IS HIV STD CONTROL IN JAMAICA MAKING A DIFFERENCE/

Objective: To assess the impact of the comprehensive HIV/STD Control P rogram established in Jamaica since the late 1980s on the HIV/AIDS epi demic. Methods: AIDS case reports, HIV testing of blood donors, antena tal clinic attenders (ANC), food service workers, sexually transmitted disease (STD! clinic attenders, female prostitutes, homosexuals and o ther groups were used to monitor the HIV/AIDS epidemic. Primary and se condary syphilis and cases of congenital syphilis were also monitored. National knowledge, altitude and practice (KAP) surveys were conducte d in 1988, 1989, 1992, 1994 and 1996. Results: The annual AIDS inciden ce rate in Jamaica increased only marginally in the past three years f rom 18.5 per 100 000 population to 21.4 in 1997. HIV prevalence in the general population groups tested has been about 1% or less. Among tho se at high risk, HIV prevalence rates have risen to 6.3% (95% confiden ce interval 5.0-8.0) in STD clinic attenders, around 10% and 21% in fe male prostitutes in Kingston and Montego Bay respectively and approxim ately 30% among homosexuals. Syphilis rates and congenital syphilis ca ses have declined. The proportion of men aged 15-49 years reporting se x with a non-regular partner declined from 35% in 1994 to 26% in 1996 (P< 0.001). Women ever having used condoms increased from 51% in 1988 to 62.5% in 1992 and 73% in 1994 and 1996 (P< 0.001), while condom use with a nonregular partner increased from 37% in 1992 to 73% in 1996 ( P = 0.006). Condom use among men was high over the period: around 81% had ever used condoms and 77% used them with non-regular partners. Gay men, inner-city adults and adolescents aged 12-14 years all reported increases in condom use while condom sales and distribution increased from around 2 million in 1985 to 10 million in 1995. Conclusion: HIV/S TD control measures appear to have slowed the HIV/AIDS epidemic in Jam aica, however a significant minority of persons continue to have unpro tected sex in high risk situations. (C) 1998 Lippincott Williams & Wil kins.