GENERAL AND HIV-1-ASSOCIATED MORBIDITY IN A RURAL UGANDAN COMMUNITY

Objectives: The AIDS epidemic in sub-Saharan Africa affects whole comm unities, adding to the. already high burden of morbidity. Reports of A IDS cases are usually from hospital attenders, often diagnosed using t he World Health Organization (WHO) clinical case definition. Little is known about the extent of HIV-associated morbidity in the general pop ulation. The objectives of this study were to describe the prevalence of (1) markers of general morbidity and (2) the criteria of the WHO cl inical case definition for AIDS and (3) to determine the association b etween these markers and HIV-1 serostatus in a rural Ugandan community . Methods: A survey was conducted among the adult population (aged gre ater-than-or-equal-to 13 years) of 15 neighbouring villages in Masaka District, south-west Uganda. The survey included medical history, phys ical examination and testing for HIV-1 antibodies. Results: The HIV-1 seroprevalence among 4175 out of 5278 (79%) eligible adults was 8.2%. Current health problems were reported by 57.6% of adults, with increas ed rates in HIV-1-positive subjects, women and older people. Five of t he 10 most common complaints showed significant associations with HIV- 1 status, as did reported genital ulcer and vaginal discharge. The cru de HIV-1 attributable disease burden in the population was 1.2% for cu rrent illness, 4.3% for previous serious illness and 9.9% for illness leading to hospital admission. Overall, 11 (3.3%) of the HIV-1-positiv e and nine (0.2%) of the HIV-1-negative subjects had AIDS as defined b y the clinical case definition. The positive and negative predictive v alues and specificity were 55.0, 92.0%, and 99.8%, respectively. Concl usions: Against a background of high general morbidity, we observed a relatively small population attribution of HIV-1-associated morbidity. The results indicate that the clinical AIDS case definition may provi de a useful tool for population surveys.