GHENT UNIVERSITY Karoline FONCK - International Centre for ...
GHENT UNIVERSITY Karoline FONCK - International Centre for ... GHENT UNIVERSITY Karoline FONCK - International Centre for ...
HIV-1 serology was performed every 3 months. A full medical examination, with STI screening and treatment was performed every 6 months. Free medical care was offered to all FSWs who volunteered for screening, regardless of the HIV-1 serostatus. Condoms were also provided free of charge through the clinic, along with health education on safe sex methods. The study was approved by the Ethical Review Committees of the University of Nairobi and of the University of Manitoba. Informed consent was obtained from all study participants. A drug safety and monitoring board (DSMB) was established to monitor the study closely. Vaginal swabs were taken for T. vaginalis culture, pH and Gram stain. Cervical swabs were obtained for N. gonorrhoeae and C. trachomatis PCR, for N. gonorrhoeae culture, and for a Pap smear. If a genital ulcer was present, the ulcer base was swabbed for culture and multiplex PCR (M-PCR). Blood was drawn for HIV-1 and syphilis serology. Vaginal pH was read using pH indicator strips (Merck, Darmstadt, Germany). Vaginal smears were heat-fixed and Gram stained. Bacterial vaginosis was defined using a quantitative scoring system (Nugent 1991). T. vaginalis culture was performed using the In Pouch TM TV (Biomed Diagnostics, San Jose, California). The Pap smear, taken by cytobrush, was read using the Bethesda classification (Nat Cancer Instit 1989). The swab for N. gonorrhoeae was inoculated directly onto Thayer-Martin medium and incubated at 37ºC, 5% CO2 for 24-48 h. H. ducreyi culture was performed on an activated charcoal medium (Lockett 1991). PCR testing was performed for C. trachomatis and N. gonorrhoeae (Amplicor PCR Diagnostics, Roche Diagnostic System, Ontario, Canada). If a genital ulcer was present, a swab of the ulcer base was used for M-PCR detection of H. ducreyi, herpes simplex virus and T. pallidum (Roche Molecular Systems, Ontario, Canada). The rapid plasma reagin test (RPR test, Becton Dickinson, Groot-Bijgaarden, Belgium) was performed for syphilis serology and positive samples were confirmed by Treponema pallidum haemagglutination assay (TPHA) (Randox Laboratories, UK). HIV-1 screening ELISA was performed using the Detect-HIV kit (BioChem ImmunoSystems Inc, Montreal, Canada) and positive tests were confirmed with the Recombigen HIV-1/HIV-2 EIA (Cambridge Biotech Corporation, Galway, Ireland). Data were entered in ACCESS Microsoft, and analysis performed after export into Statistical Package for Social Sciences (SPSS) for Windows version 8.0. (SPSS Inc. Chicago). PREVENTION OF SEXUALLY TRANSMITTED INFECTIONS INCLUDING HIV 83
In univariate analysis, the odds ratios (OR) and 95% confidence intervals (CI) were used for the measurement of association of proportions. Comparisons were made using Pearson's χ 2 , Fisher's exact tests and χ 2 test for trend. Student's t-test was used for comparison of means. Stepwise logistic regression was used to take into account risk factors and presence of other STIs for the risk of HIV infection. Results Between May and December 1998, 318 women were screened (Table 1). Two women deferred examination after interview. The mean age was 32 years. Although none of the women were married, 60% of them reported having at least one regular partner. They had been in prostitution for a mean of 7 years. The average number of sexual encounters was 4 per day and 16 per week. The average amount charged per sex act was 118 Kenyan Shilling (~2 US dollar). Condom use in this population was variable: while 42% of FSWs reported using condoms more than half the time, 37% never used condoms. Most of the women worked at home, fewer worked in bars and a minority worked in nightclubs. About half of the women did not use any form of contraception. Of the remainder, the contraceptive method most commonly used was Norplant (17%) followed by oral contraceptives (11%). Condoms as a form of contraception were reported by 11% of the women. Sixteen women were pregnant. Vaginal douching, understood as inserting fluids in the vagina, was practiced by 69% of the women, and most did so after every intercourse. Table 1. Demographic, sexual and high- risk behavior and medical history of 318 sex workers in Kibera, Nairobi. n or mean % or range Age 32 18-57 Resident in Nairobi Marital status 11 1-50 Never married 131 41 Widowed/divorced/separated 186 59 Age at first sex 16 9-28 Duration of prostitution in years 7 0-34 Partners per day 4 1-10 Partners per week 16 1-70 Charges for sex act (in KSh) Condom use 118 10-1,000 Never 118 37 1-49% 70 22 50-99% 88 22 Always 62 20 Women with regular partner 192 60 Number of regular partners 1,7 1-8 Pregnant 16 5 No contraception use 171 54 Practice vaginal douching 223 82 After every intercourse With 209 66 Water 27 9 Water and soap 158 50 Other (OMO, Dettol) Use of lubricants 15 5 None 240 75 Vaseline 64 20 Saliva 9 3 Other 5 2 Sex during menses 71 23 Anal intercourse 45 14 Use alcohol Medical (STD) history 158 50 Vaginal discharge 70 22 Genital ulcer 11 4 Abdominal pain 92 29 Genital itch 39 12 PREVENTION OF SEXUALLY TRANSMITTED INFECTIONS INCLUDING HIV 84
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HIV-1 serology was per<strong>for</strong>med every 3 months. A full medical examination, with STI<br />
screening and treatment was per<strong>for</strong>med every 6 months. Free medical care was offered to all<br />
FSWs who volunteered <strong>for</strong> screening, regardless of the HIV-1 serostatus. Condoms were<br />
also provided free of charge through the clinic, along with health education on safe sex<br />
methods.<br />
The study was approved by the Ethical Review Committees of the University of Nairobi and<br />
of the University of Manitoba. In<strong>for</strong>med consent was obtained from all study participants. A<br />
drug safety and monitoring board (DSMB) was established to monitor the study closely.<br />
Vaginal swabs were taken <strong>for</strong> T. vaginalis culture, pH and Gram stain. Cervical swabs were<br />
obtained <strong>for</strong> N. gonorrhoeae and C. trachomatis PCR, <strong>for</strong> N. gonorrhoeae culture, and <strong>for</strong> a<br />
Pap smear. If a genital ulcer was present, the ulcer base was swabbed <strong>for</strong> culture and<br />
multiplex PCR (M-PCR). Blood was drawn <strong>for</strong> HIV-1 and syphilis serology.<br />
Vaginal pH was read using pH indicator strips (Merck, Darmstadt, Germany). Vaginal smears<br />
were heat-fixed and Gram stained. Bacterial vaginosis was defined using a quantitative<br />
scoring system (Nugent 1991). T. vaginalis culture was per<strong>for</strong>med using the In Pouch TM TV<br />
(Biomed Diagnostics, San Jose, Cali<strong>for</strong>nia). The Pap smear, taken by cytobrush, was read<br />
using the Bethesda classification (Nat Cancer Instit 1989).<br />
The swab <strong>for</strong> N. gonorrhoeae was inoculated directly onto Thayer-Martin medium and<br />
incubated at 37ºC, 5% CO2 <strong>for</strong> 24-48 h. H. ducreyi culture was per<strong>for</strong>med on an activated<br />
charcoal medium (Lockett 1991). PCR testing was per<strong>for</strong>med <strong>for</strong> C. trachomatis and N.<br />
gonorrhoeae (Amplicor PCR Diagnostics, Roche Diagnostic System, Ontario, Canada). If a<br />
genital ulcer was present, a swab of the ulcer base was used <strong>for</strong> M-PCR detection of H.<br />
ducreyi, herpes simplex virus and T. pallidum (Roche Molecular Systems, Ontario, Canada).<br />
The rapid plasma reagin test (RPR test, Becton Dickinson, Groot-Bijgaarden, Belgium) was<br />
per<strong>for</strong>med <strong>for</strong> syphilis serology and positive samples were confirmed by Treponema pallidum<br />
haemagglutination assay (TPHA) (Randox Laboratories, UK). HIV-1 screening ELISA was<br />
per<strong>for</strong>med using the Detect-HIV kit (BioChem ImmunoSystems Inc, Montreal, Canada) and<br />
positive tests were confirmed with the Recombigen HIV-1/HIV-2 EIA (Cambridge Biotech<br />
Corporation, Galway, Ireland).<br />
Data were entered in ACCESS Microsoft, and analysis per<strong>for</strong>med after export into Statistical<br />
Package <strong>for</strong> Social Sciences (SPSS) <strong>for</strong> Windows version 8.0. (SPSS Inc. Chicago).<br />
PREVENTION OF SEXUALLY TRANSMITTED INFECTIONS INCLUDING HIV 83
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