Document 0770
 DOCN  M9550770
 TI    Incident HIV-1 infection in a cohort of young women in Butare, Rwanda.
 DT    9505
 AU    Bulterys M; Chao A; Habimana P; Dushimimana A; Nawrocki P; Saah A;
       Department of Epidemiology, School of Hygiene and Public Health,; Johns
       Hopkins University, Baltimore, Maryland.
 SO    AIDS. 1994 Nov;8(11):1585-91. Unique Identifier : AIDSLINE MED/95151236
 AB    OBJECTIVE: To determine the incidence of HIV-1 infection and associated
       risk factors among young, seronegative, and sexually active women in a
       mixed rural and urban population in southern Rwanda. DESIGN: A
       prospective cohort study. METHODS: Between October 1991 and April 1993,
       we completed a 2-year follow-up survey among HIV-1-seronegative women
       aged < or = 30 years at the time of their initial HIV-1 screening during
       pregnancy. All women aged < or = 25 years and a randomly selected sample
       of 26-30-year olds were invited to participate from five prenatal
       clinics in the Butare region. The interview focused on potential risk
       factors for HIV-1 acquisition during the 2-year interval between blood
       collection. RESULTS: Out of 1524 women selected, 1150 (75%) participated
       in the follow-up survey. The 2-year incidence of HIV-1 infection was
       2.7% [95% confidence interval (CI), 1.8-3.9]. Teenage women were at the
       highest risk (incidence, 10.5%; 95% CI, 5.2-19.4), with incidence
       leveling off with increasing age (P < 0.001). Women who began sexual
       activity recently were also at higher risk; the lowest risk category
       consisted of women aged 26-30 years with 5 or more years of sexual
       experience. The more urban the geographic residence of the woman, the
       more likely she was to have acquired HIV-1 infection (P < 0.001). In the
       urban and peri-urban zones, the poorest women were at significantly
       higher risk of incident HIV-1 infection than women reporting higher
       household income. In a multivariate analysis, young maternal age,
       marital status (being single, divorced or widowed), multiple sexual
       partners, and a history of sexually transmitted diseases remained
       strongly associated with incident HIV-1 infection. Geographic residence,
       hormonal contraception, and receipt of injections were no longer
       significantly associated with incident HIV-1 infection when these other
       factors were accounted for simultaneously. CONCLUSION: Among young
       Rwandan women, the early years of sexual activity are particularly
       dangerous for acquisition of HIV-1 infection. Interventions should focus
       on young teenagers before they become sexually active.
 DE    Acquired Immunodeficiency Syndrome/*EPIDEMIOLOGY  Adolescence  Adult
       Age Factors  Cohort Studies  Comparative Study  Demography  Female
       Follow-Up Studies  Human  HIV Seronegativity  *HIV-1  Incidence
       Pregnancy  Random Allocation  Risk Factors  Rural Population
       Rwanda/EPIDEMIOLOGY  Sex Behavior  Support, U.S. Gov't, P.H.S.  Urban
       Population  *Women  JOURNAL ARTICLE

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