3.1.7 HIV prevalence trends in Rakai District: Makerere, Johns Hopkins, and Columbia Universities.

This study offers critically important insights into HIV dynamics in a predominantly rural population. It is unique in that it is the likely site of initial epidemic spread of HIV in the early 1980s in Uganda, It has some of the highest HIV prevalence rates ever recorded in the general population (45%) together with empirical evidence of negative population growth at village level in Rakai district (Low-Beer, Stoneburner, Mukulu: Nature Medicine, May 1997 appended). The direction of recent secular HIV trends from 1993 onward is not yet clear from current data, but Dr David Serwaada believes data relevant to this could be released by the summer of 1997. They will be of critical importance in interpreting differential HIV incidence and prevalence trends in Uganda, particularly with respect to heterogeneity of HIV risk behaviours. A major STD experimental intervention trial is also underway there, and the understanding of current and previous HIV incidence dynamics before and during the trial will be critical to any interpretation of the effect of interventions. This,, like the MRC cohort, could be an important site for a population-based KABP survey of HIV risk behaviours. A population-based HIV survey to replicate earlier surveys would similarly allow a better longitudinal evaluation of HIV incidence and prevalence.