       Document 0785
 DOCN  M9610785
 TI    The social dynamics of HIV transmission as reflected through discordant
       couples in rural Uganda.
 DT    9601
 AU    Serwadda D; Gray RH; Wawer MJ; Stallings RY; Sewankambo NK; Konde-Lule
       JK; Lainjo B; Kelly R; Institute of Public Health, Makerere University,
       Kampala, Uganda.
 SO    AIDS. 1995 Jul;9(7):745-50. Unique Identifier : AIDSLINE MED/96035238
 AB    OBJECTIVE: To describe the role of men and women as sources of HIV
       transmission and to estimate HIV incidence among discordant couples
       resident in diverse rural communities in Uganda. SETTING: Rakai, a rural
       district in Uganda, East Africa. METHODS: A population-based cohort
       study, which has been conducted as annual serological and behavioral
       surveys since 1989. Community clusters were stratified into trading
       centers on main roads, intermediate trading villages on secondary roads
       and agricultural villages off roads. In the 1990 survey round,
       serological data were available for 79 discordant and 411 concordant
       HIV-negative couples aged 13-49 years. The present analysis examines
       sex-specific seropositivity associated with place of residence and the
       incidence of seroconversion among discordant couples between 1990 and
       1991. RESULTS: Seventy-nine discordant couples were followed; the
       HIV-positive partner was male in 44 couples (57%) and female in 35
       couples (43%). There was marked variation in the sex of the seropositive
       partner by place of residence: women were the HIV-positive partner in
       57% of couples from trading centers, 52% from intermediate villages, and
       20% from agricultural communities (P < 0.008). Condom use was higher in
       discordant couples in which the man was the uninfected partner (17.1%)
       rather than the woman (9.5%). HIV-positive women, but not HIV-positive
       men, reported significantly more sexual partners and more genital ulcers
       than seronegative individuals of the same sex. Seroincidence rates among
       men and women in discordant relationship were 8.7 and 9.2 per 100
       person-years (PY), respectively, which was much higher than in
       concordant seronegative couples (men, 0.82; women, 0.87 per 100 PY).
       CONCLUSIONS: In this Ugandan population, men are the predominant source
       of new infections in rural villages. Risk factors and preventive
       behaviors vary with the sex of the infected partner, and seroconversion
       rates are similar in both sexes.
 DE    Acquired Immunodeficiency Syndrome/EPIDEMIOLOGY/*TRANSMISSION
       Adolescence  Adult  Cohort Studies  Disease Transmission, Horizontal
       Female  Human  HIV Seropositivity  HIV-1  Male  Middle Age  Rural Health
       *Sexual Partners  *Social Conditions  Support, Non-U.S. Gov't  Support,
       U.S. Gov't, P.H.S.  Uganda/EPIDEMIOLOGY  JOURNAL ARTICLE

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).

