Rapid spread of HIV infections in Abidjan, Ivory Coast, 1987-1990.

In 1986 relatively high HIV seroprevalence rates were observed among prostitutes tuberculosis patients and pregnant women living in Abidjan Ivory Coast (1). Soon thereafter a high number of AIDS cases were reported (2). In order to evaluate the spread of HIV-1 and HIV-2 infections in Abidjan we continued the surveillance of these populations from 1987 to 1990. The populations tested were selected each year in the same hospital for the pregnant women and the tuberculosis patients and in the same areas of Abidjan for the prostitutes. The number tested each year is shown in Table 1. The mean ages in the groups were similar. The serum samples were tested for antibodies to HIV-1 and HIV-2 by an ELISA (ELAVIA-1 and ELAVIA-2; Diagnostics Pasteur France). All positive sera were retested by a corresponding Western blot (Dupont de Nemours US and Diagnostics Pasteur). The criterion for positivity was the presence of antibodies to at least 2 envelope proteins (WHO criteria). Comparison of the groups was done by chi-square analysis. Among prostitutes overall HIV seroprevalence increased from 39.7% +or- 4.5% to 69.4% +or- 10.9% (chi square=17.5 p<0.001) between 1987 and 1990. This overall increase was due to increases in HIV-1 (22.4% +or- 7.7% to 41.7% +or- 11.6%; chi square=7.76 p<0.01) and dual HIV-1 + HIV-2 infection (6.9% +or- 4.7% to 20.8% +or- 9.5%; chi square=8 p<0.01) whereas HIV-2 infection remained stable (Figure 1). Among pregnant women no significant increase of HIV infection was observed (5.9% +or- 3.8% to 8.1% +or- 3.8%; chi square=0.55 n.s.). Among tuberculosis patients overall HIV seroprevalence increased from 27% +or- 3.5% to 38.7% +or- 5.5% (chi square=13.5 p<0.001) and was due to an increase of HIV-1 infection (10% +or- 2.4% to 30.4% +or- 5%; chi square=63.8 p<0.001). These data illustrate the dramatic spread of HIV infection in Abidjan especially among Abidjan prostitutes. Considering the low frequency of effective preventive measures taken the women are at very high risk of acquiring and/or transmitting HIV. Targeted interventions aiming at increasing condom use are therefore of highest priority. AIDS is still the leading cause of death in Abidjan (3) and our data show that the impact of AIDS on the public health will be still greater in the coming years. (full text) (5 references cited in original document)