HIV incidence and HIV-associated mortality in a cohort of factory workers and their spouses in Tanzania, 1991 through 1996

Objective: To describe HIV incidence and HIV-associated mortality in a cohort of factory workers and their spouses with access to adequate sexually transmitted diseases (STD) treatment services and moderate exposure to sexual health interventions. Methods: Follow-up visits at 4-month intervals and home follow-up of those who failed to keep appointments were used to estimate HIV incidence and mortality in a cohort of factory workers and their spouses in Mwanza, Tanzania, during 1991 to 1996. Results: HIV prevalence at intake was 10.5% and 15.3% among 1594 men and 880 women, respectively. HIV incidence was just over 1/100 person-years (PY) in 1427 men and 1.9/100 PY in 745 women. The main risk factors were related to sexual behavior and clinical evidence of an STD, although only one seventh of those with HIV seroconversions had had an STD during the period following the second-from-last follow-up visit. HIV incidence among discordant couples was 5.0 and 8.3/100 PY for 41 men and 37 women, respectively. Mortality rates were 9.0 and 7.8/1000 PY for men and women, respectively, and 65% of male and 60% of female deaths were attributable to HIV infection. Conclusions: In this factory population with good access to and use of STD treatment and with a moderate level of exposure to HIV prevention education, HIV incidence among men and women is still over 1/100 PY, which suggests a relatively high level of program effort is needed to lower incidence. More than half of all adult deaths were attributable to HIV, but greater increases in HIV-associated mortality are likely.