Adolescents, sexual behavior and HIV-1 in rural Rakai district, Uganda

Abstract

To describe the epidemiology of HIV-1 infection among adolescents aged 13–19 years, in rural Rakai district, Uganda. Baseline survey and 2-year follow-up (1990–1992) of adolescents in a population-based, open rural cohort. Annual enumeration and behavioral/serological survey of all consenting adolescents aged 13–19 years at recruitment, residing in 31 randomly selected community clusters. At baseline, of 909 adolescents present in study clusters, 824 (90.6%) provided interview data and serological samples. No adolescents 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 women aged 15–19 years in marital/consensual union, 21.3% were HIV-positive; this rate did not differ significantly from the 29.1% prevalence in those reporting non-permanent relationships; prevalence was significantly lower in women reporting no current relationship (4.3%). After multivariate adjustment, female sex, age 17–19 years, residence in trading centers/trading villages and a history of sexually transmitted disease 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 person-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 age 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. By 1992, knowledge of sexual transmission was almost universal, the proportions reporting multiple partners had decreased and condom use had increased over baseline. Adolescents, and young women in particular, are vulnerable to HIV infection. Despite reported behavioral changes, HIV incidence rates remain substantial, and there is a need for innovative HIV preventive measures.