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Sarr M, Gueye D, Mboup A, Diouf O, Bao MDB, Ndiaye AJ, Ndiaye BP, Hawes SE, Tousset E, Diallo A, Jones F, Kane CT, Thiam S, Ndour CT, Gottlieb GS, Mboup S. Uptake, retention, and outcomes in a demonstration project of pre-exposure prophylaxis among female sex workers in public health centers in Senegal. Int J STD AIDS 2020; 31:1063-1072. [PMID: 32819210 PMCID: PMC7750667 DOI: 10.1177/0956462420943704] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The Senegal pre-exposure prophylaxis (PrEP) Demonstration Project was an open-label cohort study assessing the delivery of daily oral PrEP to HIV-negative female sex workers (FSWs) in four Ministry of Health (MoH)-run clinics in Dakar, Senegal. We assessed uptake, retention in care, and adherence over up to 12 months of follow-up as well as HIV infection rates. Between July and November 2015, 350 individuals were approached and 324 (92.6%) were preliminarily eligible. Uptake was high, with 82.4% of eligible participants choosing to enroll and take PrEP. The mean age of those enrolled was 37.7 years (SD = 8.7), and approximately half had not attended school (41.2%). Among the 267 participants who were prescribed PrEP, 79.9 and 73.4% were retained in PrEP care at 6 and 12 months, respectively. Older age among FSWs was found to be the only significant predictor of lower discontinuation. We did not find significant differences in retention by site, education, condom use, or HIV risk perception. There were no new HIV infections at follow-up. Our results showed evidence of high interest in PrEP and very good PrEP retention rates among FSWs at 12-month follow-up when offered in MoH-run clinics, with older age as the only significant predictor of higher PrEP retention. This highlights the role that these clinics can play in expanding PrEP access nationwide.
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Affiliation(s)
- Moussa Sarr
- Westat, Inc., Rockville, MD, USA
- IRESSEF: Institut de Recherche en Santé de Surveillance
Epidémiologique et de Formations, Dakar, Sénégal
- Moussa Sarr, 1600 Research Blvd, WB 258,
Rockville, MD 20850, USA.
| | - Daouda Gueye
- IRESSEF: Institut de Recherche en Santé de Surveillance
Epidémiologique et de Formations, Dakar, Sénégal
| | - Aminata Mboup
- IRESSEF: Institut de Recherche en Santé de Surveillance
Epidémiologique et de Formations, Dakar, Sénégal
| | - Ousmane Diouf
- IRESSEF: Institut de Recherche en Santé de Surveillance
Epidémiologique et de Formations, Dakar, Sénégal
| | - Mame D Bousso Bao
- IRESSEF: Institut de Recherche en Santé de Surveillance
Epidémiologique et de Formations, Dakar, Sénégal
| | - Anna Julienne Ndiaye
- IRESSEF: Institut de Recherche en Santé de Surveillance
Epidémiologique et de Formations, Dakar, Sénégal
| | - Birahim P Ndiaye
- IRESSEF: Institut de Recherche en Santé de Surveillance
Epidémiologique et de Formations, Dakar, Sénégal
| | - Stephen E Hawes
- Departments of Epidemiology and Global Health, School of Public
Health, University of Washington, Seattle, WA, USA
| | | | | | | | - Coumba T Kane
- IRESSEF: Institut de Recherche en Santé de Surveillance
Epidémiologique et de Formations, Dakar, Sénégal
- Faculte de Médicine et de Pharmacie, Université Cheikh Anta
Diop, Dakar, Sénégal
| | - Safiatou Thiam
- Conseil national de lutte contre le sida (CNLS), Dakar,
Sénégal
| | - Cheikh T Ndour
- Division de Lutte contre le Sida et les IST, Ministère de la
Santé et de l’Action Sociale, Dakar, Sénégal
| | - Geoffrey S Gottlieb
- Department of Medicine, Allergy and Infectious Diseases, Center
for Emerging and Re-Emerging Infectious Diseases and Department of Global
Health, University of Washington, Seattle, WA, USA
| | - Souleymane Mboup
- IRESSEF: Institut de Recherche en Santé de Surveillance
Epidémiologique et de Formations, Dakar, Sénégal
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Diop-Ndiaye H, Beiter K, Gheit T, Sow Ndoye A, Dramé A, McKay-Chopin S, Tommasino M, Bouh Boye CS, Sylla B, Kane CT. Human Papillomavirus infection in senegalese female sex workers. PAPILLOMAVIRUS RESEARCH (AMSTERDAM, NETHERLANDS) 2019; 7:97-101. [PMID: 30771492 PMCID: PMC6411505 DOI: 10.1016/j.pvr.2019.02.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 02/04/2019] [Accepted: 02/12/2019] [Indexed: 01/05/2023]
Abstract
OBJECTIVES Several studies have documented the HPV genotypes in the Senegalese general population. The objective was to explore the HPV genotype distribution in Senegalese FSWs in order to assess the potential relevance of currently-available vaccines. METHODS Vaginal swabs samples collected as part of the National Integrated Biological and Behavioral Survey in 14 regions throughout the country were randomly selected for HPV testing using bead-based multiplex genotyping (TS-MPG). RESULTS Among the 436 FSW samples analyzed, the overall HPV prevalence was 79.8% (N = 348), with 70.1% (N = 244) cases presenting as multiple infections. High Risk HPV genotypes affecting at least 10% of FSWs included in order of decreasing frequency: 52, 16, 35, 51, 33, 31, 18, and 45. Sixty-seven (15.4%) FSWs were HIV positive and they were significantly more affected by HPV (94% vs 77%; p < 0.01) than seronegative FSWs as well as infections with multiple genotype. CONCLUSION The present study indicates that FSW in Senegal experience a high burden of HPV infection with a high frequency of coinfection with HIV and multiple HPV genotypes. Public health interventions for this key population should include an earlier cervical dysplasia/cancer detection and preventative measures such as vaccination programs that must consider the HPV genotype distribution.
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Affiliation(s)
| | - Kaylin Beiter
- Bacteriology-Virology Laboratory, CHU Aristide le Dantec, Dakar, Senegal
| | - Tarik Gheit
- Infections and Cancer Biology group, International Agency for Research on Cancer, Lyon, France
| | - Aissatou Sow Ndoye
- Bacteriology-Virology Laboratory, CHU Aristide le Dantec, Dakar, Senegal
| | - Aboubacry Dramé
- Bacteriology-Virology Laboratory, CHU Aristide le Dantec, Dakar, Senegal
| | - Sandrine McKay-Chopin
- Infections and Cancer Biology group, International Agency for Research on Cancer, Lyon, France
| | - Massimo Tommasino
- Infections and Cancer Biology group, International Agency for Research on Cancer, Lyon, France
| | | | - Bakary Sylla
- Infections and Cancer Biology group, International Agency for Research on Cancer, Lyon, France
| | - Coumba Touré Kane
- Bacteriology-Virology Laboratory, CHU Aristide le Dantec, Dakar, Senegal
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Tine RC, Dia L, Sylla K, Sow D, Lelo S, Ndour CT. Trichomonas vaginalis and Mycoplasma infections among women with vaginal discharge at Fann teaching hospital in Senegal. Trop Parasitol 2019; 9:45-53. [PMID: 31161092 PMCID: PMC6542312 DOI: 10.4103/tp.tp_50_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2019] [Indexed: 12/25/2022] Open
Abstract
Background: Trichomonas vaginalis and genital Mycoplasmas are two synergistic pathogens, but in many settings, limited data on the co-infection by Trichomonas and Mycoplasma are available. Objective: This study aimed at assessing Mycoplasma prevalence and its association with Trichomonas vaginalis among women with vaginal discharge. Materials and Methods: A retrospective analysis of laboratory records (2012 and 2013) from patients referred at the Fann teaching hospital in Dakar Senegal for vaginal discharge was carried out. Detection of genital mycoplasmas was based on the commercial Kit Mycoplasma Duo Bio-Rad™ using endo-cervical swabs. Vaginal swabs were collected and examined using optic microscopy with 40x magnification to detect T. vaginalis. Results: Overall, data from 1257 women were analysed. Prevalence of Mycoplasma hominis represented 57.4%, 95%CI(54.6-60.1), versus 54.9%, 95%CI(52.1-57.5) for Ureaplasma urealyticum. Trichomonas vaginalis infection was observed with a frequency of 3%. Out of the 50 patients with trichomoniasis, 76% of them were co-infected by Mycoplasma hominis and patients with Trichomonas vaginalis had an increased risk of acquiring Mycoplasma infection (adjusted OR:2.5, 95%CI(1.2-5.2);p=0.02)). Conclusion: Trichomonas vaginalis and Mycoplasmas are two closely associated pathogens in the urogenital tract of women. This clinically significant symbiotic action may require systematic screening of Mycoplasma among patients with trichomoniasis for optimal management of sexually transmitted infections.
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Affiliation(s)
- Roger C Tine
- Department of Medical Parasitology, Faculty of Medicine, University Cheikh Anta Diop, Dakar, Senegal.,Department of Medical Parasitology, Faculty of Medicine, University Cheikh Anta Diop, Dakar, Senegal
| | - Lamine Dia
- Centre for Diagnostic and Medical Imagery, Laboratory of Bacteriology and Virology, Fann Teaching Hospital, Dakar, Senegal
| | - Khadime Sylla
- Department of Medical Parasitology, Faculty of Medicine, University Cheikh Anta Diop, Dakar, Senegal.,Centre for Diagnostic and Medical Imagery, Laboratory of Parasitology and Mycology, Fann Teaching Hospital, Dakar, Senegal
| | - Doudou Sow
- Department of Medical Parasitology, Faculty of Medicine, University Cheikh Anta Diop, Dakar, Senegal.,Centre for Diagnostic and Medical Imagery, Laboratory of Parasitology and Mycology, Fann Teaching Hospital, Dakar, Senegal
| | - Souleye Lelo
- Centre for Diagnostic and Medical Imagery, Laboratory of Parasitology and Mycology, Fann Teaching Hospital, Dakar, Senegal
| | - Cheikh T Ndour
- Department of Infectious and Tropical Diseases, Fann Teaching Hospital, Dakar, Senegal.,Division for AIDS and Sexually Transmitted Infections Control, Ministry of Health, Senegal
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A Study of Trichomonas vaginalis Infection and Correlates in Women with Vaginal Discharge Referred at Fann Teaching Hospital in Senegal. J Parasitol Res 2019; 2019:2069672. [PMID: 31057956 PMCID: PMC6463574 DOI: 10.1155/2019/2069672] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 02/11/2019] [Indexed: 11/17/2022] Open
Abstract
Introduction Trichomoniasis is nowadays the most prevalent non-viral sexually transmitted infection in the world. In Senegal, the epidemiology of trichomoniasis is not well known. The current study aimed at assessing the prevalence and factors associated with T. vaginalis infection among women with vaginal discharge. Methods A retrospective analysis of laboratory records from patients referred at the Fann Teaching Hospital in Dakar, Senegal, for vaginal discharge was carried out. The study covered the period from 2006 to 2011. For each participating woman, a vaginal swab was collected and a wet mount smear performed immediately. Optic microscopic examination with 40x magnification was done to detect T. vaginalis and assess biological modifications such as presence of epithelial cells, white blood cells, and red blood cells. A gram stained smear was also performed and examined under oil immersion (100x magnification) to assess the vaginal flora. Results Overall, 3893 women were enrolled with a mean age at 31.2 ± 10 years. The prevalence of Trichomoniasis represented 4.8%, 95%CI(3.1-5.7) and it was lower among women less than 30 years (4.1%), while divorced women more likely to be infected compared to married and single women (aOR:2.1, 95%CI (1.2-3.7)). Trichomoniasis was associated with abnormal vaginal flora such as type III (aOR:2.6, 95%CI(1.5-4.4)) and type IV (aOR:3.3, 95%CI(2.1-5.3)). In addition, patients with erythrocytes excretion were more likely to be infected by T. vaginalis (aOR:2.8, 95%CI(1.9-3.9). Conclusion Trichomonas vaginalis remains prevalent among sexually active women. Strategies aiming at improving disease awareness in these high-risk groups are needed to improve trichomoniasis prevention but extensive epidemiological data are still needed for a better understanding of the disease transmission dynamic.
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Mukandavire C, Walker J, Schwartz S, Boily M, Danon L, Lyons C, Diouf D, Liestman B, Diouf NL, Drame F, Coly K, Muhire RSM, Thiam S, Diallo PAN, Kane CT, Ndour C, Volz E, Mishra S, Baral S, Vickerman P. Estimating the contribution of key populations towards the spread of HIV in Dakar, Senegal. J Int AIDS Soc 2018; 21 Suppl 5:e25126. [PMID: 30033604 PMCID: PMC6055131 DOI: 10.1002/jia2.25126] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 05/16/2018] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Key populations including female sex workers (FSW) and men who have sex with men (MSM) bear a disproportionate burden of HIV. However, the role of focusing prevention efforts on these groups for reducing a country's HIV epidemic is debated. We estimate the extent to which HIV transmission among FSW and MSM contributes to overall HIV transmission in Dakar, Senegal, using a dynamic assessment of the population attributable fraction (PAF). METHODS A dynamic transmission model of HIV among FSW, their clients, MSM and the lower-risk adult population was parameterized and calibrated within a Bayesian framework using setting-specific demographic, behavioural, HIV epidemiological and antiretroviral treatment (ART) coverage data for 1985 to 2015. We used the model to estimate the 10-year PAF of commercial sex between FSW and their clients, and sex between men, to overall HIV transmission (defined as the percentage of new infections prevented when these modes of transmission are removed). In addition, we estimated the prevention benefits associated with historical increases in condom use and ART uptake, and impact of further increases in prevention and treatment. RESULTS The model projections suggest that unprotected sex between men contributed to 42% (2.5 to 97.5th percentile range 24 to 59%) of transmissions between 1995 and 2005, increasing to 64% (37 to 79%) from 2015 to 2025. The 10-year PAF of commercial sex is smaller, diminishing from 21% (7 to 39%) in 1995 to 14% (5 to 35%) in 2015. Without ART, 49% (32 to 71%) more HIV infections would have occurred since 2000, when ART was initiated, whereas without condom use since 1985, 67% (27 to 179%) more HIV infections would have occurred, and the overall HIV prevalence would have been 60% (29 to 211%) greater than what it is now. Further large decreases in HIV incidence (68%) can be achieved by scaling up ART in MSM to 74% coverage and reducing their susceptibility to HIV by two-thirds through any prevention modality. CONCLUSIONS Unprotected sex between men may be an important contributor to HIV transmission in Dakar, due to suboptimal coverage of evidence-informed interventions. Although existing interventions have effectively reduced HIV transmission among adults, it is crucial that further strategies address the unmet need among MSM.
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Affiliation(s)
| | - Josephine Walker
- Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
| | - Sheree Schwartz
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | | | - Leon Danon
- Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
- College of Engineering, Mathematics and Physical SciencesUniversity of ExeterExeterUK
| | - Carrie Lyons
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | | | - Ben Liestman
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | - Nafissatou Leye Diouf
- Institut de Recherche en Santéde Surveillance Epidemiologique et de FormationsDakarSenegal
| | | | - Karleen Coly
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | | | - Safiatou Thiam
- Department of HealthNational AIDS Council of SenegalDakarSenegal
| | | | - Coumba Toure Kane
- Institut de Recherche en Santéde Surveillance Epidemiologique et de FormationsDakarSenegal
| | - Cheikh Ndour
- Division de La Lutte Contre Le Sida et Les ISTMinistry of HealthDakarSenegal
| | - Erik Volz
- Department of Infectious Disease EpidemiologyImperial CollegeLondonUK
| | | | - Stefan Baral
- Department of Infectious Disease EpidemiologyImperial CollegeLondonUK
| | - Peter Vickerman
- Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
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Potential Impact of Integrated Stigma Mitigation Interventions in Improving HIV/AIDS Service Delivery and Uptake for Key Populations in Senegal. J Acquir Immune Defic Syndr 2017; 74 Suppl 1:S52-S59. [PMID: 27930612 PMCID: PMC5147043 DOI: 10.1097/qai.0000000000001209] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Men who have sex with men (MSM) and female sex workers (FSW) are consistently shown to have a higher burden of HIV compared with other adults in Senegal. This study, HIV Prevention 2.0, evaluates the impact of the 3-tiered integrated stigma mitigation interventions (ISMIs) approach to optimizing HIV service delivery for key populations in Senegal. METHODS Baseline assessment includes a questionnaire and biological testing for HIV. A proportion of participants enrolled into a 24-month longitudinal cohort with questionnaires and biological testing every 3 months. In these preliminary analyses, ISMIs are evaluated from participants in the cohort through uptake of HIV services and implementation outcomes. RESULTS Overall, 724 MSM and 758 FSW participated in the baseline assessment. HIV prevalence is 30.2% (n = 219/724) among MSM and 5.3% (n = 40/758) among FSW. Fear of seeking health services among MSM is 17.7% (n = 128/724) at baseline, 10.5% (n = 18/172) at month 3, and 9.8% (n = 10/102) at month 6 (P < 0.004); and among FSW is 21.9% (n = 166/758) at baseline, 8.1% (n = 15/185) at month 3, and 10.7% (n = 18/168) at month 6 (P < 0.001). Overall, 63.9% (n = 62/97) of MSM and 82.5% (n = 118/143) of FSW agreed that the intervention is effective in addressing stigma; however, loss to follow-up was 41.1% among MSM and 10% among FSW. CONCLUSION Baseline data reinforce the need for stigma mitigation interventions, combined with enhanced linkage and retention to optimize HIV treatment. Preliminary results show high levels of HIV-related risk determinants and suggest the potential utility of the ISMI to decrease perceived stigma relating to engagement in HIV prevention, treatment, and care services among key populations in Senegal.
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Lu D, Yang S, Zhang J, Wang H, Li D. Resilience of epidemics for SIS model on networks. CHAOS (WOODBURY, N.Y.) 2017; 27:083105. [PMID: 28863477 DOI: 10.1063/1.4997177] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Epidemic propagation on complex networks has been widely investigated, mostly with invariant parameters. However, the process of epidemic propagation is not always constant. Epidemics can be affected by various perturbations and may bounce back to its original state, which is considered resilient. Here, we study the resilience of epidemics on networks, by introducing a different infection rate λ2 during SIS (susceptible-infected-susceptible) epidemic propagation to model perturbations (control state), whereas the infection rate is λ1 in the rest of time. Noticing that when λ1 is below λc, there is no resilience in the SIS model. Through simulations and theoretical analysis, we find that even for λ2 < λc, epidemics eventually could bounce back if the control duration is below a threshold. This critical control time for epidemic resilience, i.e., cdmax, seems to be predicted by the diameter (d) of the underlying network, with the quantitative relation cdmax ∼ dα. Our findings can help to design a better mitigation strategy for epidemics.
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Affiliation(s)
- Dan Lu
- School of Reliability and Systems Engineering, Beihang University, Beijing 100191, China
| | - Shunkun Yang
- School of Reliability and Systems Engineering, Beihang University, Beijing 100191, China
| | - Jiaquan Zhang
- School of Reliability and Systems Engineering, Beihang University, Beijing 100191, China
| | - Huijuan Wang
- Intelligent Systems, Delft University of Technology, Delft, Zuid-Holland 2628CD, Netherlands
| | - Daqing Li
- School of Reliability and Systems Engineering, Beihang University, Beijing 100191, China
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Luginaah I, Maticka-Tyndale E, Kairi W, Wildish J, Brouillard-Coyle C. Extending HIV/AIDS-Prevention Efforts in Kenya: Primary Schools as Community-Based Organizations. ACTA ACUST UNITED AC 2016. [DOI: 10.1068/c1511r] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The question of whether primary schools in Kenya can take on community-based activities beyond their day-to-day functioning, emerged from a larger HIV/AIDS education and prevention program—Primary School Action for Better Health (PSABH). The methodology involved both quantitative and qualitative approaches. The quantitative component was based on 163 schools, which were involved in the larger PSABH program. Qualitative analysis was based on consultative meetings with twenty key informants and follow-up focus-group discussions with representatives from eight schools involved in community-based activities. The results suggest that in this context schools have strong community ties, with most of them willing to take up community-based organization (CBO)-related activities beyond their day-to-day functioning. Schools were more likely to take on CBO-related activities, such as support for orphans, if they had a higher proportion of female teachers, a school sponsor that was involved in the selection of the head teacher, more Parent Teacher Association meetings, and if HIV/AIDS was incorporated into community festivals. A school's involvement was reinforced if it performed well in the Kenya Certificate of Primary Education examination, if the school's head teacher was committed, and if most of the teachers were from the local community. Despite several challenges, the findings point to the need to take schools seriously in their duty as CBOs which can have a positive impact in mitigating not only the effects of HIV/AIDS, but also other community-development activities in ravaged sub-Saharan African countries. The proposed expansion of PSABH further puts Kenyan schools in a stronger position to be involved in their communities through CBO-related activities.
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Affiliation(s)
- Isaac Luginaah
- Department of Geography, University of Western Ontario, London, ON, N6A 5C2, Canada
| | - Eleanor Maticka-Tyndale
- Department of Sociology and Anthropology, University of Windsor, 401 Sunset Avenue, Windsor, Ontario N9B 3P4, Canada
| | - Wambui Kairi
- Anthill Consultants, Nairobi Office, Nairobi, Kenya
| | | | - Chris Brouillard-Coyle
- Department of Sociology and Anthropology, University of Windsor, 401 Sunset Avenue, Windsor, Ontario N9B 3P4, Canada
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Lee HY, Yang BM, Kang M. Factor Configurations with Governance as Conditions for Low HIV/AIDS Prevalence in HIV/AIDS Recipient Countries: Fuzzy-set Analysis. J Korean Med Sci 2015; 30 Suppl 2:S167-77. [PMID: 26617451 PMCID: PMC4659870 DOI: 10.3346/jkms.2015.30.s2.s167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 10/04/2015] [Indexed: 11/20/2022] Open
Abstract
This paper aims to investigate whether good governance of a recipient country is a necessary condition and what combinations of factors including governance factor are sufficient for low prevalence of HIV/AIDS in HIV/AIDS aid recipient countries during the period of 2002-2010. For this, Fuzzy-set Qualitative Comparative Analysis (QCA) was used. Nine potential attributes for a causal configuration for low HIV/AIDS prevalence were identified through a review of previous studies. For each factor, full membership, full non-membership, and crossover point were specified using both author's knowledge and statistical information of the variables. Calibration and conversion to a fuzzy-set score were conducted using Fs/QCA 2.0 and probabilistic tests for necessary and sufficiency were performed by STATA 11. The result suggested that governance is the necessary condition for low prevalence of HIV/AIDS in a recipient country. From sufficiency test, two pathways were resulted. The low level of governance can lead to low level of HIV/AIDS prevalence when it is combined with other favorable factors, especially, low economic inequality, high economic development and high health expenditure. However, strengthening governance is a more practical measure to keep low prevalence of HIV/AIDS because it is hard to achieve both economic development and economic quality. This study highlights that a comprehensive policy measure is the key for achieving low prevalence of HIV/AIDS in recipient country.
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Affiliation(s)
- Hwa-Young Lee
- JW Lee Center for Global Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Bong-Min Yang
- Graduate School of Public Health, Seoul National University, Seoul, Korea
| | - Minah Kang
- Department of Public Administration, College of Social Sciences, Ewha Womans University, Seoul, Korea
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Steen R, Wheeler T, Gorgens M, Mziray E, Dallabetta G. Feasible, Efficient and Necessary, without Exception - Working with Sex Workers Interrupts HIV/STI Transmission and Brings Treatment to Many in Need. PLoS One 2015; 10:e0121145. [PMID: 26488796 PMCID: PMC4619404 DOI: 10.1371/journal.pone.0121145] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND AND OVERVIEW High rates of partner change in sex work-whether in professional, 'transactional' or other context-disproportionately drive transmission of HIV and other sexually transmitted infections. Several countries in Asia have demonstrated that reducing transmission in sex work can reverse established epidemics among sex workers, their clients and the general population. Experience and emerging research from Africa reaffirms unprotected sex work to be a key driver of sexual transmission in different contexts and regardless of stage or classification of HIV epidemic. This validation of the epidemiology behind sexual transmission carries an urgent imperative to realign prevention resources and scale up effective targeted interventions in sex work settings, and, given declining HIV resources, to do so efficiently. Eighteen articles in this issue highlight the importance and feasibility of such interventions under four themes: 1) epidemiology, data needs and modelling of sex work in generalised epidemics; 2) implementation science addressing practical aspects of intervention scale-up; 3) community mobilisation and 4) the treatment cascade for sex workers living with HIV. CONCLUSION Decades of empirical evidence, extended by analyses in this collection, argue that protecting sex work is, without exception, feasible and necessary for controlling HIV/STI epidemics. In addition, the disproportionate burden of HIV borne by sex workers calls for facilitated access to ART, care and support. The imperative for Africa is rapid scale-up of targeted prevention and treatment, facilitated by policies and action to improve conditions where sex work takes place. The opportunity is a wealth of accumulated experience working with sex workers in diverse settings, which can be tapped to make up for lost time. Elsewhere, even in countries with strong interventions and services for sex workers, an emerging challenge is to find ways to sustain them in the face of declining global resources.
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Affiliation(s)
- Richard Steen
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Tisha Wheeler
- Office of HIV/AIDS, United States Agency for International Development, Washington, District of Columbia, United States of America
| | - Marelize Gorgens
- The World Bank, Washington, District of Columbia, United States of America
| | - Elizabeth Mziray
- The World Bank, Washington, District of Columbia, United States of America
| | - Gina Dallabetta
- The Bill & Melinda Gates Foundation, Washington, District of Columbia, United States of America
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Low-Beer D, Stoneburner RL. Behaviour and communication change in reducing HIV: is Uganda unique? AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2015; 2:9-21. [PMID: 25871935 DOI: 10.2989/16085906.2003.9626555] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The clearest example of declines in HIV prevalence and changes in sexual behaviour comes from Uganda. Are there lessons to learn for other countries or is Uganda unique? In this paper, we assess the epidemiological and behavioural data on Uganda comparatively to other African countries and then analyse data from other populations where HIV has declined. In Uganda, HIV prevalence declined from 21% to 9.8% from 1991-1998, there was a reduction in non-regular sexual partners by 65% and greater levels of communication about AIDS and people with AIDS through social networks, unlike the comparison countries. There is evidence of a basic population level response initiated at community level, to avoid risk, reduce risk behaviours and care for people with AIDS. The basic elements-a continuum of communication, behaviour change and care-were integrated at community level. They were also strongly supported by distinctive Ugandan policies from the 1980s. We identify a similar, early behaviour and communication response in other situations where HIV has declined: Thailand, Zambia and the US Gay community. In Thailand, visits to sex workers decreased by 55% and non-regular partners declined from 28% to 15% (1990-1993): as important as the '100% condom use policy'. Similarly, in Zambia and Ethiopia risk behaviour has decreased and analysis of Sexually Transmitted Disease (STD) rates among Gay populations in the USA shows a decline from as early as 1985 in White Gay populations, with later declines in Hispanic and Black Gay populations. These responses preceded and exceeded HIV prevention. However, where they were built on by distinctive HIV policies, HIV prevention has been scaled and led to national level declines in HIV. It is not easy to transfer the lessons of these successes. They require real social and political capital in addition to financial capital. Nevertheless, similar characteristics are present in community responses in Africa, Asia and USA, and even in fragmented signs of HIV declines in other African cities. Only in a few situations has this behaviour and communication process been recognised, mobilised and built on by HIV prevention policy. Where this has occurred, HIV prevention success has been greater than biomedical approaches or methods introduced from outside. It represents a social vaccine for HIV from Africa, and is available now.
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Affiliation(s)
- Daniel Low-Beer
- a Health and Population Evaluation Unit and Cambridge University Health, Cambridge University , United Kingdom
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Abstract
PURPOSE OF REVIEW Globally, HIV infection remains a significant issue for key populations such as men who have sex with men (MSM) and female sex workers. A review of recent articles was conducted for west African countries to assess the burden of disease among female sex workers and MSM, access to services and identify barriers to implementation of services for key populations. RECENT FINDINGS In west Africa, key populations engage in high-risk practices for the acquisition of HIV and other sexually transmitted infections. Available HIV prevalence data fluctuate across and within countries for both MSM and female sex workers and may be five to ten times as high as that of the general population. HIV prevalence varied from 15.9% in The Gambia to 68% in Benin among female sex workers, whereas it ranged from 9.8% in The Gambia to 34.9% in Nigeria for MSM. Yet, important data gaps exist, including key populations size estimations in several countries as well as HIV prevalence, incidence and other biomarkers of HIV risk. Because of sociocultural, legal, political and economic challenges, exacerbated by a poor health system infrastructure, the HIV response is not strategically directed toward programs for key populations in countries with concentrated epidemics. Noteworthy is the low coverage of prevention care and treatment interventions offered to key populations. SUMMARY Sufficient planning and political will with legal and structural frameworks that reconcile public health and human rights are needed to prioritize HIV prevention, care and treatment programming for key populations programs in west Africa.
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Tang W, Huan X, Zhang Y, Mahapatra T, Li J, Liu X, Mahapatra S, Yan H, Fu G, Zhao J, Gu C, Detels R. Factors associated with loss-to-follow-up during behavioral interventions and HIV testing cohort among men who have sex with men in Nanjing, China. PLoS One 2015; 10:e115691. [PMID: 25559678 PMCID: PMC4283967 DOI: 10.1371/journal.pone.0115691] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Accepted: 11/24/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Behavioral interventions (BIs) remained the cornerstone of HIV prevention in resource-limited settings. One of the major concerns for such efforts is the loss-to-follow-up (LTFU) that threatens almost every HIV control program involving high-risk population groups. METHODS To evaluate the factors associated with LTFU during BIs and HIV testing among men who have sex with men (MSM), 410 HIV sero-negatives MSM were recruited using respondent driven sampling (RDS) in Nanjing, China during 2008, they were further followed for 18 months. At baseline and each follow-up visits, each participant was counseled about various HIV risk-reductions BIs at a designated sexually transmitted infection (STI) clinic. RESULTS Among 410 participants recruited at baseline, altogether 221 (53.9%) were LTFU at the 18-month follow-up visit. Overall, 46 participants were found to be positive for syphilis infection at baseline while 13 participants were HIV sero-converted during the follow-up period. Increasing age was less (Adjusted Odds Ratio(aOR) of 0.90, 95% confidence Interval (CI) 0.86-0.94) and official residency of provinces other than Nanjing (AOR of 2.49, 95%CI 1.32-4.71), lower level of education (AOR of 2.01, 95%CI 1.10-3.66) and small social network size (AOR of 1.75, 95%CI 1.09-2.80) were more likely to be associated with higher odds of LTFU. CONCLUSION To improve retention in the programs for HIV control, counseling and testing among MSM in Nanjing, focused intensified intervention targeting those who were more likely to be LTFU, especially the young, less educated, unofficial residents of Nanjing who had smaller social network size, might be helpful.
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Affiliation(s)
- Weiming Tang
- Guangdong Provincial Center for Skin Disease and STI Control, Guangzhou, Guangdong, 510095, China
- Jiangsu Provincial Central for Disease Control and Prevention, Nanjing, Jiangsu, 210009, China
- University of North Carolina Project-China, Number 2 Lujing Road, Guangzhou, 510095, China
| | - Xiping Huan
- Jiangsu Provincial Central for Disease Control and Prevention, Nanjing, Jiangsu, 210009, China
| | - Ye Zhang
- Guangdong Provincial Center for Skin Disease and STI Control, Guangzhou, Guangdong, 510095, China
| | - Tanmay Mahapatra
- Department of Epidemiology, School National Institute of Cholera and Enteric Diseases, Kolkata, West Bengal, India
| | - Jianjun Li
- Jiangsu Provincial Central for Disease Control and Prevention, Nanjing, Jiangsu, 210009, China
| | - Xiaoyan Liu
- Jiangsu Provincial Central for Disease Control and Prevention, Nanjing, Jiangsu, 210009, China
| | - Sanchita Mahapatra
- Department of Epidemiology, School National Institute of Cholera and Enteric Diseases, Kolkata, West Bengal, India
| | - Hongjing Yan
- Jiangsu Provincial Central for Disease Control and Prevention, Nanjing, Jiangsu, 210009, China
| | - Gengfeng Fu
- Jiangsu Provincial Central for Disease Control and Prevention, Nanjing, Jiangsu, 210009, China
| | - Jinkou Zhao
- Strategy, Investment and Impact Division, The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland
| | - Chenghua Gu
- Jiangsu Provincial Central for Disease Control and Prevention, Nanjing, Jiangsu, 210009, China
- * E-mail: (CG); (RD)
| | - Roger Detels
- Department of Epidemiology, School National Institute of Cholera and Enteric Diseases, Kolkata, West Bengal, India
- * E-mail: (CG); (RD)
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Dhana A, Luchters S, Moore L, Lafort Y, Roy A, Scorgie F, Chersich M. Systematic review of facility-based sexual and reproductive health services for female sex workers in Africa. Global Health 2014; 10:46. [PMID: 24916010 PMCID: PMC4070634 DOI: 10.1186/1744-8603-10-46] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 04/07/2014] [Indexed: 12/19/2022] Open
Abstract
Background Several biological, behavioural, and structural risk factors place female sex workers (FSWs) at heightened risk of HIV, sexually transmitted infections (STIs), and other adverse sexual and reproductive health (SRH) outcomes. FSW projects in many settings have demonstrated effective ways of altering this risk, improving the health and wellbeing of these women. Yet the optimum delivery model of FSW projects in Africa is unclear. This systematic review describes intervention packages, service-delivery models, and extent of government involvement in these services in Africa. Methods On 22 November 2012, we searched Web of Science and MEDLINE, without date restrictions, for studies describing clinical and non-clinical facility-based SRH prevention and care services for FSWs in low- and middle-income countries in Africa. We also identified articles in key non-indexed journals and on websites of international organizations. A single reviewer screened titles and abstracts, and extracted data from articles using standardised tools. Results We located 149 articles, which described 54 projects. Most were localised and small-scale; focused on research activities (rather than on large-scale service delivery); operated with little coordination, either nationally or regionally; and had scanty government support (instead a range of international donors generally funded services). Almost all sites only addressed HIV prevention and STIs. Most services distributed male condoms, but only 10% provided female condoms. HIV services mainly encompassed HIV counselling and testing; few offered HIV care and treatment such as CD4 testing or antiretroviral therapy (ART). While STI services were more comprehensive, periodic presumptive treatment was only provided in 11 instances. Services often ignored broader SRH needs such as family planning, cervical cancer screening, and gender-based violence services. Conclusions Sex work programmes in Africa have limited coverage and a narrow scope of services and are poorly coordinated with broader HIV and SRH services. To improve FSWs’ health and reduce onward HIV transmission, access to ART needs to be addressed urgently. Nevertheless, HIV prevention should remain the mainstay of services. Service delivery models that integrate broader SRH services and address structural risk factors are much needed. Government-led FSW services of high quality and scale would markedly reduce SRH vulnerabilities of FSWs in Africa.
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Affiliation(s)
| | | | | | | | | | | | - Matthew Chersich
- Centre for Health Policy, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
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Gilbert H. Re-visioning local biologies: HIV-2 and the pattern of differential valuation in biomedical research. Med Anthropol 2013; 32:343-58. [PMID: 23768219 DOI: 10.1080/01459740.2013.773328] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The discovery of HIV-2, a distinctly West African variant of HIV, is often portrayed as the result of a straightforward, if serendipitous, error. This article reframes the history of how HIV-2 came to be a knowable scientific identity. Relying on narratives from an African laboratory and clinic, it suggests that the rise and fall of HIV-2 as a viable research entity is indicative of a differential visibility and valuation of both human bodies and viruses. Understanding how HIV-2 emerged as a local biology reveals the complex set of relations that contemporary African scientists face in navigating local moral economies and the mercurial politics of the contemporary global health industry.
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Affiliation(s)
- Hannah Gilbert
- Department of Anthropology, McGill University, Montreal, Quebec, Canada.
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Agarwal S, de Araujo P, Paudel J. HIV-Related Knowledge and Risky Sexual Behaviour in Sub-Saharan Africa. ACTA ACUST UNITED AC 2013. [DOI: 10.1080/13600818.2013.790950] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Scale-up of combination prevention and antiretroviral therapy for female sex workers in West Africa: time for action. AIDS 2013; 27:1369-74. [PMID: 23945501 DOI: 10.1097/qad.0b013e32835fd7bd] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Heitzinger K, Sow PS, Dia Badiane NM, Gottlieb GS, N'Doye I, Toure M, Kiviat NB, Hawes SE. Trends of HIV-1, HIV-2 and dual infection in women attending outpatient clinics in Senegal, 1990-2009. Int J STD AIDS 2013; 23:710-6. [PMID: 23104745 DOI: 10.1258/ijsa.2012.011219] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We assessed trends in the relative prevalences of HIV-1, HIV-2 and dual HIV-1/HIV-2 infection in 10,321 women attending outpatient clinics in Senegal between 1990 and 2009. The relative prevalence of HIV-1 (defined as the proportion of seropositive subjects having HIV-1) rose sharply from 38% in 1990 until 1993 (P < 0.001), whereupon it continued to rise, but at a slower rate, reaching 72% of HIV infections in 2009. As compared with HIV-1, the relative prevalence of HIV-2 decreased sharply from 54% in 1990 until 1993 (P < 0.001) and continued to decrease at a slower rate through 2009. The relative prevalence of dual infection, as compared with HIV-1, was stable from 1990 to 1993, but decreased slightly thereafter (P < 0.001). These study findings indicate that during the early 1990s, the relative prevalence of HIV-1 increased markedly, while the relative prevalence of HIV-2 decreased and the relative prevalence of dual infection remained stable in Senegal. From 1993 to 2009, the relative prevalence of HIV-1 increased at a slower rate, while the relative prevalences of HIV-2 and dual infection decreased. These results confirm trends in HIV prevalence observed in other West African populations and provide a critical update on HIV transmission risk among women in Senegal.
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Affiliation(s)
- K Heitzinger
- Department of Epidemiology, School of Public Health, University of Washington, Box 357236, Seattle, WA 98195, USA.
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Priority interventions to reduce HIV transmission in sex work settings in sub-Saharan Africa and delivery of these services. J Int AIDS Soc 2013; 16:17980. [PMID: 23462140 PMCID: PMC3589546 DOI: 10.7448/ias.16.1.17980] [Citation(s) in RCA: 103] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Revised: 09/17/2012] [Accepted: 10/24/2012] [Indexed: 12/04/2022] Open
Abstract
Introduction Virtually no African country provides HIV prevention services in sex work settings with an adequate scale and intensity. Uncertainty remains about the optimal set of interventions and mode of delivery. Methods We systematically reviewed studies reporting interventions for reducing HIV transmission among female sex workers in sub-Saharan Africa between January 2000 and July 2011. Medline (PubMed) and non-indexed journals were searched for studies with quantitative study outcomes. Results We located 26 studies, including seven randomized trials. Evidence supports implementation of the following interventions to reduce unprotected sex among female sex workers: peer-mediated condom promotion, risk-reduction counselling and skills-building for safer sex. One study found that interventions to counter hazardous alcohol-use lowered unprotected sex. Data also show effectiveness of screening for sexually transmitted infections (STIs) and syndromic STI treatment, but experience with periodic presumptive treatment is limited. HIV testing and counselling is essential for facilitating sex workers’ access to care and antiretroviral treatment (ART), but testing models for sex workers and indeed for ART access are little studied, as are structural interventions, which create conditions conducive for risk reduction. With the exception of Senegal, persistent criminalization of sex work across Africa reduces sex workers’ control over working conditions and impedes their access to health services. It also obstructs health-service provision and legal protection. Conclusions There is sufficient evidence of effectiveness of targeted interventions with female sex workers in Africa to inform delivery of services for this population. With improved planning and political will, services – including peer interventions, condom promotion and STI screening – would act at multiple levels to reduce HIV exposure and transmission efficiency among sex workers. Initiatives are required to enhance access to HIV testing and ART for sex workers, using current CD4 thresholds, or possibly earlier for prevention. Services implemented at sufficient scale and intensity also serve as a platform for subsequent community mobilization and sex worker empowerment, and alleviate a major source of incident infection sustaining even generalized HIV epidemics. Ultimately, structural and legal changes that align public health and human rights are needed to ensure that sex workers on the continent are adequately protected from HIV.
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Abstract
While there is a growing body of work on moral issues and global governance in the fields of global justice and international relations, little work has connected principles of global health justice with those of global health governance for a theory of global health. Such a theory would enable analysis and evaluation of the current global health system and would ethically and empirically ground proposals for reforming it to more closely align with moral values. Global health governance has been framed as an issue of national security, human security, human rights, and global public goods. The global health governance literature is essentially untethered to a theorized framework to illuminate or evaluate governance. This article ties global health justice and ethics to principles for governing the global health realm, developing a theoretical framework for global and domestic institutions and actors.
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Robinson RS. From population to HIV: the organizational and structural determinants of HIV outcomes in sub-Saharan Africa. J Int AIDS Soc 2011; 14 Suppl 2:S6. [PMID: 21968262 PMCID: PMC3194165 DOI: 10.1186/1758-2652-14-s2-s6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Background There exists no consistent explanation for why some countries are successful in combating HIV/AIDS and others are not, and we need such an explanation in order to design effective policies and programmes. Research evaluating HIV interventions from a biomedical or public health perspective does not always take full account of the historical and organizational characteristics of countries likely to influence HIV outcomes. The analysis in this paper addresses this shortcoming by testing the impact of organizational and structural factors, particularly those resulting from population interventions, on HIV outcomes at the country level in sub-Saharan Africa. Methods The primary independent variables are factors that originated from efforts to slow population growth: whether a country has a long-time affiliate of the International Planned Parenthood Federation and whether a country has a population policy. Additional structural factors likely to impact HIV outcomes include the level of wealth, the level of cultural fractionalization, and the former colonial power. The present study uses multivariate regression techniques with countries in sub-Saharan Africa as the unit of analysis, and four measures of success in addressing HIV: the change in prevalence between 2001 and 2009; the change in incidence between 2001 and 2009; the level of overall antiretroviral coverage in 2009; and the level of antiretroviral coverage for prevention of vertical transmission in 2009. Results Countries with the greatest declines in HIV prevalence and incidence had older International Planned Parenthood Federation affiliates and had adopted population policies, even after controlling for age of epidemic, level of antiretroviral coverage, and funding for HIV. Population policies are also important predictors of levels of overall antiretroviral coverage and of coverage of HIV-positive pregnant women to prevent vertical transmission. Structural factors with significant impacts include wealth, cultural fractionalization and former colonial power. Conclusions The organizational and structural context of African countries is strongly predictive of HIV outcomes. This finding implies that policy and programmatic efforts should be put towards strengthening existing organizations and perhaps even creating new ones. The fact that cultural fractionalization also influences HIV outcomes suggests that efforts must be put towards identifying ways to reach political consensus in diverse societies.
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Affiliation(s)
- Rachel Sullivan Robinson
- School of International Service, American University, 4400 Massachusetts Avenue NW, Washington, DC 20016-8071, USA.
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Foley EE, Nguer R. Courting success in HIV/AIDS prevention: the challenges of addressing aconcentrated epidemic in Senegal. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2010; 9:325-36. [DOI: 10.2989/16085906.2010.545628] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Jobarteh M, Malfroy M, Peterson I, Jeng A, Sarge-Njie R, Alabi A, Peterson K, Cotten M, Hall A, Rowland-Jones S, Whittle H, Tedder R, Jaye A, Mendy M. Seroprevalence of hepatitis B and C virus in HIV-1 and HIV-2 infected Gambians. Virol J 2010; 7:230. [PMID: 20843322 PMCID: PMC2949835 DOI: 10.1186/1743-422x-7-230] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2010] [Accepted: 09/15/2010] [Indexed: 12/12/2022] Open
Abstract
Background The prevalence of HIV/hepatitis co-infection in sub-Saharan Africa is not well documented, while both HIV and HBV are endemic in this area. Objective The aim of this study is to determine the seroprevalence of HBV and HCV virus in HIV-infected subjects in the Gambia. Methods Plasma samples from HIV infected patients (190 individuals with clinically defined AIDS and 382 individuals without AIDS) were tested retrospectively for the presence of HBV sero-markers and for serum HBV DNA, screened for HCV infection by testing for anti-HCV antibody and HCV RNA. Results HBsAg prevalence in HIV-positive individuals is 12.2%. HIV/HBV co-infected individuals with CD4 count of <200 cells uL-1 have a higher HBV DNA viral load than patients with higher CD4 count (log 4.0 vs. log 2.0 DNA copies/ml, p < 0.05). Males (OR = 1.8, 95% CI: 1.0, 3.2) were more likely to be HBsAg positive than female. HCV seroprevalence was 0.9% in HIV-positive individuals. Conclusion The prevalence of HBsAg carriage in HIV- infected Gambians is similar to that obtained in the general population. However co-infected individuals with reduced CD4 levels, indicative of AIDS had higher prevalence of HBeAg retention and elevated HBV DNA levels compared to non-AIDS patients with higher CD4 count.
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Affiliation(s)
- Modou Jobarteh
- Medical Research Council, Fajara, P O Box 273, Banjul, The Gambia
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Johnson LF, Dorrington RE, Bradshaw D, Coetzee DJ. The effect of syndromic management interventions on the prevalence of sexually transmitted infections in South Africa. SEXUAL & REPRODUCTIVE HEALTHCARE 2010; 2:13-20. [PMID: 21147454 DOI: 10.1016/j.srhc.2010.08.006] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Revised: 08/07/2010] [Accepted: 08/12/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Few studies have assessed the effect of syndromic management interventions on the prevalence of sexually transmitted infections (STIs) at a population level. This study aims to determine the effect of syndromic management protocols that have been introduced in South Africa since 1994. STUDY DESIGN A mathematical model of sexual behaviour patterns in South Africa was used to model the incidence of HIV, genital herpes, syphilis, chancroid, gonorrhoea, chlamydial infection, trichomoniasis, bacterial vaginosis and vaginal candidiasis. Assumptions about health seeking behaviour and treatment effectiveness were based on South African survey data. The model was fitted to available STI prevalence data. MAIN OUTCOME MEASURES Reductions in STI prevalence due to syndromic management. RESULTS Between 1995 and 2005, there were significant reductions in the prevalence of syphilis, chancroid, gonorrhoea, trichomoniasis and chlamydial infection. In women aged between 15 and 49, syndromic management resulted in a 33% (95% CI: 23-43%) decline in syphilis prevalence, a 6% (95% CI: 3-11%) reduction in gonorrhoea prevalence, a 5% (95% CI: 1-13%) reduction in the prevalence of bacterial vaginosis and a substantial decline in chancroid. However, syndromic management did not significantly reduce the prevalence of other STIs. For all STIs, much of the modelled reduction in STI prevalence between 1995 and 2005 can be attributed to either increased condom usage or AIDS mortality. CONCLUSIONS Syndromic management of STIs can be expected to decrease the prevalence of curable STIs that tend to become symptomatic, but has little effect on the prevalence of STIs that are mostly asymptomatic.
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Affiliation(s)
- Leigh F Johnson
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town, South Africa.
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Sirotin N, Strathdee SA, Lozada R, Nguyen L, Gallardo M, Vera A, Patterson TL. A comparison of registered and unregistered female sex workers in Tijuana, Mexico. Public Health Rep 2010; 125 Suppl 4:101-9. [PMID: 20626197 DOI: 10.1177/00333549101250s414] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Sex work is regulated in Tijuana, Mexico, but only half of the city's female sex workers (FSWs) are registered with the municipal health department, which requires regular screening for sexually transmitted infections (STIs) and human immunodeficiency virus (HIV). We examined correlates of registration to determine if it confers measurable health benefits. METHODS From 2004 to 2006, we interviewed FSWs in Tijuana > or = 18 years of age who reported recent unprotected sex with at least one client and were not knowingly HIV-positive, and tested them for HIV, syphilis, gonorrhea, and chlamydia. Logistic regression identified factors associated with registration. RESULTS Of 410 FSWs, 44% were registered, 69% had been tested for HIV, 6% were HIV-positive, and 44% tested positive for any STI. Compared with unregistered FSWs, registered FSWs were more likely to have had HIV testing (86% vs. 56%, p < 0.001) and less likely to test positive for any STI (33% vs. 53%, p < 0.001) or HIV (3% vs. 8%, p = 0.039). Factors independently associated with registration included ever having an HIV test (adjusted odds ratio [AOR] = 4.19) and earning > $30 per transaction without a condom (AOR = 2.41), whereas working on the street (AOR = 0.34), injecting cocaine (AOR = 0.06), snorting or smoking methamphetamine (AOR = 0.27), and being born in the Mexican state of Baja California (AOR = 0.35) were inversely associated with registration. CONCLUSION Registered FSWs were more likely than unregistered FSWs to have had HIV testing and to engage in less drug use, but did not have significantly lower HIV or STI prevalence after adjusting for confounders. Current regulation of FSWs in Tijuana should be further examined to enhance the potential public health benefits of registration.
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Affiliation(s)
- Nicole Sirotin
- Division of Global Public Health, Department of Medicine, University of California-San Diego, LaJolla, CA 92093-0680, USA
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Westercamp N, Mattson CL, Madonia M, Moses S, Agot K, Ndinya-Achola JO, Otieno E, Ouma N, Bailey RC. Determinants of consistent condom use vary by partner type among young men in Kisumu, Kenya: a multi-level data analysis. AIDS Behav 2010; 14:949-59. [PMID: 18791819 DOI: 10.1007/s10461-008-9458-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2008] [Accepted: 08/25/2008] [Indexed: 10/21/2022]
Abstract
To evaluate whether determinants of consistent condom use vary by partner type among young sexually active Kenyan men, we conducted a cross-sectional assessment of lifetime sexual histories from a sub-sample of men enrolled in a clinical trial of male circumcision. 7913 partnerships of 1370 men were analyzed. 262 men (19%) reported never, 1018 (74%) sometimes and 92 (7%) always using a condom with their partners. Condoms were always used in 2672 (34%) of the total relationships-212 (70%) of the relationships with sex workers, 1643 (40%) of the casual and 817 (23%) of the regular/marital relationships. Factors influencing condom use varied significantly by partner type, suggesting that HIV prevention messages promoting condom use with higher-risk partners have achieved a moderate level of acceptance. However, in populations of young, single men in generalized epidemic settings, interventions should promote consistent condom use in all sexual encounters, independently of partner type and characteristics.
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Abstract
OBJECTIVE The Middle East and North Africa (MENA) region continues to be perceived as a region with very limited HIV epidemiological data, raising many controversies about the status of the epidemic in this part of the world. The objective of this review and synthesis was to address the dearth of strategic interpretable data on HIV in MENA by delineating a data-driven overview of HIV epidemiology in this region. METHODS A comprehensive systematic review of HIV, sexually transmitted infections (STIs) and risk behavior studies in MENA, irrespective of design, was undertaken. Sources of data included Medline for peer-reviewed publications, Google Scholar for other scientific literature published in nonindexed local and regional journals, international organizations reports and databases, country-level reports and database including governmental and nongovernmental organizations publications, as well as various other institutional documents. RESULTS Over 5000 sources of data related to HIV and STIs were identified and reviewed. The quality of data and nature of study designs varied substantially. There was no evidence for a sustainable HIV epidemic in the general population in any of the MENA countries, except possibly for southern Sudan. The general pattern in different countries in MENA points towards emerging epidemics in high-risk populations including injecting drug users, men who have sex with men (MSM) and to a lesser extent female sex workers, with heterogeneity between countries on the relative role of each of these high-risk groups. Exogenous HIV exposures among nationals linked to travel abroad appeared to be the dominant HIV transmission pattern in a few MENA countries with no evidence for much epidemic or endemic transmission. The role of bridging populations in bridging the HIV infection to the general population was found to be very limited. CONCLUSION Although they do not provide complete protection against HIV spread, near universal male circumcision and possibly the prevailing sexually conservative cultural norms seemed to have played so far a protective role in slowing and limiting HIV transmission in MENA relative to other regions. If the existing social and epidemiological context remains largely the same, HIV epidemic transmission is likely to remain confined to high-risk populations and their sexual partners, in addition to exogenous exposures. HIV prevention efforts in this region, which continue to be stymied by stigma associated with HIV/AIDS and related risk behaviors, need to be aggressively expanded with a focus on controlling HIV spread along the contours of risk and vulnerability. There is still a window of opportunity to control further HIV transmission among high-risk groups in MENA that, if missed, may entail a health and socioeconomic burden that the region, in large part, is unprepared for.
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Steen R, Wi TE, Kamali A, Ndowa F. Control of sexually transmitted infections and prevention of HIV transmission: mending a fractured paradigm. Bull World Health Organ 2010; 87:858-65. [PMID: 20072772 DOI: 10.2471/blt.08.059212] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2009] [Accepted: 08/31/2009] [Indexed: 11/27/2022] Open
Abstract
Control of sexually transmitted infections (STIs) is feasible, leads to improved sexual and reproductive health and contributes to preventing HIV transmission. The most advanced HIV epidemics have developed under conditions of poor STI control, particularly where ulcerative STIs were prevalent. Several countries that have successfully controlled STIs have documented stabilization or reversal of their HIV epidemics. STI control is a public health outcome measured by reduced incidence and prevalence. The means to achieve this include: (i) targeting and outreach to populations at greatest risk; (ii) promoting and providing condoms and other means of prevention; (iii) effective clinical interventions; (iv) an enabling environment; and (v) reliable data. Clinical services include STI case management, screening and management of STIs in sex partners. Syndromic case management is effective for most symptomatic curable STIs and screening strategies exist to detect some asymptomatic infections. Presumptive epidemiologic treatment of sex partners and sex workers complement efforts to interrupt transmission and reduce prevalence. Clinical services alone are insufficient for control since many people with STIs do not attend clinics. Outreach and peer education have been effectively used to reach such populations. STI control requires effective interventions with core populations whose rates of partner change are high enough to sustain transmission. Effective, appropriate targeting is thus necessary and often sufficient to reduce prevalence in the general population. Such efforts are most effective when combined with structural interventions to ensure an enabling environment for prevention. Reliable surveillance and related data are critical for designing and evaluating interventions and for assessing control efforts.
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Affiliation(s)
- Richard Steen
- World Health Organization Regional Office for South-East Asia, New Delhi, India.
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Harijaona V, Ramambason J, Morisset R, Rasamindrakotroka A, Ravaoarinoro M. Prevalence of and risk factors for sexually-transmitted infections in hidden female sex workers. Med Mal Infect 2009; 39:909-13. [DOI: 10.1016/j.medmal.2009.01.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2008] [Accepted: 01/30/2009] [Indexed: 10/21/2022]
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Willems R. The importance of interdisciplinary collaborative research in responding to HIV/AIDS vulnerability in rural Senegal. AFRICAN JOURNAL OF AIDS RESEARCH : AJAR 2009; 8:433-42. [PMID: 25875707 DOI: 10.2989/ajar.2009.8.4.7.1044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
HIV prevalence in Senegal is less than 1%, a success generally attributed to the country's quick response to the nascent epidemic of the 1980s and its continued efforts to curtail the spread of HIV. However, as the bulk of the healthcare infrastructure and support for HIV-positive individuals and AIDS patients are located in urban areas, there remains limited information on HIV and AIDS prevalence in rural areas. Several focus group discussions held with small-holder farmers in 2006, in the regions of Kolda and Tambacounda, Senegal, in the framework of a regional food-security development programme, revealed the growing vulnerability of rural populations to HIV and AIDS. Because current HIV/AIDS campaigns are strongly influenced by generalised, internationally formulated guidelines that fail to take into account the cultural particularities of the Senegalese context, the initial positive impact of these campaigns has dramatically decreased and at-risk behaviour in rural Senegal has been found to be on the increase. The article argues that in order for HIV/AIDS campaigns to have an impact there is an urgent need for evidence-based approaches built on a deeper understanding of the local socio-cultural situation through interdisciplinary research and collaboration.
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Affiliation(s)
- Roos Willems
- a Department Social and Cultural Anthropology , Catholic University of Leuven , Dalemstraat 2 bus 6 , B-3078 , Everberg , Belgium
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Prevalence and incidence of HIV-1 and HIV-2 before, during and after a civil war in an occupational cohort in Guinea-Bissau, West Africa. AIDS 2009; 23:1575-82. [PMID: 19521234 DOI: 10.1097/qad.0b013e32832cedfb] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To study prevalence and incidence of HIV-1 and HIV-2 between 1990 and 2007 and to examine impact of the civil war in 1998-1999. We also wanted to investigate possible interaction between HIV-1 and HIV-2. DESIGN Open prospective cohort study of 4592 police officers in Guinea-Bissau, West Africa. METHODS Analysis of HIV-1 and HIV-2 prevalence and incidence divided in 2-3 years time strata. RESULTS HIV-1 prevalence (including HIV-1/HIV-2 dual reactivity) increased gradually from 0.6 to 3.6% before the war and was 9.5% in the first serosurvey after the war. HIV-1 incidence more than doubled during and shortly after the war, from 0.50 to 1.22 per 100 person-years. Both prevalence and incidence of HIV-1 decreased in the following periods after the war. HIV-2 prevalence decreased from 13.4 to 6.2% during the entire study period and HIV-2 incidence decreased from 1.38 to 0.18 per 100 person-years. Adjusted incidence rate ratios of HIV-1 incidence in HIV-2-positive participants compared with HIV-negative participants ranged from 1.02 to 1.18 (not significant) depending on the confounding variables included. CONCLUSION HIV-1 has increased, whereas HIV-2 has decreased and the risk of acquiring HIV-1 is now more than four times higher as compared with HIV-2. The civil war in 1998-1999 appears to have induced a temporary increase in HIV-1 transmission, but now a stabilization of HIV-1 incidence and prevalence seems to have taken place. There was no evidence of a protective effect of HIV-2 against HIV-1 infection.
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Boily MC, Baggaley RF, Wang L, Masse B, White RG, Hayes RJ, Alary M. Heterosexual risk of HIV-1 infection per sexual act: systematic review and meta-analysis of observational studies. THE LANCET. INFECTIOUS DISEASES 2009; 9:118-29. [PMID: 19179227 PMCID: PMC4467783 DOI: 10.1016/s1473-3099(09)70021-0] [Citation(s) in RCA: 570] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
We did a systematic review and meta-analysis of observational studies of the risk of HIV-1 transmission per heterosexual contact. 43 publications comprising 25 different study populations were identified. Pooled female-to-male (0.04% per act [95% CI 0.01-0.14]) and male-to-female (0.08% per act [95% CI 0.06-0.11]) transmission estimates in high-income countries indicated a low risk of infection in the absence of antiretrovirals. Low-income country female-to-male (0.38% per act [95% CI 0.13-1.10]) and male-to-female (0.30% per act [95% CI 0.14-0.63]) estimates in the absence of commercial sex exposure (CSE) were higher. In meta-regression analysis, the infectivity across estimates in the absence of CSE was significantly associated with sex, setting, the interaction between setting and sex, and antenatal HIV prevalence. The pooled receptive anal intercourse estimate was much higher (1.7% per act [95% CI 0.3-8.9]). Estimates for the early and late phases of HIV infection were 9.2 (95% CI 4.5-18.8) and 7.3 (95% CI 4.5-11.9) times larger, respectively, than for the asymptomatic phase. After adjusting for CSE, presence or history of genital ulcers in either couple member increased per-act infectivity 5.3 (95% CI 1.4-19.5) times versus no sexually transmitted infection. Study estimates among non-circumcised men were at least twice those among circumcised men. Low-income country estimates were more heterogeneous than high-income country estimates, which indicates poorer study quality, greater heterogeneity of risk factors, or under-reporting of high-risk behaviour. Efforts are needed to better understand these differences and to quantify infectivity in low-income countries.
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Affiliation(s)
- Marie-Claude Boily
- Department of Infectious Disease Epidemiology, Faculty of Medicine, Imperial College, London, UK.
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Gilbert SS. The influence of Islam on AIDS prevention among Senegalese university students. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2008; 20:399-407. [PMID: 18956981 DOI: 10.1521/aeap.2008.20.5.399] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Few studies have attempted to quantify Islam's contributions to HIV/AIDS prevention. Senegal has involved Muslim leaders in its prevention campaign for over a decade. Senegal also has the lowest HIV/AIDS prevalence rate in sub-Saharan Africa. This study examines how Islam influences AIDS prevention by testing whether Senegalese participants' religiosity scores explain their risky decisions associated with sex, condom use, and drug use. Participants with higher religiosity scores were more likely to abstain from sex. However, participants high in religiosity were not more likely to report that they did not use condoms when sexually active.
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Affiliation(s)
- Sarah S Gilbert
- Department of Psychology, University of Pennsylvania, Philadelphia, USA.
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Changes in prevalence and incidence of HIV-1, HIV-2 and dual infections in urban areas of Bissau, Guinea-Bissau: is HIV-2 disappearing? AIDS 2008; 22:1195-202. [PMID: 18525265 DOI: 10.1097/qad.0b013e328300a33d] [Citation(s) in RCA: 122] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To assess the changes in HIV prevalence and incidence between 1996 and 2006 in urban areas of Bissau. DESIGN A cross-sectional survey of 384 randomly selected houses within a community-based follow-up study of HIV-1 and HIV-2. METHODS A total of 3242 individuals aged at least 15 years were eligible for inclusion. Participants were interviewed about behavioral and socio-economic factors and had a blood sample drawn. A total of 2548 individuals were tested for antibodies to HIV-1 and HIV-2, of whom 649 had taken part in a similar survey in 1996. RESULTS With 0.5% HIV dual reactions included, the overall HIV-1 prevalence was 4.6% (118 out of 2548) and the HIV-2 prevalence was 4.4% (112 out of 2548). The prevalence of HIV-1 increased more for women than men especially in the 25-34-year age group. HIV-2 prevalence decreased below 45 years of age but not for individuals more than 45 years old. The incidence rate between 1996 and 2006 was 0.5 per 100 person-years for HIV-1 and 0.24 per 100 person-years for HIV-2. Compared with a previous period from 1987 to 1996, the incidence of HIV-2 is declining whereas no significant increase in the incidence of HIV-1 was observed. CONCLUSIONS The present study shows an increasing prevalence of HIV-1 and a decreasing prevalence of HIV-2 in Guinea-Bissau. HIV is generally a bigger problem for women. Despite the general decline in prevalence, HIV-2 may continue as an infection in older people, especially women.
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Chiao C, Morisky DE, Ksobiech K, Masson CL, Malow RM. Clinic appointment attendance for sexually transmitted infection screening among Filipina sex workers: a multilevel analysis. AIDS Care 2008; 19:1166-70. [PMID: 18058401 DOI: 10.1080/09540120701402798] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This study evaluates putative individual- and contextual-level social risk factors that may influence the likelihood that Filipina female sex workers (FSWs) attend and utilize health services for STI screening. Face-to-face interviews were conducted with 1004 FSWs and their 86 employers. Research staff also collected clinic appointment attendance data. Hierarchical linear modelling was used to estimate the simultaneous effects of individual- and workplace-level factors. Results showed that both individual- and contextual-level characteristics were associated with STI screening appointment attendance. Individual characteristics found to have significant effects on clinic attendance included occupation, income, length of work and commercial sex involvement. City of establishment was a workplace characteristic significantly associated with appointment attendance. In addition to cross-level interactions, the impact of individual-level occupation depended upon characteristics of the workplace. These findings suggest that individual health service utilization is contingent upon contextual-level risk factors in the workplace. Intervention implications aimed at increasing clinic attendance are discussed.
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Affiliation(s)
- C Chiao
- Department of Public Health, School of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Godin G, Tinka Bah A, Sow A, Minani I, Morin D, Alary M. Correlates of condom use among sex workers and their boyfriends in three West African countries. AIDS Behav 2008; 12:441-51. [PMID: 17710526 DOI: 10.1007/s10461-007-9296-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2007] [Accepted: 07/23/2007] [Indexed: 11/26/2022]
Abstract
The aim of this study was to identify correlates associated with condom use at last intercourse between sex workers (SW) and their boyfriends (BF). The sample was derived as a convenience sample recruited through existing HIV prevention organizations in Benin, Guinea and Senegal. The Theory of Planned Behavior served as the conceptual framework. A total of 406 individuals (220 SW and 186 BF) participated in the study. Socio-demographic, behavioral and psychological variables were collected through a face-to-face administered questionnaire. Condom use at last intercourse was significantly associated with intention and perceived control among SW as well as their BF. With respect to intention, perceived control, attitude and moral norm explained 82 and 74% of intention of SW and BF, respectively. These results suggest that promoting condom use among SW and BF should be based primarily on the development of personal ability to overcome obstacles to condom use.
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Affiliation(s)
- Gaston Godin
- Chaire de recherche du Canada sur les comportements et la santé, Université Laval, Quebec, Canada.
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Akhtar S, Mohammad HGHH. Spectral analysis of HIV seropositivity among migrant workers entering Kuwait. BMC Infect Dis 2008; 8:37. [PMID: 18366744 PMCID: PMC2324079 DOI: 10.1186/1471-2334-8-37] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2007] [Accepted: 03/25/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is paucity of published data on human immunodeficiency virus (HIV) seroprevalence among migrant workers entering Middle-East particularly Kuwait. We took advantage of the routine screening of migrants for HIV infection, upon arrival in Kuwait from the areas with high HIV prevalence, to 1) estimate the HIV seroprevalence among migrant workers entering Kuwait and to 2) ascertain if any significant time trend or changes had occurred in HIV seroprevalence among these migrants over the study period. METHODS The monthly aggregates of daily number of migrant workers tested and number of HIV seropositive were used to generate the monthly series of proportions of HIV seropositive (per 100,000) migrants over a period of 120 months from January 1, 1997 to December 31, 2006. We carried out spectral analysis of these time series data on monthly proportions (per 100,000) of HIV seropositive migrants. RESULTS Overall HIV seroprevalence (per 100,000) among the migrants was 21 (494/2328582) (95% CI: 19 -23), ranging from 11 (95% CI: 8 - 16) in 2003 to 31 (95% CI: 24 -41) in 1998. There was no discernable pattern in the year-specific proportions of HIV seropositive migrants up to 2003; in subsequent years there was a slight but consistent increase in the proportions of HIV seropositive migrants. However, the Mann-Kendall test showed non-significant (P = 0.741) trend in de-seasonalized data series of proportions of HIV seropositive migrants. The spectral density had a statistically significant (P = 0.03) peak located at a frequency (radians) 2.4, which corresponds to a regular cycle of three-month duration in this study. Auto-correlation function did not show any significant seasonality (correlation coefficient at lag 12 = - 0.025, P = 0.575). CONCLUSION During the study period, overall a low HIV seroprevalence (0.021%) was recorded. Towards the end of the study, a slight but non-significant upward trend in the proportions of HIV seropositive migrants was recorded. A significant rhythmic cycle of three-month duration was observed in the proportions of HIV seropositive migrants. The underlying factors for a consistent upward trend towards the end of study period and for a significant quarterly cycle in the proportions of HIV seropositive migrants merit further investigations.
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Affiliation(s)
- Saeed Akhtar
- Department of Community Medicine and Behavioural Sciences, Faculty of Medicine, Kuwait University, PO Box 24923, Safat 13110, Kuwait.
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Wang C, Hawes SE, Gaye A, Sow PS, Ndoye I, Manhart LE, Wald A, Critchlow CW, Kiviat NB. HIV prevalence, previous HIV testing, and condom use with clients and regular partners among Senegalese commercial sex workers. Sex Transm Infect 2007; 83:534-40. [PMID: 17942575 DOI: 10.1136/sti.2007.027151] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To assess HIV prevalence and risk factors for HIV infection, to investigate condom use among registered female commercial sex workers (CSWs) in Senegal, West Africa, and to examine the association between previous HIV testing, knowledge of HIV serostatus and condom use with both regular sex partners and clients within this population. METHODS A cross-sectional study was conducted at three sexually transmitted disease clinics among 1052 Senegalese registered CSWs between 2000 and 2004. Inperson interviews soliciting information concerning demographic characteristics, medical history, sexual behaviour with clients and regular partners, and previous HIV testing history were performed. Blood samples were collected for determination of HIV-1 and/or HIV-2 serostatus. Multivariable, Poisson and log-binomial models were used to calculate prevalence ratios. RESULTS The overall HIV prevalence was 19.8%. Over 95% of CSWs reported always using a condom with clients, but only 18% reported always using a condom with their regular partners. A history of previous HIV testing was not associated with condom use with clients (adjusted prevalence ratio (APR) = 0.98, 95% confidence intervals, CI: 0.90 to 1.06). However, prior HIV testing was associated with decreased condom use with their regular partners (APR = 0.44, 95% CI: 0.28 to 0.69), especially in women who tested HIV negative (APR = 0.17, 95% CI: 0.08 to 0.36). CONCLUSIONS CSWs in Senegal have a high HIV prevalence; therefore preventing HIV transmission from this population to the general population is important. Condom use with regular partners is low among registered CSWs in Senegal, and a prior HIV negative test is associated with even less condom use with regular partners. Intervention efforts to increase condom use with regular sexual partners are needed.
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Affiliation(s)
- C Wang
- Department of Epidemiology, School of Public Health and Community Medicine, University of Washington, Seattle, WA 98103, USA
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Hamel DJ, Sankalé JL, Eisen G, Meloni ST, Mullins C, Gueye-Ndiaye A, Mboup S, Kanki PJ. Twenty years of prospective molecular epidemiology in Senegal: changes in HIV diversity. AIDS Res Hum Retroviruses 2007; 23:1189-96. [PMID: 17961103 DOI: 10.1089/aid.2007.0037] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Over a 20-year period we have observed the dynamics of HIV-1 subtypes and HIV-2 infection in a prospective cohort of registered female sex workers (FSW) in Dakar, Senegal. Prevalence and incidence rates for HIV-1 and HIV-2 are described from 290 seroprevalent and 193 seroincident subjects who were among the 3,910 women enrolled between 1985 and 2004. We report a significant decrease of HIV-2 prevalence in the cohort, parallel to the introduction and rise of HIV-1 infection. In 328 HIV-1-infected women, a 385-bp C2-V3 fragment of the envelope gene was sequenced and classified into the following subtypes or recombinant forms: 239 (72%) were subtype A [of which 180 (55%) were CRF02_AG and 53 (16%) were A3], 10 (3%) were B, 12 (4%) were C, 11 (4%) were D, 18 (6%) were G, 24 (7%) were CRF06_cpx, and 7 (2%) were CRF09_cpx. We found an increasing proportion of CRF02_AG over many years, but recently subsubtype A3 has over-taken CRF02_AG, with the largest proportion of new infections. The predominance of existing HIV-1 subtypes did not preclude the emergence and increase of other closely related subtypes or recombinant forms. This 20-year prospective serological and sequence analysis of HIV viruses reveals a complex and changing HIV epidemic in Senegal.
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Affiliation(s)
- Donald J. Hamel
- Department of Immunology and Infectious Disease, Harvard School of Public Health, Boston, Massachusetts 02115
| | - Jean-Louis Sankalé
- Department of Immunology and Infectious Disease, Harvard School of Public Health, Boston, Massachusetts 02115
| | - Geoffrey Eisen
- Department of Immunology and Infectious Disease, Harvard School of Public Health, Boston, Massachusetts 02115
| | - Seema Thakore Meloni
- Department of Immunology and Infectious Disease, Harvard School of Public Health, Boston, Massachusetts 02115
| | - Christopher Mullins
- Department of Immunology and Infectious Disease, Harvard School of Public Health, Boston, Massachusetts 02115
| | - Aissatou Gueye-Ndiaye
- Laboratory of Bacteriology-Virology, Cheikh Anta Diop University, and Institut d'Hygiene Sociale, Dakar, Senegal
| | - Souleymane Mboup
- Laboratory of Bacteriology-Virology, Cheikh Anta Diop University, and Institut d'Hygiene Sociale, Dakar, Senegal
| | - Phyllis J. Kanki
- Department of Immunology and Infectious Disease, Harvard School of Public Health, Boston, Massachusetts 02115
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Månsson F, Alves A, Silva ZJD, Dias F, Andersson S, Biberfeld G, Fenyö EM, Norrgren H. Trends of HIV-1 and HIV-2 prevalence among pregnant women in Guinea-Bissau, West Africa: possible effect of the civil war 1998 1999. Sex Transm Infect 2007; 83:463-7. [PMID: 17611233 PMCID: PMC2598716 DOI: 10.1136/sti.2007.025353] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Sentinel surveys in Bissau, the capital of Guinea-Bissau, have shown low prevalence of HIV-1 but high HIV-2 prevalence before 1998. Guinea-Bissau experienced a civil war in 1998-1999. To examine specifically the trends of HIV prevalence from antenatal surveys in Bissau, Guinea-Bissau in 1987-2004, and whether the civil war in 1998-1999 could have an effect on HIV prevalence levels after the conflict. METHODS Since 1987, anonymous HIV testing in delivering women has been performed at the maternity clinic, Simão Mendes National Hospital, Bissau, as part of the national sentinel surveillance programme. Consecutive sampling was performed for approximately 3 months between September and December each year. Serological analyses were performed at the National Public Health Laboratory in Guinea-Bissau. RESULTS A total of 20 422 women were tested for HIV between 1987 and 2004. The total HIV-1 prevalence increased from 0.0% in 1987 to 4.8% in 2004 and the total HIV-2 prevalence decreased from 8.3% in 1987 to 2.5% in 2004. The HIV-1 prevalence increased from 2.5% in 1997 to 5.2% in 1999, but stabilized in subsequent years. CONCLUSIONS There was a significant increase in HIV-1 prevalence in the years 1987-2004 and a significant decline in HIV-2 prevalence over the same period. The civil war in 1998-1999 may have sparked HIV-1 transmission, as HIV-1 prevalence more than doubled between 1997 and 1999, but there is no evidence of a long-term effect on the trends of HIV-1 or HIV-2 prevalence.
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Affiliation(s)
- Fredrik Månsson
- Department of Infectious Diseases, Malmö University Hospital, SE-205 02, Malmö, Sweden.
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Abstract
Sexual health is defined in terms of well-being, but is challenged by the social, cultural and economic realities faced by women and men with HIV. A sexual rights approach puts women and men with HIV in charge of their sexual health. Accurate, accessible information to make informed choices and safe, pleasurable sexual relationships possible is best delivered through peer education and health professionals trained in empathetic approaches to sensitive issues. Young people with HIV especially need appropriate sex education and support for dealing with sexuality and self-identity with HIV. Women and men with HIV need condoms, appropriate services for sexually transmitted infections, sexual dysfunction and management of cervical and anogenital cancers. Interventions based on positive prevention, that combine protection of personal health with avoiding HIV/STI transmission to partners, are recommended. HIV counselling following a positive test has increased condom use and decreased coercive sex and outside sexual contacts among discordant couples. HIV treatment and care have reduced stigma and increased uptake of HIV testing and disclosure of positive status to partners. High adherence to antiretroviral therapy and safer sexual behaviour must go hand-in-hand. Sexual health services have worked with peer educators and volunteer groups to reach those at higher risk, such as sex workers. Technological advances in diagnosis of STIs, microbicide development and screening and vaccination for human papillomavirus must be available in developing countries and for those with the highest need globally.
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Adu-Oppong A, Grimes RM, Ross MW, Risser J, Kessie G. Social and behavioral determinants of consistent condom use among female commercial sex workers in Ghana. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2007; 19:160-72. [PMID: 17411418 DOI: 10.1521/aeap.2007.19.2.160] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
This study investigated the social and behavioral predictors of consistent condom use among female commercial sex workers (FCSWs) in Ghana. Four hundred fifty street commercial sex workers were interviewed in Accra, Kumasi and Techiman. The level of condom education was very low (14%); however consistent condom use (all the time) with clients was relatively high (49.6%). Two hundred seventy-seven of the participants did not use condoms all the time.
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Affiliation(s)
- Ahmed Adu-Oppong
- Georgia Southern University, Jiann-Ping Hsu College of Public Health in Statesboro, GA 30460-8015, USA.
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Voeten HACM, Egesah OB, Varkevisser CM, Habbema JDF. Female sex workers and unsafe sex in urban and rural Nyanza, Kenya: regular partners may contribute more to HIV transmission than clients. Trop Med Int Health 2007; 12:174-82. [PMID: 17300623 DOI: 10.1111/j.1365-3156.2006.01776.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To compare the sexual behaviour of female sex workers in urban and rural areas in Nyanza province in Kenya, and to compare their unsafe sex with clients and with regular partners. METHODS In a cross-sectional study among 64 sex workers (32/32 in urban/rural areas), sex workers kept a sexual diary for 14 days after being interviewed face-to-face. RESULTS Most sex workers were separated/divorced and had one or two regular partners, who were mostly married to someone else. Sex workers in Kisumu town were younger, had started sex work at an earlier age, and had more clients in the past 14 days than rural women (6.6 vs. 2.4). Both groups had an equal number of sex contacts with regular partners (4.7). With clients, condom use was fairly frequent (75%) but with regular partners, it was rather infrequent (<40%). For both urban and rural areas, the mean number of sex acts in which no condom was used was greater for regular partners (3.2 and 2.8 respectively) than for clients (1.9 and 1.0 respectively). CONCLUSIONS Sex workers in urban and rural areas of Nyanza province practise more unsafe sex with regular partners than with clients. Interventions for sex workers should also focus on condom use in regular partnerships.
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Affiliation(s)
- H A C M Voeten
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, The Netherlands.
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Bor J. The political economy of AIDS leadership in developing countries: an exploratory analysis. Soc Sci Med 2007; 64:1585-99. [PMID: 17276568 DOI: 10.1016/j.socscimed.2006.12.005] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2006] [Indexed: 11/30/2022]
Abstract
The commitment of high-level government leaders is widely recognized as a key factor in curbing national AIDS epidemics. But where does such leadership come from? This paper presents a quantitative analysis of the determinants of AIDS leadership in 54 developing countries, using the 2003 AIDS Program Effort Index "political support" score as an indicator of political commitment. Explanatory variables include measures of political institutions as well as economic development and integration. Models developed in the analysis explain over half of the variation in commitment across the countries in the sample. In particular, press freedoms, income equality, and HIV prevalence stand out as determinants of political commitment.
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Affiliation(s)
- Jacob Bor
- Harvard University, Cambridge, MA, USA.
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van der Loeff MFS, Awasana AA, Sarge-Njie R, van der Sande M, Jaye A, Sabally S, Corrah T, McConkey SJ, Whittle HC. Sixteen years of HIV surveillance in a West African research clinic reveals divergent epidemic trends of HIV-1 and HIV-2. Int J Epidemiol 2006; 35:1322-8. [PMID: 16543363 DOI: 10.1093/ije/dyl037] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The HIV-1 epidemic in West Africa is characterized by a slower rise than that in Eastern and Southern Africa. The HIV-2 epidemic in West Africa may be declining, but few long-term data exist. METHODS In a research clinic in The Gambia, HIV-1 and HIV-2 prevalence trends among all new patients being tested for HIV were examined over a 16 year period (1988 till 2003). In newly diagnosed patients a baseline CD4 count was done. RESULTS An HIV test was done in 23 363 patients aged 15 years or older. The prevalence of HIV-1 was 4.2% in 1988-91 and rose to 17.5% in 2001-03 (P < 0.0001, chi(2)-test for trend). The prevalence of HIV-2 was 7.0% in 1988-91 and declined to 4.0% in 2001-03 (P < 0.0001). HIV-1 prevalence increased and HIV-2 prevalence decreased with time in logistic regression models adjusting for age, sex, and indication for test (P < 0.0001). Baseline CD4 counts were available for 65% of patients. The median CD4 count was 215 cells/mm3 [interquartile range (IQR) 72-424] for HIV-1, and 274 (IQR 100-549) for HIV-2 infected patients. There was no marked trend of rise or decline in baseline CD4 count in either HIV-1 or HIV-2 infected patients over the study period. Forty-five per cent of newly diagnosed HIV patients had a CD4 count <200 cells/mm3. CONCLUSIONS These data suggest that HIV-1 prevalence is rising in The Gambia, and that HIV-2 is declining. HIV patients in The Gambia present late and almost half of patients would qualify for anti-retroviral treatment at their first visit.
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Riedner G, Hoffmann O, Rusizoka M, Mmbando D, Maboko L, Grosskurth H, Todd J, Hayes R, Hoelscher M. Decline in sexually transmitted infection prevalence and HIV incidence in female barworkers attending prevention and care services in Mbeya Region, Tanzania. AIDS 2006; 20:609-15. [PMID: 16470126 DOI: 10.1097/01.aids.0000210616.90954.47] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess trends in sexually transmitted infection (STI) prevalence and HIV incidence and associated factors in a cohort of female barworkers exposed to behavioural interventions and STI screening and treatment. METHODS An open cohort of 600 female barworkers in Mbeya Region, Tanzania was offered 3-monthly information and education sessions on HIV/STI and reproductive health, voluntary HIV counselling and testing and clinical health check-ups including STI syndromic management with simple STI laboratory support. Outcome assessments included HIV, herpes simplex virus type 2 (HSV-2) and syphilis serology, polymerase chain reaction for Neisseria gonorrhoeae, Chlamydia trachomatis and ulcerative STI, microscopy for Trichomonas vaginalis, Candida albicans and bacterial vaginosis and interviews on sociodemographic and behavioural characteristics. RESULTS Over a period of 30 months 600 barworkers were enrolled at the baseline examination round and 153 thereafter as replacements for losses to follow-up. At 3-monthly examinations the prevalence of gonorrhoea declined steadily from 22.2 to 6.8% (odds ratio for trend per quarter: 0.81; P < 0.001). The prevalence of all other STI/RTI, except for genital herpes and bacterial vaginosis, also decreased significantly. HIV incidence declined from 13.9/100 to 5.0/100 person-years over three consecutive 9-month periods. HIV incidence was significantly associated with genital ulcers and positive syphilis serology, but not with genital herpes or HSV-2 seropositivity. CONCLUSION A relatively simple intervention consisting of regular 3-monthly STI screening and syndromic management in combination with HIV/STI information and counselling sessions was well accepted and effective in reducing STI among barworkers. Such interventions should be implemented more widely in high-risk environments in sub-Saharan Africa.
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Sow PS, Hawes SE, Critchlow CW, McIntosh MW, Diop A, Diouf MB, Gottlieb GS, Starling AK, Coll-Seck AM, Kiviat NB. Characteristics and presenting complaints of outpatients with undiagnosed HIV infection: potential utility in selecting subjects for HIV testing. J Acquir Immune Defic Syndr 2006; 37:1520-8. [PMID: 15602131 DOI: 10.1097/01.qai.0000128525.04862.ab] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
HIV testing of individuals presenting to outpatient medical clinics has generally been based upon a selection system, with testing limited to those having signs or symptoms previously found associated with HIV-1 infection among hospitalized patients. However, little is known about the efficacy of this approach, particularly in Africa. Among patients presenting to a large outpatient infectious disease clinic in Dakar, Senegal, the utility of using specific demographic and behavioral characteristics and individual presenting complaints to identify individuals with previously undiagnosed HIV-1 or HIV-2 infection was examined. Using a simple statistical approach, a composite screening rule was estimated to identify subjects with the highest probability of testing HIV positive, ie, patients who would most benefit from HIV testing. Using the presenting complaint allows identification of 83% of HIV-infected women by testing only 35% of women presenting to the clinic. Similarly, using the presenting complaint and various demographic and behavioral characteristics, it was possible to identify 84% of HIV-infected men by screening 40% of men presenting to the clinic. This study suggests that this method might provide a cost-effective approach that permits limited screening resources to be spent in a way that maximizes individual and societal benefit.
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Affiliation(s)
- Papa Salif Sow
- Department of Infectious Diseases, University of Dakar, Senegal
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Hasnain M, Sinacore JM, Mensah EK, Levy JA. Influence of religiosity on HIV risk behaviors in active injection drug users. AIDS Care 2005; 17:892-901. [PMID: 16120505 DOI: 10.1080/09540120500038280] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Previous studies have shown a positive relationship between religiosity and the practice or adoption of protective health behaviors, including reduction of illicit drug use among hard-core injecting drug users (IDUs). The purpose of this study was to examine the role of religiosity in predicting HIV high-risk drug and sexual practices among a sample of IDUs in Chicago, USA. We hypothesized that high religiosity would be associated with a lower likelihood of IDUs engaging in risky behaviors for HIV transmission. Snowball sampling techniques were used to recruit 1,095 active IDUs for HIV testing, counseling and partner notification. Data were analyzed from 880 subjects who self-identified with one of three religions, Christianity, Islam or Judaism. Logistic regression was used to examine the relationship between religiosity (based on self-reports of personal strength of religious belief: very strong; somewhat strong; not at all), independent of specific religion, and HIV risk behaviors (defined as 12 unsafe sex- and drug-related practices) as well as HIV serostatus. Contrary to our hypothesis, subjects with stronger religiosity were more likely to engage in four risk behaviors related to sharing injection paraphernalia. Compared to those who self-reported having no religiosity, subjects who stated that their lives were strongly influenced by religious beliefs were significantly more likely to share injection outfits, cookers, cotton and water. The association of certain HIV risk behaviors with higher religiosity has implications for HIV prevention and warrants further research to explore IDUs' interpretation of religious teachings and the role of religious education in HIV prevention programs.
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Affiliation(s)
- M Hasnain
- Department of Family Medicine, College of Medicine, University of Illinois at Chicago, Illinois 60612-7309, USA.
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Wade AS, Kane CT, Diallo PAN, Diop AK, Gueye K, Mboup S, Ndoye I, Lagarde E. HIV infection and sexually transmitted infections among men who have sex with men in Senegal. AIDS 2005; 19:2133-40. [PMID: 16284463 DOI: 10.1097/01.aids.0000194128.97640.07] [Citation(s) in RCA: 159] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND No epidemiological study has been conducted on HIV and vulnerability to sexually transmitted diseases (STI) among men who have sex with men (MSM) in sub-Saharan Africa. METHOD A survey including questionnaire, physical examination and detection of HIV and STI was carried out among 463 MSM, aged 18-52 years, recruited through the snowball technique in five urban sites throughout Senegal. RESULTS A total of 21.5% of men were found to be infected with HIV [95% confidence interval (CI), 17.8-25.6]. Active syphilis, positive serology for herpes simplex virus (HSV)-2, and polymerase chain reaction detection in urine of Chlamydia and gonorrhea infections were recorded in 4.8, 22.3, 4.1 and 5.4% of participants, respectively. Most respondents reported sex with women (94.1%). In the month preceding the interview, 24% reported at least one unprotected insertive anal intercourse with a male partner, 20% at least one unprotected receptive anal intercourse, and 18% at least one unprotected intercourse with a female partner. Genital examination showed that 5% of participants had at least one clinical sign of STI. Factors associated with HIV infection were age group, the reporting of more than nine lifetime male partners [odds ratio (OR), 3.76; 95% CI, 1.61-8.79], being a waiter or bartender (OR, 3.33; 95% CI, 1.41-7.84), and living in Dakar (OR, 3.33; 95% CI, 1.07-3.43). CONCLUSION Men who have sex with men in Senegal are highly infected with HIV and other STI. Intervention programs targeting this population are urgently needed, given their particular vulnerability and because infections are likely to disseminate into the general population given the high proportion of bisexual activity in this community.
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Luginaah IN, Yiridoe EK, Taabazuing MM. From mandatory to voluntary testing: balancing human rights, religious and cultural values, and HIV/AIDS prevention in Ghana. Soc Sci Med 2005; 61:1689-700. [PMID: 15913859 DOI: 10.1016/j.socscimed.2005.03.034] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2004] [Accepted: 03/15/2005] [Indexed: 11/22/2022]
Abstract
This paper examines efforts by some churches in Ghana to reduce the spread of HIV/AIDS. The analysis is based on focus group discussions with two groups of men and two groups of women, along with in-depth interviews with 13 pastors and marriage counsellors in the churches studied. In response to government and public criticisms about human rights violations, churches that previously imposed mandatory HIV testing on members planning to marry now have voluntary testing programmes. However, the results suggest that what the churches refer to as voluntary testing may not be truly voluntary. Cultural values and traditional practices, including traditional courtship and marriage rites (which are performed before church weddings), not only clash with considerations about pre-marital HIV testing but also complicate the contentious issue of confidentiality of information on HIV testing. Associated with these complexities and issues of confidentiality is a reluctance among participants, particularly those from northern Ghana, to test for HIV. The results reveal how broader social impacts of HIV testing for those planning to marry may extend beyond individuals or couples in different cultural contexts. The findings also support the general view that there are no perfect or easy solutions to combating the HIV/AIDS pandemic. Practical solutions and programs for Ghana cannot be neutral to cultural values and need to be tailored for particular (ethnic) populations.
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Affiliation(s)
- Isaac N Luginaah
- Department of Geography, University of Western Ontario, London, Ont., Canada N6A 5C2
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