GHENT UNIVERSITY Karoline FONCK - International Centre for ...

prevalence found in a family planning clinic in Nairobi; however, family planning clients are
often perceived as a low-risk population (Temmerman 1998).
We failed to demonstrate an association between trichomoniasis and HIV infection, which
has been reported by others (Draper 1998). Although the wet mounts were done in the clinic
by the study physician, this was made impossible during several months because of power
interruptions in Nairobi. The association between chlamydia and HIV did not reach statistical
significance but showed a trend toward protection, which has been shown by others (Minkoff
1999). There is no definite explanation of this finding, but one possibility might be that we
used enzyme-linked immunosorbent assay for the detection of C. trachomatis. The more
sensitive polymerase chain reaction technique was not yet available; hence, chlamydia
prevalence is probably underreported and might have contributed to the lack of a significant
association with HIV. Also, selection bias may explain this finding. Minkoff et al. explain the
negative association by suggesting that HIV positive women have an increased condom use
and, hence, have lower STD prevalence rates. This explanation might be true in the United
States, but is certainly not the case in the setting where we worked, in which people seldom
know their HIV status.
Few women claimed to have had more than one sexual partner in the last 3 months. A 3month
period was used in this study as to minimize the recall bias. We think that most of
these women did have only one sexual partner and, hence, must have been infected by their
spouse or regular partner, as stipulated in other studies (Quigley 1997). If HIV and STD
prevention campaigns aim for a significant impact, the transmission between regular partners
will have to be addressed. This will be challenging, as women find it difficult to negotiate safe
sex with their spouse. More gender-sensitive prevention campaigns and womenempowerment
strategies will be needed. However, without strong commitment from the
government, enforcing laws to protect women against rape, sexual abuse, and violence in
their home, this aim will be difficult to achieve.
Few of the classic risk factors studied were significantly associated with genital infections.
This might be explained by the low occurrence of these risk factors in this population and,
hence, the relative lack of power to prove an association. Some trends did emerge for all
STDs, such as positive associations with factors relating to sexual behavior. This study
confirms that having multiple partners simultaneously heightens the risk for STDs more than
the number of new sex partners (Morris 1997).
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