High HIV prevalence and associated factors in a remote community in the Rwenzori region of Western Uganda.

John Rubaihayo,Surat Akib,Andrew Abaasa,Ezekiel Mughusu

doi:10.4081/idr.2010.e13

Abstract

In Uganda, previous studies have shown a tremendous decline in HIV prevalence over the past two decades due to changes in sexual behavior with a greater awareness of the risks involved. However, studies in Fort-Portal municipality, a rural town in Western Uganda, continued to show a persistent high HIV prevalence despite the various interventions in place. We conducted a study to establish the current magnitude of HIV prevalence and the factors associated with HIV prevalence in this community. This cross-sectional study was conducted between July and November 2008. Participants were residents of Fort-Portal municipality aged 15–49 years. A populationbased HIV sero-survey and a clinical review of prevention of mother to child HIV transmission (PMTCT) and voluntary counseling and HIV Testing (VCT) records were used to collect quantitative data. An inteviewer administered structured questionnaire was used to collect qualitative data on social deographics, risk behaviour and community perceptions. Focus group discussions (FGDs) and in-depth interviews provided supplementary data on community perceptions. Logistic regression was used in the analysis. The overall HIV prevalence in the general population was 16.1% [95% CI; 12.5–20.6]. Prevalence was lower among women (14.5%; 95% CI; 10.0–19.7) but not significantly different from that among men (18.7%; 95% CI; 12.5–26.3) (χ2 =0.76, P=0.38). Having more than 2 sexual partners increased the odds of HIV by almost 2.5 times. None or low education and age over 35 years were independently associated with HIV prevalence (P<0.05). Most participants attributed the high HIV prevalence to promiscuity/multiple sexual partners (32.5%), followed by prostitution (13.6%), alcoholism (10.1%), carelessness (10.1%), poverty (9.7%), ignorance (9.5%)), rape (4.7%), drug abuse (3.6%) and others (malice/malevolence, laziness, etc.) (6.2%). Although there was a slight decline compared to previous reports, the results from this study confirm that HIV prevalence is still high in this community. In order to prevent new infections, the factors mentioned above need to be addressed, and we recommend that education aimed at changing individual behavior should be intensified in this community.

Highlights

Variability in HIV prelavence has been observed in subpopulations in different countries with generalized HIV epidemics in sub-Saharan Africa.[1,2,5,9]
Uganda is among the African countries with generalized HIV epidemics that have registered a significant decline in the overall prevalence of HIV/AIDS in the last two decades.[1,9,10]
HIV prevalence among women aged 15-45 years was significantly higher in voluntary HIV counseling and testing (VCT) (21.9%) [95% confidence intervals (95% CI); 19.7-24.3] than in the general population (14.5%) and prevention of mother to child HIV transmission (PMTCT) (13.4%) (P

Summary

Introduction

Several studies in sub-Saharan Africa have reported divergent trends of the HIV epidemic with some countries experiencing declining or stabilizing epidemic while a few others still record an increasing epidemic.[1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21] Variability in HIV prelavence has been observed in subpopulations in different countries with generalized HIV epidemics in sub-Saharan Africa.[1,2,5,9] Uganda is among the African countries with generalized HIV epidemics that have registered a significant decline in the overall prevalence of HIV/AIDS in the last two decades.[1,9,10] there is new evidence of an increase in HIV infections in some parts of Uganda,[12] several other studies in both urban and rural areas have shown a tremendous decline in HIV prevalence associated with increased awareness and significant decrease in sexual behavior at risk.[12,13,14,15,16,17,18,19,20,21,22] The Uganda National sero and behavioural survey 2004/510 showed adult HIV prevalence declined from 18-30 % in the early 1990s to 6.4% in 2005. The report further showed an estimated 1.1 million Ugandans living with the HIV/AIDS in 2005 with lowest prevalence in the West Nile region (2.3%) and highest prevalence in Central region (8.5%), followed by North ern region (8.2%), Western region (6.9%) and Eastern region (5.3%)

Methods

Discussion

Conclusion