Is sexual contact with sex workers important in driving the HIV epidemic among men in rural Zimbabwe?
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.
Cowan
Frances M
FM
Department of Sexually Transmitted Diseases, Royal Free and University College Medical School, London, United Kingdom. frances@uz-ucsf.co.zw
Langhaug
Lisa F
LF
Hargrove
John W
JW
Jaffar
Shabbar
S
Mhuriyengwe
Lovemore
L
Swarthout
Todd D
TD
Peeling
Rosanna
R
Latif
Ahmed
A
Basset
Mary T
MT
Brown
David W G
DW
Mabey
David
D
Hayes
Richard J
RJ
Wilson
David
D
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