Urban to rural routes of HIV infection spread in Ethiopia.

A descriptive survey to identify routes of spread of HIV infection from urban to rural populations was carried out in a rural south-central Ethiopian district. High risk practices for HIV infection and transmission were first documented among rural residing former soldiers, merchants and students. Extramarital intercourse during the previous 3 months was reported by 45-50% of these subgroups. In 25-37%, intercourse with an urban commercial sex worker (CSW) was reported and condom use varied from 10 to 30% among subgroups. The perceived risk for AIDS was low and changes in risk behaviours were minimal. Next, 502 rural males farmers were surveyed. An extramarital sexual contact in the past 3 months was reported by 13.5%, with 7% reporting their most recent contact with an urban CSW. Only 6% of farmers reported using condoms. Awareness of AIDS was reported by 59% and, of these, only 28% perceived they were vulnerable. In this study increased knowledge was associated with more frequent high risk sexual practices. It is concluded that the spread of AIDS into rural communities is occurring as a result of the high frequency of high risk sexual behaviours in specific rural residing subgroups which frequently travel into urban communities in combination with a low background prevalence of high risk practices among the general male farmer population.