Trends in HIV prevalence by self-report among MSM diagnosed and reported with gonorrhea in six United States jurisdictions from 2010 to 2019

BACKGROUND

HIV co-infection among persons diagnosed with gonorrhea is not well characterized. Trends in HIV prevalence among persons diagnosed with gonorrhea may have significant implications for HIV prevention interventions, especially for MSM. MSM are increasingly and disproportionately represented among incident gonorrhea cases reported in a multistate sentinel surveillance network. Using data from this network, we estimated HIV prevalence among MSM by self-report and explored trends in co-infection by key demographics.

DESIGN

Observational study using enhanced surveillance data.

METHODS

Six geographically diverse jurisdictions in the STD Surveillance Network (SSuN) 2010-2019 randomly sampled laboratory-confirmed gonorrhea cases. Enhanced investigations on sampled cases included patient interviews eliciting demographic, behavioral and HIV testing history. These data were weighted to adjust for study design and nonresponse to estimate trends in HIV prevalence.

RESULTS

Of 653 522 reported cases, 28 979 were sampled and investigated. The proportion of cases reporting living with diagnosed HIV at the time of their gonorrhea diagnosis increased 61% across the study period from 6.6% in 2010 to 10.8% in 2019. The observed increase in HIV prevalence is concurrent with an increase in the proportion of gonorrhea cases attributable to MSM. HIV prevalence among MSM decreased in two jurisdictions and increasing trends were observed among non-Hispanic Black and Hispanic MSM. HIV prevalence decreased among non-Hispanic white MSM, MSM under 20 and those 40 years of age or older.

CONCLUSION

Diagnosis with gonorrhea, especially among MSM, should be a sentinel event triggering screening for HIV, referral to high-impact HIV prevention interventions or to HIV primary care.

Barriers, Facilitators, and Cost of Integrating HIV-Related Activities Into Sexually Transmitted Disease Partner Services in Jackson, Mississippi

BACKGROUND

Many US health departments now integrate HIV-related outcomes (e.g., relinkage to HIV care and preexposure prophylaxis [PrEP]) into sexually transmitted disease (STD) partner services (PS) programs. We sought to determine the barriers, facilitators, and cost of integrating these activities into PS.

METHODS

From 2016 to 2018, the Mississippi State Department of Health integrated 3 new activities into STD PS: HIV testing for partners of HIV-negative men who have sex with men with gonorrhea/chlamydia, relinkage to HIV care for STD PS recipients previously diagnosed with HIV, and PrEP referrals. We conducted direct observations and interviews with disease intervention specialists (DIS) in Jackson to assess barriers and facilitators to implementing these activities. We completed time and motion studies with 8 DIS and case tracking forms for 90 unique cases to estimate the incremental staff time and associated personnel cost of added services compared with a standard PS case.

RESULTS

Disease intervention specialists were optimistic about integrating HIV-related activities but noted disparate data systems, nonsystematic documentation, and lack of training as barriers. The mean time for a standard STD PS case without HIV-related activities was 195 minutes (cost, $77.69/case). The cost to conduct PS for HIV-negative men who have sex with men with gonorrhea/chlamydia was 36% higher than a standard case. Integrating relinkage to care and PrEP referrals resulted in a 44% and 20% increase in cost, respectively.

CONCLUSIONS

Integrating HIV care relinkage and PrEP referrals into STD partner services was generally acceptable by DIS and added marginal cost per case. Coupling these cost metrics with an assessment of the effectiveness of these activities can inform prioritization of partner services activities.

Sexual Behavior With Noncommercial Partners: A Concurrent Partnership Study Among Middle-Aged Female Sex Workers in China

Female sex workers (FSWs) often engage in concurrent partnerships, meaning they have multiple sexual relationships at the same time. The objective of this study was to investigate sexual concurrency and its associations with condom use and syphilitic infections among FSWs over age 35. Respondent-driven sampling was used to recruit 1,245 FSWs in Nanning, Hefei, and Qingdao, China. FSWs were asked to report whether they had concurrent partners in the past six months. Concurrency was defined as engagement in sex with commercial clients and (1) husbands and boyfriends (n = 167); (2) husbands only (n = 301); or (3) boyfriends only (n = 469). FSWs with only commercial clients were used as the comparison group (n = 308). Across all groups, the percentage of FSWs with prevalent and active syphilis ranged from 19.6% to 25.6% and 9.1% to 11.5%, respectively. Condom use was low with noncommercial sexual partners and was more likely to be used when FSWs' boyfriends had other partners. Three components of the theory of planned behavior were significantly associated with consistent condom use. Concurrent relationships may lead to increased transmission of syphilis at the workplace and family levels. Effective interventions should target concurrency with both commercial and noncommercial partners.

A Network Analysis of Sexually Transmitted Diseases and Online Hookup Sites Among Men Who Have Sex With Men

BACKGROUND

Sexually transmitted diseases (STDs) are increasing among gay, bisexual, and other men who have sex with men (MSM). Little is known about the use of websites and mobile phone applications to meet sexual partners ("hookup sites") and association with STD diagnoses.

METHODS

We performed a demographic and behavioral assessment of 415 MSM presenting to the Rhode Island STD clinic. Bivariate and multivariable analyses assessed associations between using hookup sites and testing positive for syphilis, gonorrhea, or chlamydia. Venue-based affiliation networks were created to evaluate hookup sites and their association with STD diagnoses.

RESULTS

Among 415 MSM, 78% reported meeting a partner online in the last 12 months, and 25% tested positive for at least one STD. Men who met partners online were more likely to be white (67% vs. 54%, P = 0.03) and have more than 10 lifetime partners (87% vs. 58%, P < 0.05). The most commonly used hookup sites included Grindr (78%), Scruff (35%), and Tinder (22%). In the multivariable analysis, only Scruff use was associated with testing positive for an STD (odds ratio, 2.28; 95% confidence interval, 1.09-4.94). However, among men who met partners online, 75% of men diagnosed as having an STD had met a sexual partner on Grindr, including 100% of those who were diagnosed as having gonorrhea.

CONCLUSIONS

Use of hookup sites was nearly ubiquitous among MSM undergoing STD screening. Specific hookup sites were significantly associated with STD diagnoses among MSM. Greater efforts are needed to promote STD screening and prevention among MSM who meet partners online.

Dyadic Qualitative Analysis of Condom Use Scripts Among Emerging Adult Gay Male Couples

Sexual risk reduction among gay male couples has received increasing attention in light of evidence that primary partners account for many-and possibly most-new HIV infections. This study examined the content of condom use scripts in interviews conducted with both members of 17 HIV-negative gay male couples. In each couple, at least one partner was an emerging adult (aged 18 to 29). Three scripts were identified: romantic love, unanticipated condomless anal intercourse (CAI), and negotiated safety. Scripts varied in their emphasis on emotional factors versus HIV risk reduction, the salience of sexual agreements, and the presence of an explicit communication goal. Results indicated that condom use may vary for couples as a result of script content and from the fluid adoption of scripts across contexts. Results highlighted potential tensions between emotional closeness and HIV prevention. Condom use cessation and sexual agreements-a potential mechanism for HIV risk reduction-may also serve as expressions of intimacy. This implies interventions that facilitate direct communication about sexual and relational goals-as well as those that expand couples' repertoires for expressing emotional closeness-may enhance sexual health for gay couples, particularly during the period of emerging adulthood.

Intimate Partner Violence, Sexual Autonomy and Postpartum STD Prevention Among Young Couples: A Mediation Analysis

CONTEXT

The transition to parenthood is a stressful time for young couples and can put them at risk for acquiring STDs. Mechanisms underlying this risk-particularly, intimate partner violence (IPV) and sexual autonomy-have not been well studied.

METHODS

Between 2007 and 2011, a prospective cohort study of the relationships and health of pregnant adolescents and their male partners recruited 296 couples at four hospital-based obstetrics and gynecology clinics in the U.S. Northeast; participants were followed up six and 12 months after the birth. Structural equation modeling identified associations among IPV at baseline and six months, sexual autonomy at six months and STD acquisition at 12 months. Mediating effects of sexual autonomy were tested via bootstrapping.

RESULTS

Females were aged 14-21, and male partners were 14 or older. For females, IPV victimization at baseline was positively associated with the likelihood of acquiring a postpartum STD (coefficient, 0.4); level of sexual autonomy was inversely associated with the likelihood of acquiring an STD and of having a male partner who acquired one by the 12-month follow-up (-0.4 for each). For males, IPV victimization at baseline was negatively correlated with a female partner's sexual autonomy (-0.3) and likelihood of acquiring an STD (-0.7); victimization at six months was positively related to a partner's sexual autonomy (0.2). Sexual autonomy did not mediate these relationships.

CONCLUSIONS

Females' sexual autonomy appears to protect against postpartum STDs for both partners. Future research should explore the efficacy of IPV-informed approaches to improving women's sexual and reproductive health.

A Latent Class Analysis of Behavioral and Psychosocial Dimensions of Adolescent Sexuality: Exploring Race Differences

Adolescent sexuality is a multidimensional concept involving sexual behavior as well as aspects of youth's sexual self-concept and sexual socialization. The current study used latent class analysis (LCA) to examine patterns of adolescent sexuality, with data from a nationally representative sample of youth (Add Health; n = 13,447), incorporating information on behavioral and psychosocial dimensions of adolescent sexual experiences. LCA results highlighted that youth may exhibit similar sexual behaviors but vary on psychosocial dimensions, including sexual self-efficacy, knowledge, and views about sex. Sociodemographic characteristics, family factors, mental health, and substance use emerged as predictors of membership into different latent classes of sexuality. Given persistent racial differences in sexual outcomes and sexually transmitted infection (STI) rates, the current study also examined how adolescent patterns of sexuality may help mediate racial differences in sexual outcomes by young adulthood. Results suggested that racial differences in adolescent patterns of sexuality help mediate racial differences in the number of sexual partners by young adulthood but not differences in STI diagnosis. Findings highlight the need for research on multiple aspects of adolescent sexuality to understand linkages with later outcomes and group differences.

Reciprocal sex partner concurrency and STDs among heterosexuals at high-risk of HIV infection

Inconsistent findings on the relationship of sex partner concurrency to infection with HIV and other sexually transmitted diseases (STDs) may result from differences in how sex partner concurrency is conceptualized. We examine the relationship of reciprocal sex partner concurrency (RSPC) to diagnosed STDs among heterosexuals. Heterosexually active adults (N = 717) were recruited for a cross-sectional study using respondent-driven sampling (RDS) from high-HIV-risk areas in New York City (NYC, 2006-2007) and interviewed about their sexual risk behaviors, number of sex partners, last sex partners, and STD diagnoses (prior 12 months). RSPC was when both the participant and her/his last sex partner had sex with other people during their sexual relationship. Odds ratios (OR), adjusted odds ratios (aOR), and 95 % confidence intervals (95%CI) were estimated by logistic regression. The sample was 52.4 % female, 74.3 % Black; median age was 40 years. RSPC was reported by 40.7 % and any STD diagnoses by 23.4 %. Any STDs was reported by 31.5 % of those reporting RSPC vs. 17.9 % of those who did not (OR = 2.11, 95%CI = 1.49-3.0). Any STDs was independently associated with RSPC (aOR = 1.54, 95%CI = 1.02-2.32), female gender (aOR = 2.15, 95%CI = 1.43-3.23), having more than three sex partners (aOR = 1.72, 95%CI = 1.13-2.63), and unprotected anal sex (aOR = 1.65, 95%CI = 1.12-2.42). Heterosexuals in high-HIV-risk neighborhoods in sexual partnerships that involve RSPC are at greater risk of STDs and, potentially, HIV. RSPC, in addition to sexual risk behaviors and the number of sex partners, may facilitate the heterosexual spread of HIV through STD cofactors and linkage into larger STD/HIV sexual transmission networks.

IL-22 levels are associated with Trichomonas vaginalis infection in the lower genital tract

PROBLEM

IL-22 has important functions at mucosal surfaces, including the induction of antimicrobial peptides and maintenance of epithelium. However, IL-22 has not been investigated in the genital tract during TV infection.

METHODS OF STUDY

Women who visited an STD clinic and women from a cohort with frequent Trichomoniasis were studied. IL-22, IL-17, and antimicrobial peptides were measured in cervicovaginal lavage by ELISA.

RESULTS

In women visiting the STD clinic, those without STDs (n = 10) had a median IL-22 of 0 pg/mL, while women with infections (n = 30) had 27 pg/mL (P = 0.04). In the cohort, women with Trichomoniasis (n = 19) had significantly higher IL-22 than women with no infections (n = 21, 74 versus 0 pg/mL, P = 0.0001). IL-17 was also significantly increased in Trichomoniasis, and there was a correlation between IL-22 and IL-17 (P = 0.001).

CONCLUSION

IL-22 is increased in STDs generally and in Trichomoniasis specifically suggesting an antimicrobial response of the mucosa and an epithelial repair process induced by the STDs.

Towards Linking Anonymous Authorship in Casual Sexual Encounter Ads

Objective

This paper constructs an authorship-linked collection or corpus of anonymous, sex-seeking ads found on the classifieds website Craigslist. This corpus is then used to validate an authorship attribution approach based on identifying near duplicate text in ad clusters, providing insight into how often anonymous individuals post sex-seeking ads and where they meet for encounters.

Introduction

The increasing use of the Internet to arrange sexual encounters presents challenges to public health agencies formulating STD interventions, particularly in the context of anonymous encounters. These encounters complicate or break traditional interventions. In previous work [1], we examined a corpus of anonymous personal ads seeking sexual encounters from the classifieds website Craigslist and presented a way of linking multiple ads posted across time to a single author. The key observation of our approach is that some ads are simply reposts of older ads, often updated with only minor textual changes. Under the presumption that these ads, when not spam, originate from the same author, we can use efficient near-duplicate detection techniques to cluster ads within some threshold similarity. Linking ads in this way allows us to preserve the anonymity of authors while still extracting useful information on the frequency with which authors post ads, as well as the geographic regions in which they seek encounters.

While this process detects many clusters, the lack of a true corpus of authorship-linked ads makes it difficult to validate and tune the parameters of our system. Fortunately, many ad authors provide an obfuscated telephone number in ad text (e.g., 867–5309 becomes 8sixseven5three oh nine) to bypass Craigslist filters, which prohibit including phone numbers in personal ads. By matching phone numbers of this type across all ads, we can create a corpus of ad clusters known to be written by a single author. This authorship corpus can then be used to evaluate and tune our existing near-duplicate detection system, and in the future identify features for more robust authorship attribution techniques.

Methods

From 7-1-2009 until 7-1-2011, RSS feeds were collected daily for 8 personal ad categories from 414 sites across the United States, for a total of 67 million ads. To create an anonymous, author-linked corpus, we used a regular expression to identify obfuscated phone numbers in ad text. We measure the ability of near-duplicate detection to link clusters in two ways: 1) detecting all ads in a cluster; and 2) correctly detecting a subset of ads within a single cluster. Ads incorrectly assigned to more than 1 cluster are considered false positives. All results are reported in terms of precision, recall, and F-scores (common information retrieval metrics) across cluster size, expressed as number of ads.

Results

652,014 ads contained phone numbers, producing a total of 46,079 authorship-linked ad clusters. For detecting all ads within a cluster, precision ranged from 0.05 to 0.0 and recall from 0.02 to 0.0 for all cluster sizes. For detecting partial clusters, see Figure 1.

Conclusions

We find that near-duplicate detection alone is insufficient to detect all ads within a cluster. However, we do find that the process can, with high precision and low recall, detect a subset of ads associated with a single author. This follows the intuition that an author’s total set of ads is itself comprised of multiple self-similar subsets. While a near-duplicate detection approach can correctly identify subsets of ads linked to a single author, this process alone cannot attribute multiple clusters to a single author. Future work will explore leveraging additional linguistic features to improve author attribution.

The use of drinking and condom-related protective strategies in association with condom use and sex-related alcohol use

Approximately 40% of American college students engage in heavy drinking, and heavy drinking is associated with sexual risk behaviors. It is imperative to gain a better understanding of the relationship between alcohol and sexual risk behaviors for prevention efforts. This article examined the use of drinking and condom-related protective behavioral strategies (PBS) in relation to drinking and condom-use outcomes in 436 college students. Drinking PBS are related to drinking and negative alcohol-related consequences. Furthermore, condom-related PBS are related to condom use; however, it is unclear if drinking PBS are related to condom use, particularly condom use when drinking. It was hypothesized that the use of drinking PBS would be related to less alcohol-related sexual activity, that the use of condom-related PBS would be related to greater condom use and condom use while drinking, and that drinking PBS would be related to greater condom use, especially condom use when drinking. It was found that condom-related PBS were associated with condom behavior and drinking PBS were related to drinking behavior, but we did not find support for a relationship between drinking PBS and condom use. This suggests that condom-related PBS may be a more effective target for increasing condom use than drinking PBS alone.

NIMH Multisite HIV/STD Prevention Trialfor African American Couples Group. The contribution of male and female partners' substance use to sexual risks and STDs among African American HIV serodiscordant couples

Growing evidence suggests that drug and alcohol use are fueling the heterosexual transmission of HIV among African Americans. This study aims to examine the relative contribution of drug and alcohol use of male and female partners to risks of heterosexual transmission of HIV among 535 African American HIV serodiscordant couples (N = 1,070 participants) who participated in an HIV prevention trial. Associations found between use of drugs and alcohol by one or both partners and sexual risk indicators varied by type of substance and whether male or female partner or both partners reported use. The findings suggest multiple ways in which substance use of male and female partners may be contributing to the heterosexual transmission of HIV and other STDs among African Americans and underscore the need for HIV prevention strategies to address dyadic patterns of substance use that lead to sexual risks.

Erectile dysfunction drug receipt, risky sexual behavior and sexually transmitted diseases in HIV-infected and HIV-uninfected men

BACKGROUND

Health care providers may be concerned that prescribing erectile dysfunction drugs (EDD) will contribute to risky sexual behavior.

OBJECTIVES

To identify characteristics of men who received EDD prescriptions, determine whether EDD receipt is associated with risky sexual behavior and sexually transmitted diseases (STDs), and determine whether these relationships vary for certain sub-groups.

DESIGN

Cross-sectional study.

PARTICIPANTS

Two thousand seven hundred and eighty-seven sexually-active, HIV-infected and HIV-uninfected men recruited from eight Veterans Health Affairs outpatient clinics. Data were obtained from participant surveys, electronic medical records, and administrative pharmacy data.

MEASURES

EDD receipt was defined as two or more prescriptions for an EDD, risky sex as having unprotected sex with a partner of serodiscordant or unknown HIV status, and STDs, according to self-report.

RESULTS

Overall, 28% of men received EDD in the previous year. Eleven percent of men reported unprotected sex with a serodiscordant/unknown partner in the past year (HIV-infected 15%, HIV-uninfected 6%, P < 0.001). Compared to men who did not receive EDD, men who received EDD were equally likely to report risky sexual behavior (11% vs. 10%, p = 0.9) and STDs (7% vs 7%, p = 0.7). In multivariate analyses, EDD receipt was not significantly associated with risky sexual behavior or STDs in the entire sample or in subgroups of substance users or men who had sex with men.

CONCLUSION

EDD receipt was common but not associated with risky sexual behavior or STDs in this sample of HIV-infected and uninfected men. However, risky sexual behaviors persist in a minority of HIV-infected men, indicating ongoing need for prevention interventions.

NIMH Multisite HIV/STD Prevention Trial for African American Couples Group. Methodological overview of an African American couple-based HIV/STD prevention trial

OBJECTIVE

To provide an overview of the National Institute of Mental Health Multisite HIV/sexually transmitted disease (STD) Prevention Trial for African American Couples conducted in 4 urban areas: Atlanta, Los Angeles, New York, and Philadelphia. The rationale, study design methods, proposed data analyses, and study management are described.

DESIGN

This is a 2-arm randomized trial, implementing a modified randomized block design, to evaluate the efficacy of a couples-based intervention designed for HIV-serodiscordant African American couples.

METHODS

The study phases consisted of formative work, pilot studies, and a randomized clinical trial. The sample is 535 HIV-serodiscordant heterosexual African American couples. There are 2 theoretically derived behavioral interventions with 8 group and individual sessions: the Eban HIV/STD Risk Reduction Intervention (treatment) versus the Eban Health Promotion Intervention (control). The treatment intervention was couples based and focused on HIV/STD risk reduction whereas the control was individual based and focused on health promotion. The 2 study conditions were structurally similar in length and types of activities. At baseline, participants completed an audio computer-assisted self-interview and interviewer-administered questionnaire and provided biological specimens to assess for STDs. Similar follow-up assessments were conducted immediately after the intervention, at 6 months, and at 12 months.

RESULTS

The trial results will be analyzed across the 4 sites by randomization assignment. Generalized estimating equations and mixed-effects modeling are planned to test: (1) the effects of the intervention on STD incidence and condom use and on mediator variables of these outcomes and (2) whether the effects of the intervention differ depending on key moderator variables (eg, gender of the HIV-seropositive partners, length of relationship, psychological distress, sexual abuse history, and substance abuse history).

CONCLUSIONS

The lessons learned from the design and conduct of this clinical trial provide guidelines for future couples-based clinical trials in HIV/STD risk reduction and can be generalized to other couples-based behavioral interventions.

Condom misuse among adjudicated girls: associations with laboratory-confirmed chlamydia and gonorrhea

OBJECTIVES

To identify the prevalence of condom use errors among detained female teens and to test two inter-related hypotheses concerning condom failure.

METHODS

A cross-sectional survey of 134 female teens recruited within eight detention facilities. Measures were collected using audio-computer assisted self-interviewing. Assessment for the presence of C. trachomatis and N. gonorrhoeae was also conducted.

RESULTS

Five forms of condom use errors/problems were common: not discussing condom use with the partner (34.3%), not having a condom when one was desired (48.5%), starting sex before application (21.6%), removing condoms before sex concludes (26.9%), and breakage (32.8%). Significant, associations were found between condom errors/problems and drug/alcohol use. Errors/problems with condom use were significantly higher among teens diagnosed with an sexually transmitted disease (STD) (P = 0.039 for an index measure; P = 0.022 for a single-item measure).

CONCLUSIONS

Findings suggest that detained female teens may have experienced multiple condom use error and problems thereby increasing their vulnerability to STD acquisition.

Relationship of STD-related shame and stigma to female adolescents' condom-protected intercourse

PURPOSE

Shame and stigma associated with sexually transmitted diseases (STDs) are barriers to adolescents seeking prompt and appropriate diagnosis and treatment. However, little is known about how these constructs are related to STD-protective behaviors, such as condom-protected intercourse. Thus, we prospectively examined the relationship between shame and stigma and condom use in adolescent females.

METHODS

There were 192 African American females age 17.4 +/- 1.7 years (range 15-21 years) recruited for the study from local teen-oriented health clinics. At baseline, participants completed demographic and psychosocial measures (including STD-related shame and stigma), and chart- or laboratory-confirmed history of STDs was obtained. At 6 months follow-up, rate of condom-protected intercourse in past 14 days was assessed. Participants' baseline shame and stigma scores, prior history of STDs, and select demographic and theoretically important psychosocial variables were entered into a hierarchical linear regression model to predict condom-protected intercourse in the 14 days prior to the 6-month follow-up assessment.

RESULTS

After controlling for variables identified in bivariate correlations, STD-related shame was significantly predictive of condom-protected intercourse in the 14 days prior to follow-up, with higher shame predicting higher rates of condom-protected intercourse.

CONCLUSIONS

Future prevention efforts attempting to reduce adolescents' risks for STDs and HIV may benefit from addressing STD-related shame and stigma in addition to explicitly linking health-promoting behavior changes (condom use) to a decreased likelihood of future infection with STDs.

Sexual activity and condom use among Eastern European adolescents--the Study of Hungarian Adolescent Risk Behaviours

While rates of HIV and STD infection in Eastern Europe are increasing rapidly, little is known about sexual behaviour, including condom use, among Eastern European youths. The Study of Hungarian Adolescent Risk Behaviours was designed to assess the knowledge, attitudes, and behaviours of adolescents studying in secondary schools in Budapest, Hungary. Students (n =3486) in a random sample of public secondary schools completed a self-administered questionnaire, including measures of sexual activity and condom use. Thirty-eight percent of students reported ever having had vaginal intercourse. Condom use by those reporting having had sex in the past five weeks was classified as consistent/every time (40%); irregular (25.6%); and none (34.3%). Multivariate analysis revealed positive opinions about condoms, fear of AIDS, and initiation of condom use by both partners to predict more frequent condom use. Implications for targeted AIDS/STD education and prevention among adolescents are discussed.

HIV/AIDS in Bangladesh: a national surveillance

Nationwide surveillance of HIV/AIDS from 1989 through 1996 in Bangladesh included several risk groups such as professional blood donors, patients with sexually transmitted diseases (STDs), pregnant women at antenatal clinics, commercial sex workers (CSWs), patients with tuberculosis, long-distance truck drivers, sailors, and non-residents. The population was enrolled by convenience sampling after taking informed consent. Among 70,676 persons tested, 80 (1.13 per 1000) were HIV positive. The prevalence rate was steady until 1994, and then increased rapidly. The rate among male heterosexuals was significantly higher than that in females (3.40 per 1000 versus 0.29 per 1000; odds ratio (OR) 11.60; 95% confidence intervals (CI) 6.45 to 21.16; P < 0.0001). Twelve per cent of patients with STDs had HIV. The HIV cases concentrated in 2 districts, Sylhet (25/72) and Chittagong (20/72), that border India and Myanmar (formerly Burma), respectively. Frequent movement of people of Bangladesh to India, Pakistan, Myanmar and Thailand, where HIV rates are higher, is one of the possible sources of spread of the cases. Bangladesh has the potential to avert epidemic spread of HIV at its early stage.