Sexually transmitted disease and HIV prevalence and risk factors in concentrated and generalized HIV epidemic settings

Abstract

Background: In many developing countries, the threat of nascent HIV epidemics expanding rapidly requires immediate and appropriate HIV prevention activities. Inexpensive and sustainable interventions are especially relevant in resource-constrained environments. In 2001, we assessed the prevalence and behavioral risk of sexually transmitted disease (STD) and HIV among at-risk populations in five developing countries in preparation for a community-randomized controlled trial, the NIMH Collaborative HIV/STD Prevention Trial. Methods: Using a standardized protocol, more than 1000 participants in each country (China, India, Peru, Russia, and Zimbabwe) were selected by random sampling methods, completed a behavioral risk assessment, and provided biological specimens using a common laboratory protocol. Sample characteristics were studied within each country, and risk factors for HIV/STD acquisition were evaluated using logistic regression models. Results: HIV rates were low (< 1%) in China, India, Peru, and Russia but were high (26%) in rural Zimbabwe. STDs were generally twice as common in women as men, and serological evidence of herpes simplex virus type 2 infection was the most frequently detected STD. Behavioral data showed high rates of multiple partners in the Russian sample, and very low condom use rates in India and China. Among participants who reported ever having sex, female sex and having two or more sex partners were the factors most frequently associated with an increased risk of prevalent STD. Conclusion: Behavioral or biological risks were of sufficient magnitude in the locations selected in China, Russia, and Zimbabwe to implement the community-based randomized trial. Higher-risk subsets of community residents in India and Peru were identified before beginning the Trial.