Risk factors for HIV-1 infection among women in the Arusha region of Tanzania

A population-based cross-sectional study conducted in northern Tanzanias Arusha region found women to be at even greater risk of human immunodeficiency virus (HIV) infection than men. Three diverse sites--Unga limited (urban) the town of Babati (semi-urban) and the roadside village of Matufa (rural)--were selected. 862 (567 women and 295 men) out of 2216 eligible respondents both completed a questionnaire and provided a blood sample for HIV testing. Overall HIV-1 seroprevalence was significantly higher for women (8.5%) than men (2.0%) with a range from 2.3% among women in the rural village of Matufa to 14.4% among urban women in Unga limited. Marital status occupation age at first intercourse educational status religion and travel within the Arusha region were not associated with a significant increase in HIV infection; however travel out of the region or out of Tanzania was a significant risk factor. Also significant was having two or more sexual partners in the last six months or past five years. Finally HIV rates were significantly higher among women who used condoms and those who had sexual intercourse under the influence of alcohol. The high HIV seroprevalence rate identified in this study among women may reflect selection bias and other potential risk factors (e.g. previous history of sexually transmitted diseases) that were not assessed. Of particular concern is the likelihood given condom use as an HIV risk factor that condoms are being used incorrectly or inconsistently in this population. Since Tanzanian women lack power in sexual relations HIV/AIDS preventive interventions must target men as well as women.