Risk factors for HIV-1 infection in adults in a rural Ugandan community: a case-control study

AIDS. 1994 Feb;8(2):253-7. doi: 10.1097/00002030-199402000-00014.


Objective: To study in depth sexual history and sexual behaviour variables as risk factors for HIV-1 infection in a rural Ugandan population.

Methods: Following a socioeconomic and serological survey of a rural population in Masaka District, south-west Uganda, 233 randomly selected HIV-1-positive cases and 233 negative controls matched on age and village of residence, were invited in October 1990 to participate in a case-control study. A total of 132 cases and 161 controls attended for in-depth investigation including an interview about sexual behaviour.

Results: The factor most strongly associated with increased risk of infection was a greater number of lifetime sexual partners, with odds ratios (OR) of 2.1 and 4.9 for those reporting 4-10 and 11 or more partners, respectively, compared with those reporting less than four partners. Having only one sexual partner did not provide complete protection, a total of seven (one male, six female) subjects reporting only one sexual partner were HIV-1-positive. Other significant factors were a history of genital ulcers [OR, 2.9; 95% confidence intervals (CI), 1.0-9.1) and not being a Muslim (OR, 5.4; 95% CI, 1.8-16.5) suggesting a possible protective effect of circumcision. There was a suggestion that those who married within the last 7 years (OR, 2.4; 95% CI, 0.9-6.1) and men exposed to menstrual blood (OR, 5.7; 95% CI, 0.7-49.8) were at an increased risk of HIV-1 infection.

Conclusions: These results confirm the predominant role of sexual behaviour in the HIV-1 epidemic. Of particular concern is the observation of HIV-1 infection among those reporting only one partner. Where HIV-1 infection is widely distributed in the general population, risk reduction strategies should, in addition to the promotion of partner reduction, place strong emphasis on safe-sex techniques.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Blood / microbiology
  • Case-Control Studies
  • Circumcision, Male / statistics & numerical data
  • Comorbidity
  • Ethnic Groups
  • Female
  • Genital Diseases, Female / epidemiology
  • Genital Diseases, Male / epidemiology
  • HIV Infections / epidemiology*
  • HIV Infections / transmission
  • HIV-1*
  • Humans
  • Male
  • Marriage / statistics & numerical data
  • Menstruation
  • Middle Aged
  • Risk Factors
  • Rural Population
  • Sex Work / statistics & numerical data
  • Sexual Behavior / statistics & numerical data*
  • Sexual Partners
  • Sexually Transmitted Diseases / epidemiology
  • Socioeconomic Factors
  • Travel / statistics & numerical data
  • Uganda / epidemiology
  • Ulcer / epidemiology