HETEROSEXUAL TRANSMISSION OF HIV IN HAITI

Background: Despite the importance of human immunodeficiency virus (HI V) transmission through heterosexual contact, the incidence of HIV inf ection in heterosexual cohorts has not been well studied, particularly in the developing world. Objective: To 1) determine the incidence of HIV infection in discordant heterosexual couples (couples in which one partner had HIV infection and the other did not) in Haiti and 2) asse ss risk factors for and methods of preventing HIV infection. Design: P rospective study. Setting: National Institute for Laboratory Research, Port-au-Prince, Haiti. Participants: 475 HIV-infected patients and th eir noninfected regular sex partners. Measurements: Patients and their partners were evaluated at 3- to 6-month intervals for HIV infection, sexually transmitted diseases, and sexual practices. The efficacy of counseling and provision of free condoms was also evaluated. Results: Among the 177 couples who remained sexually active during the prospect ive study period, 20 seroconversions to HIV positivity occurred, for a n incidence rate of 5.4 per 100 person-years (95% CI 5.16 to 5.64 per 100 person-years). Thirty-eight couples (21.5%) discontinued sexual ac tivity during the study. Only 1 seroconversion occurred among the 42 s exually active couples (23.7% of the 177 sexually active couples) who always used condoms. In contrast, the incidence in sexually active cou ples who infrequently used or did not use condoms was 6.8 per 100 pers on-years (CI, 6.49 to 7.14 per 100 person-years). Transmission of HIV was associated with genital ulcer disease, syphilis, and vaginal or pe nile discharge in the HIV-negative partner and with syphilis in the HI V-infected partner. Conclusion: Counseling and the provision of free c ondoms contributed to the institution of safe sex practices or abstine nce in 45% of discordant heterosexual couples. However, 55% of couples reported that they continued to have unprotected sex, resulting in an incidence of HIV infection of 6.8 per 100 person-years.