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Risk Factors for Herpes Simplex Virus Type 2 and HIV Among Women at High Risk in Northwestern Tanzania: Preparing for an HSV-2 Intervention Trial

Watson-Jones, Deborah MD, PhD*†; Weiss, Helen A PhD*; Rusizoka, Mary DipClinMed; Baisley, Kathy MSc*‡; Mugeye, Kokugonza MPH; Changalucha, John MSc; Everett, Dean MSc*‡; Balira, Rebecca MPH; Knight, Louise MSc*‡; Ross, David MD*; Hayes, Richard J DSc*

JAIDS Journal of Acquired Immune Deficiency Syndromes: December 15th, 2007 - Volume 46 - Issue 5 - p 631-642
doi: 10.1097/QAI.0b013e31815b2d9c
Epidemiology and Social Science

Objectives: To determine prevalence of and risk factors for herpes simplex virus type 2 (HSV-2) and HIV among women being screened for a randomized, controlled trial of HSV suppressive therapy in northwestern Tanzania.

Methods: Two thousand seven hundred nineteen female facility workers aged 16 to 35 were interviewed and underwent serological testing for HIV and HSV-2. Factors associated with HSV-2 and HIV in women aged 16 to 24 were examined using logistic regression to estimate odds ratios (OR) and 95% confidence intervals (CI).

Results: HSV-2 seroprevalence was 80%, and HIV seroprevalence was 30%. Among women aged 16 to 24, both infections were significantly and independently associated with older age, being a bar worker, working at a truck stop, and having more lifetime sexual partners. HSV-2 infection was also associated with lower socioeconomic status, increased alcohol intake, younger age at first sex, inconsistent condom use, and vaginal douching. There was a strong association between the 2 infections after adjustment for other factors (OR = 4.22, 95% CI: 2.6 to 6.9).

Conclusions: Female facility workers in northwestern Tanzania are vulnerable to HSV-2 and HIV infections. Programs designed to increase safer sexual behavior and reduce alcohol use could be effective in reducing HSV-2 incidence and, in turn, HIV infection. This is a suitable population for an HSV suppressive therapy trial.

From the *London School of Hygiene and Tropical Medicine, London, England; †African Medical and Research Foundation (AMREF), Mwanza, Tanzania; and the ‡National Institute for Medical Research (NIMR), Mwanza, Tanzania.

Received for publication April 24, 2007; accepted September 13, 2007.

Support provided by the Wellcome Trust and the Department for International Development UK. Salary for Dr. Weiss was provided by the UK Medical Research Council.

Preliminary findings presented at the 16th meeting of the International Society for Sexually Transmitted Disease Research (ISSTDR), Amsterdam, July 11-13, 2005, as “Risk Factors for HIV and HSV in High Risk Women, Tanzania,” abstract #TP016.

Correspondence to: Deborah Watson-Jones, MD, PhD, Department of Infectious and Tropical Diseases, Keppel Street, London, WC1E 7HT England (e-mail: deborah.watson-jones@lshtm.ac.uk).

© 2007 Lippincott Williams & Wilkins, Inc.