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HIV and Other Sexually Transmitted Infections in a Cohort of Women Involved in High-Risk Sexual Behavior in Kampala, Uganda

Vandepitte, Judith MD, MSc*; Bukenya, Justine MD, MPH*; Weiss, Helen A. PhD; Nakubulwa, Susan BSc*; Francis, Suzanna C. MSc, MPH; Hughes, Peter MSc, CSci*; Hayes, Richard DSc; Grosskurth, Heiner MD, PhD*†

Sexually Transmitted Diseases: April 2011 - Volume 38 - Issue 4 - p 316-323
doi: 10.1097/OLQ.0b013e3182099545
Original Study

Background: Uganda has long been successful in controlling the HIV epidemic; however, there is evidence that HIV prevalence and incidence are increasing again. Data on the HIV/STI epidemic among sex workers are so far lacking from Uganda. This paper describes the baseline epidemiology of HIV/STI in a newly established cohort of women involved in high-risk sexual behavior in Kampala, Uganda.

Methods Women were recruited from red-light areas in Kampala. Between April 2008 and May 2009, 1027 eligible women were enrolled. Sociodemographic and behavioral information were collected; blood and genital samples were tested for HIV/STI. Risk factors for HIV infection were examined using multivariate logistic regression.

Results: HIV seroprevalence was 37%. The prevalence of Neisseria gonorrhoeae was 13%, Chlamydia trachomatis, 9%; Trichomonas vaginalis, 17%; bacterial vaginosis, 56% and candida infection, 11%. Eighty percent had herpes simplex virus 2 antibodies (HSV-2), 21% were TPHA-positive and 10% had active syphilis (RPR+TPHA+). In 3% of the genital ulcers, Treponema pallidum (TP) was identified, Haemophilus ducreyi in 6%, and HSV-2 in 35%. Prevalent HIV was independently associated with older age, being widowed, lack of education, sex work as sole income, street-based sex work, not knowing HIV-status, using alcohol, and intravaginal cleansing with soap. HIV infection was associated with N. gonorrhoeae, T. vaginalis, bacterial vaginosis, HSV-2 seropositivity and active syphilis.

Conclusions: Prevalence of HIV/STI is high among women involved in high-risk sexual behavior in Kampala. Targeted HIV prevention interventions including regular STI screening, voluntary HIV testing and counseling, condom promotion, and counseling for reducing alcohol use are urgently needed in this population.

High prevalence of HIV (37%) and other STI combined with high alcohol use and risky sexual behavior among women involved in sex work in Kampala, Uganda urges for specific HIV prevention interventions in high-risk population groups.

From the *MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda and the †MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, United Kingdom

The authors acknowledge Women At Work International Uganda for their assistance in recruiting study participants; the GHWP study team for their dedication to the work; and the study participants for their collaboration.

Supported by Medical Research Council, United Kingdom; European and Developing Countries Clinical Trials Partnership.

Correspondence: Judith Vandepitte, MD, MSc, MRC/UVRI Uganda Research Unit on AIDS, PO Box 49, Entebbe, Uganda. E-mail:

Received for publication May 29, 2010, and accepted September 8, 2010.

© Copyright 2011 American Sexually Transmitted Diseases Association