Risk of HIV Infection among Dutch Expatriates in Sub-Saharan Africa

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Abstract
In order to study the prevalence of human immunodeficiency virus (HIV) infections and related risk factors, Dutch expatriates returning from sub-Saharan Africa were asked to complete a questionnaire on sexual, occupational and other risk factors, and to donate a sample of blood to test for antibodies against HIV. The 1968 participants were workers of various professions and their family members over 16 years of age posted in sub-Saharan African countries by Dutch governmental, non-governmental and commercial organizations for at least 6 months cumulative time between 1 January 1979 and 1 January 1990. Antibodies against HIV-1 were found among 4 of 1122 men (0.4%) and 1 of 846 women (0.1%). The woman and 3 of the men had had sexual contact with African partners and had been treated for sexually transmitted diseases, 2 of these 3 men also had an African life partner. One man reported occupational exposure only. Of the 1968 participants 89 men (7.9%) and 18 women (2.1%) lived with an African partner; 344 men (30.7%) and 111 women (13.1%) had heterosexual contact with other African partners. Only 22.3% (men) and 18.6% (women) of casual sexual contacts with African partners were always protected by a condom. Two hundred and thirty-two of 408 (56.9%) (para)medics reported needlesticks. Groups at risk of HIV infection through sexual exposure were identified using logistic regression models. In conclusion, the observed prevalence of HIV-1 is low. However, unprotected sexual contact with African partners and needlestick accidents were common. This study underscores the continuous need for health education of expatriates on the risks of transmission of HIV in Africa.