HIV incidence and sexually transmitted disease prevalence associated with condom use: a population study in Rakai, Uganda

Objective: Evidence of condom effectiveness for HIV and sexually transmitte d disease (STD) prevention is based primarily on high-risk populations. We examined condom effectiveness in a general population with high HIV prevale nce in rural Africa. Methods: Data were from a randomized community trial in Rakai, Uganda. Cond om usage information was obtained prospectively from 17 264 sexually active individuals aged 15-59 years over a period of 30 months. HIV incidence and STD prevalence was determined for consistent and irregular condom users, c ompared to non-users. Adjusted rate ratios (RR) of HIV acquisition were est imated by Poisson multivariate regression, and odds ratios of STDs estimate d by logistic regression. Results: Only 4.4% reported consistent condom use and 16.5 lo reported inco nsistent use during the prior year. Condom use was higher among males, and younger, unmarried and better educated individuals, and those reporting mul tiple sex partners or extramarital relationships. Consistent condom use sig nificantly reduced HIV incidence [RR, 0.37; 95% confidence interval (CI), 0 .15-0.88], syphilis [odds ratio (OR), 0.71; 95% CI, 0.53-0.94] and gonorrhe a/Chlamydia (OR, 0.50; 95% CI, 0.25-0.97) after adjustment for socio-demogr aphic and behavioral characteristics. Irregular condom use was not protecti ve against HIV or STD and was associated with increased gonorrhea/Chlamydia risk (OR, 1.44; 95% CI, 1.06-1.99). The population attributable fraction o f consistent use for prevention of HIV was -4.5% (95% CI, -8.3 to 0.0), due to the low prevalence of consistent use in the population. Conclusions: Consistent condom use provides protection from HIV and STDs, w hereas inconsistent use is not protective. Programs must emphasize consiste nt condom use for HIV and STD prevention. (C) 2001 Lippincott Williams & Wi lkins.