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OBJECTIVE--To assess the trend in HIV-1 seroprevalence in an adult population in Uganda. DESIGN--An observational cohort study with four year follow up. SETTING--A cluster of 15 villages in rural Uganda. SUBJECTS--All residents of the 15 villages--about 10,000 people. MAIN OUTCOME MEASURE--Prevalence of HIV-1 infection as assessed by enzyme immunoassay. RESULTS--During the five year period the overall standardised seroprevalence of HIV-1 showed little change; 8.2% in 1990, 7.6% in 1994. Among males aged 13-24 years the prevalence decreased from 3.4% to 1.0% (P for trend < 0.001); among females of the same age the corresponding values were 9.9% and 7.3%. The decrease was greatest in males aged 20-24 years and females aged 13-19 years. CONCLUSION--This is the first report of a decline in HIV-1 prevalence among young adults in a general population in sub-Saharan Africa with high overall HIV-1 prevalence. It is too early to conclude that the epidemic in this population is in decline, but the results of this study should be reason for some cautious optimism and encourage the vigorous pursuit of AIDS control measures.