HIV-1 prevalence and risk factors among sexually transmitted disease clinic attenders in Trinidad

During mid-1987 to mid-1988 and mid-1990 to mid-1991 researchers conducted cross sectional serological surveys at the STD clinic in Port of Spain in Trinidad to examine trends in HIV-1 prevalence among 2019 and 1606 STD patients respectively. They also conducted a case control study of risk factors for HIV-1 infection among heterosexual STD patients (131 cases and 173 age- and sex-matched controls) in 1992-1993. Between 1987-1988 and 1990-1991 HIV-1 seroprevalence increased markedly (3% to 13.6%). It increased more in women than in men (9- vs. 4-fold). During 1987-1988 men were more likely to be infected with HIV-1 (odds ratio [OR] = 3.1) but by 1990-1991 gender was no longer a significant risk factor (OR = 1.3). In 1990-1991 significant risk factors for HIV-1 infection were urban residence (OR = 2.2) HTLV-1 infection (OR = 3.1) and being at least 40 years old (OR = 1.8). None of these risk factors were significant in 1987-1988. HIV-1/HTLV-1 coinfection increased between the two surveys (0.05% to 1.5%). Significant independent HIV-1 risk factors in men identified in the case control study were: used crack cocaine in the past 6 months (adjusted OR [AOR] = 6.2; p = 0.0001); ever had anal sex (AOR = 7.2; p = 0.003); ever had syphilis (AOR = 3.2; p = 0.02); current genital ulcer disease (AOR = 5.2; p = 0.0001); and current genital warts (AOR = 3.9; p = 0.02). Significant independent HIV-1 risk factors in women were: less than 14 years old at first sex (OR = 4.8; p = 0.01); ever been a commercial sex worker (AOR = 5.7; p = 0.02); and ever had nongonococcal cervicitis (AOR = 4.1; p = 0.005). These findings suggest that sexual exposure to HIV-1 through ulcers for men and inflammatory STD and/or prostitution for women all fueled by the crack cocaine epidemic account for much of HIV-1 exploding in Trinidad. Public health interventions to prevent detect and treat STDs and crack cocaine addition may greatly reduce HIV-1 transmission.