Abstract:
Background: Variability in stages of the HIV-1 epidemic and hence HIV-1 prevalence exists in different
areas in sub-Saharan Africa. The purpose of this study was to investigate the magnitude of HIV-1 infection
and identify HIV-1 risk factors that may help to develop preventive strategies in rural Kilimanjaro,
Tanzania.
Methods: A cross-sectional study was conducted between March and May of 2005 involving all individuals
aged between 15–44 years having an address in Oria Village. All eligible individuals were registered and
invited to participate. Participants were interviewed regarding their demographic characteristics, sexual
behaviors, and medical history. Following a pre-test counseling, participants were offered an HIV test.
Results: Of the 2 093 eligible individuals, 1 528 (73.0%) participated. The overall age and sex adjusted
HIV-1 prevalence was 5.6%. Women had 2.5 times higher prevalence (8.0% vs. 3.2%) as compared to men.
The age group 25–44 years, marriage, separation and low education were associated with higher risk of
HIV-1 infection for both sexes. HIV-1 infection was significantly associated with >2 sexual partners in the
past 12 months (women: Adjusted odds ratio [AOR], 2.5 (95%CI: 1.3–4.7), and past 5 years, [(men: AOR,
2.2 (95%CI:1.2–5.6); women: AOR, 2.5 (95%CI: 1.4–4.0)], unprotected casual sex (men: AOR,1.8 95%CI:
1.2–5.8), bottled alcohol (Men: AOR, 5.9 (95%CI:1.7–20.1) and local brew (men: AOR, 3.7 (95%CI: 1.5–
9.2). Other factors included treatment for genital ulcers and genital discharge in the past 1 month. Healthrelated
complaints were more common among HIV-1 seropositive as compared to seronegative
participants and predicted the presence of HIV-1 infection.
Conclusion: HIV-1 infection was highly prevalent in this population. As compared to our previous
findings, a shift of the epidemic from a younger to an older age group and from educated to uneducated
individuals was observed. Women and married or separated individuals remained at higher risk of
infection. To prevent further escalation of the HIV epidemic, efforts to scale up HIV prevention
programmes addressing females, people with low education, lower age at marriage, alcohol consumption,
condom use and multiple sexual partners for all age groups remains a top priority. Care and treatment are
urgently needed for those infected in rural areas.
