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High prevalent and incident HIV-1 and herpes simplex virus 2 infection among male migrant and non-migrant sugar farm workers in Zambia
  1. Renee Heffron1,2,
  2. Ann Chao1,3,
  3. Alwyn Mwinga1,
  4. Sylvester Sinyangwe4,5,
  5. Alex Sinyama5,
  6. Rokaya Ginwalla1,
  7. J Mark Shields1,
  8. Emmanuel Kafwembe6,
  9. Lovemore Kaetano6,
  10. Chanda Mulenga6,
  11. Webster Kasongo6,
  12. Victor Mukonka1,7,
  13. Marc Bulterys1,8
  1. 1Centers for Disease Control and Prevention (CDC), Global AIDS Program, Lusaka, Zambia
  2. 2Department of Epidemiology, University of Washington, Seattle, Washington, USA
  3. 3CDC China-US Collaborative Program for Maternal-Child and Family Health, Beijing, China
  4. 4Department of Medicine, University of Zambia, Lusaka, Zambia
  5. 5Zambia Sugar Medical Department, Mazabuka, Zambia
  6. 6Immunology Unit, Tropical Diseases Research Centre, Ndola, Zambia
  7. 7Department of Public Health, Zambian Ministry of Health, Lusaka, Zambia
  8. 8CDC Global AIDS Program—China, Beijing, China
  1. Correspondence to Renee Heffron, Department of Epidemiology, University of Washington, Box 359927, Seattle, WA 98195-7236, USA; rheffron{at}


Background More insight is needed regarding risk factors for prevalent and incident HIV-1 infection among male farm workers in Sub-Saharan Africa to control the HIV-1 epidemic.

Methods Male farm workers were recruited from a sugar estate in Zambia to participate in a prospective cohort study. Questionnaire data were collected via interview, and testing was conducted for HIV-1, herpes simplex virus type 2 (HSV-2), and syphilis infection at baseline and follow-up between May 2006 and September 2007.

Results Among 1062 workers enrolled, HIV-1 prevalence at baseline was 20.7%. Testing HSV-2 seropositive (adjusted odds ratio (AOR) 5.4, 95% CI 3.6 to 8.1), self-reported genital ulcers in the past year (AOR 2.8, 95% CI 1.9 to 4.2), and being widowed (AOR 3.7, 95% CI 2.0 to 6.9) were significantly associated with prevalent HIV-1 infection. The HIV-1 incidence among 731 initially negative participants with at least one follow-up visit was 4.1 per 1000 person-months (95% CI 2.6 to 5.7); seroconversion was independently associated with prevalent HSV-2 infection (adjusted hazard ratio (AHR) 2.4, 95% CI 1.0 to 5.8) and incident HSV-2 infection (AHR 18.0, 95% CI 4.2 to 76.3). HIV-1 prevalence and incidence rates were similar among migrant and non-migrant workers.

Conclusions HIV-1 prevalence and incidence were high, and HSV-2 infection was a risk factor for HIV-1 acquisition. There is an urgent need to expand HIV-1 prevention programmes tailored to farm workers and their communities.

  • HIV-1
  • Zambia
  • migrants
  • farm workers
  • Herpes virus 2
  • male
  • herpes
  • HIV
  • males

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  • Disclosure: The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the US Centers for Disease Control and Prevention or the Zambia Ministry of Health.

  • Funding This work was supported by the US Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333, USA, primarily through funding from the President's Emergency Plan for AIDS Relief and by the sugar company.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Centers for Disease Control and Prevention, Atlanta, Georgia, USA and the Tropical Diseases Research Centre, Ndola, Zambia.

  • Provenance and peer review Not commissioned; externally peer reviewed.