DEMOGRAPHIC-IMPACT OF HIV-INFECTION IN RURAL RAKAI DISTRICT, UGANDA -RESULTS OF A POPULATION-BASED COHORT STUDY

Objectives: To examine HIV-l-related mortality and demographic impact in a high HIV prevalence rural district of Uganda. Design: One-year fo llow-up (1940-1991) in a population-based rural cohort. Setting and pa rticipants: Annual enumeration of all consenting residents of 1945 hou seholds in 31 randomly selected community clusters in Rakai District. Subjects provided yearly HIV serological samples, behavioral and healt h information. Main outcome measure: Mortality in HIV-infected and uni nfected persons. Results: Mortality among HIV-seropositive adults aged greater than or equal to 15 years of 118.4 per 1000 person-years (PY) was substantially higher than in HIV-seronegative adults [12.4 per 10 00 PY; relative risk (RR), 9.5; 95% confidence interval (CI), 6.0-14.9 ]. Infant mortality among offspring of HIV-infected mothers was almost double that for uninfected women (210 compared with 111 per 1000 live births; RR, 1.9; 95% CI, 1.0-3.5). Adult HIV-related mortality was as sociated with HIV prevalence and, in this cohort, with higher educatio n, non-agricultural occupation and residence in roadside trading cente rs. We estimate that adult HIV prevalence in the district is 13% and a dult HIV attributable mortality 52%. For all ages combined, district H IV attributable mortality is 28%. Conclusion: HIV is the leading cause of adult death in Rakai. Its effects on mortality are particularly ma rked in the most economically active sectors. However, the overall cru de birth rate in the district (45.7 per 1000 population) remains highe r than the crude death rate (28.1 per 1000 population), resulting in c ontinued rapid population growth