ADOLESCENTS, SEXUAL-BEHAVIOR AND HIV-1 IN RURAL RAKAI DISTRICT, UGANDA

Objectives: To describe the epidemiology of HIV-1 infection among adol escents aged 13-19 years, in rural Rakai district, Uganda. Study desig n: Baseline survey and 2-year follow-up (1990-1992) of adolescents in a population-based, open rural cohort. Methods: Annual enumeration and behavioral/serological survey of all consenting adolescents aged 13-1 9 years at recruitment, residing in 31 randomly selected community clu sters. Results: At baseline, of 909 adolescents present in study clust ers, 824 (90.6%) provided interview data and serological samples. No a dolescents aged 13-14 years were HIV-infected. Among those aged 15-19 years, 1.8% of men and 19.0% of women were HIV-positive. Among young w omen aged 15-19 years in marital/consensual union, 21.3% were HIV-posi tive; this rate did not differ significantly from the 29.1% prevalence in those reporting non-permanent relationships; prevalence was signif icantly lower in women reporting no current relationship (4.3%). After multivariate adjustment, female sex, age 17-19 years, residence in tr ading centers/trading villages and a history of sexually transmitted d isease symptoms remained significantly associated with HIV infection. Seventy-nine per cent of adolescents provided a follow-up serological sample. No young men aged 13-14 years seroconverted during the study; in young women aged 13-14 years, HIV seroincidence was 0.6 per 100 per son-years (PY) of observation. Among young men aged 15-19 years, there were 1.1 +/- 0.6 seroconversions per 100 PY of observation prior to a ge 21 years; among women 15-19 years, the incidence rate was 3.9 +/- 1 .0 per 100 PY of observation prior to age 21 years. The mortality rate among HIV-positive adolescents aged 15-19 years, at 3.9 per 100 PY of observation, was 13-fold higher than that among the HIV-uninfected. B y 1992, knowledge of sexual transmission was almost universal, the pro portions reporting multiple partners had decreased and condom use had increased over baseline. Conclusions: Adolescents, and young women in particular, are vulnerable to HIV infection. Despite reported behavior al changes, HIV incidence rates remain substantial, and there is a nee d for innovative HIV preventive measures.