The incidence of HIV & HTLV-I infection among STD clinic attenders in Jamaica

Of 970 sexually transmitted disease (STD) patients enrolled at the Comprehensive Health Centre, Kingston, in January 1991, 710 (73 percent, 333 men and 377 women) were re-examined between January 1992 and July 1993 in order to estimate the incidence of HIV and HTLV-I infection and to identify risk factors for transmission. Of those re-examined, 20 percent were recruited passively when they returned to the clinic of their own accord, and 80 percent were recruited actively through field visits to their homes. Passively recruited persons were significantly more likely than active recruits to have had a STD since enrolment or at their follow-up visit. Seven men and one woman became HIV-positive during the period of follow-up. The overall HIV incidence rate was 0.7 per 100 person years (CI 0.3-1.4); or for men 1.4 (CI 0.5-2.8) and for women 0.2 (CI0.004-0.9). Four of 270 men and four of 318 women were HTLV-I-positive, an overall incidence of 0.9 per 100 person years (CI 0.4-1.7); 1.0 for men and 0.8 for women. The presumed lower transmission probability for HTLV-I may combine with a higher prevalence of HTLV-I in sexual partners to produce similar overall incidence rates for the two infections. The HIV and HTLV-I incidence rates may have been underestimated because some of the study subjects who were not included may have had a somewhat higher risk. On univariate analysis there were significant associations between HIV transmission in men and drinking alcohol before sex, cocaine use, total number of sex partners and sex with a prostitute since enrollment and ever accepting money for sex, the average number of sex partners per month, bruising during sex and genital ulcers on follow-up examination. This analysis needs to be intepreted with caution in view of the small number of seroconverters which did not allow testing for independent effects in a logistic regression model (AU)