title: Trend in HIV-1 prevalence in an antenatal clinic in North Uganda and adjusted rates for the general female population.
abstract: OBJECTIVE
  To estimate HIV-1 prevalence among women attending an antenatal clinic in the Gulu District (North Uganda) and, based on these data, among the district's female population.
  
  
  METHODS
  Anonymous HIV-1 screening was performed for 8555 antenatal clinic attendees aged 15-39 years in the period 1993-1997. The results were used to estimate the prevalence among the district's female population, accounting for differences in fertility rates by HIV-1 serostatus.
  
  
  RESULTS
  Among antenatal clinic attendees, HIV-1 prevalence showed a significant linear decrease (P < 0.001), from 26.0% in 1993 [95% confidence Interval (CI), 23.2-29.0%] to 16.1% in 1997 (95% CI, 14.8-17.5%). This decrease was mostly due to a marked decrease until 1995 (14.3%; 95% Cl, 12.7-16.0%) and was more pronounced among women aged under 30 years (P < 0.001), from both urban and rural areas (P < 0.001). The risk of being infected was higher among women from urban areas (Gulu Municipality), both over the entire period (adjusted prevalence proportion ratio = 1.54; 95% CI, 1.40-1.68) and by individual year. The estimated prevalence for the 15-39-year-old female population, standardized by age and area of residence, decreased from 25.4% in 1993-1994 to 17.8% in 1996-1997; these rates were 1.22 and 1.28 times higher, respectively, than those among antenatal clinic attendees.
  
  
  CONCLUSIONS
  The trend of decrease among young women, for whom changes in HIV-1 prevalence more closely reflect incidence, could be partially due to a reduction in risk behaviour and a consequent decreasing incidence. Differences in fertility rates by HIV-1 serostatus should be addressed when using antenatal clinic data to estimate prevalence among the general female population.
authors.affiliation: Laboratory of Epidemiology and Biostatistics, Istituto Superiore di Sanità, Rome, Italy. fabiani@iss.it
authors.forename: M
authors.initials: M
authors.lastname: Fabiani
authors.forename: S
authors.initials: S
authors.lastname: Accorsi
authors.forename: M
authors.initials: M
authors.lastname: Lukwiya
authors.forename: T
authors.initials: T
authors.lastname: Rosolen
authors.forename: E O
authors.initials: EO
authors.lastname: Ayella
authors.forename: P A
authors.initials: PA
authors.lastname: Onek
authors.forename: S
authors.initials: S
authors.lastname: Declich
mesh_terms: D000293:Adolescent; D000328:Adult; D000554:Ambulatory Care Facilities; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D015497:HIV-1; D006801:Humans; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology; D015995:Prevalence; D014454:Uganda / Q000453:epidemiology; D016387:Women's Health