Hiv testing and counselling for women attending child health clinics: An opportunity for entry to prevent mother-to-child transmission and hiv treatment. Author
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Langauage: English Keywords: KENYA | RESEARCH REPORT | CLINICAL TRIALS | WOMEN | SEX WORKERS | VAGINAL ABNORMALITIES | INFECTIONS | RISK FACTORS | HIV INFECTIONS | DRUGS | ADMINISTRATION AND DOSAGE | DEVELOPING COUNTRIES | AFRICA, EASTERN | AFRICA, SUB SAHARAN | AFRICA | CLINICAL RESEARCH | RESEARCH METHODOLOGY | DEMOGRAPHIC FACTORS | POPULATION | SEX BEHAVIOR | BEHAVIOR | DISEASES | BIOLOGY | VIRAL DISEASES | TREATMENT | MEDICAL PROCEDURES | MEDICINE | HEALTH SERVICES | DELIVERY OF HEALTH CARE | HEALTH Document Number: 326470 Herpes simplex virus type 2 infection among young uncircumcised men in Kisumu, Kenya. Author: Mehta SD; Moses S; Agot K; Agingu W; Parker C Source: Sexually Transmitted Infections. Abstract: The objectives were to identify factors associated with herpes simplex virus type 2 (HSV-2) infection among men aged 18-24 in Kisumu, Kenya. Baseline data from a randomised trial of male circumcision were analysed. Participants were interviewed for tors were considered singly and in combination through logistic regression models. Asociodemographic and behavioural risks. The outcome was HSV-2 by antibody status. Risk facmong 2771 uncircumcised men, 766 (27.6%; 95% confidence interval (CI) 26.0% to 29.3%) tested antibody positive for HSV-2. The median age at first sex was 16 years, and the median number of lifetime sexual partners was four. HSV-2 seroprevalence increased from 19% among 18-year-olds to 43% among 24-year-olds (p less than 0.001). In multivariable analysis, statistically significant risks for infection were increasing age (adjusted odds ratio (AOR)=1.22-2.58), being married or having a live-in female partner (AOR=1.80; 95% CI 1.28 to 2.53), preferring "dry" sex (AOR=1.39; 95% CI 1.14 to 1.69), reported penile cuts or abrasions during sex (AOR=1.58; 95% CI 1.32 to 1.91), increasing lifetime sex partners (multiple response categories; AORs ranging from 1.65 to 1.97), and non-student occupation (multiple response categories; AORs ranging from 1.44 to 1.93). Risk decreased with reported condom used at last sex (AOR=0.82; 95% CI 0.68 to 0.99). Primary prevention efforts should be initiated at an early age. The same behavioural interventions used currently for HIV prevention-abstinence, reducing the number of sex partners and increasing condom use-should be effective for HSV-2 prevention. (author's) Langauage: English Keywords: KENYA | RESEARCH REPORT | INTERVIEWS | CLINICAL RESEARCH | CROSS SECTIONAL ANALYSIS | YOUTH | MEN | MALE CIRCUMCISION | HERPES GENITALIS | RISK FACTORS | DEVELOPING COUNTRIES | AFRICA, EASTERN | AFRICA, SUB SAHARAN | AFRICA | DATA COLLECTION | RESEARCH METHODOLOGY | AGE FACTORS | POPULATION CHARACTERISTICS | DEMOGRAPHIC FACTORS | POPULATION | MEDICAL PROCEDURES | MEDICINE | HEALTH SERVICES | DELIVERY OF HEALTH CARE | HEALTH | SEXUALLY TRANSMITTED DISEASES | REPRODUCTIVE TRACT INFEC IVE TIONS | INFECTIONS | DISEASES | BIOLOGY Document Number: 323782 Sexual and demographic determinants for herpes simplex virus type 2 among fishermen along Lake Victoria, Kenya. Author: Ng'ayo MO; Bukusi E; Morrow RA; Rowhani-Rahbar A; Obare BA Source: Sexually Transmitted Infections Abstract: The objectives were to determine the prevalence and correlates of herpes simplex virus type 2 (HSV-2) seropositivity among fishermen along the shores of Lake Victoria in Kisumu district, Kenya. Sera from a random sample of 250 fishermen from 18 beaches were collected after a detailed sociodemographic interview. HSV-2 infection was tested by Kalon HSV-2 ELISA. The HSV-2 seroprevalence was 63.9%. In multivariate analysis, fishermen were more likely to be infected with HSV-2 if they were HIV positive (prevalence ratio (PR) 1.27; 95% CI 1.06 to 1.52) compared with those testing HIV negative, were aged 18-20 (PR 0.49; 95% CI 0.24 to 0.99) and older than 40 (PR 1.66; 95% CI 1.30 to 2.14) years compared with those aged 21-25 years, perceived their last two sexual partners to have a sexually transmitted infection (STI; PR 1.27; 95% CI 1.06 to 1.52) compared with those who did not and were more likely to be circumcised (PR 1.49; 95% CI 1.19 to 1.86). HSV-2 seroprevalence is high among this population and is associated with HIV serostatus, age, perception about partner's STI status and circumcision. (author's) Langauage: English Keywords: KENYA | RESEARCH REPORT | SAMPLING STUDIES | MEN | ADULTS | HERPES GENITALIS | PREVALENCE | RISK FACTORS | DEMOGRAPHIC FACTORS | FISHING | DEVELOPING COUNTRIES | AFRICA, EASTERN | AFRICA, SUB SAHARAN | AFRICA | STUDIES | RESEARCH METHODOLOGY | POPULATION | AGE FACTORS | POPULATION CHARACTERISTICS | SEXUALLY TRANSMITTED DISEASES | REPRODUCTIVE TRACT INFECTIONS | INFECTIONS | DISEASES | MEASUREMENT | BIOLOGY | OCCUPATIONS | HUMAN RESOURCES | ECONOMIC FACTORS Document Number: 325713 Role of governmental and non-governmental organizations in mitigation of stigma and discrimination among HIV / AIDS persons in Kibera, Kenya. Author: Odindo MA; Mwanthi MA Source: East African Journal of Public Health Abstract: This study assessed the role of governmental and non-governmental organizations in mitigation of stigma and discrimination among people infected and affected by HIV/AIDS in informal settlements of Kibera. This was a descriptive cross-sectional study and used a multi stage stratified sampling method. The study was conducted in Kibera, an informal settlement with a population of over one million people which makes it the largest slum not only in Kenya but in sub-Saharan Africa. The study targeted infected individuals, non-infected community members, managers of the organizations implementing HIV/AIDS programmes and service providers. In the process 1331 households were interviewed using qualitative and quantitative data collection instruments. Statistical Package for Social Sciences (SPSS) and Nudist 4 packages were used to analyze the quantitative and qualitative data respectively. More than 61% of the respondents had patients in their households. Fifty five percent (55%) of the households receivedassistance from governmental and non-governmental organizations in taking care of the sick. Services provided included awareness, outreach, counseling, testing, treatment, advocacy, home based care, assistance to the orphans and legal issues. About 90% of the respondents perceived health education, counseling services and formation of post counseling support groups to combat stigma and discrimination to be helpful. Stigma and discrimination affects the rights of People Living with HIV/AIDS (PLWHAs). Such stigmatization and discrimination goes beyond and affects those who care for the PLWHAs, and remains the biggest impediment in the fight against HIV/AIDS in Kibera. Governmental and non-governmental organizations continue to provide key services in the mitigation of stigma and discrimination in Kibera. However, personal testimonies by PLWHAs showed that HIV positive persons still suffer from stigma and discrimination. Approximately 43% of the study population experienced stigma and discrimination. (author's) Langauage: English Keywords: KENYA | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | SAMPLING STUDIES | INTERVIEWS | PERSONS LIVING WITH HIV/AIDS | GOVERNMENT | NONGOVERNMENTAL ORGANIZATIONS | STIGMA | SOCIAL DISCRIMINATION | DEVELOPING COUNTRIES | AFRICA, EASTERN | AFRICA, SUB SAHARAN | AFRICA | RESEARCH METHODOLOGY | STUDIES | DATA COLLECTION | HIV INFECTIONS | VIRAL DISEASES | DISEASES | POLITICAL FACTORS | SOCIOCULTURAL FACTORS | ORGANIZATIONS | SOCIAL PROBLEMS Document Number: 327599 Acute HIV infection among Kenyan infants. Author: Richardson BA; Nduati R; Mbori-Ngacha D; Overbaugh J; John-Stewart GC Source: Clinical Infectious Diseases Abstract: Clinical signs and symptoms of acute human immunodeficiency virus (HIV) infection in infants are not well characterized. Serial clinical assessments and HIV PCR assays were conducted in a cohort of children born to HIV-seropositive mothers from birth to 2 years of age. Acute HIV infection visits were defined as those up to 3 months prior to and including the visit at which HIV DNA was first detected. Noninfection visits included all visits at which the child had test results negative for HIV, including the last visit at which a test result negative for HIV DNA was obtained in children who later acquired HIV infection. Differences in the prevalence of symptoms at acute infection versus noninfection visits were determined overall and were stratified by age at infection (< 2 months vs. >/= 2 months). HIV RNA was measured serially in infected infants and was compared between infants with and infants without symptoms of acute HIV infection. There were 125 acute infection visits (among 56 infants) and 3491 noninfection visits (among 306 infants). Acute HIV infection was associated with rash (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.1-2.8), failure to thrive (OR, 1.9; 95% CI, 1.0-3.5), and lymphadenopathy (OR, 2.5; 95% CI, 1.4-4.8). Acute HIV infection was associated with lymphadenopathy (OR, 2.6; 95% CI, 1.3-5.0) in infants < 2 months of age and with pneumonia (OR, 3.2; 95% CI, 1.1-9.3) and dehydration (OR, 6.0; 95% CI, 1.9-18.5) in infants >/= 2 months of age. Infant peak viral load and mortality were not associated with symptoms of acute HIV infection. However, infants with symptoms had higher viral levels later in the course of infection than did those without symptoms (P = .05). Infants may manifest symptoms early during the course of HIV infection, and symptoms of acute HIV infection may correlate with poor viral control. Rash, failure to thrive, lymphadenopathy, pneumonia, and dehydration may signify acute HIV infection in infants. (author's) Clinical signs and symptoms of acute human immunodeficiency virus (HIV) infection in infants are not well characterized. Serial clinical assessments and HIV PCR assays were conducted in a cohort of children born to HIV-seropositive mothers from birth to 2 years of age. Acute HIV infection visits were defined as those up to 3 months prior to and including the visit at which HIV DNA was first detected. Noninfection visits included all visits at which the child had test results negative for HIV, including the last visit at which a test result negative for HIV DNA was obtained in children who later acquired HIV infection. Differences in the prevalence of symptoms at acute infection versus noninfection visits were determined overall and were stratified by age at infection (< 2 months vs. >/= 2 months). HIV RNA was measured serially in infected infants and was compared between infants with and infants without symptoms of acute HIV infection. There were 125 acute infection visits (among 56 infants) and 3491 noninfection visits (among 306 infants). Acute HIV infection was associated with rash (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.1-2.8), failure to thrive (OR, 1.9; 95% CI, 1.0-3.5), and lymphadenopathy (OR, 2.5; 95% CI, 1.4-4.8). Acute HIV infection was associated with lymphadenopathy (OR, 2.6; 95% CI, 1.3-5.0) in infants < 2 months of age and with pneumonia (OR, 3.2; 95% CI, 1.1-9.3) and dehydration (OR, 6.0; 95% CI, 1.9-18.5) in infants >/= 2 months of age. Infant peak viral load and mortality were not associated with symptoms of acute HIV infection. However, infants with symptoms had higher viral levels later in the course of infection than did those without symptoms (P = .05). Infants may manifest symptoms early during the course of HIV infection, and symptoms of acute HIV infection may correlate with poor viral control. Rash, failure to thrive, lymphadenopathy, pneumonia, and dehydration may signify acute HIV infection in infants. (author's) Language: English Keywords: KENYA | RESEARCH REPORT | COHORT ANALYSIS | PREGNANT WOMEN | INFANT | HIV INFECTIONS | PREVALENCE | LABORATORY PROCEDURES | MOTHER-TO-CHILD TRANSMISSION | AGE FACTORS | SIGNS AND SYMPTOMS | MORTALITY | DEVELOPING COUNTRIES | AFRICA, EASTERN | AFRICA, SUB SAHARAN | AFRICA | RESEARCH METHODOLOGY | POPULATION CHARACTERISTICS | DEMOGRAPHIC FACTORS | POPULATION | YOUTH | VIRAL DISEASES | DISEASES | MEASUREMENT | LABORATORY EXAMINATIONS AND DIAGNOSES | EXAMINATIONS AND DIAGNOSES | MEDICAL PROCEDURES | MEDICINE | HEALTH SERVICES | DELIVERY OF HEALTH CARE | HEALTH | TRANSMISSION | INFECTIONS | POPULATION DYNAMICS Langauage: English Document Number: 323115 Characteristics of psychosocial support seeking during HIV-related treatment in western Kenya. Author: Shacham E; Reece M; Ong'or WO; Omollo O; Monahan PO; Ojwang C Source: AIDS Patient Care and STDs Abstract: While the characteristics of those who seek psychosocial support following an HIV diagnosis have been well documented in western countries where linkages between HIV-related treatment and psychosocial support programs are well established, little is known about those who become engaged with such services in countries of the world where comprehensive HIV-related care and prevention systems are continuing to develop. Data were collected from 397 individuals who had enrolled in HIV-related psychosocial support groups in western Kenya in November 2005. Demographic and HIV-related characteristics, as well as assessments of psychological distress, were collected from each participant and analyzed by gender in order to document the characteristics of those seeking psychosocial care in conjunction with their participation in an HIV-related treatment and prevention program. Those seeking psychosocial support were primarily female (72%), living with HIV for an average of 2.5 years, and unemployed (70%). Women were younger and more likely to be either widowed or never married; while men were more likely to have advanced HIV disease, including lower CD4 counts and an AIDS diagnosis. Across all participants, HIV serostatus disclosure was rarely reported to sex partners, family members, and friends. Symptoms of psychological distress were more prevalent among women on multiple measures, including depression, anxiety, paranoid ideation, interpersonal sensitivity, and somatization. An increased understanding of the characteristics of those likely to seek psychosocial support groups will help HIV program managers to develop protocols necessary for facilitating linkages to psychosocial support for those enrolled in HIV-related treatment programs. Patient engagement in psychosocial support may facilitate improvements in psychological function and support an individual's maintenance of HIV treatment and prevention behaviors. (author's) Langauage: English Keywords: KENYA | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | QUESTIONNAIRES | PERSONS LIVING WITH HIV/AIDS | HIV INFECTIONS | PSYCHOSOCIAL FACTORS | STRESS | SIGNS AND SYMPTOMS | TREATMENT | CARE AND SUPPORT | AFRICA, EASTERN | AFRICA, SUB SAHARAN | AFRICA | DEVELOPING COUNTRIES | RESEARCH METHODOLOGY | VIRAL DISEASES | DISEASES | BEHAVIOR | PSYCHOLOGICAL FACTORS | MEDICAL PROCEDURES | MEDICINE | HEALTH SERVICES | DELIVERY OF HEALTH CARE | HEALTH Document Number: 328369 A prospective study of risk factors for bacterial vaginosis in HIV-1-seronegative African women. Author: McClelland RS; Richardson BA; Graham SM; Masese LN; Gitau R Source: Sexually Transmitted Diseases. 2008 Jun;35(6):617-623. Abstract: Bacterial vaginosis (BV) is common and has been associated with increased HIV-1 susceptibility. The objective of this study was to identify risk factors for BV in African women at high risk for acquiring HIV-1. We conducted a prospective study among 151 HIV-1-seronegative Kenyan female sex workers. Nonpregnant women were eligible if they did not have symptoms of abnormal vaginal itching or discharge at the time of enrollment. At monthly follow-up, a vaginal examination and laboratory testing for genital tract infections were performed. Multivariate Andersen-Gill proportional hazards analysis was used to identify correlates of BV. Participants completed a median of 378 (interquartile range 350-412) days of follow-up. Compared with women reporting no vaginal washing, those who reported vaginal washing 1 to 14 [adjusted hazard ratio (aHR) 1.29, 95% confidence interval (CI) 0.88-1.89], 15 to 28 (aHR 1.60, 95% CI 0.98 -2.61), and greater than 28 times/wk (aHR 2.39, 95% CI 1.35-4.23) were at increased risk of BV. Higher BV incidence was also associated with the use of cloth for intravaginal cleansing (aHR 1.48, 95% CI 1.06 -2.08) and with recent unprotected intercourse (aHR 1.75, 95% CI 1.47-2.08). Women using depot medroxyprogesterone acetate contraception were at lower risk for BV (aHR 0.59, 95% CI 0.48-0.73). Vaginal washing and unprotected intercourse were associated with increased risk of BV. These findings could help to inform the development of novel vaginal health approaches for HIV-1 risk reduction in women. (author's) Language: English Keywords: KENYA | RESEARCH REPORT | PROSPECTIVE STUDIES | SEX WORKERS | VAGINOSIS | RISK FACTORS | LABORATORY EXAMINATIONS AND DIAGNOSES | SEX BEHAVIOR | HYGIENE | DEPO-PROVERA | DEVELOPING COUNTRIES | AFRICA, EASTERN | AFRICA, SUB SAHARAN | AFRICA | STUDIES | RESEARCH METHODOLOGY | BEHAVIOR | VAGINAL ABNORMALITIES | DISEASES | BIOLOGY | EXAMINATIONS AND DIAGNOSES | MEDICAL PROCEDURES | MEDICINE | HEALTH SERVICES | DELIVERY OF HEALTH CARE | HEALTH | PUBLIC HEALTH | MEDROXYPROGESTERONE ACETATE | CONTRACEPTIVE AGENTS, PROGESTIN | CONTRACEPTIVE AGENTS, FEMALE | CONTRACEPTIVE AGENTS | CONTRACEPTION | FAMILY PLANNING Document Number: 327423 HIV / AIDS and cultural practices in western Kenya: The impact of sexual cleansing rituals on sexual behaviours. Author: Ayikukwei R; Ngare D; Sidle J; Ayuku D; Baliddawa J Source: Culture, Health and Sexuality. 2008 Aug;10(6):587-599. Abstract: This paper reports on an exploratory study examining the role of sexual cleansing rituals in the transmission of HIV among the Luo community in western Kenya. Data were collected using both i-ndepth interviews and focus group discussions. The study population consisted of 38 widows, 12 community elders and 44 cleansers. Data were collected on non-behavioural causes, behavioural causes and behavioural indicators associated with sexual rituals. Content analysis revealed five central themes: the effect of the ritual on sexual behaviours; factors contributing to the continued practice of the ritual, including a sub-theme on the commercialization of the ritual; the inseparable relationship between the sanctity of sex, prosperity and fertility of the land; and the effects of modernization on the ritual, including a sub-theme on the effects of mass media on HIV-prevention awareness campaigns. Causal factors of unchanging sexual behaviours are deeply rooted in traditional beliefs, which the community uphold strongly. These beliefs encourage men and women to have multiple sexual partners in a context where the use of condoms is rejected and little HIV testing is carried out. (author's) Language: English Keywords: KENYA | RESEARCH REPORT | PILOT PROJECTS | INTERVIEWS | FOCUS GROUPS | HIV TRANSMISSION | SEX BEHAVIOR | CULTURE | BELIEFS | ETHNIC GROUPS | TRADITIONAL HEALTH PRACTICES | AFRICA, EASTERN | AFRICA, SUB SAHARAN | AFRICA | DEVELOPING COUNTRIES | STUDIES | RESEARCH METHODOLOGY | DATA COLLECTION | HIV INFECTIONS | VIRAL DISEASES | DISEASES | BEHAVIOR | SOCIOCULTURAL FACTORS | CULTURAL BACKGROUND | POPULATION CHARACTERISTICS | DEMOGRAPHIC FACTORS | POPULATION Document Number: 327818 Kaposi’s sarcoma in patients with and without human immunodeficiency virus infection, in a tertiary referral centre in Kenya. Author: Mwanda OW; Fu P; Collea R; Whalen C; Remick SC Source: Annals of Tropical Medicine and Parasitology Abstract: The clinical features of Kaposi’s sarcoma (KS), in patients with and without HIV infection, were investigated in a tertiary referral centre in Kenya between 1997 and 1999. Although 186 cases were identified prospectively, the data analysis was restricted to the 91 (49%) cases who had pathological confirmation of Kaposi’s sarcoma and documented HIV serostatus. Among these 91 subjects (58% of whom were male), the age-group holding the largest number of KS cases was that of individuals aged 31–40 years; most of the paediatric cases were aged 6–10 years. The ratio of HIV-seropositives to HIV-seronegatives was 8.5:1 for the adult cases and 0.9:1 for the paediatric. Of the signs and symptoms of Kaposi’s sarcoma seen at presentation, only peripheral lympadenopathy was found to be significantly associated with underlying HIV infection (P=0.05). The median survival was 104 days. It is apparent that, as the HIV epidemic advances in regions of the world with endemic KS, the clinical presentation and natural history of the endemic KS are blending with those of the epidemic or AIDS-associated disease, leading to a reduction in the mean age of the cases and a nearly identical incidence in men and women. In regions of the world where patients have ready access to such chemotherapy, the impact of treatment with highly active antiretroviral drugs on the incidence and natural history of KS has been dramatic. It will be important to monitor the clinico–pathological features of KS in the developing world, as more active antiretroviral regimens become available in clinical practice there. (author's) Language: English Keywords: KENYA | RESEARCH REPORT | CLINICAL RESEARCH | PROSPECTIVE STUDIES | HIV POSITIVE PERSONS | TARGET POPULATION | CANCER | REFERRAL AND CONSULTATION PROGRAM DESIGN | PROGRAMS | ORGANIZATION AND ADMINISTRATION | NEOPLASMS | PROGRAM ACTIVITIES | POPULATION CHARACTERISTICS | DEMOGRAPHIC FACTORS | POPULATION | MEASUREMENT | HIV Document Number: 279454 Men's condom use in higher-risk sex: Trends and determinants in five Sub-Saharan countries. Author: Adair T Source: Calverton, Maryland, Macro International, MEASURE DHS, 2008 Apr. |