Infectious Disease Reports 2010; volume 2:e13 High HIV prevalence and tion (13.6%), alcoholism (10.1%), carelessness (10.1%), poverty (9.7%), ignorance (9.5%)), Correspondence: John Rubaihayo, Public Health associated factors in a remote rape (4.7%), drug abuse (3.6%) and others Department, Mountains of the Moon University, community in the Rwenzori (malice/malevolence, laziness, etc.) (6.2%). P.O. Box 837, Fort-Portal, Uganda. region of Western Uganda Although there was a slight decline compared E-mail: [email protected] to previous reports, the results from this study Key words: HIV, epidemiology, infectious dis - John Rubaihayo, 1 Surat Akib, 2 confirm that HIV prevalence is still high in this community. In order to prevent new infections, eases. Ezekiel Mughusu, 3 Andrew Abaasa 4 the factors mentioned above need to be 1Public Health Department, Mountains Contributions: JR developed the study design, addressed, and we recommend that education participated in data collection, analysis and man - of the Moon University, Fort Portal; aimed at changing individual behavior should uscript writing; AS participated in study design 2 School of Health Sciences, Kampala be intensified in this community. and manuscript writing; EM participated in data International University, Western collection, laboratory work and manuscript writ - Campus; ing; AA participated in study design, data analysis 3Medical Department, Kabarole District and manuscript writing. Local Government; Introduction Acknowledgments: we acknowledge the study 4Medical Research Council (MRC)/ Several studies in sub-Saharan Africa have participants who volunteered to give samples and Uganda Virus Research Institute (UVRI) relevant information unreservedly. We also reported divergent trends of the HIV epidemic Research Unit on AIDS, Entebbe, Uganda acknowledge the contribution of the local leaders with some countries experiencing declining or of the six parishes of Fort-Portal municipality stabilizing epidemic while a few others still (i.e. Kitumba, Njara, Kagote, Rwengoma, Kasusu record an increasing epidemic. 1-21 Variability in and Bazaar) without whom access to the study HIV prelavence has also been observed in sub- participants would have been difficult. We extend Abstract populations in different countries with gener - our sincere appreciation to Mountains of the alized HIV epidemics in sub-Saharan Africa. 1,2,5,9 Moon University for the financial support and Dr. In Uganda, previous studies have shown a Uganda is among the African countries with Okech Joa Ojony, the District Health officer tremendous decline in HIV prevalence over the generalized HIV epidemics that have regis - Kabarole for the HIV test kits and the Medical past two decades due to changes in sexual tered a significant decline in the overall preva - Superintendents of Fort-Portal regional referral behavior with a greater awareness of the risks lence of HIV/AIDS in the last two decades. 1,9,10 hospital, Kabarole hospital and Virika hospital for their support. involved. However, studies in Fort-Portal Although there is new evidence of an increase municipality, a rural town in Western Uganda, in HIV infections in some parts of Uganda, 12 Conflict of interest: the authors report no con - continued to show a persistent high HIV preva - several other studies in both urban and rural flicts of interest. lence despite the various interventions in areas have shown a tremendous decline in HIV place. We conducted a study to establish the prevalence associated with increased aware - Received for publication: 19 December 2009. current magnitude of HIV prevalence and the ness and significant decrease in sexual behav - Revision received: 7 September 2010. factors associated with HIV prevalence in this ior at risk. 12-22 The Uganda National sero and Accepted for publication: 8 September 2010. 10 community. This cross-sectional study was behavioural survey 2004/5 showed adult HIV This work is licensed under a Creative Commons conducted between July and November 2008. prevalence declined from 18-30 % in the early Attribution 3.0 License (by-nc 3.0). Participants were residents of Fort-Portal 1990s to 6.4% in 2005. The report further municipality aged 15-49 years. A population- showed an estimated 1.1 million Ugandans liv - ©Copyright J. Rubaihayo et al., 2010 based HIV sero-survey and a clinical review of ing with the HIV/AIDS in 2005 with lowest Licensee PAGEPress, Italy prevention of mother to child HIV transmission prevalence in the West Nile region (2.3%) and Infectious Disease Reports 2010; 2:e13 doi:10.4081/idr.2010.e13 (PMTCT) and voluntary counseling and HIV highest prevalence in Central region (8.5%), Testing (VCT) records were used to collect followed by North ern region (8.2%), Western quantitative data. An inteviewer administered region (6.9%) and Eastern region (5.3%). country. To monitor HIV incidence and preva - structured questionnaire was used to collect According to the 2003 sexually transmitted lence trends, four surveillance systems have qualitative data on social deographics, risk diseases (STDs)/AIDS surveillance report by been used in Uganda: longitudinal cohort stud - behaviour and community perceptions. Focus the Uganda Ministry of Health, 23 the most pre - ies describing the trends in HIV incidence, group discussions (FGDs) and in-depth inter - dominant factors driving the HIV epidemic in antenatal care (ANC)/prevention of mother to views provided supplementary data on commu - most communities in Uganda were sexual child HIV transmission (PMTCT) sentinel sur - nity perceptions. Logistic regression was used behavior at risk (multiple sexual partners, veillance, voluntary HIV counseling and testing in the analysis. The overall HIV prevalence in extra-marital sex, early age sex, unprotected (VCT) sentinel surveillance and population- the general population was 16.1% [95% CI; casual sex), infection with sexually transmit - based HIV-sero surveys which describe trends 12.5-20.6]. Prevalence was lower among ted infections (STIs) such as syphilis and her - in HIV prevalence. 24 women (14.5%; 95% CI; 10.0-19.7) but not sig - pes simplex virus type 2 (HSV-2), and socio- Population based sero-surveys are the most nificantly different from that among men cultural and economic factors (poverty, alco - preferred means for monitoring HIV preva - (18.7%; 95% CI; 12.5-26.3) ( c2=0.76, P=0.38). holism, prostitution, drug abuse, lack of male lence because data are systematically collected Having more than 2 sexual partners increased circumcision, domestic violence, conflict and and are more representative than in the odds of HIV by almost 2.5 times. None or civil strife). Since HIV infection in Uganda is ANC/PMTCT and VCT-based sero-surveil - low education and age over 35 years were inde - mainly sexually transmitted, 10 promotion of lance. 25-26 However, they are expensive and are pendently associated with HIV prevalence safer sexual behavior, particularly sexual usually conducted after long intervals. 25 ANC (P<0.05). Most participants attributed the abstinence, mutual faithfulness and condom sentinel HIV surveillance system based on high HIV prevalence to promiscuity/multiple use (the “ABC” approach), has been the main annual antenatal HIV serological surveys in sexual partners (32.5%), followed by prostitu - HIV/AIDS prevention strategy throughout the selected sentinel clinics was established in [page 40 ] [Infectious Disease Reports 2010; 2:e13] Article Uganda in 1989. 23 Later, the Uganda Ministry of overall prevalence of 22.1% for the period 1991- being represented by two parishes. Secondly, Health adopted the policy on PMTCT following 94 and 19.0% for the period 1995-2004 among from each parish, three villages/wards were evidence in 1999 that single dose nevirapine women of reproductive age (15-49 years). randomly selected and finally, from each vil - can significantly lower mother to child HIV Another study that reviewed VCT data at the lage/ward, 20 households were randomly transmission. 14 Since then, the Ministry of three major hospitals in 2007 33 reported an HIV selected. Any member of the household who Health has implemented a nation-wide PMTCT prevalence of 25.4%. In addition, the 2004/5 met the inclusion criteria and gave their con - program integrated with ANC services in National HIV sero-survey report indicated that sent was considered in the study. If more than selected sentinel HIV surveillance sites spread the Batooro ethnic community (the predomi - one or all the members of a household were throughout the country. However, since nant tribe in Fort Portal municipality) had the interested, then simple random sampling was PMTCT is ANC-based, the program does not highest HIV prevalence in Uganda at 14.8%. 10 applied to select only one person per house - collect any information on HIV prevalence in However, the factors responsible for this high hold. If no household member was present or men, non-pregnant women, nor women who HIV prevalence in this remote community were willing to participate, the household was either do not attend clinics for pregnancy care not well known. We, therefore, conducted a replaced by the next one. or who receive ANC at facilities not represent - study: i) to establish the current HIV sero- ed in the PMTCT program. 27 VCT programs prevalence in the general population and at Household survey were developed to address gaps in the PMTCT PMTCT and VCT centers in the municipality; During the population survey, participants program and have expanded rapidly in recent ii) to determine the factors associated with were sensitized about the purpose of the study years as a complementary data source for mon - HIV prevalence in the community. and requested to provide informed consent. itoring the trend of the HIV epidemic in many Consenting participants were interviewed sub-Saharan African countries. 28-29 In Uganda, using an interviewer administered structured the Ministry of Health developed the first VCT questionnaire on socio-demographics, sexual policy in 2002. 29 This was later revised in 2005 Materials and Methods behavior and perceived risk factors.