Data on national HIV prevalence in Ethiopia are sparse, especially in rural areas where more than 85 percent of the population lives. To support health policy planning, Ethiopia's Ministry of Defense decided to estimate HIV prevalence in army recruits. The current study described HIV prevalence in relation to socio-demographic characteristics among nearly 72,000 men recruited in 1999 and 2000. It is the first study, according to the authors, to report extensively on rural areas.

Of 71,626 recruits enrolled in the study 9,713, (14 percent) were from urban areas and enrolled in 1999, and 61,913 (86 percent) were from rural areas and enrolled in 2000. Compared to the 1994 population census, the sample of nearly 62,002 rural recruits was fairly representative of the general population's marital status and geographical origin, but over- representative of Orthodox Christians and under-representative of people without education.

The researchers found an unexpectedly low HIV prevalence in the army recruits, contrasting with previous HIV estimates based on sentinel surveillances among pregnant mothers in Addis Ababa and the Amhara region and recent models suggesting that urban HIV prevalence peaked at 19 percent in 1995 and declined to roughly 15 percent in 2000, while non-urban HIV prevalence would plateau at under 10 percent in 2000.

This study found that HIV prevalence in rural recruits was 3.8 percent. Prevalence was lowest in recruits ages 18-19 and highest in the 25-29 age group. Farmers and students had the lowest overall HIV prevalence.

In urban recruits, overall HIV prevalence was 7.2 percent. Prevalence was lowest in the 18-19 age group, increased to 9.4 percent for the 20-24 age group, and rose to 15.3 percent among the 25-29 age group.

In rural recruits, risk factors for HIV included higher education levels. "The impact of education on HIV prevalence in rural areas suggests a role for primary and secondary schools in (rural) Ethiopian HIV programs," the authors noted. Also, rural Orthodox Christians were more likely than Muslim recruits to have HIV. Circumcision was not a factor, as both religions practice it. "Orthodox church officials should be involved in exploring their potential role in HIV prevention efforts," the researchers stated.

Age and urban residence in the Amhara region were risk factors for urban recruits, while education and ethnicity were not significantly associated with infection.

The authors pointed out that in Africa, HIV prevalence can vary widely among geographical areas. This study found pockets of high and low HIV prevalence, and the investigators suggested that proximity to road or trading centers and perhaps cultural factors may account for the regional differences. The Amhara region appeared to be most affected by the epidemic, with higher HIV estimates among both rural and urban recruits.

"The impact of religion, education, and region on HIV prevalence suggests avenues for targeting HIV prevention efforts in Ethiopia," the authors concluded. "Thus our study may be instrumental in targeting HIV control efforts in Ethiopia. It also, for the first time, provides a geographical picture of the country's HIV epidemic, which can aid in the design and interpretation of future HIV studies in Ethiopia."

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