Risk factors for HIV-1 infection in adults in a rural Ugandan community: a case-control study.
OBJECTIVE
To study in depth sexual history and sexual behaviour variables as risk factors for HIV-1 infection in a rural Ugandan population.


METHODS
Following a socioeconomic and serological survey of a rural population in Masaka District, south-west Uganda, 233 randomly selected HIV-1-positive cases and 233 negative controls matched on age and village of residence, were invited in October 1990 to participate in a case-control study. A total of 132 cases and 161 controls attended for in-depth investigation including an interview about sexual behaviour.


RESULTS
The factor most strongly associated with increased risk of infection was a greater number of lifetime sexual partners, with odds ratios (OR) of 2.1 and 4.9 for those reporting 4-10 and 11 or more partners, respectively, compared with those reporting less than four partners. Having only one sexual partner did not provide complete protection, a total of seven (one male, six female) subjects reporting only one sexual partner were HIV-1-positive. Other significant factors were a history of genital ulcers [OR, 2.9; 95% confidence intervals (CI), 1.0-9.1) and not being a Muslim (OR, 5.4; 95% CI, 1.8-16.5) suggesting a possible protective effect of circumcision. There was a suggestion that those who married within the last 7 years (OR, 2.4; 95% CI, 0.9-6.1) and men exposed to menstrual blood (OR, 5.7; 95% CI, 0.7-49.8) were at an increased risk of HIV-1 infection.


CONCLUSIONS
These results confirm the predominant role of sexual behaviour in the HIV-1 epidemic. Of particular concern is the observation of HIV-1 infection among those reporting only one partner. Where HIV-1 infection is widely distributed in the general population, risk reduction strategies should, in addition to the promotion of partner reduction, place strong emphasis on safe-sex techniques.
Malamba
S S
SS
Medical Research Council (UK) Programme on AIDS in Uganda, Entebbe.
Wagner
H U
HU
Maude
G
G
Okongo
M
M
Nunn
A J
AJ
Kengeya-Kayondo
J F
JF
Mulder
D W
DW
D000293:Adolescent; D000328:Adult; D000368:Aged; D001769:Blood / Q000382:microbiology; D016022:Case-Control Studies; D002944:Circumcision, Male / Q000706:statistics & numerical data; D015897:Comorbidity; D005006:Ethnicity; D005260:Female; D005831:Genital Diseases, Female / Q000453:epidemiology; D005832:Genital Diseases, Male / Q000453:epidemiology; D015658:HIV Infections / Q000453:epidemiology* / Q000635:transmission; D015497:HIV-1; D006801:Humans; D008297:Male; D008393:Marriage / Q000706:statistics & numerical data; D008598:Menstruation; D008875:Middle Aged; D012307:Risk Factors; D012424:Rural Population; D011477:Sex Work / Q000706:statistics & numerical data; D012725:Sexual Behavior / Q000706:statistics & numerical data*; D012747:Sexual Partners; D012749:Sexually Transmitted Diseases / Q000453:epidemiology; D012959:Socioeconomic Factors; D014195:Travel / Q000706:statistics & numerical data; D014454:Uganda / Q000453:epidemiology; D014456:Ulcer / Q000453:epidemiology