GHENT UNIVERSITY Karoline FONCK - International Centre for ...
GHENT UNIVERSITY Karoline FONCK - International Centre for ... GHENT UNIVERSITY Karoline FONCK - International Centre for ...
the family (Temmerman 1995). Programs involving partner notification should weigh the benefits and risks for the women involved. We have shown a marked difference in pregnancy outcome between women whose partners were treated during pregnancy and those who were not. Although the figures are small and the difference does not reach statistical significance, we think that this effect is a real one. We found an HIV seroprevalence of 22% in RPR-positive women and 12% among the partners tested. The HIV discordance rate was 18%, which corresponds to what has been reported in Uganda (Serwadda 1995), Zambia (McKenna 1997) and Rwanda (King 1993). We found that 35% of the partners of HIV-seropositive women were positive compared with 80% in Rwanda (Allen 1992), 15% in Zaire (Ryder 1990) and 5% in the UK (Johnson 1989). These differences might be explained by the fact that all women in our study were RPR positive. They might be at higher risk of acquiring HIV through their high-risk behavior or through the interaction of the STD with the acquisition of HIV infection (Wasserheit 1992). In conclusion, innovative strategies to improve partner notification are needed, but should take into account the potential disastrous consequences of increased violence, divorce or loss of security. Targeted education could reduce this problem making it possible for the full benefits of partner notification to be appreciated. Studies to design strategies that can motivate more partners to go for treatment after delivery are needed. PREVENTION OF SEXUALLY TRANSMITTED INFECTIONS INCLUDING HIV 79
6.3. A Randomized, Placebo-controlled Trial of Monthly Azithromycin Prophylaxis to Prevent Sexually Transmitted Infections and HIV-1 in Kenyan Sex Workers: Study Design and Baseline Findings. Summary Published in the International Journal of STD & AIDS 2000; 11:804-11 by Fonck K, Kaul R, Kimani J, Keli F, MacDonald K, Ronald A, Plummer F, Kirui P, Bwayo J, Ngugi E, Moses S and Temmerman M. Our objectives were to describe the baseline findings of a trial of antibiotic prophylaxis to prevent sexually transmitted infections (STIs) and HIV-1 in a cohort of Nairobi female sex workers (FSWs). A questionnaire was administered and a medical examination was performed. HIV-negative women were randomly assigned to either one gram azithromycin or placebo monthly. Mean age of the 318 women was 32 years, mean duration of sex work 7 years and mean number of clients was 4 per day. High-risk behavior was frequent: 14% practiced anal intercourse, 23% sex during menses, and 3% used intravenous drugs. While 20% reported condom use with all clients, 37% never use condoms. However, STI prevalence was relatively low: HIV-1 27%, bacterial vaginosis 46%, Trichomonas vaginalis 13%, Neisseria gonorrhoeae 8%, Chlamydia trachomatis 7%, syphilis 6% and cervical intraepithelial neoplasia (CIN) 3%. It appears feasible to access a population of high-risk FSWs in Nairobi with prevention programs, including a proposed trial of HIV prevention through STI chemoprophylaxis. Introduction Sexually transmitted infections are among the most common diseases worldwide, with major medical, social and economic consequences. The prevalence of STIs in the general population in Kenya is unknown, but has been shown to exceed 20% in pregnant women in Nairobi. The prevalence of N. gonorrhoeae, C. trachomatis, Treponema pallidum and HIV-1 among pregnant women were 7%, 9%, 6% and 15% respectively (Temmerman 1994). Surveillance data from antenatal clinics in Nairobi in 1996 revealed an HIV-1 prevalence of 16% (Jackson 1999). PREVENTION OF SEXUALLY TRANSMITTED INFECTIONS INCLUDING HIV 80
- 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 and 46: Stigmatization by health staff also
- Page 47 and 48: 4.2. Health-Seeking Behavior and Se
- 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: studies, indicating that couples ar
- 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
6.3. A Randomized, Placebo-controlled Trial of Monthly<br />
Azithromycin Prophylaxis to Prevent Sexually Transmitted<br />
Infections and HIV-1 in Kenyan Sex Workers: Study Design and<br />
Baseline Findings.<br />
Summary<br />
Published in the <strong>International</strong> Journal of STD & AIDS 2000;<br />
11:804-11 by Fonck K, Kaul R, Kimani J, Keli F, MacDonald K,<br />
Ronald A, Plummer F, Kirui P, Bwayo J, Ngugi E, Moses S and<br />
Temmerman M.<br />
Our objectives were to describe the baseline findings of a trial of antibiotic prophylaxis to<br />
prevent sexually transmitted infections (STIs) and HIV-1 in a cohort of Nairobi female sex<br />
workers (FSWs). A questionnaire was administered and a medical examination was<br />
per<strong>for</strong>med. HIV-negative women were randomly assigned to either one gram azithromycin<br />
or placebo monthly. Mean age of the 318 women was 32 years, mean duration of sex work<br />
7 years and mean number of clients was 4 per day. High-risk behavior was frequent: 14%<br />
practiced anal intercourse, 23% sex during menses, and 3% used intravenous drugs. While<br />
20% reported condom use with all clients, 37% never use condoms. However, STI<br />
prevalence was relatively low: HIV-1 27%, bacterial vaginosis 46%, Trichomonas vaginalis<br />
13%, Neisseria gonorrhoeae 8%, Chlamydia trachomatis 7%, syphilis 6% and cervical<br />
intraepithelial neoplasia (CIN) 3%. It appears feasible to access a population of high-risk<br />
FSWs in Nairobi with prevention programs, including a proposed trial of HIV prevention<br />
through STI chemoprophylaxis.<br />
Introduction<br />
Sexually transmitted infections are among the most common diseases worldwide, with major<br />
medical, social and economic consequences. The prevalence of STIs in the general<br />
population in Kenya is unknown, but has been shown to exceed 20% in pregnant women in<br />
Nairobi. The prevalence of N. gonorrhoeae, C. trachomatis, Treponema pallidum and HIV-1<br />
among pregnant women were 7%, 9%, 6% and 15% respectively (Temmerman 1994).<br />
Surveillance data from antenatal clinics in Nairobi in 1996 revealed an HIV-1 prevalence of<br />
16% (Jackson 1999).<br />
PREVENTION OF SEXUALLY TRANSMITTED INFECTIONS INCLUDING HIV 80
Change language