Skip to main content
Top
Published in: BMC Public Health 1/2007

Open Access 01-12-2007 | Research article

Prevalence and risk factors for HIV-1 infection in rural Kilimanjaro region of Tanzania: Implications for prevention and treatment

Authors: Elia J Mmbaga, Akhtar Hussain, Germana H Leyna, Kagoma S Mnyika, Noel E Sam, Knut-Inge Klepp

Published in: BMC Public Health | Issue 1/2007

Login to get access

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. Health-related 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.
Literature
1.
go back to reference Asamoah-Odei E, Garcia Calleja JM, Boerma JT: HIV prevalence and trends in sub-Saharan Africa: no decline and large subregional differences. Lancet. 2004, 364: 35-40. 10.1016/S0140-6736(04)16587-2.CrossRefPubMed Asamoah-Odei E, Garcia Calleja JM, Boerma JT: HIV prevalence and trends in sub-Saharan Africa: no decline and large subregional differences. Lancet. 2004, 364: 35-40. 10.1016/S0140-6736(04)16587-2.CrossRefPubMed
2.
go back to reference Cheluget B, Baltazar G, Oreqe P, Ibrahim M, Marum LH, Stover J: Evidence for population level declines in adult HIV prevalence in Kenya. Sex Transm Infect. 2006, 82 Suppl 1: i21-i26. 10.1136/sti.2005.015990.CrossRefPubMed Cheluget B, Baltazar G, Oreqe P, Ibrahim M, Marum LH, Stover J: Evidence for population level declines in adult HIV prevalence in Kenya. Sex Transm Infect. 2006, 82 Suppl 1: i21-i26. 10.1136/sti.2005.015990.CrossRefPubMed
3.
go back to reference Fylkesnes K, Musonda RM, Sichone M, Ndhlovu Z, Tembo F, Monze M: Declining HIV prevalence and risk behaviours in Zambia: evidence from surveillance and population-based surveys. AIDS. 2001, 15: 907-916. 10.1097/00002030-200105040-00011.CrossRefPubMed Fylkesnes K, Musonda RM, Sichone M, Ndhlovu Z, Tembo F, Monze M: Declining HIV prevalence and risk behaviours in Zambia: evidence from surveillance and population-based surveys. AIDS. 2001, 15: 907-916. 10.1097/00002030-200105040-00011.CrossRefPubMed
4.
go back to reference Michelo C, Sandoy IF, Fylkesnes K: Marked HIV prevalence declines in higher educated young people: evidence from population-based surveys (1995-2003) in Zambia. AIDS. 2006, 20: 1031-1038. 10.1097/01.aids.0000222076.91114.95.CrossRefPubMed Michelo C, Sandoy IF, Fylkesnes K: Marked HIV prevalence declines in higher educated young people: evidence from population-based surveys (1995-2003) in Zambia. AIDS. 2006, 20: 1031-1038. 10.1097/01.aids.0000222076.91114.95.CrossRefPubMed
5.
go back to reference Wilkinson D, Abdool Karim SS, Williams B, Gouws E: High HIV incidence and prevalence among young women in rural South Africa: developing a cohort for intervention trials. J Acquir Immune Defic Syndr. 2000, 23: 405-409.CrossRefPubMed Wilkinson D, Abdool Karim SS, Williams B, Gouws E: High HIV incidence and prevalence among young women in rural South Africa: developing a cohort for intervention trials. J Acquir Immune Defic Syndr. 2000, 23: 405-409.CrossRefPubMed
6.
go back to reference Yahya-Malima KI, Olsen BE, Matee MI, Fylkesnes K: The silent HIV epidemic among pregnant women within rural Northern Tanzania. BMC Public Health. 2006, 6: 109-10.1186/1471-2458-6-109.CrossRefPubMedPubMedCentral Yahya-Malima KI, Olsen BE, Matee MI, Fylkesnes K: The silent HIV epidemic among pregnant women within rural Northern Tanzania. BMC Public Health. 2006, 6: 109-10.1186/1471-2458-6-109.CrossRefPubMedPubMedCentral
7.
go back to reference Arroyo MA, Hoelscher M, Sateren W, Samky E, Maboko L, Hoffman O, Kijak G, Robb M, Birx DL, McCutchan FE: HIV-1 diversity and prevalence differ between urban and rural areas in the Mbeya region of Tanzania. AIDS. 2005, 19: 1517-1524. 10.1097/01.aids.0000183515.14642.76.CrossRefPubMed Arroyo MA, Hoelscher M, Sateren W, Samky E, Maboko L, Hoffman O, Kijak G, Robb M, Birx DL, McCutchan FE: HIV-1 diversity and prevalence differ between urban and rural areas in the Mbeya region of Tanzania. AIDS. 2005, 19: 1517-1524. 10.1097/01.aids.0000183515.14642.76.CrossRefPubMed
8.
go back to reference Barongo LR, Borqdorff MW, Mosha FF, Nicoll A, Grosskurth H, Senkoro KP, Newell JN, Changalucha J, Klokke AH, Killewo JZ, et al: The epidemiology of HIV-1 infection in urban areas, roadside settlements and rural villages in Mwanza Region, Tanzania. AIDS. 1992, 6: 1521-1528. 10.1097/00002030-199212000-00016.CrossRefPubMed Barongo LR, Borqdorff MW, Mosha FF, Nicoll A, Grosskurth H, Senkoro KP, Newell JN, Changalucha J, Klokke AH, Killewo JZ, et al: The epidemiology of HIV-1 infection in urban areas, roadside settlements and rural villages in Mwanza Region, Tanzania. AIDS. 1992, 6: 1521-1528. 10.1097/00002030-199212000-00016.CrossRefPubMed
9.
go back to reference Killewo J, Nyamuryekunge K, Sandstrom A, Bredberg-Raden U, Wall S, Mhalu F, Biberfeld G: Prevalence of HIV-1 infection in the Kagera region of Tanzania: a population-based study. AIDS. 1990, 4: 1081-1085. 10.1097/00002030-199011000-00005.CrossRefPubMed Killewo J, Nyamuryekunge K, Sandstrom A, Bredberg-Raden U, Wall S, Mhalu F, Biberfeld G: Prevalence of HIV-1 infection in the Kagera region of Tanzania: a population-based study. AIDS. 1990, 4: 1081-1085. 10.1097/00002030-199011000-00005.CrossRefPubMed
10.
go back to reference Klouman E, Masenga EJ, Klepp KI, Sam NE, Nkya W, Nkya C: HIV and reproductive tract infections in a total village population in rural Kilimanjaro, Tanzania: women at increased risk. J Acquir Immune Defic Syndr Hum Retrovirol. 1997, 14: 163-168.CrossRefPubMed Klouman E, Masenga EJ, Klepp KI, Sam NE, Nkya W, Nkya C: HIV and reproductive tract infections in a total village population in rural Kilimanjaro, Tanzania: women at increased risk. J Acquir Immune Defic Syndr Hum Retrovirol. 1997, 14: 163-168.CrossRefPubMed
11.
go back to reference Mnyika KS, Klepp KI, Kvale G, Ole-King'ori N: Risk factors for HIV-1 infection among women in the Arusha region of Tanzania. J Acquir Immune Defic Syndr Hum Retrovirol. 1996, 11: 484-491.CrossRefPubMed Mnyika KS, Klepp KI, Kvale G, Ole-King'ori N: Risk factors for HIV-1 infection among women in the Arusha region of Tanzania. J Acquir Immune Defic Syndr Hum Retrovirol. 1996, 11: 484-491.CrossRefPubMed
12.
go back to reference Msuya SE, Mbizvo E, Hussain A, Uriyo J, Sam NE, Stray-Pedersen B: HIV among pregnant women in Moshi Tanzania: the role of sexual behaviours, male partners characteristics and sexually transmitted infections. AIDS Res Ther. 2006, 3: 27-10.1186/1742-6405-3-27.CrossRefPubMedPubMedCentral Msuya SE, Mbizvo E, Hussain A, Uriyo J, Sam NE, Stray-Pedersen B: HIV among pregnant women in Moshi Tanzania: the role of sexual behaviours, male partners characteristics and sexually transmitted infections. AIDS Res Ther. 2006, 3: 27-10.1186/1742-6405-3-27.CrossRefPubMedPubMedCentral
13.
go back to reference Rehle T, Lazzari S, Dallabetta G, Asamoah-Odei E: Second-generation HIV surveillance: better data for decision-making. Bull World Health Organ. 2004, 82: 121-127.PubMedPubMedCentral Rehle T, Lazzari S, Dallabetta G, Asamoah-Odei E: Second-generation HIV surveillance: better data for decision-making. Bull World Health Organ. 2004, 82: 121-127.PubMedPubMedCentral
14.
go back to reference Fabiani M, Nattabi B, Opoi AA, Musinguzi J, Biryahwaho B, Ayella EO, Ogwang M, Declich S: A high prevalence of HIV-1 infection among pregnant women living in a rural district of north Uganda severely affected by civil strife. Trans R Soc Trop Med Hyg. 2006, 100: 586-593. 10.1016/j.trstmh.2005.09.002.CrossRefPubMed Fabiani M, Nattabi B, Opoi AA, Musinguzi J, Biryahwaho B, Ayella EO, Ogwang M, Declich S: A high prevalence of HIV-1 infection among pregnant women living in a rural district of north Uganda severely affected by civil strife. Trans R Soc Trop Med Hyg. 2006, 100: 586-593. 10.1016/j.trstmh.2005.09.002.CrossRefPubMed
15.
go back to reference Kapiga SH, Sam NE, Mlay J, Aboud S, Ballard RC, Shao JF, Larsen U: The epidemiology of HIV-1 infection in northern Tanzania: results from a community-based study. AIDS Care. 2006, 18: 379-387. 10.1080/09540120500465012.CrossRefPubMed Kapiga SH, Sam NE, Mlay J, Aboud S, Ballard RC, Shao JF, Larsen U: The epidemiology of HIV-1 infection in northern Tanzania: results from a community-based study. AIDS Care. 2006, 18: 379-387. 10.1080/09540120500465012.CrossRefPubMed
16.
go back to reference Mulder DW, Nunn AJ, Kamali A, Nakiyingi J, Wagner HU, Kengeya-Kayondo JF: Two-year HIV-1-associated mortality in a Ugandan rural population. Lancet. 1994, 343: 1021-1023. 10.1016/S0140-6736(94)90133-3.CrossRefPubMed Mulder DW, Nunn AJ, Kamali A, Nakiyingi J, Wagner HU, Kengeya-Kayondo JF: Two-year HIV-1-associated mortality in a Ugandan rural population. Lancet. 1994, 343: 1021-1023. 10.1016/S0140-6736(94)90133-3.CrossRefPubMed
17.
go back to reference Mwaluko G, Urassa M, Isingo R, Zaba B, Boerma JT: Trends in HIV and sexual behaviour in a longitudinal study in a rural population in Tanzania, 1994-2000. AIDS. 2003, 17: 2645-2651. 10.1097/00002030-200312050-00012.CrossRefPubMed Mwaluko G, Urassa M, Isingo R, Zaba B, Boerma JT: Trends in HIV and sexual behaviour in a longitudinal study in a rural population in Tanzania, 1994-2000. AIDS. 2003, 17: 2645-2651. 10.1097/00002030-200312050-00012.CrossRefPubMed
18.
go back to reference Todd J, Balira R, Grosskurth H, Mayaud P, Mosha F, ka-Gina G, Klokke A, Gabone R, Gavyole A, Mabey D, Hayes R: HIV-associated adult mortality in a rural Tanzanian population. AIDS. 1997, 11: 801-807. 10.1097/00002030-199706000-00013.CrossRefPubMed Todd J, Balira R, Grosskurth H, Mayaud P, Mosha F, ka-Gina G, Klokke A, Gabone R, Gavyole A, Mabey D, Hayes R: HIV-associated adult mortality in a rural Tanzanian population. AIDS. 1997, 11: 801-807. 10.1097/00002030-199706000-00013.CrossRefPubMed
19.
go back to reference Urassa M, Boerma JT, Isingo R, Ngalula J, Ng'weshemi J, Mwaluko G, Zaba B: The impact of HIV/AIDS on mortality and household mobility in rural Tanzania. AIDS. 2001, 15: 2017-2023. 10.1097/00002030-200110190-00015.CrossRefPubMed Urassa M, Boerma JT, Isingo R, Ngalula J, Ng'weshemi J, Mwaluko G, Zaba B: The impact of HIV/AIDS on mortality and household mobility in rural Tanzania. AIDS. 2001, 15: 2017-2023. 10.1097/00002030-200110190-00015.CrossRefPubMed
21.
go back to reference WHO: Summary country profile for HIV/AIDS treatment scale-up. Republic of Tanzania WHO. 2005 WHO: Summary country profile for HIV/AIDS treatment scale-up. Republic of Tanzania WHO. 2005
22.
go back to reference EJ M, A H, G L, al : Trends in HIV-1 prevalence and risk behaviours in a rural population in Kilimanjaro Tanzania. Submitted. 2007 EJ M, A H, G L, al : Trends in HIV-1 prevalence and risk behaviours in a rural population in Kilimanjaro Tanzania. Submitted. 2007
23.
go back to reference Mmbaga EJ, Hussain A, Leyna G, et al: Incidence of HIV-1 infection and changes in the prevalence of reproductive tract infection and sexual risk behaviours: a population based longitudinal study in rural Tanzania. AJAR. 2006, 5: 281-287.PubMed Mmbaga EJ, Hussain A, Leyna G, et al: Incidence of HIV-1 infection and changes in the prevalence of reproductive tract infection and sexual risk behaviours: a population based longitudinal study in rural Tanzania. AJAR. 2006, 5: 281-287.PubMed
24.
go back to reference Kwesigabo G, Killewo J, Urassa W, Lugalla J, Emmelin M, Mutembei A, Mhalu F, Biberfeld G, Wall S, Sandstrom A: HIV-1 infection prevalence and incidence trends in areas of contrasting levels of infection in the Kagera region, Tanzania, 1987-2000. J Acquir Immune Defic Syndr. 2005, 40: 585-591. 10.1097/01.qai.0000168183.22147.c4.CrossRefPubMed Kwesigabo G, Killewo J, Urassa W, Lugalla J, Emmelin M, Mutembei A, Mhalu F, Biberfeld G, Wall S, Sandstrom A: HIV-1 infection prevalence and incidence trends in areas of contrasting levels of infection in the Kagera region, Tanzania, 1987-2000. J Acquir Immune Defic Syndr. 2005, 40: 585-591. 10.1097/01.qai.0000168183.22147.c4.CrossRefPubMed
25.
go back to reference Gregson S, Garnett GP, Nyamukapa CA, Hallett TB, Lewis JJ, Mason PR, Chandiwana SK, Anderson RM: HIV decline associated with behaviour change in eastern Zimbabwe. Science. 2006, 311: 664-666. 10.1126/science.1121054.CrossRefPubMed Gregson S, Garnett GP, Nyamukapa CA, Hallett TB, Lewis JJ, Mason PR, Chandiwana SK, Anderson RM: HIV decline associated with behaviour change in eastern Zimbabwe. Science. 2006, 311: 664-666. 10.1126/science.1121054.CrossRefPubMed
26.
go back to reference Joint United Nations Programme on HIV/AIDS (UNAIDS) WHO: AIDS epidemic update. UNAIDS 2006. 2006 Joint United Nations Programme on HIV/AIDS (UNAIDS) WHO: AIDS epidemic update. UNAIDS 2006. 2006
27.
go back to reference Michelo C, Sandoy IF, Dzekedzeke K, Siziya S, Fylkesnes K: Steep HIV prevalence declines among young people in selected Zambian communities: population-based observations (1995-2003). BMC Public Health. 2006, 6: 279-10.1186/1471-2458-6-279.CrossRefPubMedPubMedCentral Michelo C, Sandoy IF, Dzekedzeke K, Siziya S, Fylkesnes K: Steep HIV prevalence declines among young people in selected Zambian communities: population-based observations (1995-2003). BMC Public Health. 2006, 6: 279-10.1186/1471-2458-6-279.CrossRefPubMedPubMedCentral
28.
go back to reference Kelly MJ, Coombe C: Education as a vehicle for combating HIV/AIDS. Prospects. 2001, XXXI: 438-445. Kelly MJ, Coombe C: Education as a vehicle for combating HIV/AIDS. Prospects. 2001, XXXI: 438-445.
29.
go back to reference de Walque D: How does the impact of a HIV/AIDS campaign vary with education attainment? Evidence from rural Uganda. In: World Bank, policy research. working papers 3289,. World Bank. 2004 de Walque D: How does the impact of a HIV/AIDS campaign vary with education attainment? Evidence from rural Uganda. In: World Bank, policy research. working papers 3289,. World Bank. 2004
30.
go back to reference Lugoe WL, Klepp KI, Skutle A: Sexual debut and predictors of condom use among secondary school students in Arusha, Tanzania. AIDS Care. 1996, 8: 443-452. 10.1080/09540129650125632.CrossRefPubMed Lugoe WL, Klepp KI, Skutle A: Sexual debut and predictors of condom use among secondary school students in Arusha, Tanzania. AIDS Care. 1996, 8: 443-452. 10.1080/09540129650125632.CrossRefPubMed
31.
go back to reference Ao TT, Sam NE, Masenga EJ, Seage GR, Kapiga SH: Human immunodeficiency virus type 1 among bar and hotel workers in northern Tanzania: the role of alcohol, sexual behavior, and herpes simplex virus type 2. Sex Transm Dis. 2006, 33: 163-169. 10.1097/01.olq.0000187204.57006.b3.CrossRefPubMed Ao TT, Sam NE, Masenga EJ, Seage GR, Kapiga SH: Human immunodeficiency virus type 1 among bar and hotel workers in northern Tanzania: the role of alcohol, sexual behavior, and herpes simplex virus type 2. Sex Transm Dis. 2006, 33: 163-169. 10.1097/01.olq.0000187204.57006.b3.CrossRefPubMed
32.
go back to reference Simbayi LC, Kalichman SC, Jooste S, Mathiti V, Cain D, Cherry C: Alcohol use and sexual risks for HIV infection among men and women receiving sexually transmitted infection clinic services in Cape Town, South Africa. J Stud Alcohol. 2004, 65: 434-442.CrossRefPubMed Simbayi LC, Kalichman SC, Jooste S, Mathiti V, Cain D, Cherry C: Alcohol use and sexual risks for HIV infection among men and women receiving sexually transmitted infection clinic services in Cape Town, South Africa. J Stud Alcohol. 2004, 65: 434-442.CrossRefPubMed
33.
go back to reference Kapiga SH, Sam NE, Shao JF, Masenga EJ, Renjifo B, Kiwelu IE, Manongi R, Fawzi WW, Essex M: Herpes simplex virus type 2 infection Among Bar and Hotel Workers in Northern Tanzania: prevalence and Risk factors. Sex Transm Dis. 2003, 30: 187-192. 10.1097/00007435-200303000-00001.CrossRefPubMed Kapiga SH, Sam NE, Shao JF, Masenga EJ, Renjifo B, Kiwelu IE, Manongi R, Fawzi WW, Essex M: Herpes simplex virus type 2 infection Among Bar and Hotel Workers in Northern Tanzania: prevalence and Risk factors. Sex Transm Dis. 2003, 30: 187-192. 10.1097/00007435-200303000-00001.CrossRefPubMed
34.
go back to reference Kapiga SH, Lugalla JL: Sexual behaviour patterns and condom use in Tanzania: results from the 1996 Demographic and Health Survey. AIDS Care. 2002, 14: 455-469. 10.1080/09540120220132991.CrossRefPubMed Kapiga SH, Lugalla JL: Sexual behaviour patterns and condom use in Tanzania: results from the 1996 Demographic and Health Survey. AIDS Care. 2002, 14: 455-469. 10.1080/09540120220132991.CrossRefPubMed
35.
go back to reference Hallett TB, Aberle-Grasse J, Bello G, Boulos LM, Cayemittes MP, Cheuget B, Chipeta J, Dorrington R, Dube S, Ekra AK, et al: Declines in HIV prevalence can be associated with changing sexual behaviour in Uganda, Urban Kenya, Zimbabwe and Urban Haiti. Sex Transm Infect. 2006, 82 Suppl 1: i1-i8. 10.1136/sti.2005.016014.CrossRefPubMed Hallett TB, Aberle-Grasse J, Bello G, Boulos LM, Cayemittes MP, Cheuget B, Chipeta J, Dorrington R, Dube S, Ekra AK, et al: Declines in HIV prevalence can be associated with changing sexual behaviour in Uganda, Urban Kenya, Zimbabwe and Urban Haiti. Sex Transm Infect. 2006, 82 Suppl 1: i1-i8. 10.1136/sti.2005.016014.CrossRefPubMed
36.
go back to reference Mishra V, Vaessen M, Boerma JT, Arnold F, Way A, Barrere B, Cross A, Hong R, Sangha J: HIV testing in national population-based surveys: experience from the Demographic and Health Surveys. Bull World Health Organ. 2006, 84: 537-545.CrossRefPubMedPubMedCentral Mishra V, Vaessen M, Boerma JT, Arnold F, Way A, Barrere B, Cross A, Hong R, Sangha J: HIV testing in national population-based surveys: experience from the Demographic and Health Surveys. Bull World Health Organ. 2006, 84: 537-545.CrossRefPubMedPubMedCentral
Metadata
Title
Prevalence and risk factors for HIV-1 infection in rural Kilimanjaro region of Tanzania: Implications for prevention and treatment
Authors
Elia J Mmbaga
Akhtar Hussain
Germana H Leyna
Kagoma S Mnyika
Noel E Sam
Knut-Inge Klepp
Publication date
01-12-2007
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2007
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/1471-2458-7-58

Other articles of this Issue 1/2007

BMC Public Health 1/2007 Go to the issue