The epidemiology of HSV-2 infection and its association with HIV infectionin four urban African populations

Objectives: To estimate age- and sex-specific herpes simplex virus type-2 ( HSV-2) prevalence in urban African adult populations and to identify factor s associated with infection. Design and methods: Cross-sectional, population-based samples of about 2000 adults interviewed in each of the following cities: Cotonou, Benin; Yaound e, Cameroon; Kisumu, Kenya and Ndola, Zambia. Consenting study participants were tested for HIV, HSV-2 and other sexually, transmitted infections. Results: HSV-2 prevalence was over 50% among women and over 25% among men i n Yaounde, Kisumu and Ndola, with notably high rates of infection among you ng women in Kisumu and Ndola (39% and 23%, respectively, among women aged 1 5-19 years). The prevalence in Cotonou was lower (30% in women and 12% in m en). Multivariate analysis showed that HSV-2 prevalence was significantly a ssociated with older age, ever being married, and number of lifetime sexual partners, in almost all cities and both sexes. There was also a strong, co nsistent association with HIV infection. Among women, the adjusted odds rat ios for the association between HSV-2 and HIV infections ranged from 4.0 [9 5% confidence interval (CI) = 2.0-8.0] in Kisumu to 5.5 (95% CI = 1.7-18) i n Yaounde, and those among men ranged from 4.6 (95% Cl = 2.7-7.7) in Ndola to 7.9 (95% Cl = 4.1-15) in Kisumu. Conclusions: HSV-2 infection is highly prevalent in these populations, even at young ages, and is strongly associated with HIV at an individual level. At a population level, HSV-2 prevalence was highest in Kisumu and Ndola, t he cities with the highest HIV rates, although rates were also high among w omen in Yaounde, where there are high rates of partner change but relativel y little HIV infection. The high prevalence of both infections among young people underlines the need for education and counselling among adolescents. (C) 2001 Lippincott Williams & Wilkins.