% CI, 2.8-13.3; divorced vs never married, aOR, 3.0; 95% CI, 1.5-6.1); geographic region (north central Uganda vs central Uganda/Kampala, aOR, 2.6; 95% CI, 1.7-4.1); number of sex partners in past year ( 2 compared with none; aOR, 2.9; 95% CI, 1.6-5.5); herpes simplex virus type 2 infection (aOR, 3.9; 95% CI, 2.6-5.8); report of a sexually transmitted disease in the past year (aOR, 1.7; 95% CI, 1.2-2.4); and being an uncircumcised man (aOR, 2.5; 95% CI, 1.1-5.3). Among married participants, recent HIV infection was associated with never using condoms with partners outside of marriage (aOR, 3.2; 95% CI, 1.7-6.1) compared with individuals having no outside partners. The risk of incident HIV infection for married individuals who used condoms with at least 1 outside partner was similar to that of those who did not have any partners outside of marriage (aOR, 1.0; 95% CI, 0.3-2.7).
Conclusion A survey of individuals in Uganda who were tested with an HIV assay used to establish recent infection identified risk factors, which offers opportunities for prevention initiatives.
Author Affiliations: Global AIDS Program, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention (CDC)–Uganda, Entebbe, Uganda (Drs Mermin, Hladik, Kaharuza, Downing, and Bunnell and Mr Ekwaru); Uganda Ministry of Health (Drs Musinguzi, Opio, and Kirungi); and Coordinating Office for Global Health, CDC-Kenya, Nairobi, Kenya (Dr Mermin).
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