Seventy-five married men found to be positive for HIV-1 in Harare, Zimbabwe, were interviewed in order to define behaviours associated with acquisition of infection and to determine factors associated with transmission of infection to their wives. The majority of infected men reported sexual intercourse with multiple heterosexual partners and female prostitutes, and gave a history of sexually transmitted diseases (STDs). All subjects denied homosexual activity and parenteral drug abuse. Serological testing of the wives of seropositive men showed that 45 (60%) were HIV-antibody-positive. Wives of men with AIDS and AIDS-related complex (ARC) and wives of men who gave a history of genital ulcer disease were more likely to be seropositive. The study demonstrates that HIV-1 infection in Zimbabwe occurs through heterosexual intercourse and is associated with other STDs. In addition, the study shows that male to female transmission of HIV-1 is facilitated by the presence of genital ulcers in infected men.
PIP: As part of a prospective cohort study of Zimbabweans seropositive for human immunodeficiency virus (HIV) infection, the factors associated with HIV transmission from husband to wife were analyzed in 75 couples. The mean age of the infected men was 32.1 years; all had been married for at least 1 year and 53 had at least 1 child. None of the men acknowledged a history of homosexual practices or intravenous drug use. All 75 had received injections, but only at reputable health care facilities, and none had been blood transfusion recipients. 4 men (5%) were asymptomatic, 40 (53%) had persistent generalized lymphadenopathy, 24 (32%) had acquired immunodeficiency syndrome (AIDS)-related complex (ARC), and 7 (9%) had full-blown AIDS. Of the 75 wives tested, 45 (60%) were seropositive for HIV-1 infection. Seropositivity was significantly more common among women married to men with ARC (71% infection rate) and AIDS (86% infection rate). Comparison of concordant (both seropositive) and discordant (husband only seropositive) couples indicated no significant differences in terms of age, duration of marriage, number of children, oral contraceptive use by the wife, husband's contact with prostitutes, or sexual activity on the part of the husband with multiple partners in the preceding 3 years. In addition, there was no significant difference between groups in terms of history of sexually transmitted diseases. However, men who reported a history of genital ulcer disease were significantly more likely to have a wife who was seropositive (relative risk, 1.94; 95% confidence interval, 1.62-15.13). This difference persisted even when the male's stage of disease was controlled. Thus, it appears that HIV-1 infected men with genital ulcers are likely to transmit the infection through vaginal intercourse.