Journal of Preventive Medicine and Public Health

Volume 32(2); June 1999

Original Articles

Trends of Preventive Medicine Research according to The Korean Journal of Preventive Medicine and Qualitative Meta-analysis on Articles of Lead Poisoning.: Chun Bae Kim, Jung Ae Rhee, Jong Ku Park, Seok Joon Sohn; Korean J Prev Med. 1999;32(2):113-122.

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The purpose of this study was to describe the trends of original research in the Korean Journal of Preventive Medicine, and to evaluate the quality of original articles about lead poisoning. METHOD: The data for the analysis of trends in preventive medicine research was taken from a total of 829 original articles published in the Korean Journal of Preventive Medicine from 1968 to 1997. The qualitative meta-analysis was measured against a checklist of evaluation criteria, which were divided into 10 categories, with 46 articles on lead poisoning. The evaluation process was performed independently by two evaluators. RESULTS: The number of articles per 100 members over the study period increased by almost 4 pieces in the early 1980s, and by more than 9 pieces in the mid-1990s. In the major classifications of subjects, environmental and industrial health, epidemiology and health statistics, and health policy and management published 370 pieces (44.6%), 137 pieces (16.5%), 322 pieces (38.9%) respectively. In the order of the number of articles, five themes about health significance, including metal exposure (73 pieces), diseases associated with exposure to organic solvents (45 pieces), air pollution (36 pieces), maternal and child health (32 pieces), and occupational health (30 pieces) received consistent attention throughout the years 1968-1997. The overall mean score of article quality about lead poisoning was 37.8 out of 50. Of the articles any information on the purpose and hypothesis described well. Of those the originality of the subjects, the form of articles (including tables and figures), and the number of inappropriate words of abstracts showed very low score. For multiple regression analyses, the number of joint research institutes and the acceptance of research grants about the article quality were statistically significant. CONCLUSIONS: The number of original research reports in the Korean J Prev Med has recently increased and their subjects have diversified. Of the basis of this study, the articles need improvement in the areas of abstracts, tables and illustrations (figures), etc. The Korean Society for Preventive Medicine will revise contribution regulations for manuscripts submitted to the Korean J Prev Med. Future studies should address these issues and perform the quantitative mata-analysis about the specific subjects including the quality of articles.; Summary

A Case-Control Study on Effects of Genetic Polymorphisms of GSTM1, GSTT1, CYP1A1 and CYP2E1 on Risk of Lung Cancer.: Hong Mei Nan, Heon Kim, Jong Won Kang, Jang Whan Bae, Kang Hyeon Choe, Ki Hyeong Lee, Seung Taik Kim, Choong Hee Won, Yong Min Kim; Korean J Prev Med. 1999;32(2):123-129.

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This study was performed to investigate effects of genetic polymorphisms of glutathione S-transferase M1 (GSTM1), glutathione S-transferase M1 (GSTT1), cytochrome P450 1A1 (CYP1A1) and cytochrome P450 2E1 (CYP2E1) on lung cancer development. METHODS: Ninety-eight lung cancer patients and 98 age-sex matched non-cancer patients hospitalized in Chungbuk National University Hospital from March 1997 to August 1998, were the subjects of this case-control study. Direct interview was done and genotypes of GSTM1, GSTT1, CYP1A1 and CYP2E1 were investigated using multiplex PCR or PCR-RFLP methods with DNA extracted from venous blood. Effects of the polymorphisms of GSTM1, GSTT1, CYP1A1 and CYP2E1, lifestyle factors including smoking, and their interactions on lung cancer were statistically analyzed. RESULTS: GSTM1 was deleted in 67.01% of the cases and 58.16% of the controls, and the odds ratio(95% CI) was 1.46(0.82-2.62). GSTT1 deletion was 58.76% for the lung cancer patients and 50.00% for the controls OR:1.43(0.81-2.51). The frequencies of Ile/Ile, Ile/Val and Val/Val of the CYP1A1 polymorphisms were 59.18%, 35.71%, and 5.10% for the cases, and 52.04%, 45.92%, 2.04% for the controls, respectively. Risk of lung cancer was not associated with polymorphism of CYP1A1 (x2trend=0.253, p-value>0.05). The respective frequency of c1/c1, c1/c2, c2/c2 genotypes for CYP2E1 were 50.00%, 42.86%, 7.14% for the lung cancer patients, and 66.33%, 30.61%, 3.06% for the controls (x2trend=5.783, p<0.05). c2 allele was a significant risk factor for lung cancer. We also observed a significant association of cigarette smoking history with lung cancer risk. The odds ratio(95% CI) of cigarette smoking was 3.03(1.58-5.81). In multiple logistic analysis including genotypes of GSTM1, GSTT1, CYP1A1 and CYP2E1, and smoking habit, only smoking habit came out to be a significant risk factor for lung cancer. CONCLUSION: Genetic polymorphisms of GSTM1, GSTT1, CYP1A1 and CYP2E1 are not so strongly associated with lung cancer as lifestyle factors including cigarette smoking.; Summary

Characteristics of Occupational Skin Disease Reported by Surveillance System.: Yeon Soon Ahn, Hyoung Ok Kim, Jun Young Lee, Ho Keun Jung; Korean J Prev Med. 1999;32(2):130-140.

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This study was carried out to estimate the magnitude of skin disease related to occupation and to find out the characteristics of it. METHODS: We collected and analyzed the cases of occupational skin disease reported by surveillance system composed of doctors and nurses in 150 enterprises with dispensary or attached hospital and physicians in 92 specific health examination institutes and 150 dermatologists from May to November, 1998. RESULTS: Among members of surveillance system, 66 enterprises and 47 specific health examination institutes and 55 dermatologists reported 571 cases of occupational skin disease in 512 workers. Excepting 81 cases reported by dermatologists, We analyzed 490 cases reported by enterprises and specific health examination institutes. Among 490 cases, contact dermatitis was most common(368 cases, 75.1%) and the second was hyper or hypopigmentation(36 cases, 7.3%). When we analyzed the characteristics of workers with occupational contact dermatitis, male workers were 281(79.2%) and female were 74(20.8%). 165 workers(64.5%) had chronic skin disease with repeated cure and relapse. 245 workers(72.5%) answered positively that their coworkers had similar skin disease. 27 workers(8.7%) experienced absence due to contact dermatitis related to occupation. To analyze the type of industries of workers with occupational contact dermatitis, automobile and trailer manufacturing industry was most common(105 cases, 29.6%) and the second was manufacturing industry for image, sound and communication equipment(55 cases, 15.5%). Organic solvent(183 cases, 46.7%) was the most common treating material of workers with contact dermatitis and the second was various kinds of chemicals(59cases, 15.1%). CONCLUSIONS: This is the first study using nationwide surveillance system to collect data of occupational skin disease. We found that many workers had skin disease related to occupation and characteristics of occupational skin disease were chronic and clustering. Therefore, we had to establish counterplan to manage occupational skin disease and to operate surveillance system to identify trends of occupational skin disease, continuously.; Summary

Hematological Changes of Welders.: Choong Ryeol Lee, Cheol In Yoo, Ji Ho Lee, Jeong Hak Kang, Hun Lee; Korean J Prev Med. 1999;32(2):141-146.

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To ascertain whether some result of hematological examination could be as reference data for health management of welders. METHOD: The authors conducted the hematological examination of 1,018 welders and 531 control workers of a shipbuilding industry in Ulsan using automatic blood analyzer. RESULTS: The WBC count of welders was lower than that of control on controlling the age and the duration of employment, but changes of other blood cells were not observed. CONCLUSION: We could use the results of hematological examination such as WBC counts as an indicator for subtle changes of health status of welders.; Summary

Factors Associated with the Use of Pap Test in a Rural Area.: Kun Sei Lee, Hye Won Koo, Won Jin Lee, Soung Hoon Chang, Keun Young Yoo; Korean J Prev Med. 1999;32(2):147-154.

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To construct basic data to develop strategies for achieving higher Pap test coverage rate by evaluating factors associated with the use of Pap test through population-based survey. METHODS: 16.4%(671) of the 4,090 women, who were eligible population for this study, in 3 Myens of Chung-ju City participated in this study voluntarily from July 21 to 26, 1997. After basic physical examination by trained doctors, they were interviewed with structured questionnaire by well-educated interviewers. RESULTS: It shows that only 54.3% of study participants experienced Pap test. The strongest factor which is related with the use of Pap test was the history of having breast screening tests(aOR=8.71, 95% CI=4.25-17.84). Probability of ever having Pap test was also higher in married women(aOR of single=0.46, 95% CI=0.29-0.72), younger(Ptrend<0.05), more educated (Ptrend<0.001), non-smoker (aOR of smoker=0.26, 95% CI=0.12-0.55), women of ever having hepatitis test(aOR=2.60, 95% CI=1.73-3.88) in multiple linear logistic analysis. CONCLUSIONS: This study suggests that several factors significantly associated with the use of Pap test, and especially, high-risk population for cervical cancer such as women of older ages, less educated, living alone are less likely to have the Pap test. We should concentrate on encouraging high-risk women in the use of Pap test to improve Pap test coverage rate.; Summary

Risk Assessment on Carcinogenic Pesticides of Vegetables in Korea.: Jae Hong Yoon, Jong Tae Lee, Yong Chung, Dongchun Shin; Korean J Prev Med. 1999;32(2):155-161.

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The study was conducted to estimate the carcinogenic risks from the ingestion of some carcinogenic pesticides (CPs) in vegetables sampled at a local agricultural product market in Seoul. METHODS: After applying a hazard identification step, we selected four pesticides, such as DDT, dieldrin, folpet, and heptachlor epoxide, for this risk assessment. Concentrations of each pesticide were measured from randomly sampled vegetables. In order to estimate the human exposure levels, we combined the concentration of pesticides in the vegetables with consumption rate of those vegetables. Three scenarios were hypothesized for human exposure assessment. Scenario I was the most conservative which supposed the undetected CPs would be the detection limit values. Scenario II was assumed that the undetected CPs would be a half of the detection limit values, and finally scenario III merely considered only values greater than the detection limit values. We finally presented the estimated carcinogenic risks on the basis of the traditional risk assessment procedure suggested by U.S. EPA. RESULTS: Pesticides including DDT, dieldrin, folpet and heptachlor epoxide were detected in 9 samples (6%) in the range of 0.0006~0.09ppm. The daily intake levels of carcinogenic pesticides were estimated in the range of 0.0009~0.0079 microgram/day. As we expected, excess cancer risks based on scenario I was also the highest (1.1x10-8~ 5.5x10-5). CONCLUSIONS: We found that the estimated risks from the pesticides we investigated were not serious. We, however, propose that a continuos monitoring is needed to make sure for the protection of public health.; Summary

Attitudes toward Complementary and Alternative Medicine in Suwon City.: Mi Sook Song, Ki Hong Chun, Hyun Jong Song, In Whee Park, Seung Chul Yoo; Korean J Prev Med. 1999;32(2):162-169.

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The aim of this study was to investigate the attitudes toward complementary and alternative medicine among 1,490 residents(339 households) in Suwon city. METHODS: All respondents were asked about types, frequency, effects, side-effects, views, and cost of complementary or alternative medicine through a questionnaire from July 24th to 27th. Six therapies were investigated: diet; acupuncture/ massage/ chiropractic etc.; mind control such as Ki/ Yoga/ spiritual therapy/ relaxation therapy etc.; nutritional supplements, cultural remedies; and Herb medications. RESULTS: The results of this survey were as follows: 35.6% of respondents had experiences with at least one or more types of complementary and alternative medicine. The average number of different types of therapies used was 3.4. More experience with various types of therapies were found among those respondents of higher education, older age group, higher income, married group, religious group than among the opposite groups of respondents. Herb medications were used most frequently(39.8%), followed by minor grains(37.9%), Ginseng(23.8%), Boshintang(21.5%), acupuncture(20.3%), Gaesojou (15.3%), Gingko nut(12.0%), mushroom(11.5%), Cupping therapy(10.2%), and black goat(0.0%). Acupuncture and Herb medications were used for treatment of hypertension the most frequently; minor grains or silkworm for treatment of diabetic mellitus; vegetables for treatment of obesity; acupuncture, Cupping Therapy, Herb medications for treatment of rheumatism; and acupuncture, Herb medications, or exercises for treatment of Cerebro Vascular Accident(CVA). The average costs of treatment were 108,000 Won for hypertension, 87,200 Won for diabetic mellitus, 16,800 Won for obesity, 68,800 Won for rheumatism, and 87,500 Won for CVA. Among 10.9% of respondents, there were 13 cases of side-effects with acupuncture, Herb medications, and Gaesojou. Among the cases of side-effects, majority was due to Herb medications. Respondents reported that Cupping Therapy was the most effective, followed by acupuncture, Ginseng, Gingko nut, Boshintang, black goat, minor grains, Gaesojou, Herb medications, vegetables, and mushroom. In response to the views of complementary and alternative medicine which they had used, they recommended minor grains first, followed by Ginseng, acupuncture, Gingko nut, Cupping Therapy, vegetables, Boshintang, black goat, mushroom and Herb medications. In contrast, they did not recommend Herb medications, acupuncture, nor Gaesojou. CONCLUSIONS: These findings indicate that many people use various complementary and alternative medicine without any guidelines for treatment of serious chronic diseases not even to invigorate themselves. It is, therefore, suggested that medical doctors or scientists verify the true effects or side-effects from the most common complementary or alternative therapies through experiments. Also medical doctors should provide a comfortable atmosphere for discussion among doctors and patients who would like to try these therapies.; Summary

A Study on the Protective Effects of Glutathione on Cytotoxicity of Mercury and Cadmium.: Jae Ho Jeong, Jun Youn Kim, Dai Ha Koh; Korean J Prev Med. 1999;32(2):170-176.

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To evaluate the protective effects of glutathione (GSH) on the cytotoxicity of mercurial compounds(CH3HgCl, HgCl2) or cadmium chloride(CdCl2) in EMT-6 cells. METHODS: The compounds investigated were CH3HgCl, HgCl2, CdCl2, GSH, buthionine sulfoximine(BSO), L-2-oxothiazolidine-4-carboxylic acid(OTC). Cytotoxicity analysis consist of nitric oxide(NO) production, ATP production and cell viability. RESULTS: Mercurial compounds and cadmium chloride significantly decreased cell viability and the synthesis of NO and cellular ATP in EMT-6 cells. GSH was not toxic at concentrations of 0 - 1.6 mM. In the presence of GSH, mercurial compounds and cadmium did not decrease the production of ATP and nitrite in EMT-6 cells. The protective effects of GSH against the cytotoxicity of mercurial compounds and cadmium depended on the concentration of added GSH to the culture medium for EMT-6 cells. We evaluated the effects of intracellular GSH level on mercury- or cadmium-induced cytotoxicity by the pretreatment experiments. Pretreatment of GSH was not changed NO2- and ATP production, and pretreatment of BSO was decreased in dose- and time-dependent manner. Pretreatment of OTC was increased NO2- and ATP production in dose- and time-dependent manner. Because intracellular GSH level was increased by OTC pretreatment, the protective effect on mercury- and cadmium-induced cytotoxicity was increased. CONCLUSIONS: These results indicated that sulfhydryl compounds had the protective effects against mercury-induced cytotoxicity by the intracellular GSH levels.; Summary

A Meta-analysis of Ambient Air Pollution in Relation to Daily Mortality in Seoul, 1991~1995.: Jong Tae Lee, Douglas W Dockery, Chun Bae Kim, Sun Ha Jee, Yong Chung; Korean J Prev Med. 1999;32(2):177-182.

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To reexamine the association between air pollution and daily mortality in Seoul, Korea using a method of meta-analysis with the data filed for 1991 through 1995. METHODS: A separate Poisson regression analysis on each district within the metropolitan area of Seoul was conducted to regress daily death counts on levels of each ambient air pollutant, such as total suspended particulates (TSP), sulfur dioxide (SO2), and ozone (O3), controlling for variability in the weather condition. We calculated a weighted mean as a meta-analysis summary of the estimates and its standard error. RESULTS: We found that the p value from each pollutant model to test the homogeneity assumption was small (p<0.01) because of the large disparity among district-specific estimates. Therefore, all results reported here were estimated from the random effect model. Using the weighted mean that we calculated, the mortality at a 100 microgram/m3 increment in a 3-day moving average of TSP levels was 1.034 (95% CI 1.009-1.059). The mortality was estimated to increase 6% (95% CI 3-10%) and 3% (95% CI 0-6%) with each 50 ppb increase for 3-day moving average of SO2 and 1-hr maximum O3, respectively. CONCLUSIONS: Like most of air pollution epidemiologic studies, this meta-analysis cannot avoid fleeing from measurement misclassification since no personal measurement was taken. However, we can expect that a measurement bias be reduced in a district-specific estimate since a monitoring station is better representative of air quality of the matched district. The similar results to those from the previous studies indicated existence of health effect of air pollution at current levels in many industrialized countries, including Korea.; Summary

Factors Related to the Health Behavior of Urban Residents on the Basis of Theory of Reasoned Action.: Sunhee Lee, Heuisug Jo; Korean J Prev Med. 1999;32(2):183-190.

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The purpose of this study is to analyse factors related to the health promotion behavior on the basis of theory of reasoned action(TRA). METHODS: 509 residents in the city of Kyunggi-do were selected through multistage random sampling. A structured questionnaire was developed on the basis of Triandis model and collected by interviewing. RESULTS: Expectation toward act and social normative influence and age showed significant relationship to health promotion behavior. Also, facilitating factors, affective attitude, education level are indirectly related to health promotion behavior. CONCLUSIONS: The result suggest that TRA is useful in understanding the mechanism of health promotion behavior.; Summary

Air Pollution and Daily Mortality in Seoul.: Ho Jang Kwon, Soo Hun Cho; Korean J Prev Med. 1999;32(2):191-199.

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To examine the relationship between air pollution exposure and mortality in Seoul for the years of 1991-1995. METHODS: Daily counts of death were analyzed by general additive Poisson model, with adjustment for effects of secular trend, seasonal factor, day of the week, heat wave, temperature, and humidity. Pollution variables were ozone, nitrogen dioxide, total suspended particles(TSP), and sulfur dioxide. RESULTS: Daily death counts were associated with ozone(1 day before), nitrogen dioxide(1 day before), TSP(2 days before), sulfur dioxide(2 days before). The association with ozone was most statistically significant and independent of other air pollutants. Increase of 100 ppb in ozone was associated with 6%(95% CI= 2%-10%) increase in the daily number of death. This effect was greater in persons aged 65 and older. The relative risks of death from respiratory disease and cardiovascular disease were greater than for all-cause mortality in each pollutant. After ozone level exceeds 25 ppb, the dose-response relationship between mortality and ozone was almost linear. However, the effect of TSP, sulfur dioxide, and nitrogen dioxide on mortality might be confounded with each other. CONCLUSION: Daily variations in air pollution within the range currently occurring in Seoul might have an adverse effect on daily mortality.; Summary

Effect on Aluminum and Silicon in Peptic Ulcer Patients.: Joon Youn Kim, Hae Rim Shin, Jung Il Kim, Doo Hee Kim, Suk Ryol Choi, Jung Il Seoh, Norman B Roberts; Korean J Prev Med. 1999;32(2):200-205.

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This study was carried out to investigate the aluminum concentrations in blood, urine and drinking water, the factors which affect the concentrations and the role of silicon in patients who were taking antacid containing aluminum. METHODS: We selected 122 peptic ulcer patients as cases and 144 healthy examinees as controls. Blood, urine, and drinking water were collected from the each study subject and we measured aluminum concentrations as well as silicon concentrations in the specimens. The factors including silicon affect on the aluminum concentrations were also analyzed. RESULTS: 1. The mean duration of antacid administration was 12 months, and the mean daily and total amount of aluminum administration were 0.9 g and 304 g per each patient, respectively. 2. The blood and urine aluminum concentrations were significantly higher in the case. 3. The blood silicon concentration was significantly lower in the control group, and the urine silicon concentration was significantly higher in the case. 4. Urine aluminum concentration was significantly correlated with blood aluminum concentration (r=0.18), and urine silicon concentration was correlated with blood aluminum (r=0.19) and urine aluminum concentrations (r=0.13). 5. The longer the duration of antacid administration and the larger the total and daily amount of aluminum in the antacid were, the higher urine aluminum and silicon concentrations were, but not to a statistically significant degree. CONCLUSIONS: Blood and urine aluminum concentrations were higher in the ulcer patients. The authors suggest that follow-up studies of the patients who administered antacid with high aluminum content for long duration should be done.; Summary

Health Care Utilization of Workers with Skin Disease in Inchon.: Yeon Soon Ahn, Jae Seok Song, Jong Uk Won, Jaehoon Roh; Korean J Prev Med. 1999;32(2):206-214.

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This study was carried out to identify relation of health care utilization due to skin disease(ICD-10, L00-L99) and characteristics(sex, age, exposure status, type of industry, size of enterprise) of workers. METHODS: We made new database composed of 30,536 workers' health examination results in one specific health examination institute in Inchon and data of medical insurance utilization due to skin disease in 4 medical insurance associations for enterprise from January, 1995 to December, 1997. And we analyzed determinants of health care utilization due to skin disease of workers. RESULTS: Among 30,536 study subjects, 8,837(28.9%) workers and 4,181(13.7%) workers utilized medical insurance due to total skin disease(ICD-10, L00-L99) and contact dermatitis(ICD-10, L23-L25), respectively. Female workers(p<.001), workers exposed to organic solvents(p<.05), workers in manufacturing industries(p<.05, p<.01, respectively) and in large scale enterprises(p<.001) utilized more medical insurance due to total skin disease and contact dermatitis than male workers, workers not exposed to organic solvents, workers in non-manufacturing industries and small scale enterprises. With multiple logistic regression analysis, significant explanatory variables affecting workers' medical utilization due to total skin disease and dermatitis and eczema(ICD-10, L20-L30) in total workers were sex, age, specific chemicals and size of enterprises. And age, type of industries, organic solvents, specific chemicals and size of enterprises were significant explanatory variables related to medical insurance utilization due to dermatitis and eczema and contact dermatitis in male workers. CONCLUSION: From the above results, we found that workers exposed to organic solvents utilized more medical insurance due to skin disease than workers not exposed to. And, comparing to workers in large scale enterprises, workers in small scale enterprises may have unmet medical care utilization due to skin disease. Therefore we have to establish counterplan to manage occupational skin disease of high risk group(organic solvent exposure group) and to satisfy unmet medical care utilization of workers in small scale enterprises.; Summary

Patient Compliance and Associated Factors in the Community-based Hypertension Control Program.: Sangsoo Bae, Jee Kim, Kyungbok Min, Soonho Kwon, Dalsun Han; Korean J Prev Med. 1999;32(2):215-227.

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To investigate compliance of hypertension patients using modified Theory of Reasoned Action(TRA). METHODS: The data were collected for 7-12 April 1997, by interviewing 190 hypertension patients in Hwachon, Kangwon-do. The analytical techniques employed include contingency table analysis and logit analysis. RESULTS: 15.1% of patients were unaware of the fact that he/she has hypertension and 11.2% did not know that he/she should take drug. 26.8% of patients took drug continuously, 20.1% had drug intermittently, and 53.1% had never have treatment. In the contingency table analysis, several variables were found to be significantly related to patient compliance. They included variables for attitude towards the consequences of taking drugs, normative beliefs, systolic BP at the enrollment, knowledge of how to take hypertensive drugs, variables for general health behavior and experience with having health worker's home visit. The logit analysis was performed by two steps. First step uses experience with drug treatment of hypertension as the dependent variable, and second step uses continuity of treatment. Included in the predictors that are significantly related to the former analysis are subjected norms produced by combining normative beliefs and motivation to comply, knowledge of how to take hypertensive drugs, and opinion about natural recovery of diseases. The only significant determinant of continuous treatment was knowledge of how to take hypertensive drugs. CONCLUSIONS: The results of analysis suggest the usefulness of TRA as a framework for the study of compliance of hypertensive patients. The findings have some practical implication as well. One is that efforts for enhancing compliance should be directed not only patients but also to other persons influencing patient's attitude and behavior. It also suggest that correct understanding of hypertension treatment is essential to perform the appropriate patient role.; Summary

Male to Female Heterosexual Transmission of HIV in Korea: Transmission Rate and Risk Factors.: Unyeong Go, Mee Kyung Kee, Byeong Sun Choi, Chun Kang, Kyoung Mee Do, Ju Hyun Lee, Joo Shil Lee; Korean J Prev Med. 1999;32(2):228-235.

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Despite the importance of human immunodefi-ciency virus(HIV) transmission through heterosexual contact, the features of heterosexual transmission has not been well studied in Korea. So we conducted a cross sectional study to determine the transmission rates in married couples and assess risk factors for male to female heterosexual transmission of HIV. METHODS: 169 HIV-infected males and their female sex partners were recruited from 1985 to June 1998. We examined female sex partners HIV infection status and interviewed male index partners and their female sex partners about demographic characteristics and sexual practices. We analysed heterosexual transmission rate by epidemiologic characteristics, disease status and sexual practices. And we assessed risk factors for HIV infection by univariate and multivariate analysis. RESULTS: 30 female sex partners were infected at enrollment, yielding an transmission rate of 17.8%. Among couples who had used condoms consistently, none of the female sex partners was infected with HIV. In univariate analysis the significant risk factors were full blown AIDS status (OR=4.1, 95% CI: 1.49-11.43) and low CD4 T cell count of index partners at enrollment (OR=7.8, 95% CI: 2.19-27.80). In multivariate analysis HIV-1 RNA levels was significant risk factor when adjusted by CD4 T cell counts and mean sexual contacts per month (OR=19.2, 95% CI: 1.03-357.59) CONCLUSION: The risk of male to female heterosexual transmission increased with advanced stages of HIV infection in the index male partners.; Summary

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