HIV-1 INFECTION IN JUBA, SOUTHERN SUDAN

Thirty years of civil war in the Sudan have resulted in the isolation of the southern provinces which border Central and East Africa. Conseq uently, little is known about the epidemiology of HIV-1 infection in t his region. To estimate the prevalence of HIV-1 infection in southern Sudan and the risk factors associated with disease transmission, a ser oepidemiologic survey was conducted in the township of Juba. Study sub jects invited to participate in this study included medical outpatient s, inpatients hospitalized for active tuberculosis, and female prostit utes. A total of 401 subjects participated in the study. HIV-1 infecti on was confirmed in 25 subjects. The prevalence of HIV-1 infection was 19% (8/42) among tuberculosis patients, 16% (8/50) among prostitutes, and 3% (9/309) among outpatients. A significantly higher prevalence o f HIV-1 infection was found among female prostitutes when compared to female outpatients: 16% (8/50) vs. 2% (4/178), P < 0.001. Correspondin gly, the prevalence of seropositives was significantly higher among ma le outpatients reporting a history of sexual relations with prostitute s during the prior 10 years compared to male outpatients denying relat ions with prostitutes: 14% (5/37) vs. 0% (0/94), P = 0.001. A history of a sexually transmitted disease (STD) was also associated with HIV-1 infection among male outpatients. The findings of this study indicate that HIV-1 infection is highly prevalent in southern Sudan and that p rostitutes and their sexual partners represent a major reservoir of HI V infection in this population. This epidemiologic pattern resembles t hat seen in the African nations neighboring southern Sudan. Further sp read of HIV-1 to northern Sudan could occur because of the movement of military personnel and refugees between the North and South of Sudan. (C) 1995 Wiley-Liss, Inc.()