GHENT UNIVERSITY Karoline FONCK - International Centre for ...

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In 1982, Dr Elizabeth Ngugi, a senior nursing- sister in the Ministry of Health, initiated a community self-improvement program among commercial sex workers in the Pumwani area of Nairobi and opened a second front for ongoing research into the control of STI. In 1985, the group was joined by the department of Dr King Holmes from the University of Washington. The Seattle group identified the spread of HIV among the prostitute cohort and a series of studies were implemented to understand the heterosexual epidemiology of the virus and the risk factors associated with its rapid spread. From 1986 onwards, the research was almost entirely devoted to the epidemiology of HIV and AIDS, and its parallelism with the STI already being investigated. In 1992, Dr Joan Kreiss from the University of Washington set up another research site in Mombasa, on the Kenyan coast, starting up a cohort of female sex workers. The site chosen was the Ganjoni clinic, an infectious disease clinic where female sex workers are regularly seen for medical check-up. In 1993, the Ghent University joined in with the EU program mainly focusing on STI prevention and control as well as operational research. The Ghent University also did research on mother-to-child transmission of HIV at the provincial hospital in Mombasa. The Erasmus University started its collaboration with the group in 1996. The main objective of their work was the testing of a computer modeling to predict the spread of HIV in a given population. As the previous studies from the other collaborating universities had generated an amount of invaluable data on several key issues, the Nairobi site was an ideal setting to test the model. The Oxford University also joined the Nairobi group. The University had been working on an AIDS vaccine, based on earlier studies from the collaborating group. The site was prepared to start the first human HIV trial in Africa. During the entire study period, Dr Job Bwayo has been the Head of the Department of Medical Microbiology. Professor Jeconiah Ndinya-Achola, the former Head of Department, continued to play a major role in the research activities of the center. Annex 127
S UMMARY Sexually transmitted infections (STIs) have, in all likelihood, always been present. The recent emergence of HIV/AIDS has however added new relevance to STIs and has also reinforced the tremendous cultural burden of diseases associated with sexual contact. This work focuses on the epidemiology of STI among different population groups in Nairobi, Kenya. We studied women at antenatal clinics as well as at maternity level, men and women seeking care for STI complaints, men and women seeking general health care, and female sex workers. A cross sectional study of 520 female patients in the referral STI clinic took place to determine the etiologies of STIs and presence of cervical dysplasia (CIN). The prevalence rates were: HIV 29%, candidiasis 35%, trichomoniasis 25%, bacterial vaginosis 16%, gonorrhoea 6%, chlamydia 4%, syphilis seropositivity 6%, genital warts 6% and genital ulcers 12%. CIN was found in 12%. Factors related to sexual behavior, especially the number of sex partners, were associated with several STI. Gonorrhoea, bacterial vaginosis, CIN and genital warts/ulcers were independently associated with HIV infection. These data indicate an alarming prevalence of STI/HIV, especially in the young age groups, and the lack of safe sex methods, and call for more aggressive prevention campaigns. Risk factors for STI were mainly related to the number of sex partners. Sexual behavior and health-seeking behavior are important components of STI control. A study to assess this behavior was done among 471 patients attending the STI referral clinic, and among 555 patients attending three PHC clinics in low socio-economic areas. It was found that a large proportion of patients had sought treatment in public and private sectors before attending the STI clinic. Major gender differences in delay of health-seeking for STI were observed with women waiting longer than men to seek medical care. In addition, women more than men had sex while symptomatic, mostly with their regular partner. Condoms were rarely used during illness. Men at the STI clinic admitted extra-marital affairs in 68% and paying for sex in 30%, but blamed their wives for their STI. At the PHC clinics, men reported extra-marital affairs in 17% versus 8% for women. Women’s knowledge about health in general and about STI in particular was poor. Significantly more men than women reported a history of STI. A high prevalence of gonorrhoea (3%) and chlamydia (6%) was found among the PHC patients with no difference between sexes. Summary 128
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GHENT UNIVERSITY STI PREVENTION AND
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AIDS Acquired Immune Deficiency Syn
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1.1. Sexually Transmitted Infection
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countries, the rate of reporting co
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district of Uganda randomized villa
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By identifying where significant
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4.5%, 3.9%, 67.7% and 30.1% while t
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female primary health care or anten
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The research data have been publish
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2.1. OBJECTIVES 2.1.1. General obje
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2.2.3. Laboratory procedures The mi
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C HAPTER 3 PREVALENCE AND RISK FACT
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After registration by the clinic cl
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The majority of the women were infe
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eing single, ever having been treat
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prevalence found in a family planni
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3.2. Declining Syphilis Prevalence
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Training Nurses at the antenatal cl
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We believe that the observed declin
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Wasserheit 1992, Laga 1993). In Nai
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Table 1: Demographic data of 471 pa
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women. Overall, significantly fewer
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Stigmatization by health staff also
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4.2. Health-Seeking Behavior and Se
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Between September and November 1998
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Table 2: Healthcare-seeking behavio
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Thirteen women had engaged in sex w
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Men reported more extramarital affa
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C HAPTER 5 DIAGNOSIS AND MANAGEMENT
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discharge and abdominal pain-two co
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Data were entered and analyzed in S
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One of the peripheral health center
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Evaluation of Algorithms The result
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In this study of symptomatic women,
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C HAPTER 6 PREVENTION OF SEXUALLY T
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Table 1: Syphilis Rapid Plasma Reag
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One should keep these problems in m
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The use of mailed reminders did not
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Page 87 and 88: Widows, divorcees and separated wom
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Page 109 and 110: C HAPTER 8 FINAL REMARKS STIs illus
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Page 113 and 114: Bell G, Ward H, Day S et al. Partne
Page 115 and 116: Fleming D and Wasserheit J. From ep
Page 117 and 118: Jackson DJ, Rakwar JP, Chohan B et
Page 119 and 120: Manning B, Moodley J, Ross SM. Syph
Page 121 and 122: Oberlander L, Elverdam B. Malaria i
Page 123 and 124: Serwadda D, Gray R, Wawer M et al.
Page 125 and 126: Van Dam J, Anastasi MC. Male Circum
Page 127: WHO Collaborating Center on HIV/AID
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Page 135 and 136: Nous avons démontré que le coût
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