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After logistic regression, only trichomoniasis (P=0.02) remains significantly associated with HIV infection. The trend for association between SIL and HIV remains in the regression analysis (P=0.07). Discussion Table 4 : Characteristics of the 272 women working at home or in bars according to place of work. Home n=216 % or mean Bar n=56 % or mean OR (95% CI) P Age 33 29 0.001 Single 40 50 1.4 (0.9-1.0) 0.1 Duration prostitution 6.8 6.0 0.3 Partners/day 3.7 3.7 0.9 Partners/week 14 27 0.04 Charge per act Condom use : 110 120 0.6 Never 40 27 1.2 (0.8-1.7)* 0.5* 1-49% 19 36 50-75% 22 20 Always 19 18 Douching 69 77 1.5 (0.7-2.9) 0.2 Lubricants 22 27 1.3 (0.7-2.6) 0.3 Sex during menses 20 31 1.6 (1.0-2.6) 0.06 Anal intercourse 15 13 0.8 (0.4-1.7) 0.4 Alcohol use 43 66 2.2 (1.3-3.6) 0.001 HIV infection 25 29 1.0 (0.9-1.2) 0.3 *P value for categories «always» and «never». OR= odds ratios; CI= confidence intervals. This paper describes the baseline data of the 318 sex workers screened during the first 7 months of the enrolment phase of a randomized placebo controlled trial with azithromycin to reduce STI incidence. This cohort of female sex workers was set up in a slum area in Nairobi. The women in our study were initially mainly recruited through an existing network of peer leaders. As it became clear that some FSWs were not reached by these peer-leaders, other ways of recruiting them were identified. As a result, women working in bars and clubs were also enrolled later on in the study although at a slower pace. The women we enrolled form a non-coherent group of sex workers with striking differences in relation to demography as well as to risk behavior according to the place where they were working. Women carrying out their activities at home were older, more often divorced or widowed and had been in prostitution for a longer time. PREVENTION OF SEXUALLY TRANSMITTED INFECTIONS INCLUDING HIV 87
They did not report much condom use but on the other hand did not report other high-risk sexual behavior very often. A smaller group of women worked out of bars. These bars are located within the slum area and are often not more than a shabby construction where locally brewed beer is served. The women working here were younger, had more sex partners and reported a little more high-risk sexual behavior. This group of women shows the highest rate of HIV infection. We recruited only 10 women working in clubs. Although they have different characteristics, it is difficult to draw conclusions given the low numbers. The assumption can be made that the clients of these 3 subgroups of FSWs are quite different, which may also account for different rates in condom use as well as different HIV prevalence rates. However, as no questions on client characteristics were included in the questionnaire, this cannot be confirmed. It is clear however that adapted target interventions will be needed to reach these different women. Most of the FSWs in our study, especially the ones working at home, have been reached by a community-based program through peer leaders that has been in place for several years. This program focused on health education towards behavioral change as well as on alternative income generation. This might explain the differences observed in this cohort as compared with the sex workers of earlier established cohorts in Nairobi, before health education programs had been initiated. The most obvious difference is the rather low STI prevalence rates in our cohort. The earliest cohort of FSWs in the Pumwani slum area in Nairobi showed an HIV prevalence rate of 67% (Plummer 1991). We found an overall prevalence rate of 27%. Although this rate is higher than what was observed among pregnant women in Nairobi (Jackson 1999), it corresponds to the prevalence rate among women with vaginal discharge in the same area (Fonck 2000). The pattern of HIV infection in relation to duration of prostitution, with decreasing HIV prevalence as duration of sex work increases, as we observed, has been described before (Fowke 1996, Simonsen 1990). Selection bias is a possible explanation of this finding. The women who became rapidly infected have progressed towards immune deficiency and possibly death. The other subset of women might be resistant to infection. This was first described by Fowke et al. in another prostitute cohort in Nairobi. Also the prevalence rates of the other STD were surprisingly low in our cohort. In a similar cohort of sex workers in the Nairobi area in 1985, gonorrhea was found in 50%, chlamydia in 25%, genital ulcers in 28% and syphilis in 32% (Simonsen 1990). We found respectively 8%, 7%, 2% and 6%. No H. ducreyi was detected in the actual cohort while 13% of the sex workers had culture proven chancroid in 1985. Studies among sex workers in other parts of Africa have also reported much higher STI prevalence than what we found (Ramjee 1998, PREVENTION OF SEXUALLY TRANSMITTED INFECTIONS INCLUDING HIV 88
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GHENT UNIVERSITY STI PREVENTION AND
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AIDS Acquired Immune Deficiency Syn
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1.1. Sexually Transmitted Infection
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countries, the rate of reporting co
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district of Uganda randomized villa
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By identifying where significant
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4.5%, 3.9%, 67.7% and 30.1% while t
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female primary health care or anten
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The research data have been publish
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2.1. OBJECTIVES 2.1.1. General obje
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2.2.3. Laboratory procedures The mi
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C HAPTER 3 PREVALENCE AND RISK FACT
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After registration by the clinic cl
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The majority of the women were infe
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eing single, ever having been treat
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prevalence found in a family planni
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3.2. Declining Syphilis Prevalence
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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 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: Widows, divorcees and separated wom
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
Page 131 and 132: 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
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We hebben aangetoond dat de kost va
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