https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(97)01063-5.pdf

Hiv-1 infection associated with abnormal vaginal flora morphology and bacterial vaginosis

There has been considerable interest in understanding what may have led to Uganda's dramatic decline in HIV prevalence, one of the world's earliest and most compelling AIDS prevention successes. Survey and other data suggest that a decline in multi-partner sexual behavior is the behavioral change most likely associated with HIV decline. It appears that behavior change programs, particularly involving extensive promotion of “zero grazing” (faithfulness and partner reduction), largely developed by the Ugandan government and local NGOs including faith-based, women’s, people-living-with-AIDS and other community-based groups, contributed to the early declines in casual/multiple sexual partnerships and HIV incidence and, along with other factors including condom use, to the subsequent sharp decline in HIV prevalence. Yet the debate over “what happened in Uganda” continues, often involving divisive abstinence-versus-condoms rhetoric, which appears more related to the culture wars in the USA than to African social reality.

/pdf/uganda-s-hiv-prevention-success-the-role-of-sexual-behavior-gt0rm582b0.pdf

Uganda's HIV prevention success: the role of sexual behavior change and the national response.

Traditionally, fertility and family planning research and programs have focused on women. With the expansion of the field to include reproductive health following the 1994 International Conference on Population in Cairo, the more appropriate focus for most reproductive health components appears to be the sexually active couple. This review of studies of couples and reproductive health outcomes examines reports of objective reproductive events, of attitudes and reproductive intentions, of the effect of each partner's attitudes and intentions, of reproductive outcomes, and of the effectiveness of interventions that target couples compared with those that target one partner or the other. For couples' statements about reproductive events, studies throughout the world typically show identical reports less than 90 percent of the time. Concordance between partners on subjective matters is in the range of 60 to 70 percent. Data based on reports of reproductive intentions from both partners have been shown to lead to better predictions of behavior than have data from only one partner. Finally, reproductive health interventions that target couples are found to be more effective than those directed to only one sex. The evidence clearly justifies a focus on couples.

Couples and reproductive health: a review of couple studies.

https://www.jstor.org/stable/info/3776411

Sexually transmitted infections among adolescents: the need for adequate health services

To monitor the HIV-1 epidemic in western Uganda and the possible impact of interventions age-specific trends in HIV-1 prevalence during 1991-1997 among antenatal clinic (ANC) attenders in Fort Portal where a comprehensive AIDS control program has been implemented since 1991 were analyzed and results compared with outputs from a mathematical model simulating the HIV-1 epidemic in the country. Scenarios with and without behavior change were modelled. Sentinel surveillance data were compared with data from a population-based HIV-1 serosurvey at the study site which was conducted in early 1995. Data from 3271 ANC attenders found greater education and single status to be risk factors for HIV-1 infection. A significant decrease of risk for women with secondary school education over time was observed while the risk for illiterate women remained high. Among the 1045 women aged 15-19 years education and marital status-adjusted HIV-1 prevalence declined steadily from 32.2% to 10.3% over the period. For the 1010 women aged 20-24 years prevalence increased until 1993 from 19.9% to 31.7% then declined thereafter to 21.7% in 1997. These declining trends of HIV-1 prevalence probably reflect a reduced HIV-1 incidence attributable to changes in behavior. No clear trends of HIV-1 prevalence were found in older women.

Reductions in risk behaviour provide the most consistent explanation for declining HIV-1 prevalence in Uganda.

OBJECTIVE--To define the geographical distribution of HIV infection and the community characteristics associated with HIV prevalence in a rural population of Uganda. DESIGN--Seroprevalence survey and interviews of the population aged 13 years and older in 21 randomly selected clusters. SETTING--Rural population of Rakai district, south west Uganda. SUBJECTS--1292 adults, of whom 594 men and 698 women gave a blood sample and answered the questionnaire. MAIN OUTCOME MEASURES--HIV status determined by ELISA and western blotting in relation to community characteristics. RESULTS--The weighted seroprevalence of HIV for the district was 12.6% with prevalence by cluster varying from 1.2% to 52.8%. Seroprevalence was highest in main road trading centres (men 26%, women 47%), intermediate in rural trading villages on secondary roads (men 22%, women 29%), and lowest in rural agricultural villages (men 8%, women 9%). For both men and women, multiple regression showed a strong negative association between cluster seroprevalence and the proportion of the population employed in agriculture (beta = -0.677 for men, -0.807 for women). Among women, cluster seroprevalence increased with a higher proportion of the population reporting multiple sex partners (beta = 0.814), external travel (beta = 0.579), and injections (beta = 0.483). CONCLUSIONS--Community characteristics, particularly the proportion of the population in agriculture, are associated with HIV prevalence and can be used for targeting interventions. The seroprevalences of HIV suggest spread of infection from main road trading centres, through intermediate trading villages, to rural agricultural villages.

https://www.bmj.com/content/bmj/303/6813/1303.full.pdf

Dynamics of spread of HIV-I infection in a rural district of Uganda.

The study population consisted of all adults aged 15–59 residing in 56 rural commu-nities of Rakai District, southwest Uganda, enrolled in the Rakai STD Control for AIDS Preven-tion Study. Participants were interviewed about the occurrence of vaginal or urethral dischargeand frequent or painful urination in the previous 6 months. Respondents were asked to provideblood and a ﬁrst catch urine sample. Serum was tested for HIV-1. Urine was tested with ligasechain reaction (LCR) for

Original article Asymptomatic non-ulcerative genital tract infections in a rural Ugandan population

OBJECTIVE: To document the prevalence of asymptomatic non-ulcerative genital tract infections (GTI) in a rural African cohort. METHODS: The study population consisted of all adults aged 15-59 residing in 56 rural communities of Rakai District, southwest Uganda, enrolled in the Rakai STD Control for AIDS Prevention Study. Participants were interviewed about the occurrence of vaginal or urethral discharge and frequent or painful urination in the previous 6 months. Respondents were asked to provide blood and a first catch urine sample. Serum was tested for HIV-1. Urine was tested with ligase chain reaction (LCR) for N gonorrhoeae and C trachomatis. Women provided two self administered vaginal swabs; one for T vaginalis culture and the other for a Gram stained slide for bacterial vaginosis (BV) diagnosis. RESULTS: A total of 12,827 men and women were enrolled. Among 5140 men providing specimens, 0.9% had gonorrhoea and 2.1% had chlamydia. Among 6356 women, 1.5% had gonorrhoea, 2.4% had chlamydia, 23.8% were infected with trichomonas and 50.9% had BV.53% of men and 66% of women with gonorrhoea did not report genital discharge or dysuria at anytime within the previous 6 months. 92% of men and 76% of women with chlamydia and over 80% of women with trichomonas or BV were asymptomatic. The sensitivities of dysuria or urethral discharge for detection of infection with either gonorrhoea or chlamydia among men were only 21.4% and 9.8% respectively; similarly, among women the sensitivity of dysuria was 21.0% while that of vaginal discharge was 11.6%. For trichomonas or BV the sensitivity of dysuria was 11.7% and that of vaginal discharge was 10.5%. CONCLUSION: The prevalence of non-ulcerative GTIs is very high in this rural African population and the majority are asymptomatic. Reliance on reported symptoms alone would have missed 80% of men and 72% of women with either gonorrhoea or chlamydia, and over 80% of women with trichomonas or BV. To achieve STD control in this and similar populations public health programmes must target asymptomatic infections.

https://sti.bmj.com/content/sextrans/74/6/421.full.pdf

Asymptomatic non-ulcerative genital tract infections in a rural Ugandan population.

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/pdf/sub-saharan-africa-simulations-of-uganda-syndromic-15niz64ijw.pdf

sub-Saharan Africa: simulations of Uganda syndromic management on STD epidemiology in The effect of HIV, behavioural change, and STD

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Dynamics of spread of HIV-I infection in a rural district of Uganda.

Original article Asymptomatic non-ulcerative genital tract infections in a rural Ugandan population

Asymptomatic non-ulcerative genital tract infections in a rural Ugandan population.

sub-Saharan Africa: simulations of Uganda syndromic management on STD epidemiology in The effect of HIV, behavioural change, and STD