RISK-FACTORS FOR HIV-INFECTION AMONG WOMEN IN DAR-ES-SALAAM, TANZANIA

To identify risk factors for HIV infection among women not known to be members of high-risk groups in Dar-es-Salaam, Tanzania, and assess as sociations between contraceptive use and HIV infection, we conducted a cross-sectional case-control study at three representative family pla nning clinics. Between February 1991 and June 1992, we enrolled 2,285 women; women were interviewed using a structured questionnaire, and sp ecimens were collected for laboratory diagnosis of HIV and other sexua lly transmitted diseases (STDs). The overall HIV prevalence was 11.5% (95% CI: 10.2-12.8). Other prevalent STDs included gonorrhea (4.2%), t richomoniasis (14.3%), candidiasis (11.5%), and syphilis (2.5%). HIV s eroprevalence was significantly lower among younger women and women in nonpolygamous marriages. HIV risk increased with both women's educati on and male partner's education. Number of sex partners in the last 5 years was positively associated with HIV risk; however, among HIV-sero positive women, the median number of sexual partners was only two. For married women with only a single partner, their risk increased signif icantly if their husbands had other partners. The risk of HIV infectio n was higher among subjects with STDs, although only significantly so for gonorrhea (OR 1.95, 95% CI: 1.10-3.45). After controlling for know n and potential risk factors, the risk of HIV infection was significan tly increased among women who had ever used an intrauterine device (IU D) (OR 2.50, 95% CI: 1.35-4.64). Use of other contraceptives, includin g oral contraceptives, was not significantly associated with HIV infec tion. Our findings confirm that HIV and STDs are a major public health problem among women in Dar-es-Salaam. Prospective data are needed to confirm the association between HIV and the use of an IUD. Interventio ns involving both women and men are urgently needed to reduce further spread of HIV/STDs in this population.