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Objective: To evaluate interrelationships between bacterial vaginosis (BV), vaginal yeast, vaginal practices (cleansing and drying/tightening), mucosal inflammation, and HIV acquisition., Methods: A multicenter, prospective, observational cohort study was conducted, enrolling 4531 HIV-negative women aged 18 to 35 years attending family planning clinics in Zimbabwe and Uganda. Participants were tested for HIV and reproductive tract infections and were interviewed about vaginal practices every 3 months for 15 to 24 months. BV was measured by Gram stain Nugent scoring, vaginal yeast by wet mount, and mucosal inflammation by white blood cells on Gram stain., Results: HIV incidence was 4.12 and 1.53 per 100 woman-years of follow-up in Zimbabwe and Uganda, respectively (a total of 213 incident infections). Women with BV or vaginal yeast were more likely to acquire HIV, especially if the condition was present at the same visit as the new HIV infection and the visit preceding it (hazard ratio [HR] = 2.50, 95% confidence interval [CI]: 1.68 to 3.72 and HR = 2.97, 95% CI: 1.67 to 5.28 for BV and yeast, respectively). These relationships did not seem to be mediated by mucosal inflammation. Vaginal drying/tightening was associated with HIV acquisition in univariate (HR = 1.49, 95% CI: 1.03 to 2.15) but not multivariate models. Vaginal cleansing was not associated with HIV acquisition., Conclusions: BV and yeast may contribute more to the HIV epidemic than previously thought.

The incidence of infection by the human immunodeficiency virus (HIV) has been monitored since 1984 in an area probability sample of homosexual/bisexual men drawn from a six-kilometer square area of San Francisco where the epidemic of acquired immunodeficiency syndrome (AIDS) has been most severe. Annualized HIV seroconversion rates in previously uninfected cohort members have declined by 88 per cent from 5.9 per cent during the first six months of 1985 to 0.7 per cent during the last six months of 1987. Concurrent declines of approximately 80 per cent in the prevalence of sexual behaviors associated with HIV transmission were also observed in the sample.

Recent studies have indicated variation in the infectivity beta of HIV among heterosexual couples. We represent this heterogeneity by modelling beta as a random variable. Using data on the number of contacts and seroconversion of couples, we fit the model by maximum-likelihood estimation with a beta distribution and a discrete distribution for beta. The estimates indicate the heterogeneity is extreme. The limitations of the model and the implications of the results for epidemiologic spread and further research are discussed.

The heterosexual transmission of the acquired immunodeficiency syndrome (AIDS) has been documented in the United States by national surveillance data and heterosexual partner studies since the beginning of the epidemic. However, the efficiency of heterosexual transmission and related risk factors remain unclear. Viral transmission from males to their female sexual partners is well documented, although in the United States instances of female-to-male transmission have been observed less frequently. On the other hand, in parts of Africa and Haiti, AIDS appears to be a bidirectional, heterosexually transmitted disease that often occurs concurrently with other sexually transmitted diseases. Although a widespread heterosexual epidemic of AIDS could evolve in the United States, it seems more plausible that, like other sexually transmitted diseases, AIDS will settle in limited segments of the community characterized by certain high-risk behaviors.

The prevalence and incidence of infection by the human immunodeficiency virus (HIV) has been under study in a cohort of 1,034 single men recruited by area probability sampling from a six kilometer square area of San Francisco where the epidemic of acquired immunodeficiency syndrome (AIDS) has been most severe. Prevalence of infection among homosexual/bisexual study subjects increased from an estimated 22.8 per cent during the last half of 1982 to 48.6 per cent during the period July through December 1984. During three subsequent six-month periods, prevalence remained stable at approximately 50 per cent. Annual infection rates, measured by seroconversion among seronegative study subjects, decreased from an estimated 18.4 per cent per year from 1982 to 1984, to 5.4 and 3.1 per cent during the first and second halves of 1985, and to 4.2 per cent during the first six months of 1986. These declines were associated with reductions of 60 per cent or more in the prevalence of high-risk sexual practices associated with both acquiring and disseminating infection by the human immunodeficiency virus.

We propose establishing private and public outpatient facilities where persons with human immunodeficiency virus, type 1 (HIV-1), infection can receive state-of-the-art clinical and behavioral follow-up, treatment, and assistance. The possible advantages of enrolling HIV-1-positive persons into long-term follow-up are early treatment of clinical conditions and resulting gains in life quality and life expectancy, decreased transmission of HIV-1 to uninfected persons, more efficient use of scarce patient-care resources, and improved estimates of the total number of HIV-infected persons. The possible disadvantages of such a program are adverse psychological reactions to knowledge of HIV-1 infection, adverse societal actions against infected persons, and, finally, the economic cost of the program. These facilities, with the proper expertise and safeguards of confidentiality and trust, could prolong and improve the lives of infected persons while preventing infection of others.

The AIDS-associated retrovirus (ARV) was isolated from vaginal and/or cervical secretions from 4 out of 8 women whose sera contained antibodies to the virus. The quantity of virus recovered initially was so low that identification of ARV was accomplished only after passage of the isolates to cultured mitogen-stimulated normal human peripheral blood mononuclear cells. The results indicate that the vaginal canal under certain conditions could be a source of transmission of ARV.