Important note: Information in this article was accurate in 1998. The state of the art may have changed since the publication date.
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Newsday - July 3, 1998
By Laurie Garrett - Staff Writer
The finding, based on CDC efforts in Uganda, is troubling because it is precisely contrary to results from previous studies, and poses questions about where best to spend scarce prevention resources in HIV-ridden poor countries.
For two years a team of CDC and Ugandan researchers focused on two communities in the Rakai district, near the border of Tanzania. They knocked on every door in one community, looking for people suffering from syphilis, gonorrhea or other sexually transmitted diseases - other than HIV. And they treated every STD with curative drugs.
The team visited each household in one community three times, performing probably the most aggressive STD public health effort ever done anywhere. In the second community they also went door to door but did nothing but test for STDs and HIV.
After two years, every STD level in both communities had fallen. But in the treated community, syphilis rates fell 20 percent more than in the control area. Trichomoniasis fell 40 percent more. Gonorrhea, 33 percent more.
But HIV rates were unmoved - 16 percent of the 15-to-55-year-old population in both areas was infected with HIV at study's end, Dr. Maria Wawer, study leader, said yesterday at the 12th World Conference on AIDS. In both areas, three of every 100 residents got newly infected with HIV during the study.
"The hypothesis was that we could reduce the rate of spread of HIV through intensive control of STDs," Wawer said. "However, unfortunately, there was no concomitant effect on HIV. The whole issue of STD control for HIV prevention is going to be a whole lot more complicated than we thought."
Past studies revealed that treating STDs usually reduced HIV because the sores associated with them are entry points for the disease. But even without treatment, testing raised awareness about the connection between sexual activity and health issues, and usually itself resulted in a drop in disease. Two years ago the picture appeared quite different. Then the CDC announced that an STD-control program in Mwanza, Tanzania - located about 300 miles southwest of the Rakai area - caused a 38-percent decrease in new HIV cases. By treating STDs the CDC cut back on HIV, Dr. Judith Wasserheit, director of the CDC's STD division, said.
"Both of these studies are among the most rigorously designed of their kind ever done," Wasserheit said.
So what can explain the startling differences between Mwanza and Rakai?
Wasserheit thinks timing was the issue. In Mwanza everybody in the city had access - as needed - to STD services. But in Rakai STD treatments were offered three times over two years.
It is also possible that Rakai - which had four times more HIV to start with than Mwanza - has such a huge epidemic that STD reductions couldn't have a significant impact.
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