BACTERIAL VAGINOSIS AND HIV SEROPREVALENCE AMONG FEMALE COMMERCIAL SEX WORKERS IN CHIANG-MAI, THAILAND

Objective: To investigate the relationship between HIV seropositivity and bacterial vaginosis (BV) in a population at high risk for sexual a cquisition of HIV. Design: A cross-sectional study was conducted among 144 female commercial sex workers in Chiang Mai, Thailand. Methods: T he participants were tested for cervical gonorrhea and Chlamydia infec tion, syphilis, Trichomonas vaginitis, Candida vaginitis, BV, and HIV infection. BV was diagnosed by clinical criteria (pH>4.5, positive ami ne test, and presence of clue cells) and using Gram stains. Results: T hirty-three per cent of participants had BV, and 43% were HIV-positive . Using clinical criteria, the association of BV and HIV seropositivit y was significant [odds ratio (OR), 2.7; 95% confidence interval (CI), 1.3-5.0]. Although the association between BV and HIV prevalence was not significant using Gram stains alone for diagnosis of BV, an associ ation was found between abnormal vaginal flora and HIV (OR, 2.1; 95% C I, 1.0-4.8). In multiple logistic regression analysis, adjusting for a ge, number of sexual encounters per week, current condom use, and curr ently having a sexually transmitted disease (STD), both BV and a histo ry of an STD were independently associated with HIV seropositivity (ad justed OR for BV, 4.0 and 95% CI, 1.7-9.4; adjusted OR for history of an STD, 6.9 and 95% CI, 2.1-22.9). Conclusions: When diagnosed clinica lly, BV is independently associated with HIV seroprevalence. HIV infec tion may promote abnormal vaginal flora, or BV may increase susceptibi lity to sexual transmission of HIV. Alternatively, the association see n here may result from intervening variables; in this case BV may be a marker or a cofactor of HIV transmission.