title: Three surveys of HIV-1 prevalence and risk factors among men working at a sugar estate in Malawi.
abstract: BACKGROUND
  HIV-1 surveys in defined populations identify underlying risks and trends useful to mount interventions.
  
  
  OBJECTIVE
  The goal of the study was to determine HIV-1 prevalence and risk factors among men working at a Malawian sugar estate.
  
  
  METHODS
  Three independent surveys were conducted in 1994, 1997, and 1998. Procedures included obtaining informed consent, interviewing, and drawing blood for HIV and syphilis testing. Analyses determined prevalence of HIV and associated risk factors.
  
  
  RESULTS
  HIV prevalence was 24.3% in 1994 (n = 1691), 22.8% in 1997 (n = 615), and 20.9% in 1998 (n = 1354; P < 0.03). From 1994 to 1998, the percentage of subjects with a history of sexually transmitted disease (STD) decreased from 43.6% to 29.5% (P < 0.0001), accompanied by a substantial rise in STDs confirmed by physical examination (from 7.5% to 16.8%; P < 0.0001) and by laboratory testing for syphilis (from 6.5% to 10.4%; P < 0.0001). The percentage with multiple sex partners declined (from 62.0% to 35.2%; P < 0.0001), and condom use rose (from 10.9% to 18.9%; P < 0.0001). STDs were significantly associated with prevalent HIV infection each year.
  
  
  CONCLUSIONS
  The prevalence of HIV has remained relatively stable and high in this cohort.
authors.affiliation: Infectious Diseases Program, Department of Epidemiology, School of Hygiene and Public Health, The Johns Hopkins University, Baltimore, Maryland 21205, USA.
authors.forename: Newton I
authors.initials: NI
authors.lastname: Kumwenda
authors.forename: Taha E
authors.initials: TE
authors.lastname: Taha
authors.forename: Donald R
authors.initials: DR
authors.lastname: Hoover
authors.forename: Diane
authors.initials: D
authors.lastname: Markakis
authors.forename: George N
authors.initials: GN
authors.lastname: Liomba
authors.forename: John D
authors.initials: JD
authors.lastname: Chiphangwi
authors.forename: David D
authors.initials: DD
authors.lastname: Celentano
mesh_terms: D000328:Adult; D000383:Agriculture / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology* / Q000517:prevention & control; D015497:HIV-1; D006801:Humans; D016015:Logistic Models; D008295:Malawi / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015995:Prevalence; D012307:Risk Factors; D012725:Sexual Behavior