A randomized, community trial of intensive sexually transmitted disease control for AIDS prevention, Rakai, Uganda.

An ongoing (1994-98) randomized community-based trial in Ugandas Rakai District is assessing the assumption that intensive sexually transmitted disease (STD) control efforts result in marked declines in HIV/AIDS prevalence. Described in this article are the project design and findings of the first-round baseline survey. 56 communities were grouped into 10 clusters designed to encompass social/sexual networks and clusters within blocks were randomly assigned to the intervention or control arm. All consenting permanent residents of the district are visited in their homes at 10-month intervals where they are administered extensive questionnaires provide urine and vaginal swab samples and are offered mass treatment regardless of symptoms or laboratory testing (single oral dose STD treatment in the intervention arm and anthelmintics and iron folate in the control arm). Both groups receive identical health education condom promotion and serologic counseling services. In the first round of home visits 5834 intervention and 5784 control arm subjects were enrolled representing about 90% of eligible adults. The groups were comparable in terms of sociodemographic and behavioral characteristics and baseline rates of HIV and STDs. 16.9% of subjects were HIV-positive 10.0% had syphilis 23.8% of women had trichomonas and 50.9% had bacterial vaginosis. Detailed STD assessment is expected not only to document the relationship between STD control and HIV but also to identify which STDs confer the greatest population attributable risk for HIV transmission facilitating targeted control efforts in the future.