Objective: To describe the trends in HIV transmission and sexual behaviour in a rural population in Africa.
Design: An open community cohort study with demographic surveillance and surveys of all consenting adults.
Methods: All residing adults aged 15-44 years who participated in surveys in 1994-1995, 1996-1997 and 1999-2000 were tested for HIV infection and provided information on sexual behaviour. The district AIDS control programme was the only intervention.
Result: The prevalence of HIV among adults aged 15-44 years increased gradually from 5.9% in 1994-1995 to 6.6% in 1996-1997 and 8.1% in 1999-2000. The incidence of HIV increased from 0.8 to 1.3 per 100 person-years during 1994-1997 and 1997-2000, respectively. In spite of a modest increase in knowledge during the study period, most individuals continued to feel that they were not at risk of HIV, and sexual risk behaviour remained largely unchanged, except for a small increase in condom use. HIV transmission levels continued to be higher in the trading centre than in the nearby rural villages within this small geographical area, although differences became smaller over time.
Conclusion: The gradual and continuing spread of HIV and the striking lack of change in sexual behaviour in this rural population suggest that the low-cost district intervention package does not appear to be adequate to stem the growth of the epidemic, and more intensive AIDS control efforts are needed.