HORMONAL CONTRACEPTION, SEXUALLY-TRANSMITTED DISEASES, AND RISK OF HETEROSEXUAL TRANSMISSION OF HUMAN-IMMUNODEFICIENCY-VIRUS TYPE-1

To examine associations between method of contraception, sexually tran smitted diseases (STDs), and incident human immunodeficiency virus typ e 1 (HIV-1) infection, a prospective observational cohort study was do ne among female sex workers attending a municipal STD clinic in Mombas a, Kenya, Demographic and behavioral factors significantly associated with HIV-1 infection included type of workplace, condom use, and parit y. In multivariate models, vulvitis, genital ulcer disease, vaginal di scharge, and Candida vaginitis were significantly associated with HIV- 1 seroconversion. Women who used depo medroxyprogesterone acetate (DMP A) had an increased incidence of HIV-1 infection (hazard ratio [HR], 2 .2; 95% confidence interval [CI], 1.4-3.4). In a multivariate model co ntrolling for demographic and exposure variables and biologic covariat es, the adjusted HR for HIV-1 infection among DMPA users was 2.0 (CI, 1.3-3.1), There was a trend for an association between use of high-dos e oral contraceptive pills and HIV-1 acquisition (HR, 2.6; CI, 0.8-8.5 ).