HIV infection among youth in a South African mining town is associated with herpes simplex virus-2 seropositivity and sexual behaviour

AIDS, Volume 15, Issue 7: Pages 885-898, May 2001.

AIDS (Comment), Volume 15, Issue 7: Pages 931-934, May 2001.

Bertran Auverta,b; Ron Ballardc; Catherine Campbelld; Michel Caraële; Matthieu Cartona; Glenda Fehlerc; Eleanor Gouwsf; Catherine MacPhailg; Dirk Taljaardg; Johannes Van Damh; Brian Williamsg

From aINSERM U88, Saint-Maurice, the bHôpital Ambroise Paré, Boulogne-Billancourt, France, the cReference Centre for Sexually Transmitted Diseases, School of Pathology, University of the Witwatersrand and South African Institute for Medical Research, Johannesburg, South Africa, the dLondon Schools of Economics and Political Science, London, UK, the eUNAIDS, Geneva, Switzerland, the fMedical Research Council, Durban, the gCouncil for Scientific and Industrial Research, Johannesburg, South Africa and the hPopulation Council, Washington DC, USA.

INSERM U88, Saint-Maurice, France.

OBJECTIVES: To determine the seroprevalence of HIV and herpes simplex virus-2 (HSV-2) by age and gender among young people aged 14--24 years in a South African town and to identify risk factors for HIV infection.

DESIGN: A community-based, cross-sectional study was conducted on a random sample of men (n = 723) and women (n = 784) living in a township in the Carletonville district of South Africa.

METHODS: Potential demographic and behavioural risk factors associated with HIV were recorded by questionnaire and biological tests were performed on serum and urine. Data analysis was performed using multivariate logistic regression.

RESULTS: Among men and women the prevalence of HIV infection was 9.4 and 34.4%, respectively, and of positive HSV-2 serology was 17.0 and 53.3%, respectively. Among 24-year-old women the prevalence of HIV was 66.7% [95% confidence interval (CI), 54.6--77.3%]. HSV-2 seropositivity was a strong independent risk factor for HIV infection with odds ratios of 5.3 (95% CI, 2.7--10.3) for men and 8.4 (95% CI, 4.9--14.2) for women. There was no independent effect of age at first sex or serological markers of other sexually transmitted infections on HIV infection.

CONCLUSIONS: HIV infection among young women increases rapidly after the onset of sexual activity and reaches extremely high levels by 24 years of age. These findings suggest that rates of HIV transmission from men to women are high and that HSV-2 plays a major role in the spread of HIV in this population.

PMID: 11399961 [PubMed - indexed for MEDLINE]

Table 3: P=0.24
Circumcision status n HIV+ Odds Ratio 95% Confidence Interval
No498 (89.1%)11.2%1 
Yes61 (10.9%)16.4%1.60.7-3.2

Thus, circumcised men were more likely to be HIV+. The result was not significant (the 95% CI straddles 1.0) and there is a substantial probability of such an unbalanced result even if there is no association between circumcision and HIV. But it certainly casts doubts on the theory that circumcision protects against HIV infection.

"Circumcision was not common (only 10.1% of men were circumcised) and median (IQR) age at circumcision was 16 years (12-19 years). No protective effect of circumcision onHIV prevalence was shown."


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