(Co-Infections Study) The Epidemiology of HIV/STI Co-Infections among African and Caribbean Women in Toronto

Project Name:

Co-Infections Study

Funding Dates:



Principal Investigators:

Robert S Remis, Juan Liu, Mona Loutfy, Wangari Tharao, Anuradha Rebbapragada, Stephen J Perusini, Lisungu Chieza, Megan Saunders, LoriAnn Green-Walker, and Rupert Kaul


HIV infection is frequent in African and Caribbean women in Ontario, with a rate 24-fold greater than other women. Therefore, we aimed to characterize the epidemiology of HIV and other sexually transmitted infections (STIs) in African-Caribbean (AC) women in Toronto and to apply this knowledge to support community and public health interventions.

Purpose and Objectives:


Participants completed a socio-behavioural questionnaire using Audio Computer Assisted Self-Interview (ACASI) and provided blood for syphilis, HIV, hepatitis B and C, herpes simplex virus type 1 (HSV-1), herpes simplex virus type 2 (HSV-2), and human cytomegalovirus (CMV) serology, urine for chlamydia and gonorrhea molecular testing and vaginal secretions for bacterial vaginosis (BV) and human papillomavirus (HPV).


Women 16 years of age or older from Africa and the Caribbean living in Greater Toronto. Women were eligible if they self-identified as African or Caribbean and if they, a parent, or grandparent were born in sub-Saharan Africa or the Caribbean.



Start and End Date:



We recruited 126 HIV-positive and 291 HIV-negative women, with a median age of 40 and 31 years, respectively (p < 0.001). Active HBV infection and lifetime exposure to HBV infection were more common in HIV-positive women (4.8% vs. 0.34%, p = 0.004; and 47.6% vs. 21.2%, p < 0.0001), as was a self-reported history of HBV vaccination (66.1% vs. 44.0%, p = 0.0001). Classical STIs were rare in both groups; BV prevalence was low and did not vary by HIV status. HSV-2 infection was markedly more frequent in HIV-positive (86.3%) than HIV-negative (46.6%) women (p < 0.0001). Vaginal HPV infection was also more common in HIV-positive than in HIV-negative women (50.8% vs. 22.6%, p < 0.0001) as was infection with high-risk oncogenic HPV types (48.4% vs. 17.3%, p < 0.0001).

Project Indicators and Outcomes:

Funding Sources: