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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Document Number: 315497 Market incentives, human lives, and AIDS vaccines. Author: Craddock S Source: Social Science and Medicine. 2007 Mar;64(5):1042-1056. Abstract: For many, an AIDS vaccine holds the promise of intervening in a widespread epidemic because it is not predicated on changing economic structures and social contexts underlying vulnerability to HIV for millions of individuals. Yet 20 years into the AIDS epidemic, there is still no vaccine. Based on interviews of AIDS vaccine researchers, watchdog organizations, and ethics groups from the United States, South Africa, and Kenya conducted between August and December of 2003, this paper explores possible answers to the question of why there is no vaccine, looking in particular at contradictions between a biomedical research industry increasingly driven by market incentives and a disease that primarily affects individuals living in low-income countries with little vaccine purchasing power. Producing a vaccine that could be effective in low-income regions requires new kinds of initiatives that can coordinate research nationally and globally, and circumvent current regulatory mechanisms that dictate against the development and dissemination of low-profit medical technologies. Until such initiatives are supported, however, vaccine research will continue at a devastatingly slow pace at the cost of millions of lives annually. (author's) Language: English Keywords: UNITED STATES | SOUTH AFRICA | KENYA | RESEARCH REPORT | RESEARCH AND DEVELOPMENT | VACCINES | PHARMACY DISTRIBUTION | AIDS | MEDICINE | ECONOMIC FACTORS | NORTH AMERICA | AMERICAS | DEVELOPED COUNTRIES | AFRICA, SOUTHERN | AFRICA SOUTH OF THE SAHARA | AFRICA | DEVELOPING COUNTRIES | AFRICA, EASTERN | TECHNOLOGY | MEDICAL PROCEDURES | HEALTH SERVICES | DELIVERY OF HEALTH CARE | HEALTH | NONCLINICAL DISTRIBUTION | DISTRIBUTIONAL ACTIVITIES | PROGRAM ACTIVITIES | PROGRAMS | ORGANIZATION AND ADMINISTRATION | HIV INFECTIONS | VIRAL DISEASES | DISEASES Document Number: 312042 Urban-rural differences in the socioeconomic deprivation -- Sexual behavior link in Kenya. Author: Dodoo FN; Zulu EM; Ezeh AC Source: Social Science and Medicine. 2007 Mar;64(5):1019-1031. Abstract: We compare the impact of socioeconomic deprivation on risky sexual outcomes in rural and urban Kenya. Quantitative data are drawn from the Demographic & Health Surveys (DHS) and qualitative data from the Sexual Networking and Associated Reproductive and Social Health Concerns study. Using two separate indicators of deprivation we show that, although poverty is significantly associated with the examined sexual outcomes in all settings, the urban poor are significantly more likely than their rural counterparts to have an early sexual debut and a greater incidence of multiple sexual partnerships. The disadvantage of the urban poor is accentuated for married women; those in Nairobi's slums are at least three times as likely to have multiple sexual partners as their rural counterparts. The implications of these findings are discussed. (author's) Language: English Keywords: KENYA | RESEARCH REPORT | COMPARATIVE STUDIES | RURAL AREAS | URBAN AREAS | MULTIPLE PARTNERS | SEXUAL PARTNERS | SEX BEHAVIOR | CONDOM USE | POVERTY | SOCIOECONOMIC FACTORS | AFRICA, EASTERN | AFRICA SOUTH OF THE SAHARA | AFRICA | DEVELOPING COUNTRIES | STUDIES | RESEARCH METHODOLOGY | GEOGRAPHIC FACTORS | POPULATION | BEHAVIOR | RISK REDUCTION BEHAVIOR | ECONOMIC FACTORS Document Number: 312040 Sero-discordant couples in five African countries: Implications for prevention strategies. Author: De Walque D Source: Population and Development Review. 2007 Sep;33(3):501-523. Abstract: THE HIV/AIDS EPIDEMIC is one of the greatest challenges facing Africa. According to UNAIDS (2006), as of December 2006, between 21.8 and 27.7 million people in sub-Saharan Africa were infected by HIV/AIDS. This represents around 62.5 percent of the estimated worldwide total and implies that between 5.2 and 6.7 percent of adults living in that region are HIV positive. Between 1.8 and 2.4 million sub-Saharan Africans died from the virus in 2006 and between 2.4 and 3.2 million became newly infected. Only recently have individual-level data, including HIV test results, become available for nationally representative samples in Africa and other developing regions. Previously, studies of the HIV epidemic relied either on aggregate data or on HIV status data from nonrepresentative samples or on data from self-reported sexual behavior. The new wave of Demographic and Health Surveys (DHS), which include HIV status, now permits analysis of the socioeconomic determinants of HIV infection for nationally representative samples. The present study of sero-discordant couples uses an additional feature of the data available in the Demographic and Health Surveys. The data make it possible to assess the HIV status of cohabiting couples (formally married or not) and to compare sexual behavior reported by the man and the woman. (excerpt) Language: English Keywords: CAMEROON | KENYA | TANZANIA | BURKINA FASO | GHANA | RESEARCH REPORT | DEMOGRAPHIC AND HEALTH SURVEYS | PERSONS LIVING WITH HIV/AIDS | COUPLES | HIV PREVENTION | HIV TRANSMISSION | EXTRAMARITAL SEX BEHAVIOR | DEVELOPING COUNTRIES | AFRICA, WESTERN | AFRICA, SUB SAHARAN | AFRICA | AFRICA, EASTERN | DEMOGRAPHIC SURVEYS | POPULATION DYNAMICS | DEMOGRAPHIC FACTORS | POPULATION | HIV INFECTIONS | VIRAL DISEASES | DISEASES | FAMILY CHARACTERISTICS | FAMILY AND HOUSEHOLD | SOCIOCULTURAL FACTORS | SEX BEHAVIOR | BEHAVIOR Document Number: 320253 Orphans and schooling in Africa: A longitudinal analysis. Author: Evans DK; Miguel E Source: Demography. 2007 Feb;44(1):35-57. Abstract: AIDS deaths could have a major impact on economic development by affecting the human capital accumulation of the next generation. We estimate the impact of parent death on primary school participation using an unusual five-year panel data set of over 20,000 Kenyan children. There is a substantial decrease in school participation following a parent death and a smaller drop before the death (presumably due to pre-death morbidity). Estimated impacts are smaller in specifications without individual fixed effects, suggesting that estimates based on cross-sectional data are biased toward zero. Effects are largest for children whose mothers died and, in a novel finding, for those with low baseline academic performance. (author's) Language: English Keywords: KENYA | RESEARCH REPORT | LONGITUDINAL STUDIES | SURVEYS | ORPHANS AND VULNERABLE CHILDREN | PARENTS | MORTALITY | AIDS | RURAL AREAS | PRIMARY SCHOOLS | SOCIOECONOMIC STATUS | EDUCATIONAL STATUS | DEVELOPING COUNTRIES | AFRICA, EASTERN | AFRICA, SUB SAHARAN | AFRICA | STUDIES | RESEARCH METHODOLOGY | SAMPLING STUDIES | YOUTH | AGE FACTORS | POPULATION CHARACTERISTICS | DEMOGRAPHIC FACTORS | POPULATION | FAMILY RELATIONSHIPS | FAMILY CHARACTERISTICS | FAMILY AND HOUSEHOLD | SOCIOCULTURAL FACTORS | POPULATION DYNAMICS | HIV INFECTIONS | VIRAL DISEASES | DISEASES | GEOGRAPHIC FACTORS | SCHOOLS | EDUCATION | SOCIOECONOMIC FACTORS | ECONOMIC FACTORS Document Number: 313230 Validity of self-reported "safe sex" among female sex workers in Mombasa, Kenya -- PSA analysis. Author: Gall MF; Behets FM; Steiner MJ; Thomsen SC; Ombidi W Source: International Journal of STD and AIDS. 2007 Jan;18(1):33-38. Abstract: We assessed the validity of self-reported sex and condom use by comparing self-reports with prostate-specific antigen (PSA) detection in a prospective study of 210 female sex workers in Mombasa, Kenya. Participants were interviewed on recent sexual behaviours at baseline and 12-month follow-up visits. At both visits, a trained nurse instructed participants to self-swab to collect vaginal fluid specimens, which were tested for PSA using enzyme-linked immunosorbent assay (ELISA). Eleven percent of samples (n¼329) from women reporting no unprotected sex for the prior 48 hours tested positive for PSA. The proportions of women with this type of discordant self-reported and biological data did not differ between the enrolment and 12-month visit (odds ratio [OR] 1.1; 95% confidence interval [CI] 0.99, 1.2). The study found evidence that participants failed to report recent unprotected sex. Furthermore, because PSA begins to clear immediately after exposure, our measures of misreported semen exposure likely are underestimations. (author's) Language: English Keywords: KENYA | RESEARCH REPORT | PROSPECTIVE STUDIES | SEX WORKERS | WOMEN | LABORATORY EXAMINATIONS AND DIAGNOSES | ANTIGENS | IMMUNOLOGIC FACTORS | SELF-PERCEPTION | POSTCOITAL DOUCHING | SAFER SEX | CONDOM USE | AFRICA, EASTERN | AFRICA SOUTH OF THE SAHARA | AFRICA | DEVELOPING COUNTRIES | STUDIES | RESEARCH METHODOLOGY | SEX BEHAVIOR | BEHAVIOR | DEMOGRAPHIC FACTORS | POPULATION | EXAMINATIONS AND DIAGNOSES | MEDICAL PROCEDURES | MEDICINE | HEALTH SERVICES | DELIVERY OF HEALTH CARE | HEALTH | IMMUNITY | IMMUNE SYSTEM | PHYSIOLOGY | BIOLOGY | PERCEPTION | PSYCHOLOGICAL FACTORS | FERTILITY CONTROL, POSTCOITAL | FAMILY PLANNING | RISK REDUCTION BEHAVIOR Document Number: 315842 'Are you on the market?': A capture -- recapture enumeration of men who sell sex to men in and around Mombasa, Kenya. Author: Geibel S; van der Elst EM; King'ola N; Luchters S; Davies A Source: AIDS. 2007 Jun;21(10):1349-1354. Abstract: Men who have sex with men (MSM) are highly vulnerable to HIV infection, but this population can be particularly difficult to reach in sub-Saharan Africa. We aimed to estimate the number of MSM who sell sex in and around Mombasa, Kenya, in order to plan HIV prevention research. We identified 77 potential MSM contact locations, including public streets and parks, brothels, bars and nightclubs, in and around Mombasa and trained 37 MSM peer leader enumerators to extend a recruitment leaflet to MSM who were identified as 'on the market', that is, a man who admitted to selling sex to men. We captured men on two consecutive Saturdays, 1 week apart. A record was kept of when, where and by whom the invitation was extended and received, and of refusals. The total estimate of MSM who sell sex was derived from capture-recapture calculation. Capture 1 included 284 men (following removal of 15 duplicates); 89 men refused to participate. Capture 2 included 484 men (following removal of 35 duplicates); 75 men refused to participate. Of the 484 men in capture 2, 186 were recaptures from capture 1, resulting in a total estimate of 739 (95% confidence interval, 690-798) MSM who sell sex in the study area. We estimated that 739 MSM sell sex in and around Mombasa. Of these, 484 were contacted through trained peer enumerators in a single day. MSM who sell sex in and around Mombasa represent a sizeable population who urgently need to be targeted by HIV prevention strategies. (author's) Language: English Keywords: KENYA | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | INDIRECT ESTIMATION TECHNICS | MEN HAVING SEX WITH MEN | SEX WORKERS | INFLUENTIALS | HIV PREVENTION | SEX BEHAVIOR | AFRICA, EASTERN | AFRICA, SUB SAHARAN | AFRICA | DEVELOPING COUNTRIES | RESEARCH METHODOLOGY | ESTIMATION TECHNICS | BEHAVIOR | KNOWLEDGE SOURCES | COMMUNICATION | HIV INFECTIONS | VIRAL DISEASES | DISEASES Document Number: 313574 Total lymphocyte count as a surrogate marker for CD4+ T cell count in initiating antiretroviral therapy at Kenyatta National Hospital, Nairobi. Author: Gitura B; Joshi MD; Lule GN; Anzala O Source: East African Medical Journal. 2007 Oct;84(10):466-473. Abstract: Objective: To evaluate the utility of Total Lymphocyte Count (TLC) as a surrogate marker for CD4 + T cell count in antiretroviral (ARV) treatment initiation in a Kenyan population of HIV seropositive patients at Kenyatta National Hospital. Design: Cross-sectional descriptive study. Setting: Kenyatta National Hospital, HIV treatment and follow-up outpatient facility; Comprehensive Care Centre, Nairobi, Kenya. Subjects: Two hundred and twenty five HIV Elisa positive, ARV naive patients visiting the Comprehensive Care Centre between January 2006 to March 2006. Results: A significant linear correlation was found between TLC and CD4 cell count for the whole group with a Spearman rank correlation of 0.761 (p < 0.01); and was also independently observed in the four WHO clinical stages. The classification utility of TLC 1200 cells/mm3 cut-off was suboptimal; sensitivity 37% specificity of 99% and the NPV of 56%. The receiver operator characteristics (ROC) curve generated an optimal TLC cut-off of 1900 cells/mm3 cut-off to be of greatest utility with a sensitivity of 81.1%, specificity of 90.3%, PPV of 90.8% and NPV of 80.2%. This implies that a TLC cut-off of 1900 cells/mm3 correctly classify eight out of ten HIV positive patients as having a CD4 < 200 cells/mm3 and only misclassify two such patients. Serial CD4 testing can then be performed on the minority of patients who despite a TLC >or= 1900 cells/mm3 are, on basis of clinical data, suspect of more advanced disease warranting ARV therapy. This would reduce the number of patients tested for and focus the application of CD4 testing and thus reduce attendant cost in care provision in CD4 resource poor settings. Conclusion: Our data showed a good positive correlation between TLC and CD4 cell count, however the WHO recommended TLC cut-off of 1200/mm3 was found to be of low sensitivity in classifying patients as having a CD4 counts < 200 cells/mm3. This would result in underestimation of advanced stage of disease and to withholding ARVs treatment to persons who need treatment. We recommend a TLC cut-off of 1900 cells/mm3 for our population to classify patients as either above or below the CD4 count cut-off of 200 cells/mm3 as an indicator of when to start antiretroviral therapy. (author's) Language: English Keywords: KENYA | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | HIV POSITIVE PERSONS | CLIENTS | ANTIRETROVIRAL THERAPY | ANTIRETROVIRAL DRUGS | AUTOIMMUNE RESPONSE | TREATMENT | LABORATORY PROCEDURES | TESTING | TIME FACTORS | RECOMMENDATIONS | DEVELOPING COUNTRIES | AFRICA, EASTERN | AFRICA, SUB SAHARAN | AFRICA | RESEARCH METHODOLOGY | PERSONS LIVING WITH HIV/AIDS | HIV INFECTIONS | VIRAL DISEASES | DISEASES | PROGRAM ACTIVITIES | PROGRAMS | ORGANIZATION AND ADMINISTRATION | HIV | MEDICAL PROCEDURES | MEDICINE | HEALTH SERVICES | DELIVERY OF HEALTH CARE | HEALTH | ANTIBODIES | IMMUNOLOGIC FACTORS | IMMUNITY | IMMUNE SYSTEM | PHYSIOLOGY | BIOLOGY | LABORATORY EXAMINATIONS AND DIAGNOSES | EXAMINATIONS AND DIAGNOSES | MEASUREMENT | POPULATION DYNAMICS | DEMOGRAPHIC FACTORS | POPULATION Document Number: 324127 Associations between intravaginal practices and bacterial vaginosis in Kenyan female sex workers without symptoms of vaginal infections. Author: Hassan WM; Lavreys L; Chohan V; Richardson BA; Mandaliya K Source: Sexually Transmitted Diseases. 2007 Jun;34(6):384-388. Abstract: Bacterial vaginosis (BV) is highly prevalent among African women and has been associated with adverse pregnancy outcomes, sexually transmitted diseases, and HIV-1. The goal of this study was to analyze the relationship among intravaginal practices, bathing, and BV. The authors conducted a cross-sectional study of HIV-1-seronegative Kenyan female sex workers without symptoms of vaginal infections. Of 237 women enrolled, 206 (87%) reported vaginal washing using either a finger or cloth. Increasing frequency of vaginal washing was associated with a higher likelihood of BV (x/2 test for trend, P = 0.05). In multivariate analysis, vaginal lubrication with petroleum jelly (odds ratio [OR] = 2.8, 95% confidence interval [CI] = 1.4 -5.6), lubrication with saliva (OR = 2.3, 95% CI = 1.1-4.8), and bathing less than the median for the cohort (14 times/week; OR = 4.6, 95% CI = 1.2-17.5) were associated with a significantly higher likelihood of BV. Modification of intravaginal and general hygiene practices should be evaluated as potential strategies for reducing the risk of BV. (author's) Language: English Keywords: KENYA | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | SEX WORKERS | WOMEN | VAGINOSIS | BACTERIAL AND FUNGAL DISEASES | SIGNS AND SYMPTOMS | SEX BEHAVIOR | HYGIENE | RISK FACTORS | AFRICA, EASTERN | AFRICA SOUTH OF THE SAHARA | AFRICA | DEVELOPING COUNTRIES | RESEARCH METHODOLOGY | BEHAVIOR | DEMOGRAPHIC FACTORS | POPULATION | VAGINAL ABNORMALITIES | DISEASES | INFECTIONS | PUBLIC HEALTH | HEALTH | BIOLOGY Document Number: 317219 Cohabitation, marriage, and "sexual monogamy" in Nairobi's slums. |