Kamali A, Carpenter L M, Whitworth J A, Pool R, Ruberantwari A, Ojwiya A
Medical Research Council Programme on AIDS in Uganda, Uganda Virus Research Institute, Entebbe.
AIDS. 2000 Mar 10;14(4):427-34. doi: 10.1097/00002030-200003100-00017.
To assess trends in HIV-1 infection rates and changes in sexual behaviour over 7 years in rural Uganda.
An adult cohort followed through eight medical-serological annual surveys since 1989-1990. All consenting participants gave a blood sample and were interviewed on sexual behaviour.
On average, 65% of residents gave a blood sample at each round. Overall HIV-1 prevalence declined from 8.2% at round 1 to 6.9% at round 8 (P = 0.008). Decline was most evident among men aged 20-24 years (11.7 to 3.6%; P < 0.001) and women aged 13-19 (4.4% to 1.4%; P = 0.003) and 20-24 (20.9% to 13.8%; P = 0.003). However, prevalence increased significantly among women aged 25-34 (13.1% to 16.6%; P = 0.04). Although overall incidence declined from 7.7/1000 person-years (PY) in 1990 to 4.6/1000 PY in 1996, neither this nor the age-sex specific rates changed significantly (P > 0.2). Age-standardized death rates for HIV-negative individuals were 6.5/1000 PY in 1990 and 8.2/1000 PY in 1996; corresponding rates for HIV-positive individuals were 129.7 and 102.7/1000 PY, respectively. There were no significant trends in age-adjusted death rates during follow-up for either group. There was evidence of behaviour change towards increase in condom use in males and females, marriage at later age for girls, later sexual debut for boys and a fall in fertility especially among unmarried teenagers.
This is the first general population cohort study showing overall long-term significant reduction in HIV prevalence and parallel evidence of sexual behaviour change. There are however no significant reductions in either HIV incidence or mortality.
评估乌干达农村地区7年间HIV-1感染率的趋势以及性行为的变化。
自1989 - 1990年起，一个成年队列接受了8次年度医学血清学调查。所有同意参与的参与者都提供了血样，并接受了性行为方面的访谈。
平均而言，每一轮调查中65%的居民提供了血样。总体HIV-1感染率从第1轮的8.2%降至第8轮的6.9%（P = 0.008）。在20 - 24岁男性（从11.7%降至3.6%；P < 0.001）、13 - 19岁女性（从4.4%降至1.4%；P = 0.003）以及20 - 24岁女性（从20.9%降至13.8%；P = 0.003）中，感染率下降最为明显。然而，25 - 34岁女性的感染率显著上升（从13.1%升至16.6%；P = 0.04）。尽管总体发病率从1990年的7.7/1000人年降至1996年的4.6/1000人年，但这一变化以及按年龄和性别划分的发病率均无显著变化（P > 0.2）。1990年HIV阴性个体的年龄标准化死亡率为6.5/1000人年，1996年为8.2/1000人年；HIV阳性个体的相应死亡率分别为129.7和102.7/1000人年。在随访期间，两组的年龄调整死亡率均无显著趋势。有证据表明性行为发生了变化，男性和女性使用避孕套的情况增加，女孩结婚年龄推迟，男孩首次性行为年龄推迟，生育率下降，尤其是未婚青少年的生育率下降。
这是第一项显示HIV总体患病率长期显著下降以及性行为变化相关证据的普通人群队列研究。然而，HIV发病率和死亡率均未显著降低。
