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patients. The analysis revealed high levels of false positive test results despite intensive
training and supervision. The cost per true case of congenital syphilis averted was estimated
at $80. At the main maternity hospital in Nairobi, syphilis seroprevalence rate among women
at delivery was 3%. Partner notification and treatment at delivery was only 36%. In a cohort
of female sex workers in a Nairobi slum area, we found relatively low levels of STI, including
HIV. Condom use was higher than expected. Vaginal douching in this cohort was highly
prevalent, and douching with soap and water was associated with BV, although we did not
find an association with HIV.
A number of issues arise from the results of our studies:
- How to explain the high STI prevalence rates in low-risk groups, while overall
syphilis rates decline and STI prevalence among FSW are relatively low;
- Can we apply the “Fransen-Piot” model and draw conclusions from it;
- What about screening and treatment versus mass treatment.
7.2. Core groups, bridging population and general population
We have demonstrated that STIs including HIV are highly prevalent in Nairobi, and this not
only in the population groups considered as being at high risk. The so-called population at
low risk (married and/or pregnant women), is showing high prevalence rates, indicating that
the epidemic has already spread from the core groups to the general population. Most of the
women enrolled in our studies can be considered at low-risk as they are in a stable
relationship and declare not having multiple sex partners. Obviously, the behavior of the
male partner (bridging group) plays a critical role in the spread of STI including HIV in this
population. We confirmed the behavior of those male partners who openly admit having
multiple sexual partners. Although it is known that women tend to underreport the number of
their sex partners while men tend to do the opposite, the number of sex partners reported by
men in our studies is quite high. A small proportion of men in our studies also admit paying
money for (commercial) sex hence having sexual contact with the core group. These findings
suggest that the core groups still play a role in STI transmission in Nairobi but that
interventions in this group alone will not be able to control the epidemic.
On the other hand, the STI prevalence rates that were observed in a newly established
cohort of commercial sex workers were relatively low. This may be a reflection of impact of
intervention activities, aiming at behavior change, in this group over the past years.
CONCLUSIONS 100