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Aim: Intimate partner violence (IPV) is a public health concern that negatively impacts women’s health. Preliminary evidence from high-income countries suggests that IPV is linked with exposure to pornographic materials among men, by encouraging negative norms of masculinity. To generate evidence from low and middle-income countries, we examined the relationship between frequent exposure to pornography and IPV perpetration among young men in Mwanza, Tanzania. Subject and methods: We conducted a cross-sectional survey among 1002 randomly selected young men aged 18 to 24 living in Mwanza, Tanzania. Results: Of the 828 ever-partnered young men included in the study, 396 (47.8%) reported viewing pornography in the past 12 months, with 14.1% viewing it at least once a week. In the last 12 months, 21.4% of participants reported perpetrating sexual IPV, while 43.2% and 15% reported to have perpetrated emotional and physical IPV respectively. After adjusting for covariates, exposure to pornography was significantly associated with sexual (aOR = 2.77 95% CI 1.51 – 5.08), emotional (aOR = 1.84 95% CI: 1.01 – 3.37) and physical (aOR = 1.65 95% CI 1.00 – 2.74) IPV perpetration. Conclusion: Frequent exposure to pornography was associated with sexual, emotional, and physical IPV perpetration. Interventions to prevent violence against women therefore need to address men’s exposure to pornography.

Objectives: To compare the situational characteristics of protected and unprotected sexual encounters that involved alcohol use 2 hours prior with ones that did not. Methods: Data were collected between December 2002 and December 2005 as part of enrollment in a prospective cohort study designed to identify HIV seroconversion risk factors among women bar and hotel workers in Northern Tanzania. A total of 608 (37.3%) of the women who were inconsistent condom users were asked a set-matched questions concerning situational characteristics surrounding their last protected and unprotected sexual encounter including whether they had been drinking within 2 hours of sex. The associations between drinking 2 hours before sex (yes/no), condom use (protected/unprotected), and their interaction with the situational descriptors were examined with a 2 x 2 model for paired categorical data after controlling for time since the last type of encounter. Results: Condom failure was 5 times more likely if someone (woman, man, or both partners) had been drinking in advance of the encounter (OR, 5.19; 95% CI, 2.05-15.46) and was especially likely to occur if only the woman had been drinking before sex (OR, 14.05; 95% CI, 4.03-50.41). Alcohol use before sex was associated with sexual contacts where the woman was having sex with her partner for the first time, their relationship was casual or transitory or sex was transactional, the location was unfamiliar and less under her control, and the partner had been drinking or using drugs before having sex. Condom use was more frequent in precisely the same types of encounters. Interestingly, there were no significant interactions between alcohol use before sex and condom use, suggesting that drinking before sex and use of condom are distinct and not contingent risk factors. Conclusions: Alcohol use before sex is associated with an increased likelihood of condom failures and with high-risk sexual encounters, ones that have consistent situational characteristics regardless of whether condoms are used or not. DOI:10.1097/0LQ.0b013e318dbadfad

Objective: To determine risk factors for sexually transmitted infections (STIs) among women in Durban and Hlabisa (South Africa), Moshi (Tanzania), and Lusaka (Zambia). Study Design: Between 2003 and 2004, 958 women at risk of STIs were enrolled in a 1-year prospective study. They were interviewed at each monthly visit, and samples for STI testing were collected during quarterly and other visits when clinically indicated. Results: The incidence of infections as measured in person-years at risk (PYAR) was as follows: overall trichomoniasis, 31.9/100 PYAR; chlamydial infection in South Africa, 19.5/100 PYAR; chlamydial infection in Tanzania and Zambia, 4.9/100 PYAR; gonorrhea in South Africa, 16.5/100 PYAR; gonorrhea in Tanzania and Zambia, 5.3/100 PYAR; overall syphilis, 7.5/100 PYAR; and overall HIV, 3.8/100 PYAR. The incidence of most STIs was highest among the South African sites, where chlamydial infection and gonorrhea were detected by using a more sensitive assay. Independent risk factors included age, hormonal contraceptive methods, and measures of sexual behavior, including number of sex partners and occurrence of anal sex in the past 3 months. Women with incident HIV infection were at increased risk of chlamydial infection [odds ratio (OR) = 5.5, 95% confidence interval (CI): 2.0-15.2]and gonorrhea (OR = 5.7, 95% CI: 1.9-17.0) in South African sites. Despite ongoing counseling during the study, high-risk sexual behaviors were common, and consistent condom use remained low. Conclusions: The incidence of STIs, including HIV, was high among women in this study. These findings highlight the urgent need for effective HIV/STI prevention programs in this population.

Objectives: To examine the relationship between patterns of alcohol use and HIV infection and to assess the association between problem drinking and the prevalence of risk factors for HIV among a sample of high-risk African women. Methods: Baseline data were collected between 2002 and 2003 during enrollment of 1050 women in a prospective cohort study designed to assess risk factors for HIV. Information about demographic and employment characteristics, sexual behaviors, and drinking patterns were obtained by interviews. The CAGE questionnaire was used to assess problem drinking. The association between measures of alcohol use and HIV/STDs and sexual behaviors were summarized using odds ratios, adjusted odds ratios (AOR), and 95% confidence intervals (CI). Results: HIV prevalence was 19.0% (95% CI, 16.6%-21.4%). Overall 73.9% of the women drank alcohol whereas 34.6% were classified as problem drinkers. After adjusting for demographic and employment variables, drinkers were at increased risk to be HIV+ when compared with nondrinkers (AOR, 2.10; 95% CI, 1.29-3.42). Greater involvement with alcohol, as indicated by recency, frequency and quantity consumed, was associated with increased risk. Problem drinkers were at greater risk to be HIV+ than nonproblem drinkers (AOR, 1.79; 95% CI, 1.06-3.04 vs. AOR, 2.43; 95% CI, 1.45-4.06). Problem drinkers were also more likely to have engaged in several types of high-risk sexual behaviors and to have other STD infections including HSV-2. Conclusion: Programs aiming at limiting alcohol use or promoting abstinence from alcohol might help to reduce high-risk behaviors and lower the burden of HIV/STDs ill this population.

To summarize the association between alcohol use and human immunodeficiency virus (HIV) infection based on studies conducted in Africa, EMBASE and PubMed were searched for African studies that related alcohol use to HIV infection. Meta-analyses were conducted to obtain pooled univariate and multivariate relative risk estimates. Subgroup analyses were performed for studies having different sample types: males or females and population-based or high-risk, and ones that differentiated between problem and asymptomatic drinkers. Alcohol drinkers were more apt to be HIV+ than nondrinkers. The pooled unadjusted odds' ratio (OR) from 20 studies was 1.70 (95% confidence interval CI = 1.45-1.99). Results front I1 studies that adjusted for other risk factors produced a pooled risk estimate of 1.57 (95% CI = 1.42-1.72). Males and females had similar risk estimates, while studies involving high-risk samples tended to report larger pooled odds' ratios than studies of the general population. When compared with nondrinkers', the pooled estimates of HIV risk were 1.57 (95% CI = 1.33-1.86) for nonproblem drinkers' versus 2.04 (95% CI = 1.61-2.58)for problem drinkers, a statistically significant difference (z = 2.08, P

Objective: The objective of this study was to describe the design of a community-based study of sexually transmitted infections (STIs)/ HIV and infertility in northern Tanzania. Study Design: Households were selected using a 2-stage sampling design. Eligible women and their partners were interviewed before samples were collected for STIs/HIV detection. Posttest counseling and treatment for STIs and infertility were provided. Results: A total of 2019 women and 794 male partners were interviewed. Over 70% of interviewed women and men provided blood and urine samples. Individuals providing blood and urine samples had high-risk profiles for STIs/HIV when compared with others who did not provide these samples. Although the study results may be affected by selection bias, risk factors for STIs/HIV were similar to those in other studies supporting the generalizability of the findings. Conclusions: It is feasible to conduct a community-based survey, including collection of biomarkers and measurement of infertility, in this urban setting.

Objective: The objective of this study was to determine predictors of Trichomonas vaginalis among women and their partners in Moshi, Tanzania. Study Design: Women (N = 1440) and their partners (N = 588) were interviewed and specimens for detection of T. vaginalis and sexually transmitted infections (STIs) were collected. Results: Prevalence of T. vaginalis was 10.7% in women and 6.3% in men. Having a partner with T. vaginalis was the strongest risk factor in women (adjusted odds ratio [OR], 19.44; 95% confidence interval [CI], 7.84-48.25) and men (adjusted OR, 19.01; 95% CI, 6.8-52.40). Risk of T. vaginalis infection was increased in subjects with less education. Other risk factors in women were daily alcohol consumption, being separated, reporting infertility problems, having a partner who had children with other women, and other STIs; and in men, the risk factor was having no income. T. vaginalis was not associated with HIV-1 in women and men. Conclusions: Prevention of T. vaginalis and other STIs among couples is a major priority. Reduction of alcohol consumption in women is an important intervention.

Goals: We assessed baseline prevalence of human immunodeficiency virus type 1 (HIV-1) and other STDs, as well as behavioral and biologic risk factors for HIV-1 in a population of female bar/hotel workers in Moshi, Tanzania. Study Design: Between 2002 and 2003, we enrolled 1042 female bar/hotel workers in an ongoing prospective cohort study. We analyzed data collected at baseline to assess the associations between alcohol, sexual behavior, STDs, and HIV-1 infection. Results: The prevalence of HIV-1 infection was 19.0% (95% confidence interval [CI] = 16.6%-21.4%). Consistent condom use was low (11.1%). HIV-1 was associated with genital ulcers on examination (adjusted odds ratio [AOR] = 2.08, 95% CI = 1.16-3.74), herpes simplex virus type 2 (HSV-2) (AOR = 3.80, 95% CI = 2.42-5.97), and problem drinking (AOR = 1.92, 95% CI = 1.06-3.47). Other independent predictors of HIV-1 were increasing age, number of sex partners, cohabitating, formerly married, location of employment, and having a husband with another wife. Conclusions: These findings suggest that programs designed to control HSV-2, reduce the number of sexual partners and alcohol use, and promote condom use could be effective in reducing transmission of HIV-1 in this population.

Background: Type-specific serological tests have allowed for a better understanding of the epidemiology of herpes simplex virus type 2 (HSV-2) infection in Africa. Goal: The goal was to determine risk factors for HSV-2 among bar and hotel workers in Moshi, Tanzania. Study Design: A cross-sectional study was conducted involving 515 workers in randomly selected bars and hotels in Moshi. Results: The seroprevalence of HSV-2 was 43.5%. Women were more likely to be HSV-2-seropositive than men (age-adjusted OR = 3.8; 95% CI = 2.5-5.8). In multivariate analyses, age was positively associated with HSV-2 in both women and men. HIV-1-seropositive women had a significantly increased risk of HSV-2 infection (adjusted OR = 2.8; 95% CI = 1.5-5.1). Other predictors of HSV-2 were religion and sexual behavior for women and level of education, frequency of alcohol use, and concurrent partners for men. Conclusion: The most common genital infection was that with HSV-2. Control of HSV-2 might be an important strategy for HIV-1 infection prevention in this population.

Use of an intrauterine device (IUD) contraceptive may be associated with a higher risk of HIV infection in women. Researchers in Dar-es-Salaam, Tanzania interviewed 2,285 women between the ages of 15 and 48 at family planning clinics to evaluate risk factors for HIV infection. The incidence of HIV infection among these women was 11.5%. Fifty percent of the HIV-positive women were married. Employment outside the home and a higher level of education of both the women and their husbands were associated with a greater likelihood of HIV infection. Women whose husbands had other sex partners were also at greater risk, as were women who had multiple partners and women with sexually transmitted diseases. Housewives and young women between 15 and 19 years old had the lowest prevalence of HIV infection. There was no significant association between HIV infection and either oral or injectable contraceptive use. Women who used IUDs, however, were 2.5 times more likely to be HIV positive.

Objective measurement of alcohol consumption is important for clinical care and research. Adjusting for self‐reported alcohol use, we conducted an individual participant data (IPD) meta‐analysis to examine factors associated with the sensitivity of phosphatidylethanol (PEth), an alcohol metabolite, among persons self‐reporting unhealthy alcohol consumption. We identified 21 eligible studies and obtained 4073 observations from 3085 participants with Alcohol Use Disorders Identification Test—Consumption (AUDIT‐C) positive scores (≥3 for women and ≥4 for men) and PEth measurements. We conducted 1‐step IPD meta‐analysis using mixed effects models with random intercepts for study site. We examined the associations between demographic (sex, race/ethnicity, and age) and biologic (body mass index—BMI, hemoglobin, HIV status, liver fibrosis, and venous versus finger‐prick blood collection) variables with PEth sensitivity (PEth≥8 ng/ml), adjusting for the level of self‐reported alcohol use using the AUDIT‐C score. One third (31%) of participants were women, 32% were African, 28% African American, 28% White, and 12% other race/ethnicity. PEth sensitivity (i.e., ≥8 ng/ml) was 81.8%. After adjusting for AUDIT‐C, we found no associations of sex, age, race/ethnicity, or method of blood collection with PEth sensitivity. In models that additionally included biologic variables, those with higher hemoglobin and indeterminate and advanced liver fibrosis had significantly higher odds of PEth sensitivity; those with higher BMI and those living with HIV had significantly lower odds of PEth sensitivity. African Americans and Africans had higher odds of PEth sensitivity than whites in models that included biologic variables. Among people reporting unhealthy alcohol use, several biological factors (hemoglobin, BMI, liver fibrosis, and HIV status) were associated with PEth sensitivity. Race/ethnicity was associated with PEth sensitivity in some models but age, sex, and method of blood collection were not. Clinicians should be aware of these factors, and researchers should consider adjusting analyses for these characteristics where possible. This is an analysis of data from 21 studies that included 3085 persons from four continents who reported unhealthy alcohol use. We found that the sensitivity of phosphatidylethanol (PEth), a blood alcohol biomarker indicating prior 2–4 weeks’ alcohol use, increased with level of alcohol use, but did not vary by sex, race/ethnicity, or age. PEth sensitivity was lower for persons with higher body mass index, more severe anemia, and among persons with HIV infection. These factors may need to be considered in interpreting negative PEth results.

ABSTRACTBackgroundAlthough alcohol consumption is a well-known risk factor for intimate partner violence (IPV) perpetration, few studies have been conducted among young males in low- and middle-income countries. Alcohol consumption and IPV are both complex phenomena, whose association requires more in-depth exploration regarding drinking patterns and the alcohol-related manifestation of five different forms of IPV.ObjectiveIn this study, we sought to explore the relationship between alcohol use and IPV in young Tanzanian men and to identify differences in the magnitude of past-year IPV perpetration among alcohol drinkers and abstainers. Furthermore, we aimed to assess the association between various drinking patterns with the perpetration of different forms of IPV.MethodsA cross-sectional survey of 1002 young males residing in Mwanza, Tanzania, was conducted in 2021–2022. Data on alcohol consumption were collected using the alcohol use disorder identification test. IPV perpetration was assessed using an index total of 19 items on acts of physical, sexual, economic, emotional abuse, and controlling behaviour. Logistic regression models were conducted to estimate the relationship between alcohol use and the perpetration of each form of IPV.ResultsAmong partnered respondents currently consuming alcohol (n = 189, 18.8%), the most and the least prevalent IPV forms in the past 12 months were controlling behaviour (84.1%) and physical IPV (25.4%), respectively. Those reporting recent alcohol consumption reported higher rates of all forms of past-year IPV perpetration compared to abstainers. While no form of IPV was associated with low-risk consumption versus abstention, all forms of IPV were associated with hazardous drinking.ConclusionYoung men who drink alcohol, especially those drinking hazardously, are also more likely to report perpetrating IPV. An understanding of the different drinking patterns and manifestations of forms of IPV can contribute to better-tailored alcohol-related interventions and has the potential to improve young adults’ health and reduce IPV perpetration.

The global burden of cervical cancer remains very high, with more than 340,000 potentially preventable deaths annually and disproportionally affects low-income and middle-income countries. Countries that have adopted HPV vaccination administer a multidose schedule with 2 doses offered to girls younger than 15 years, and 3 offered to girls 15 years and older or immunocompromised individuals. Unfortunately, several barriers to full immunization remain, and only 15% of girls in the target age group worldwide are estimated to be fully vaccinated. A single-dose vaccine would remove many barriers and be significantly cheaper; however, evidence is needed on the immunogenicity and efficacy.This randomized phase 3 clinical trial (DoRIS) aimed to examine immune responses after a single dose of HPV vaccine in the target age group for HPV vaccination in Tanzania. Girls aged 9–14 years who have not been vaccinated for HPV and did not have any history of cervical lesions, treatment for positive cervical cancer screening, or immunocompromised status were invited from Government schools to participate. Participants were randomized to 1 of 6 arms comprising 3 different dose schedules of 2 different HPV vaccines (3 doses over 6 months, 2 doses given 6 months apart, or a single dose for either the 2-valent vaccine or the 9-valent vaccine). Blood samples were collected for immunological assays at 1, 7, 12, and 24 months after vaccination. The primary study outcome was noninferiority of HPV 16 and HPV 18 specific seropositivity after a single dose compared with 2 or 3 doses of the same vaccine 24 months after vaccination. Primary analyses were undertaken in the per-protocol population, including those who received the allocated doses of HPV vaccine in the protocol-defined window. A sensitivity analysis included all participants who received at least 1 dose of HPV vaccine.A total of 930 girls were enrolled and randomized with 155 participants per group. At 24 months, 856 (93%) girls were included in the per-protocol analysis of anti-HPV 16 antibody responses, and 831 (91%) in the per-protocol analysis of anti-HPV 18. All but 2 participants were seropositive for HPV 16 IgG at 24 months (1 participant in each of the 1-dose arms was not), and all but 6 participants were HPV 18 seropositive at 24 months (2 in the 1-dose 2-valent group, 3 in the 1-dose 9-valent group, and 1 in the 3-dose 9-valent group). Noninferiority of HPV 16 seroconversion was met at 24 months for 1 dose compared with 2 doses or 3 doses for both vaccines; however, noninferiority for HPV 18 seroconversion was not met despite 98% of girls in the 1-dose arms of both vaccines testing positive for anti-HPV 18. There was no difference in serious adverse events among study groups or any serious adverse events related to the vaccine.The results of this study demonstrate that, in healthy Tanzanian girls, a single dose of the 2-valent or 9-valent HPV vaccines was well tolerated and resulted in high seropositivity and induced stable vaccine responses that persisted to 24 months.

ObjectiveHuman papillomavirus (HPV) DNA has been detected in vaginal samples from adolescent girls who report no previous sex and, in high-income settings, from fingertips, raising the possibility of non-sexual transmission. No such studies originate from East Africa which bears among the highest cervical cancer incidence and HPV prevalence worldwide. HPV-related oral cancer incidence is increasing, but oral HPV prevalence data from East Africa are limited. We aimed to describe the HPV DNA prevalence in genital and non-genital sites and in the bathroom of unvaccinated adolescent girls, and examine genotype concordance between sites.MethodsWe nested a cross-sectional study of HPV in genital and extragenital sites within a cohort study of vaginal HPV acquisition. Unvaccinated girls age 16–18 years in Tanzania, who reported ever having had sex, were consented, enrolled and tested for the presence of HPV DNA in vaginal samples collected using self-administered swabs, oral samples collected using an oral rinse, and on fingertips and bathroom surfaces collected using a cytobrush.ResultsOverall, 65 girls were enrolled and 23 (35%, 95% CI 23% to 47%) had detectable vaginal HPV. Adequate (β-globin positive) samples were collected from 36 girls’ fingertips and HPV was detected in 7 (19%, 95% CI 6% to 33%). 63 girls provided adequate oral samples, 4 (6%, 95% CI 0% to 13%) of which had HPV DNA detected. In bathroom samples from 58 girls, 4 (7%, 95% CI 0% to 14%) had detectable HPV DNA. Of the 11 girls with extragenital HPV, six had the same genotype in >1 site.ConclusionWe found a high prevalence of HPV in non-genital sites in adolescent girls and in their bathrooms, in this region with a high cervical cancer incidence. Concordance of genotypes between sites supports the possibility of autoinoculation.

Women with disabilities are at heightened risk of experiencing intimate partner violence [IPV], although the mechanisms through which disability acts as a risk factor for IPV are not clear.

ObjectivesTrichomonas vaginalisis the most prevalent curable STI worldwide and has been associated with adverse health outcomes and increased HIV-1 transmission risk. We conducted a cross-sectional analysis among couples to assess how characteristics of both individuals in sexual partnerships are associated with the prevalence of male and female T. vaginalisinfection.MethodsAfrican HIV-1 serodiscordant heterosexual couples were concurrently tested for trichomoniasis at enrolment into two clinical trials. T. vaginalistesting was by nucleic acid amplification or culture methods. Using Poisson regression with robust standard errors, we identified characteristics associated with trichomoniasis.ResultsAmong 7531 couples tested for trichomoniasis, 981 (13%) couples contained at least one infected partner. The prevalence was 11% (n=857) among women and 4% (n=319) among men, and most infected individuals did not experience signs or symptoms of T. vaginalis. Exploring concordance of T. vaginalisstatus within sexual partnerships, we observed that 61% (195/319) of T. vaginalis-positive men and 23% (195/857) of T. vaginalis-positive women had a concurrently infected partner. In multivariable analysis, having a T. vaginalis-positive partner was the strongest predictor of infection for women (relative risk (RR) 4.70, 95% CI 4.10 to 5.38) and men (RR 10.09, 95% CI 7.92 to 12.85). For women, having outside sex partners, gonorrhoea, and intermediate or high Nugent scores for bacterial vaginosis were associated with increased risk of trichomoniasis, whereas age 45 years and above, being married, having children and injectable contraceptive use were associated with reduced trichomoniasis risk. Additionally, women whose male partners were circumcised, had more education or earned income had lower risk of trichomoniasis.ConclusionsWe found that within African HIV-1 serodiscordant heterosexual couples, the prevalence of trichomoniasis was high among partners of T. vaginalis-infected individuals, suggesting that partner services could play an important role identifying additional cases and preventing reinfection. Our results also suggest that male circumcision may reduce the risk of male-to-female T. vaginalistransmission.

Theories of epidemiology, health behaviour, and social science have changed the understanding of HIV prevention in the past three decades. The HIV prevention cascade is emerging as a new approach to guide the design and monitoring of HIV prevention programmes in a way that integrates these multiple perspectives. This approach recognises that translating the efficacy of direct mechanisms that mediate HIV prevention (including prevention products, procedures, and risk-reduction behaviours) into population-level effects requires interventions that increase coverage. An HIV prevention cascade approach suggests that high coverage can be achieved by targeting three key components: demand-side interventions that improve risk perception and awareness and acceptability of prevention approaches; supply-side interventions that make prevention products and procedures more accessible and available; and adherence interventions that support ongoing adoption of prevention behaviours, including those that do and do not involve prevention products. Programmes need to develop delivery platforms that ensure these interventions reach target populations, to shape the policy environment so that it facilitates implementation at scale with high quality and intensity, and to monitor the programme with indicators along the cascade.

HIV-1 subtype C has emerged as the most prevalent strain of HIV-1 worldwide, leading to speculation that subtype C may be more transmissible than other subtypes. We compared the risk of HIV-1 transmission for subtype C versus non-C subtypes (A, D, G and recombinant forms) among heterosexual African HIV-1 serodiscordant couples.

Innovative prevention strategies for HIV-1 transmission are urgently needed. PRO2000 vaginal gel was efficacious against HIV-1 transmission in studies in macaques; we aimed to assess efficacy and safety of 2% and 0·5% PRO2000 gels against vaginal HIV-1 transmission in women in sub-Saharan Africa.

Most people infected with HIV-1 are dually infected with herpes simplex virus type 2. Daily suppression of this herpes virus reduces plasma HIV-1 concentrations, but whether it delays HIV-1 disease progression is unknown. We investigated the effect of aciclovir on HIV-1 progression.

We recently identified an HIV-1 subtype C and D circulating recombinant form (CRF10_CD) in infants in Dar es Salaam, Tanzania. So far, this is the only reported HIV-1 CRF in East Africa. However, evidence for its spread in the adult population is scarce. Here we describe the presence of CRF10_CD in two asymptomatic bar and hotel workers in Moshi, Northern Tanzania. Subgenomic sequences from gag (3′p24–5′p7), env (C2–C5), and the 5′ LTR were used for phylogenetic analysis and identification of recombination. Genetic divergence between the CRF10_CD sequences from Moshi suggested that they were contracted from independent sources. A third bar worker was infected with an apparent CRF10_CD/subtype A recombinant virus. Our data indicate that CRF10_CD genomes can be transmitted both vertically and heterosexually.

ABSTRACTWe compared two techniques for CD4 T-lymphocyte counting: flow cytometry (Cyflow) and magnetic beads (Dynabead). Similar results with good correlation were obtained from the 40 adult blood samples counted (P= 0.057, r= 0.93). The Cyflow technique is more precise and cost-effective than the Dynabead method ($3 to $5 versus $12 to $22 per test, respectively), since as many as 200 samples can be measured per day.

The HIV-1 prevalence among bar and hotel workers in Tanzania suggests they are a high-risk group for HIV-1 infection. We determined the HIV-1 subtype of 3′-p24/5′-p7 gag and C2-C5 env sequences from 40 individuals representing this population in Moshi. Genetic patterns composed of A(gag)-A(env), C(gag)-C(env), and D(gag)-D(env) were found in 19 (48.0%), 8 (20.0%), and 3 (8.0%) samples, respectively. The remaining 10 samples (25%) had different subtypes in gag and env, indicative of intersubtype recombinants. Among these recombinants, two contained sequences from HIV-1 subsubtype A2, a new genetic variant in Tanzania. Five bar and hotel workers may have been infected with viruses from a common source, based on phylogenetic analysis. The information obtained by surveillance of HIV-1 subtypes in a high-risk population should be useful in the design and evaluation of behavioral, therapeutic, and vaccine trial interventions aimed at reducing HIV-1 transmission.

ObjectiveTo examine the association between maternal HIV infection and pregnancy outcomes controlling for potential confounding factors among a cohort of HIV‐uninfected and HIV‐infected pregnant women in Dar es Salaam, Tanzania.

We recently reported that the risk of sexually acquired HIV-1 infection is increased significantly by variants in the gene encoding CD101, a protein thought to modify inflammatory responses. Using blood samples from individuals with and without these variants, we demonstrate that CD101variants modify the prevalence of circulating inflammatory cell types and show that CD101variants are associated with increased proinflammatory cytokine production by circulating T cells. One category of CD101variants is associated with a reduced capacity of regulatory T cells to suppress T cell cytokine production, resulting in a reduction in the baseline level of immune quiescence. These data are supported by transcriptomics data revealing alterations in the intrinsic regulation of antiviral pathways and HIV resistance genes in individuals with CD101variants. Our data support the hypothesis that CD101 contributes to homeostatic regulation of bystander inflammation, with CD101variants altering heterosexual HIV-1 acquisition by facilitating increased prevalence and altered function of T cell subsets.

Reducing the number of sex partners and using condoms are the major means for individuals to protect themselves from STDs and AIDS in sub-Saharan Africa. To identify predictors of having only one sex partner in the last year and to assess knowledge and use of condoms among women of reproductive age in Dar-es-Salaam, Tanzania, we interviewed 2285 women at 3 representative family planning clinics between February 1991 and June 1992. After interview, blood and genital specimens were collected for laboratory diagnosis of HIV and other sexually transmitted diseases (STDs). Although knowledge of sexual transmission of AIDS was very high, less than a half of the respondents (42.8%) mentioned use of condoms as an AIDS preventive measure. Younger and more educated women were more likely to mention use of condoms for AIDS prevention, however only 4.6% of women interviewed were regular users of condoms, while 19.8% were occasional users. The majority of women who had never used a condom (57.5%) reported not using condoms because ‘men did not like them’. Condom use was positively associated with increasing level of education and increasing number of sexual partners. 14.8% of women reported having more than one sex partner in the last year; this behaviour was more likely among cohabiting women (increased by 210%); HIV-positives (increased by 120%); and among women with STDs (increased by 50%). The fact that condom use was positively associated with factors previously shown to be risk factors for HIV in this population suggests that AIDS prevention activities have been partially successful in reaching women at risk. However, condoms were still only used by a minority of women in the high-risk strata of these risk factors. Men's negative attitude about condoms was identified as the major reason for low condom usage; interventions aiming at increased condom use need to target male attitudes.