Sexual networks in Uganda: mixing patterns between a trading town, its rural hinterland and a nearby fishing village

The study was based in south-west Uganda where significant differences in HIV prevalence have been found between urban and rural areas. Longitudinal data collected in a diary format was used to determine the extent to which high-risk men and women living in a truck stop/trading town had sexual contact with people from surrounding rural areas and a nearby fishing village. Study participants were 143 men, 75 of whom were resident in the town, 40 in a fishing village and 28 in rural areas, and 81 women, of whom 47 were resident in the town, 25 in the fishing village and 9 in a rural area. During 1687 man weeks the 143 men made 3149 trips and had 5189 sexual contacts. Ninety-two per cent of these sexual contacts occurred in the man's current place of residence and 21% were with a new partner. The 81 women participated for 1280 women weeks during which they recorded 6378 sexual contacts. Women who lived in the fishing village and the rural area had around 90% of their contacts with local men while those who lived in the town fell into 3 categories: women who charged a relatively high price for commercial sex had only 11% of contacts with men living in the town, while those who charged a tenth of the price had 71% of contacts with town men. The small number of women who fell into an intermediate category, in terms of price, had sexual contact with a wide variety of men. These findings show that there is little scope for HIV infection to spread between different residential or occupational groups. This may help to explain how large differences in HIV seropositivity between neighbouring localities can be maintained for long periods, despite considerable social and economic mixing between groups and high levels of sexual partner change within groups.In southwest Uganda, there is concern that sexual mixing between rural areas with low HIV prevalence and urban areas with high HIV prevalence will produce uniformly high rates of HIV. To determine the extent of such mixing, a prospective study was conducted in a trading town on the trans-African highway with a steady flow of male truckers, an agricultural hinterland to the west, and a fishing village to the east. A total of 143 men recruited largely from bars and 81 women reported to be sexually promiscuous kept records of their sexual contacts over a 6-month period. During 1687 man-weeks of observation, the men made 3149 road trips and had 5189 sexual contacts; 92% of these contacts occurred in the men's place of residence and 21% involved a new partner. 59% of town men's sexual contacts, 61% reported by men in the fishing village, and 52% of those in rural areas involved casual partners. An additional 6378 sexual encounters were recorded during 1280 woman-weeks. Close to 90% of women's sexual contacts in the 2 rural areas involved local men. Among the highest-paid town commercial sex workers, only 11% of sexual contacts involved men from the town; in contrast, 71% of sexual encounters among town women who charged only 10% the price of their more expensive counterparts were with local men. Serologic testing of a subset of 75 men and 52 women yielded HIV prevalences of 28% and 52%, respectively. The distinct sexual networks identified in this study suggest it is unlikely that rates of HIV infection in the rural areas will reach those in nearby trading towns.