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Detection of HIV antibodies by means of an immunoenzymatic assay, an indirect immunofluorescence technique and Western blot was attempted on 375 serum samples collected in the Murunda area, a remote rural area situated in Rwanda, central Africa. Two out of 147 (1.4%) adults from a strict rural area, five out of 59 (8.5%) adults from an adjacent market place, and 49 out of 169 (30%) STD clinic attenders from the same area were HIV seropositive. In the first two groups, HIV seropositivity was associated with a history of sexually transmitted disease (STD) in the previous 2 years (P less than 0.001) and with a history of travel to a Rwandese urban centre in the previous 5 years (P less than 0.05). This study suggests that HIV seroprevalence is low in rural central Africa compared with urban centres. Risk factors for HIV seropositivity are similar in rural and urban-based adults in Rwanda, i.e. heterosexual promiscuity and STDs. Many HIV seropositive rural subjects from this study are likely to have acquired HIV infection through sexual contacts in Rwandese cities.375 serum samples collected from youth and adults in Murunda, a remote rural area in Rwanda, were analyzed for antibodies to human immunodeficiency virus (HIV). Study subjects were drawn from 3 selected populations: those from the village of Rulimba, a strictly rural area; adults from Gisiza, an adjacent rural market place that is connected by roads to 2 other cities; and patients from the same district who attended the Murunda health center for treatment of a sexually transmitted disease during the study period. The prevalence of HIV seropositivity was 2/147 (1.4%) in the strictly rural group, 5/59 (8.5%) in the market place area, and 49/169 (30%) among patients receiving treatment for sexually transmitted diseases. No significant differences existed between male and female subjects in terms of HIV seropositivity. HIV seropositivity was also associated with a history of venereal diseases in the market place sample. These results suggest that Rwanda's rural population (93%) is at lower risk of HIV infection that the urban population. Where HIV infection does exist in rural areas, it is transmitted mainly by heterosexual contact with persons from urban centers. The relatively high rate of HIV infection observed in adults living in a rural market place accessible from most of the Rwandan main cities, together with the association between HIV seropositivity and past residency or travel in urban centers, indicates that most of the rural-based seropositive adults identified in this study were infected elsewhere. These findings also contradict the popular assumption that HIV was present in an unrecognized form for many years in rural Central Africa. |
