Urban to rural routes of HIV infection spread in Ethiopia
Shabbir, I.; Larson, C.P.
Journal of Tropical Medicine and Hygiene 98(5): 338-342
1995
ISSN/ISBN: 0022-5304 PMID: 7563263 Document Number: 293543
During December 1991-February 1992, in Ethiopia, interviews were conducted with 19 merchants, 20 high school students, 20 recently returned soldiers, and 502 rural farmers to examine movement patterns and the incidence of high risk behaviors for HIV infection and transmission from urban into rural communities. 45-50% of soldiers, students, and merchants had extramarital intercourse in the last three months, mainly with a commercial sex worker (CSW) (45-78%). (HIV prevalence among CSWs exceeds 60% in some instances.) Condom use was highest in students (55%), followed by soldiers (22%). None of the merchants used a condom. Among the men who had had extramarital sex, the mean number of penetrations/contact ranged from 3.7 to 4.9 per subgroup. 90% of soldiers, 40% of students, and 32% of merchants hoped to have sexual intercourse while in town. 13% of farmers had had extramarital sex, usually with a CSW (50%), in town (54%), and without using a condom (94%). All the students knew about AIDS and condoms, yet only 40% considered themselves vulnerable to AIDS and only 10% changed their sex behavior. Most soldiers, merchants, and farmers knew about AIDS (70%, 68%, and 59%, respectively). Knowledge of condoms was lowest among farmers (11% vs. 80% for soldiers and 47% for merchants). Less than 50% of soldiers considered themselves to be vulnerable to AIDS and only 14% had adopted safer sex practices. Only 28% of farmers who knew about AIDS considered themselves at risk of AIDS. Among farmers, high risk sexual practices were related to younger age (p 0.03), literacy (p 0.05), Gurage ethnicity (p 0.008), and Moslem religion (p 0.001). When the researchers controlled for age, literacy, and religion, knowledge about AIDS had a strong positive association with high risk sexual practices (beta = 0.19; 95% confidence interval, 0.01-0.3). These findings indicate that high risk sexual behaviors for HIV infection are common among highly mobile, rural male populations. They suggest that farmers may be the main carrier of HIV into rural Ethiopian communities.