GHENT UNIVERSITY Karoline FONCK - International Centre for ...
GHENT UNIVERSITY Karoline FONCK - International Centre for ... GHENT UNIVERSITY Karoline FONCK - International Centre for ...
Water alone or water and soap were the fluids most commonly used for vaginal douching. The use of lubricants, in most cases Vaseline, was practiced by 24% of the women. High-risk sexual behavior was common. Anal intercourse was practiced by 14% of women and sex during menses by 23% women. Almost half of the women reported a past history of STIS. Alcohol use was reported by 50% and intravenous drug use by 9 (3%). Overall, 80 (27%) women were HIV-1 infected. The prevalence of bacterial vaginosis was 46%, trichomoniasis 13%, gonorrhea 8%, chlamydia 7%, syphilis 6% and clinical ulcer 2%. Squamous intraepithelial lesion (SIL) was detected in 10 cases (3%) of whom 5 were lowgrade SIL (LGSIL), and 5 were high-grade SIL (HGSIL). The STD prevalence at the time of screening for HIV-positive and HIV-negative women is shown in Table 2. Only T. vaginalis was significantly more prevalent in HIV-positive women. HIV-positive women had more bacterial vaginosis and more gonorrhea but these differences did not reach statistical significance. There was a trend to increased CIN prevalence in HIV-1 infected women. Table 2 : Sexually transmitted infection prevalence among HIV- positive and HIV- negative sex workers in Nairobi. HIV- positive HIV- negative n % n * % OR (95% CI) P Bacterial vaginosis 83/186 45 38/70 54 1.5 (0.8-2.6) 0.2 Candida Gram stain 13/187 7 2/70 3 0.4 (0.1-1.8) 0.4 Trichomoniasis 20/219 9 18/80 23 2.9 (1.4-5.8) 0.005 Chlamydia Gonorrhea 14/216 7 6/80 8 1.2 (0.4-3.2) 0.8 Culture 14/219 6 9/80 11 1.9 (0.8-4.5) 0.2 PCR 12/215 6 9/80 11 2.1 (0.9-5.3) 0.1 Syphilis 12/217 6 7/80 9 1.6 (0.6-4.3) 0.3 Clinical ulcer 5/219 2 1/80 1 0.7 (0.1-6.2) 0.6 CIN 4/219 2 5/80 6 3.6 (0.9-13.7) 0.06 *Denominators differ as not all tests were done (samples not taken, missing samples, missing results). Age, age at first sex, years in Nairobi, number of partners per day, history of past STIs, alcohol use, intravenous drug use, hormonal contraceptives, anal sex and sex during menses were not significantly associated with HIV infection (Table 3). There was no difference in mean duration of prostitution between HIV-positive and HIV-negative women. The prevalence of HIV-1 infection was highest among women who had been involved in prostitution for less than 2 years (38% vs. 24%, OR 1.6, 95% Cl 1.1-2.4, P=0.03). HIVpositive women tend to charge less on average per sex act, not to have a regular partner, not to practice vaginal douching but this was not statistically significant. HIV-positive women had a significantly higher number of partners per week than HIV-negative women. PREVENTION OF SEXUALLY TRANSMITTED INFECTIONS INCLUDING HIV 85
Widows, divorcees and separated women were more HIV infected. Women who reported always using condoms were 50% less likely to be HIV infected than women who reported no condom use. Table 3 : Characteristics among HIV- positive and HIV- negative sew workers in Nairobi. HIV negative % or mean HIV positive % or mean OR (95% CI) P Age 32.1 31.8 0.9 (0.9-1.4) 0.8 Years lived in Nairobi Marital status : 11.4 10.3 1.0 (0.9-2.3) 0.3 Never married 43 33 0.8 (0.7-1.0) 0.06 Widowed/divorced/separated 57 68 Age at first sex 16.4 15.8 1.6 (0.9-1.2) 0.1 Duration prostitution 6.9 6.1 1.1 (0.6-1.4) 0.2 Partners/day 3.7 3.6 0.9 0.8 Partners/week 13.6 23.9 1.9 (0.6-20.9) 0.06 Charge per act Condom use : 125 107 1.2 0.2 Never 36 38 1.7 (0.9-3.1)* 0.05* 1-49% 21 29 50-99% 21 23 Always 23 11 Regular partner 62 56 0.9 (0.7-1.2) 0.2 Use of oral contraceptives 11 10 1.1 (0.5-2.3) 0.5 Douching 71 66 0.9 (0.6-1.2) 0.5 Any lubricants used 28 18 1.6 (0.9-2.7) 0.04 Sex during menses 23 24 1.0 (0.9-1.2) 0.4 Anal intercourse 15 14 1.0 (0.9-1.1) 0.5 Any alcohol use 47 56 0.8 (0.7-1.1) 0.1 History of STD 41 44 0.9 (0.7-1.2) 0.4 *P value for categories «always» compared with «never». OR= odds ratios; CI= confidence intervals. We compared the characteristics of the women according to the place of work (Table 4). Women working in bars compared with women working at home were younger, had more partners per week and used alcohol more often. They had a higher HIV prevalence but this was not significantly different. Only 10 women were working in a nightclub and they were more often single, charged more per sex act, had anal sex and sex during menstruation more often, had a higher use of lubricants and used alcohol more often. Only one of them was HIV infected. To examine further the relation among risk factors for HIV infection, we performed logistic regression analysis. All variables significantly associated with HIV in univariate analysis were included in the model. These were marital status, partners per week, condom use, use of lubricants, place of work, trichomoniasis and SIL. PREVENTION OF SEXUALLY TRANSMITTED INFECTIONS INCLUDING HIV 86
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Water alone or water and soap were the fluids most commonly used <strong>for</strong> vaginal douching.<br />
The use of lubricants, in most cases Vaseline, was practiced by 24% of the women. High-risk<br />
sexual behavior was common. Anal intercourse was practiced by 14% of women and sex<br />
during menses by 23% women. Almost half of the women reported a past history of STIS.<br />
Alcohol use was reported by 50% and intravenous drug use by 9 (3%).<br />
Overall, 80 (27%) women were HIV-1 infected. The prevalence of bacterial vaginosis was<br />
46%, trichomoniasis 13%, gonorrhea 8%, chlamydia 7%, syphilis 6% and clinical ulcer 2%.<br />
Squamous intraepithelial lesion (SIL) was detected in 10 cases (3%) of whom 5 were lowgrade<br />
SIL (LGSIL), and 5 were high-grade SIL (HGSIL). The STD prevalence at the time of<br />
screening <strong>for</strong> HIV-positive and HIV-negative women is shown in Table 2. Only T. vaginalis<br />
was significantly more prevalent in HIV-positive women. HIV-positive women had more<br />
bacterial vaginosis and more gonorrhea but these differences did not reach statistical<br />
significance. There was a trend to increased CIN prevalence in HIV-1 infected women.<br />
Table 2 : Sexually transmitted infection prevalence among HIV- positive and HIV- negative sex workers in Nairobi.<br />
HIV- positive HIV- negative<br />
n % n * % OR (95% CI) P<br />
Bacterial vaginosis 83/186 45 38/70 54 1.5 (0.8-2.6) 0.2<br />
Candida Gram stain 13/187 7 2/70 3 0.4 (0.1-1.8) 0.4<br />
Trichomoniasis 20/219 9 18/80 23 2.9 (1.4-5.8) 0.005<br />
Chlamydia<br />
Gonorrhea<br />
14/216 7 6/80 8 1.2 (0.4-3.2) 0.8<br />
Culture<br />
14/219 6 9/80 11 1.9 (0.8-4.5) 0.2<br />
PCR<br />
12/215 6 9/80 11 2.1 (0.9-5.3) 0.1<br />
Syphilis 12/217 6 7/80 9 1.6 (0.6-4.3) 0.3<br />
Clinical ulcer 5/219 2 1/80 1 0.7 (0.1-6.2) 0.6<br />
CIN 4/219 2 5/80 6 3.6 (0.9-13.7) 0.06<br />
*Denominators differ as not all tests were done (samples not taken, missing samples, missing results).<br />
Age, age at first sex, years in Nairobi, number of partners per day, history of past STIs,<br />
alcohol use, intravenous drug use, hormonal contraceptives, anal sex and sex during<br />
menses were not significantly associated with HIV infection (Table 3). There was no<br />
difference in mean duration of prostitution between HIV-positive and HIV-negative women.<br />
The prevalence of HIV-1 infection was highest among women who had been involved in<br />
prostitution <strong>for</strong> less than 2 years (38% vs. 24%, OR 1.6, 95% Cl 1.1-2.4, P=0.03). HIVpositive<br />
women tend to charge less on average per sex act, not to have a regular partner, not<br />
to practice vaginal douching but this was not statistically significant. HIV-positive women had<br />
a significantly higher number of partners per week than HIV-negative women.<br />
PREVENTION OF SEXUALLY TRANSMITTED INFECTIONS INCLUDING HIV 85
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