[e-drug] BMJ on abstinence and AIDS in Uganda

["Valeria Frighi" <valeria.frighi@doctors.org.uk>]

BMJ on abstinence and AIDS in Uganda
-------------------------------

Dear e-druggers,

Could this be due to improved sanitary practices, ie less iatrogenic 
transmission via contaminated equipment? See "origins of AIDS" 
debate started by Hilbrand Haak March 2003 on the basis of a 
paper by David Gisselquist.

Valeria

BMJ  2005;330:496 (5 March)
News
Abstinence programmes do not reduce HIV prevalence in Uganda 
Bob Roehr, Boston 

Use of condoms and death explain the substantial decline in the 
prevalence of HIV in Uganda in the past decade. 

The reduction had previously been credited to ABC programmes 
(abstinence, be faithful, and use condoms). A longitudinal study, 
presented at the 12th retroviral conference in Boston, however, 
challenges the contributions of abstinence and fidelity. The study 
included a door to door survey of about 10 000 adults aged 15-49 
in 44 villages in the Rakai district of southern Uganda. 

A surge of infections in the early 1990s is the cause of rising 
numbers of deaths. In 2001-2, 125 cases of seroconversion 
added to the prevalence, and 200 died. "Death alone accounted for 
a six percentage point reduction in HIV prevalence in the one year," 
Maria Wawer, a public health researcher from Columbia 
University, New York city, said. "Overall, the HIV prevalence over the 
last decade declined 6.2 percentage points. We estimate that 
mortality alone contributed five percentage points of the decline." 

The remaining share could not be attributed to abstinence. The 
proportion of men reporting sexual abstinence in the past year 
declined, but the proportion among women did not change. Nor 
could the decline be credited to fidelity because the proportion of 
men reporting two or more partners in the past year increased in 
the decade. Sexual abstinence among men aged 15-49 in Uganda declined 
between 2001-2 and 2002-3

Use of condoms increased dramatically. "Condom use is much 
higher with casual partners than with their married partner," Dr 
Wawer said. "Condom use is associated with the significant 
reduction of HIV acquisition in this population." 

The most troubling aspect of the analysis is that men who have 
seroconverted within the past year reported having about twice as 
many sexual partners as men who have not seroconverted. The 
probability of transmitting HIV per coital act is about 10 times 
higher for someone who recently seroconverted. This group 
accounts for roughly half of all new infections in Uganda. As a 
result, the overall incidence has edged upwards from 1.3 per 100 
people per year in 1994-5 to 1.7 in 2002-3. 

The study began in 1994 and consisted of a behavioural 
questionnaire and an analysis of collected blood and urine 
samples. Its annual compliance rate was 85-90%. Researchers 
from Johns Hopkins University, in Baltimore, Maryland, and 
Makerere University in Kampala, Uganda, led the collaborative 
effort. 

HIV prevalence in women was 19.7% in 1994 and fell by a third to 
12.9% in 2003, the last year for which full analysis of the data was 
complete. For men, prevalence declined by 38% from 15.0% to 
9.3% in the same period. (see p 498.) 
------------------

Dr Valeria Frighi
Oxford Centre for Diabetes, Endocrinology and Metabolism
Churchill Hospital
Oxford
OX3 7LJ
UK
valeria.frighi@doctors.org.uk
Tel  # 44 1865 857300
Fax # 44 1865 857311
Mobile 07974 920013