GHENT UNIVERSITY Karoline FONCK - International Centre for ...

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A full physical examination, including speculum examination and laboratory STI testing, was performed at the screening visit. Data on the first 543 women screened are presented here. The study was approved by ethics review committees of the University of Nairobi and the University of Manitoba. A detailed description of the specimens taken and the laboratory tests performed has been published elsewhere (Fonck 2000). Data were entered into a database in Microsoft ACCESS (Office 97 format) and analysis performed after export into SPSS for Windows, version 8.0 (SPSS Inc, Chicago, IL, USA). In univariate analysis, the odds ratios and 95% confidence intervals were used for the measurement of associations between proportions. Comparisons were made using Pearson's χ 2 , Fisher's exact test, and χ 2 test for trend. Student's t test was used for comparison of means. Logistic regression models were developed to analyze risk factors for HIV and BV. These models used input variables that were associated with HIV or BV in univariate analysis in this cohort, or which have been reported in other cohorts. Results Between May 1998 and August 1999, 543 female sex workers were screened. Three women declined examination after interview and were excluded. The mean age was 30 years (SD 7.8 years). Overall, 161 women (30%) were HIV-1 seropositive. The prevalence of bacterial vaginosis was 49%, candidiasis 10%, trichomoniasis 16%, gonorrhea 10%, chlamydia 9%, syphilis 6%, clinical ulcer 1%, and CIN 2%. Only one woman presented with genital warts. Demographic characteristics, sexual behavior, and medical history of HIV positive and HIV negative women are compared in Table 1. There was no association between age, marital status, duration of prostitution, number of partners, and HIV serostatus. HIV positive women had had their first sexual experience at younger age than HIV negative women, charged less per sexual act, used condoms less often, were less likely to report a regular partner, and used alcohol more frequently. Use of oral contraceptives, douching, sex during menses, anal intercourse, and history of STIs were not associated with HIV serostatus. On multivariate analysis only age at first sex and alcohol use remained significantly associated with HIV seropositivity (P=0.02 and P=0.05, respectively). PREVENTION OF SEXUALLY TRANSMITTED INFECTIONS INCLUDING HIV 93
Table 1. Characteristics of HIV- positive and HIV- negative sex workers. HIV- negative (n = 373) HIV- positive (n = 161) OR (95% CI) P Mean age (years) 30.4 30.9 0.4 Mean number of years lived in Nairobi Marital status 10.6 9.9 0.4 Never married Widowed/divorced/separated 50 % 50 % 46 % 54 % 0.9 (0.7-1.1) 0.2 Mean age at first sex (years) 16.3 15.6 0.005 Mean duration of prostitution (years) 6.1 6.2 0.8 Mean number of sex partners/day 3.9 4.0 0.5 Mean number of sex partners/week 13.9 19.1 0.08 Mean charge per act ( Kenya shillings) Condom use : 118 93 0.02 Never 34 % 35 % 1.9 (1.0-3.6) 0.04 Sometimes 47% 55% 2.1 (1.2 –3.9) 0.01 Always 19 % 10 % 1.0 (reference) N/A Regular partner 57 % 47 % 0. 8 (0.6-1.0) 0.02 Use of oral contraceptives 31 % 31 % 1.0 (0.8-1.3) 0.5 Sex during menses 23 % 26 % 1.1 (0.8-1.5) 0.2 Anal intercourse 15 % 16 % 1.1 (0.8-1.5) 0.4 Alcohol use 55 % 66 % 0.7 (0.5-0.9) 0.01 History of STIs 28 % 27 % 1.0 (0.8-1.4) 0.5 History of douching 72 % 73 % 1.0 (0.7-1.6) 0.9 STI prevalence at the time of screening stratified by HIV serostatus is shown in Table 2. Bacterial vaginosis, trichomoniasis, gonorrhea, and the presence of a genital ulcer were significantly more common among HIV positive women. CIN was three times more prevalent in the HIV seropositive group. Table 2. STI prevalence among female sex workers by HIV serostatus*. HIV- negative HIV- positive n % n % OR (95% CI) P Bacterial vaginosis 138/303 46 73/129 57 1.5 (1.0-2.3) 0.05 Candida 28/303 9 11/130 9 0.9 (0.4-1.9) 0.9 Trichomoniasis 43/369 12 41/156 26 2.7 (1.7-4.4) < 0.001 Chlamydia 30/327 9 11/124 9 1.0 (0.5-2.0) 1.0 Gonorrhea 30/370 8 22/156 14 1.9 (1.0-3.3) 0.04 Syphilis 23/369 6 8/159 5 0.8 (0.3-1.8) 0.7 Clinical ulcer 2/373 1 5/161 3 6.0 (1.1-31.0) 0.03 CIN 4/373 1 5/161 3 3.0 (0.8-11.2) 0.2 * Denominators differ because of missing specimens. Of the 543 women interviewed, 392 (72%) gave a history of douching. Most of the women who practiced douching reported doing so after each sexual intercourse (91%) and most of the women douched with water and soap (81%). Water mixed with salt was used by 18%, PREVENTION OF SEXUALLY TRANSMITTED INFECTIONS INCLUDING HIV 94
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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
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We believe that the observed declin
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Wasserheit 1992, Laga 1993). In Nai
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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 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: There is some evidence that frequen
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
Page 139 and 140: We hebben aangetoond dat de kost va
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