HIV-1 prevalence and risk factors among sexually transmitted disease clinic attenders in Trinidad.
OBJECTIVE
To study trends in prevalence and to ascertain risk factors for HIV-1 among sexually transmitted disease (STD) clinic attenders in Trinidad.


METHODS
Serial cross-sectional studies were conducted in 1987-1988 and 1990-1991 at a centralized STD clinic in Port of Spain. A case-control study was carried out to examine in greater detail the demographic and behavioral risk factors for HIV-1 among self-declared heterosexuals in this population.


RESULTS
HIV-1 prevalence increased from 3.0% [95% confidence interval (CI), 2.3-3.9] in 1987-1988 to 13.6% (95% CI, 11.8-15.6) in 1990-1991. Age > or = 40 years [odds ratio (OR), 2.0; 95% CI, 1.4-2.8], urban residence (OR, 2.2; 95% CI, 1.6-3.0), and human T-lymphotropic virus-I seropositivity (OR, 3.1; 95% CI, 1.6-6.0) were significant risk factors for HIV-1 in 1990-1991. In the case-control analysis, significant independent risk factors for men included current genital ulcer disease (OR, 5.2; 95% CI, 2.2-12.5), current genital warts (OR, 3.9; 95% CI, 1.2-12.0), having ever had syphilis (OR, 3.2; 95% CI 1.6-6.1), and use of crack cocaine in the preceding 6 months (OR, 6.2; 95% CI, 2.7-14.2). Corresponding risk factors for women were commercial sex work (OR, 5.7; 95% CI, 1.3-25.7), initiation of sexual activity before age 14 years (OR, 4.8; 95% CI, 1.5-16.0), and past non-gonococcal cervicitis (OR, 4.1; 95% CI, 1.3-13.1).


CONCLUSIONS
HIV-1 in this setting is primarily heterosexually transmitted in a milieu of unprotected sexual activity fuelled by a crack cocaine epidemic. Targeted interventions to prevent, detect and treat STD and crack cocaine addiction, as well as disrupt their adverse synergism, may substantially reduce HIV-1 transmission in this population.
Cleghorn
F R
FR
Viral Epidemiology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA.
Jack
N
N
Murphy
J R
JR
Edwards
J
J
Mahabir
B
B
Paul
R
R
White
F
F
Bartholomew
C
C
Blattner
W A
WA
D000328:Adult; D000554:Ambulatory Care Facilities; D016022:Case-Control Studies; D016578:Crack Cocaine; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology* / Q000635:transmission; D015528:HIV Seroprevalence / Q000639:trends; D015497:HIV-1; D006801:Humans; D008297:Male; D012307:Risk Factors; D016036:Seroepidemiologic Studies; D012725:Sexual Behavior; D012749:Sexually Transmitted Diseases / Q000150:complications; D014300:Trinidad and Tobago / Q000453:epidemiology
D016578:Crack Cocaine