GHENT UNIVERSITY Karoline FONCK - International Centre for ...

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isk for STD/HIV infection through their spouses (Hunter 1994, Ulin 1992, Quigley 1997). It is therefore very important to educate men on taking their responsibilities, by either changing their behavior or using safe sex methods. Hence, health education at various levels must be improved, and messages should be directed more specifically to men. One third of the men in this study admitted to having ever paid for sex with money or gifts. Because of the economic situation in Kenya, many women need extra income, be it for rent or school-fees, which they obtain through one or more regular boyfriends in exchange for sex. The current study shows that some men and women are at high risk for STDs, including HIV infection, through large numbers of sexual partners. Intervention strategies therefore should aim at reducing partner change and promoting condom use. However, some individuals with a low-risk profile, especially women, may be at risk through their spouses or regular partners. This suggests that interventions should extend beyond the high-risk groups, and men especially should be targeted. Simultaneously, however, the quality of existing primary health care services should be strengthened, with STD treatment extended to more, if not all, primary health care clinics in Nairobi. These services should include health education that especially targets prevention strategies. HEALTHCARE-SEEKING BEHAVIOR AND SEXUAL BEHAVIOR IN NAIROBI 45
4.2. Health-Seeking Behavior and Sexual Behavior among Primary Health Care Patients in Nairobi, Kenya. Summary: Published in Sexually Transmitted Diseases 2002; 29:106-111, by Fonck K, Mwai C, Ndinya-Achola J, Bwayo J and Temmerman M. Health-seeking and sexual behaviors are important elements in the control of sexually transmitted infections (STIs). We examined patterns of health-seeking behavior and related sexual behavior relevant to improved prevention and care among patients attending primary health care (PHC) clinics. A Questionnaire covering social, demographic, and healthcareseeking and sexual behavior information was administered to 555 patients attending three primary health care clinics in low socio-economic areas or Nairobi, Kenya. Women's knowledge about health in general and STIs in particular was poor. A major gender difference in delay of health-seeking for STIs was observed (5 days for men versus 14 days for women). Significantly more men than women reported a history of STIs (68% versus 47%; P = 0.04). Men reported more extramarital affairs (17% versus 8%; P < 0.001). A high prevalence of gonorrhea (3%) and chlamydia (6%) was found in this population, with no difference between the genders. The urine dipstick was ineffective for the detection of these STls. There is a need for better understanding of behavioral factors, as well as gender and social aspects of health care. Health education and health promotion in these areas should be strengthened. Improved screening tests are needed for the detection of STIs. Introduction Sexually Transmitted Diseases (STDs) have long been recognized as a major public health problem in Kenya because STIs and their sequelae contribute significantly to morbidity and mortality in the population (Piot 1990, Ryder 1991, Berkowitz 1993, Temmerman 1992). In addition it is known that most STIs facilitate HIV-1 transmission (Wasserheit 1992, Sewankambo 1997, Schacker 1998, Kreiss 1994, Cameron 1989, Laga 1993). In Nairobi, STIs represent between 5 and 10% of caseloads at many outpatient clinics (Reach 1988). The overall prevalence of STIs in the general population, however, is unknown, but studies among specific population groups have illustrated high STIs prevalence in both high- and low-risk groups. HEALTHCARE-SEEKING BEHAVIOR AND SEXUAL BEHAVIOR IN NAIROBI 46
Page 1 and 2: GHENT UNIVERSITY STI PREVENTION AND
Page 3 and 4: AIDS Acquired Immune Deficiency Syn
Page 5 and 6: 1.1. Sexually Transmitted Infection
Page 7 and 8: countries, the rate of reporting co
Page 9 and 10: district of Uganda randomized villa
Page 11 and 12: By identifying where significant
Page 13 and 14: 4.5%, 3.9%, 67.7% and 30.1% while t
Page 15 and 16: female primary health care or anten
Page 17 and 18: The research data have been publish
Page 19 and 20: 2.1. OBJECTIVES 2.1.1. General obje
Page 21 and 22: 2.2.3. Laboratory procedures The mi
Page 23 and 24: C HAPTER 3 PREVALENCE AND RISK FACT
Page 25 and 26: After registration by the clinic cl
Page 27 and 28: The majority of the women were infe
Page 29 and 30: eing single, ever having been treat
Page 31 and 32: prevalence found in a family planni
Page 33 and 34: 3.2. Declining Syphilis Prevalence
Page 35 and 36: Training Nurses at the antenatal cl
Page 37 and 38: We believe that the observed declin
Page 39 and 40: Wasserheit 1992, Laga 1993). In Nai
Page 41 and 42: Table 1: Demographic data of 471 pa
Page 43 and 44: women. Overall, significantly fewer
Page 45: Stigmatization by health staff also
Page 49 and 50: Between September and November 1998
Page 51 and 52: Table 2: Healthcare-seeking behavio
Page 53 and 54: Thirteen women had engaged in sex w
Page 55 and 56: Men reported more extramarital affa
Page 57 and 58: C HAPTER 5 DIAGNOSIS AND MANAGEMENT
Page 59 and 60: discharge and abdominal pain-two co
Page 61 and 62: Data were entered and analyzed in S
Page 63 and 64: One of the peripheral health center
Page 65 and 66: Evaluation of Algorithms The result
Page 67 and 68: In this study of symptomatic women,
Page 69 and 70: C HAPTER 6 PREVENTION OF SEXUALLY T
Page 71 and 72: Table 1: Syphilis Rapid Plasma Reag
Page 73 and 74: One should keep these problems in m
Page 75 and 76: The use of mailed reminders did not
Page 77 and 78: Table 1: Characteristics of women w
Page 79 and 80: studies, indicating that couples ar
Page 81 and 82: 6.3. A Randomized, Placebo-controll
Page 83 and 84: esistance patterns in bystander flo
Page 85 and 86: In univariate analysis, the odds ra
Page 87 and 88: Widows, divorcees and separated wom
Page 89 and 90: They did not report much condom use
Page 91 and 92: The low prevalence of the other STD
Page 93 and 94: There is some evidence that frequen
Page 95 and 96: Table 1. Characteristics of HIV- po
Page 97 and 98:
A significantly higher prevalence o
Page 99 and 100:
There is now considerable evidence
Page 101 and 102:
patients. The analysis revealed hig
Page 103 and 104:
contributory factor may be that mal
Page 105 and 106:
use in Kenya. In a supplement of Se
Page 107 and 108:
with intensive behavioral change in
Page 109 and 110:
C HAPTER 8 FINAL REMARKS STIs illus
Page 111 and 112:
to protect themselves and be empowe
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 and 128:
WHO Collaborating Center on HIV/AID
Page 129 and 130:
S UMMARY Sexually transmitted infec
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notification. Innovative and locall
Page 133 and 134:
connaissance des femmes sur la sant
Page 135 and 136:
Nous avons démontré que le coût
Page 137 and 138:
vonden we een hoge prevalentie van
Page 139 and 140:
We hebben aangetoond dat de kost va
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