title: Is sexual contact with sex workers important in driving the HIV epidemic among men in rural Zimbabwe?
abstract: OBJECTIVE
  To establish the importance of commercial sex in driving the HIV epidemic in the general population by determining risk factors for HIV infection among male mine and farm workers and estimating the fraction of prevalent HIV infections attributable to sexual contact with sex workers (SWs).
  
  
  METHODS
  Five commercial farms and 2 mines in Mashonaland West, Zimbabwe.
  
  
  METHODS
  A cross-sectional interviewer-administered questionnaire and urine survey of 1405 male workers. Urine samples were tested for HIV antibodies by a particle agglutination test and enzyme-linked immunosorbent assay and for Chlamydia trachomatis and Neisseria gonorrhoeae using a polymerase chain reaction assay.
  
  
  RESULTS
  The overall prevalence of HIV antibodies was 27.3% (95% confidence interval [CI]: 24.8 to 29.5), that of C. trachomatis was 1.5% (95% CI: 1.0 to 2.1), and that of N. gonorrhoeae was 0.5% (95% CI: 0.1 to 0.9). A total of 48.4% (95% CI: 45.8 to 51.0) of men reported ever having had sexual contact with an SW, and 29.3% (95% CI: 26.9 to 31.7) reported contact in the past year. HIV was more common among men who reported SW contact on univariate (1.9% [95% CI: 1.5 to 2.4]) and multivariate (1.4% [95% CI: 1.0 to 1.8]) analysis after adjusting for confounding. HIV was also strongly associated with self-reported genital ulceration in the previous 6 months (adjusted odds ratio [OR] = 3.1, 95% CI: 2.2 to 4.3). Genital ulceration and SW contact were highly correlated. A total of 19.6% of HIV infections in men could be attributed to ever having had sexual contact with an SW (95% CI: 10.8 to 27.6).
  
  
  CONCLUSIONS
  An appreciable proportion of HIV infection in men is attributable to sexual contact with SWs. Consideration should be given to developing interventions that target male clients of SWs.
authors.affiliation: Department of Sexually Transmitted Diseases, Royal Free and University College Medical School, London, United Kingdom. frances@uz-ucsf.co.zw
authors.forename: Frances M
authors.initials: FM
authors.lastname: Cowan
authors.forename: Lisa F
authors.initials: LF
authors.lastname: Langhaug
authors.forename: John W
authors.initials: JW
authors.lastname: Hargrove
authors.forename: Shabbar
authors.initials: S
authors.lastname: Jaffar
authors.forename: Lovemore
authors.initials: L
authors.lastname: Mhuriyengwe
authors.forename: Todd D
authors.initials: TD
authors.lastname: Swarthout
authors.forename: Rosanna
authors.initials: R
authors.lastname: Peeling
authors.forename: Ahmed
authors.initials: A
authors.lastname: Latif
authors.forename: Mary T
authors.initials: MT
authors.lastname: Basset
authors.forename: David W G
authors.initials: DW
authors.lastname: Brown
authors.forename: David
authors.initials: D
authors.lastname: Mabey
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Hayes
authors.forename: David
authors.initials: D
authors.lastname: Wilson
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D002690:Chlamydia Infections / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D006069:Gonorrhea / Q000453:epidemiology; D015658:HIV Infections / Q000453:epidemiology*; D020010:Heterosexuality; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012424:Rural Population; D011477:Sex Work; D012747:Sexual Partners; D011795:Surveys and Questionnaires; D047568:Unsafe Sex; D015030:Zimbabwe / Q000453:epidemiology