Abstract

PIP: The overwhelming majority of adult HIV infections in Africa are acquired through heterosexual sexual intercourse. Many studies, however, report a close association between HIV and long-standing sexually transmitted diseases (STD) such as syphilis, gonorrhea, and chancre. It may be that these latter STDs enhance the transmission of HIV by causing breaks in the skin or by increasing the number of HIV-infected inflammatory cells in the genital tract. STDs are common in many parts of Africa, but appropriate treatment services tend to be poor or nonexistent. It may be assumed that were STDs promptly and appropriately treated, a decline in the incidence of HIV transmission may result. A HIV/STD intervention program in Mwanza region, Tanzania, was established to determine whether improved services for STD treatment would reduce the incidence of HIV infection, and if so, by how much. Twelve rural communities were selected in different parts of the region. Six were randomly chosen to receive the intervention at the beginning of the study, while the remaining six received it at the end. Designed to be effective and affordable, the program was integrated into the Tanzanian primary health care system. Existing health care staff were trained to diagnose and treat STDs using the syndromic approach recommended by the World Health Organization, and supplied with effective drugs. Regular supervisory visits were made to the health units to check drug supplies and to make sure that the staff was treating STDs correctly. Moreover, the project campaign visited the intervention villages regularly to publicize the improved services and to motivate villagers to come for treatment of STDs without delay. In the six communities with improved STD services, there were 48 new HIV infections, giving an incidence rate over two years of 1.2%. In the six other communities, there were 82 new cases for an incidence of 1.9%. Allowing for other important risk factors, the investigators estimate that the intervention reduced the incidence of HIV by 42%. This study has therefore shown that an affordable and replicable program can have a substantial effect upon the spread of HIV. Policy implications are discussed.