Faculty Bibliography

A survey of the knowledge, attitudes and practices of 3928 Ugandans concerning AIDS was done in two semi-rural communities in August 1987. Eighty-eight per cent of the respondents knew that AIDS could be acquired from other people and that having multiple sexual partners was high-risk behaviour. There were, however, many incorrect beliefs about HIV transmission, including belief in transmission by insect bites (37%), witchcraft (22%) and casual contact with ill people (21%). AIDS was believed to be curable by 15% of the respondents. As part of the survey, blood was obtained from 3907 (99%) participants; 421 (10.8%) had antibody to HIV-1 by enzyme-linked immunosorbent assay (ELISA) and females were more likely to be infected than males (12.5 versus 8.8%, relative risk 1.42). Factors significantly associated with HIV infection on univariate analysis include multiple sexual partners, sexually transmitted diseases (STDs), injections, and being female. Stratified analysis of a history of STDs in people who were monogamous still showed an association with HIV infection. Information about the AIDS epidemic is reaching the Ugandan population; however, changes in behaviour are slower to follow.

Risk factor data were collected in 1,328 inpatients and outpatients in 1987 in 15 hospitals throughout Uganda; 42% were positive for HIV antibodies by ELISA. Seropositivity was associated with urban residence, sexually transmitted diseases (STD), number of sex partners, and sex for payment or with a person with an AIDS-like illness. Homosexuality and intravenous drug abuse, recognized risk factors in western countries, were not seen as risk factors. By multivariate analysis, urban residence and sex for payment were not independently associated with infection. Among females, number of sex partners, sex with a person with an AIDS-like illness, and numbers of episodes of STDs were significantly associated with seropositivity. In males, similar associations were seen, although number of reported sex partners was not independently associated with infection. These findings support the view that heterosexual contact is the predominant mode of transmission in Uganda and suggest that the main risk factors relate to high-risk heterosexual behavior.

The pathogenic basis for the association of tampons with toxic shock syndrome (TSS) has not been explained adequately. Absorbency and chemical composition of tampons are related, and no prior study has had a sufficient number of cases to evaluate these independently as risk factors for disease. We compared national TSS passive surveillance data on the 285 tampon-associated menstrual cases of TSS reported from 1983 to 1984 with data on age- and year-matched controls from national surveys of tampon usage. Users of all brands of tampons had elevated risks when compared with non-tampon users (odds ratio, 32.8; 95% confidence interval, 15.5, 69.6). Regardless of the chemical composition of the tampon, increasing absorbency increased the odds ratio for TSS. Chemical composition also influenced odds ratios. Polyacrylate-containing tampons had odds ratios that were elevated but, once controlled for absorbency, that were lower than the odds ratios for cotton, rayon, and cotton/rayon tampons. The strong association of absorbency with risk of illness would suggest that as a public health measure the use of a low-absorbency tampon is likely to reduce the risk of TSS in the user.

A vesicular, peeling rash characteristic of a phytophototoxic dermatitis developed on the hands and arms of 30 of 127 grocery workers. The rash subsequently healed with residual hyperpigmentation. Produce workers had the highest attack rate, 100% (8 of 8, p less than 0.0001). Although contact with celery had the highest relative risk for disease (relative risk, 6.3; 95% confidence interval, 2.6, 19.2) and the strongest dose-response effect, an association with celery alone could not be shown because workers were also exposed to other produce. However, anecdotal evidence also suggested that celery might be involved. The disease-resistant, high-quality brand of celery carried by these stores had higher levels of furanocoumarins, potent photosensitizers and a known cause of phytophotodermatitis, than other brands (p = 0.01). A randomly selected nationwide sample of stores in this chain showed dermatitis in 13 of 17 states and 26% of produce workers surveyed. Plant breeding to produce a more disease-resistant celery stock may lead to increased levels of endogenous furanocoumarins, resulting in phytophotodermatitis in grocery workers.

Following a private party in Rio Piedras, PR, 23 (56 percent) of those who attended developed an illness characterized by pharyngitis, myalgia, fatigue, headache, and fever. Consumption of carrucho (conch) salad was significantly associated with illness (P = 0.013, Fisher's exact test). Group A beta-hemolytic streptococci (M nontypable T12, serum opacity factor positive) were isolated both from throat cultures in 11 of 47 persons who attended the party and from the implicated food. The original source of contamination of the conch salad was not identified. Because complications may still occur from such infections and only a small percentage of persons with sore throats seek medical attention and ultimately receive treatment for their illnesses, it is important to recognize these outbreaks.