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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Author: Hattori MK; Dodoo FN Source: Social Science and Medicine. 2007 Mar;64(5):1067-1078. Abstract: The current study investigates the extent to which sexual exclusivity--the restriction of one's sexual engagements to a single partner--prevails across various marital status, union type, and co-residence categories among Nairobi's poorest residents, slum dwellers. This question is central to the spread of HIV in the increasingly urban and poor, high prevalence countries of sub-Saharan Africa, where transmission is primarily via heterosexual sex. In many circles, sexual exclusivity is considered a prominent feature of the marriage institution. Yet, marriage and cohabitation are often not easily distinguishable in sub-Saharan Africa, meaning that the frequent use, as a proxy, of the ''in union'' category, which includes married as well as cohabiting persons can, at best, be considered tenuous. Using the 2000 Nairobi Cross-Sectional Slum Survey (NCSS), this paper confirms that marriage is associated with higher reports of sexual exclusivity even in settings where poverty provokes risky behavior. The finding, here, is of lower risk of HIV infection for married respondents, with a smaller effect observed among non-married cohabiters. Converse to the implied benefits of marriage, though, women with co-wives are more likely to report multiple partners. The implications of these findings are discussed. (author's) Language: English Keywords: KENYA | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | SLUMS | URBAN AREAS | LOW INCOME POPULATION | POVERTY | MARRIAGE | MONOGAMY | HIV INFECTIONS | AIDS | AFRICA, EASTERN | AFRICA SOUTH OF THE SAHARA | AFRICA | DEVELOPING COUNTRIES | RESEARCH METHODOLOGY | URBANIZATION | URBAN POPULATION DISTRIBUTION | POPULATION DISTRIBUTION | GEOGRAPHIC FACTORS | POPULATION | SOCIAL CLASS | SOCIOECONOMIC STATUS | SOCIOECONOMIC FACTORS | ECONOMIC FACTORS | NUPTIALITY | DEMOGRAPHIC FACTORS | MARRIAGE PATTERNS | VIRAL DISEASES | DISEASES Document Number: 312044 Clinical and laboratory characteristics of hospitalised patients with neurological manifestations of HIV / AIDS at the Nairobi Hospital. Author: Jowi JO; Mativo PM; Musoke SS Source: East African Medical Journal. 2007 Feb;84(2):67-76. Abstract: The objective was to determine the profile of clinical and laboratory characteristics of hospitalised HIV positive patients with neurological complications at a private hospital in Nairobi, Kenya from January 2000 to June 2005. The design used was a retrospective observational study. The Nairobi Hospital, Nairobi, Kenya was the setting. One hundred and fifty hospitalised patients were the subjects used in the study. Records of 708 HIV positive hospitalised patients were reviewed, 150 patients had neurological complications; giving a six-year point prevalence of 21.2%. Males were 86 (57.3%) and females 64 (42.7%) M: F ratio = 1.3:1. Mean age was 38.84 years. The five commonest neurological complications were; cryptococcal meningitis 33 (22%), encephalitis 28 (18.7%), cerebral toxoplasmosis 19 (12.7%), stroke 19 (12.7%) and tuberculous meningitis 16 (10.7%). Overall, 72 patients (63%) had CD4+ counts done. Cryptococcal meningitis patients' CD4+ count, (mean 60, median 17, range 1-273/cmm). Encephalitis patients' CD4+count, (mean 82, median 54, range 3-495/cmm). Cerebral toxoplasmosis patients' CD4+count, (mean 59, median 58, range 11-120 /cmm). Stroke patients' CD4+ count, (mean 120, median 30, range 15-394/cmm) and Tuberculous meningitis patients' CD4+ count, (mean 67, median 62 and range 12-1 54/cmm). The other rare neurological manifestations included peripheral neuropathy, HIV associated dementia (HAD), myelopathy and myopathy amongst others. One hundred and eight (72%) patients were on anti-retroviral therapy. The commonest drugs used in various regimen combinations included efavirenz and combivir. Fourteen (9.3%) patients died while in hospital; eight of them were among those with the top five neurological complications. The findings show that patients come to hospital when severely immune compromised and hence have overwhelming opportunistic infections. The profile of opportunistic infection is comparable to that observed in studies elsewhere. Some of the facts observed here may not reflect the situation in public health institutions where resources are scarce. Recommendation: To do a multi-centre prospective study of neurological manifestations of HIV/ AIDS. (author's) Language: English Keywords: KENYA | RESEARCH REPORT | RETROSPECTIVE STUDIES | CLIENTS | HIV POSITIVE PERSONS | HOSPITALS | NEUROLOGIC EFFECTS | LABORATORY PROCEDURES | DEVELOPING COUNTRIES | AFRICA, EASTERN | AFRICA, SUB SAHARAN | AFRICA | STUDIES | RESEARCH METHODOLOGY | PROGRAM ACTIVITIES | PROGRAMS | ORGANIZATION AND ADMINISTRATION | PERSONS LIVING WITH HIV/AIDS | HIV INFECTIONS | VIRAL DISEASES | DISEASES | HEALTH FACILITIES | DELIVERY OF HEALTH CARE | HEALTH | PHYSIOLOGY | BIOLOGY | LABORATORY EXAMINATIONS AND DIAGNOSES | EXAMINATIONS AND DIAGNOSES | MEDICAL PROCEDURES | MEDICINE | HEALTH SERVICES Document Number: 319368 Risk factors for treatment denial and loss to follow-up in an antiretroviral treatment cohort in Kenya. Author: Karcher H; Omondi A; Odera J; Kunz A; Harms G Source: Tropical Medicine and International Health. 2007 May;12(5):687-694. Abstract: The objectives were to evaluate risk factors for treatment denial and loss to follow-up in an antiretroviral treatment (ART) cohort in a rural African setting in western Kenya. Sociodemographic and clinical data of patients enrolled in an ART cohort were collected within 18 months of an observational longitudinal study and analysed by logistic and Cox regression models. Of 159 patients with treatment indication 35 (22%) never started ART. Pregnancy [adjusted odds ratio (AOR) 3.60, 95% confidence interval (CI) 1.10-11.8; P = 0.035] and lower level of education (AOR 3.80, 95% CI 1.14-12.7; P = 0.03) were independently associated with treatment denial. The incidence of total loss of patients under therapy was 43.2 per 100 person years (pys) (mortality rate 19.2 per 100 pys plus drop out rate 24 per 100 pys). Older age [adjusted hazard ratio (AHR) 1.06, 95% CI 1.01-1.12; P = 0.04], AIDS before starting treatment (AHR 5.83, 95% CI 1.15-29.5; P = 0.03) and incomplete adherence to treatment (AHR 1.05, 95% CI 1.03-1.07; P < 0.001) were independent risk factors for death. Incomplete adherence also independently predicted drop out because of other reasons (AHR 1.06, 95% CI 1.04-1.09; P < 0.001). Pregnancy and lower level of education, higher age, advanced AIDS stage and impaired compliance to ART were identified as risk factors for treatment denial and death, respectively. Adequate counselling strategies for patients with these characteristics could help to improve adherence and outcome of treatment programmes in resource-limited settings. (author's) Language: English Keywords: KENYA | RESEARCH REPORT | COHORT ANALYSIS | LONGITUDINAL STUDIES | HIV POSITIVE PERSONS | ANTIRETROVIRAL THERAPY | TREATMENT | DROPOUTS | PREGNANCY | EDUCATION | AGE FACTORS | MORTALITY | AFRICA, EASTERN | AFRICA, SUB SAHARAN | AFRICA | DEVELOPING COUNTRIES | RESEARCH METHODOLOGY | STUDIES | PERSONS LIVING WITH HIV/AIDS | HIV INFECTIONS | VIRAL DISEASES | DISEASES | HIV | MEDICAL PROCEDURES | MEDICINE | HEALTH SERVICES | DELIVERY OF HEALTH CARE | HEALTH | PROGRAMS | ORGANIZATION AND ADMINISTRATION | REPRODUCTION | POPULATION CHARACTERISTICS | DEMOGRAPHIC FACTORS | POPULATION | POPULATION DYNAMICS Document Number: 313410 Determinants of tuberculosis diagnosis and the role of counselling. Author: Kivihya-Ndugga L; van Cleeff M; Nyamwaya J; Miheso B; Ndalo E Source: East African Medical Journal. 2007 Feb;84(2):77-82. Abstract: The objective was to study patient determinants that may affect completion of the diagnostic process in tuberculosis control, highlighting the role of counselling. Cross-sectional study was the design used. All of the subjects used in the study were TB patients. The setting for the study was the Rhodes Chest Clinic, Nairobi, City Council. Ninety five percent of the suspects delivered three sputum samples but only 27% consented to a HIV test; several determinants for none consenting were mentioned. On average US$2.27 was spent for one clinic visit and US$8.62 for following the entire diagnostic process. Cost factors included transport, loss of income and food. Individual pre-test counselling seems important for obtaining three sputum specimens. It takes time and for settings with a large number of suspects, alternative methods may be required. To obtain consensus for a HIV test in a TB clinic is complicated. Costs spent on transport and loss in income are important determinants and may contribute to poor patient adherence to the diagnostic process. (author's) Language: English Keywords: KENYA | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | CLIENTS | TUBERCULOSIS | EXAMINATIONS AND DIAGNOSES | COUNSELING | HIV TESTING | FEES | OBSTACLES | DEVELOPING COUNTRIES | AFRICA, EASTERN | AFRICA, SUB SAHARAN | AFRICA | RESEARCH METHODOLOGY | PROGRAM ACTIVITIES | PROGRAMS | ORGANIZATION AND ADMINISTRATION | INFECTIONS | DISEASES | MEDICAL PROCEDURES | MEDICINE | HEALTH SERVICES | DELIVERY OF HEALTH CARE | HEALTH | CLINIC ACTIVITIES | LABORATORY EXAMINATIONS AND DIAGNOSES | FINANCIAL ACTIVITIES | ECONOMIC FACTORS Document Number: 319369 Social networks and HIV / AIDS risk perceptions. Author: Kohler H; Behrman JR; Watkins SC Source: Demography. 2007 Feb;44(1):1-33. Abstract: Understanding the determinants of individuals' perceptions of their risk of becoming infected with HIV and their perceptions of acceptable strategies of prevention is an essential step toward curtailing the spread of this disease. We focus in this article on learning and decision-making about AIDS in the context of high uncertainty about the disease and appropriate behavioral responses. We argue that social interactions are important for both. Using longitudinal survey data from rural Kenya and Malawi, we test this hypothesis. We investigate whether social interactions--and especially the extent to which social network partners perceive themselves to be at risk--exert causal influences on respondents' risk perceptions and on one approach to prevention, spousal communication about the threat of AIDS to the couple and their children. The study explicitly allows for the possibility that important characteristics, such as unobserved preferences or community characteristics, determine not only the outcomes of interest but also the size and composition of networks. The most important empirical result is that social networks have significant and substantial effects on risk perceptions and the adoption of new behaviors even after we control for unobserved factors. (author's) Language: English Keywords: KENYA | MALAWI | RESEARCH REPORT | SURVEYS | LONGITUDINAL STUDIES | SEXUAL PARTNERS | SEX BEHAVIOR | SOCIAL NETWORKS | PERCEPTION | RISK FACTORS | HIV TRANSMISSION | AIDS | DEVELOPING COUNTRIES | AFRICA, EASTERN | AFRICA, SUB SAHARAN | AFRICA | AFRICA, SOUTHERN | SAMPLING STUDIES | STUDIES | RESEARCH METHODOLOGY | BEHAVIOR | FRIENDS AND RELATIVES | FAMILY AND HOUSEHOLD | SOCIOCULTURAL FACTORS | PSYCHOLOGICAL FACTORS | BIOLOGY | HIV INFECTIONS | VIRAL DISEASES | DISEASES Document Number: 313229 A nested case -- control study of sexual practices and risk factors for prevalent HIV-1 infection among young men in Kisumu, Kenya. Author: Mattson CL; Bailey RC; Agot K; Ndinya-Achola JO; Moses S Source: Sexually Transmitted Diseases. 2007 Oct;34(10):731-736. Abstract: The objectives were to investigate sexual practices and risk factors for prevalent HIV infection among young men in Kisumu, Kenya. Goal: The goal of this study was to identify behaviors associated with HIV in Kisumu to maximize the effectiveness of future prevention programs. Lifetime sexual histories were collected from a nested sample of 1337 uncircumcised participants within the context of a randomized controlled trial of male circumcision to reduce HIV incidence. Sixty-five men (5%) tested positive for HIV. Multiple logistic regression revealed the following independent predictors of HIV: older age, less education, being married, being Catholic, >4 lifetime sex partners, prior treatment for an STI, sex during partner's menstruation, ever practicing bloodletting, and receipt of a medical injection in the last 6 months. Prior HIV testing and postcoital cleansing were protective. This analysis confirms the importance of established risk factors for HIV and identifies practices that warrant further investigation. (author's) Language: English Keywords: KENYA | RESEARCH REPORT | CASE CONTROL STUDIES | MEN | YOUTH | SEX BEHAVIOR | RISK BEHAVIOR | RISK FACTORS | HIV TRANSMISSION | MALE CIRCUMCISION | DEVELOPING COUNTRIES | AFRICA, EASTERN | AFRICA, SUB SAHARAN | AFRICA | STUDIES | RESEARCH METHODOLOGY | DEMOGRAPHIC FACTORS | POPULATION | AGE FACTORS | POPULATION CHARACTERISTICS | BEHAVIOR | BIOLOGY | HIV INFECTIONS | VIRAL DISEASES | DISEASES | MEDICAL PROCEDURES | MEDICINE | HEALTH SERVICES | DELIVERY OF HEALTH CARE | HEALTH Document Number: 320815 HIV-1 infection in high risk men who have sex with men in Mombasa, Kenya. Author: Sanders EJ; Graham SM; Okuku HS; van der Elst EM; Muhaari A Source: AIDS. 2007 Nov 30;21(18):2513-2520. Abstract: The role of homosexuality and anal sex practices in the African HIV -1 epidemic is not well described. We aimed to assess the risk factors for prevalent HIV-1 infection among men who have sex with men (MSM) to guide HIV-1 prevention efforts. Socio-behavioural characteristics, signs and symptoms of sexually transmitted diseases (STD), and serological evidence of HIV-1 were determined for 285MSM at enrolment into a vaccine preparedness cohort study. We used multivariate logistic regression to assess risk factors for prevalent HIV-1 infection. HIV-1 prevalence was 43.0% [49/114, 95% confidence interval (CI), 34-52%] for men who reported sex with men exclusively (MSME), and 12.3% (21/171, 95% CI, 7-17%) for men who reported sex with both men and women (MSMW). Eighty-six (75%) MSME and 69 (40%) MSMW reported recent receptive anal sex. Among 174 MSM sexually active in the last week, 44% reported no use of condoms with casual partners. In the previous 3 months, 210 MSM (74%) reported payment for sex, andmost clients (93%) were local residents. Prevalent HIV-1 infection was associated with recent receptive anal sex [odds ratio (OR), 6.1; 95% CI, 2.4-16], exclusive sex with men (OR, 6.3; 95% CI, 2.3-17), and increasing age (OR, 1.1 per year; 95% CI, 1.04-1.12). Only four MSM reported injecting drug use. The high prevalence of HIV-1 in Kenyan MSM is probably attributable to unprotected receptive anal sex. There is an urgent need for HIV-1 prevention programmes to deliver targeted risk-reduction interventions and STD services to MSM in Kenya. (author's) Language: English Keywords: KENYA | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | MULTIVARIATE ANALYSIS | HIV POSITIVE PERSONS | MEN HAVING SEX WITH MEN | MULTIPLE PARTNERS | IV DRUG USERS | HIV INFECTIONS | ANAL SEX | RISK FACTORS | SEX BEHAVIOR | CONDOM USE | PREVALENCE | AGE FACTORS | DEVELOPING COUNTRIES | AFRICA, EASTERN | AFRICA, SUB SAHARAN | AFRICA | RESEARCH METHODOLOGY | DATA ANALYSIS | PERSONS LIVING WITH HIV/AIDS | VIRAL DISEASES | DISEASES | BEHAVIOR | SEXUAL PARTNERS | DRUG USE AND ABUSE | BIOLOGY | RISK REDUCTION BEHAVIOR | MEASUREMENT | POPULATION CHARACTERISTICS | DEMOGRAPHIC FACTORS | POPULATION Document Number: 322762 Identification of novel risks for nonulcerative sexually transmitted infections among young men in Kisumu, Kenya. Author: Mehta SD; Moses S; Ndinya-Achola JO; Agot K; Maclean I Source: Sexually Transmitted Diseases. 2007 Nov;34(11):892-899. Abstract: STI prevention interventions often aim to reduce HIV incidence. Understanding STI risks may lead to more effective HIV prevention. The goal was to identify STI risks among men aged 18-24 in Kisumu, Kenya. We analyzed baseline data from a randomized trial of male circumcision. Participants were interviewed for sociodemographic and behavioral risks. Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) were diagnosed by polymerase chain reaction assay and Trichomonas vaginalis (TV) by culture. The outcome for logistic regression analysis was infection with NG, CT, or TV. Among 2743 men, 214 (7.8%; 95% CI: 6.8%-8.8%) were infected with any STI. In multivariable analysis, statistically significant risks for infection were: living one's whole life in Kisumu (OR = 1.50; 95% CI: 1.12-2.01), preferring "dry" sex (OR = 1.47; 95% CI: 1.05-2.07), HSV-2 seropositivity (OR = 1.37; 95% CI: 1.01-1.86), and inability to ejaculate during sex (OR = 2.04; 95% CI: 1.15-3.62). Risk decreased with increasing age and education, and cleaning one's penis less than 1 hour after sex (OR = 0.51; 95% CI: 0.33-0.80). Understanding how postcoital cleaning, "dry" sex, and sexual dysfunction relate to STI acquisition may improve STI and HIV prevention. (author's) Language: English Keywords: KENYA | RESEARCH REPORT | INTERVIEWS | MULTIVARIATE ANALYSIS | MEN | SEXUALLY TRANSMITTED DISEASES | RISK BEHAVIOR | SEX BEHAVIOR | RISK ASSESSMENT | SEX EDUCATION | RISK REDUCTION BEHAVIOR | LABORATORY PROCEDURES | DEVELOPING COUNTRIES | AFRICA, EASTERN | AFRICA, SUB SAHARAN | AFRICA | DATA COLLECTION | RESEARCH METHODOLOGY | DATA ANALYSIS | DEMOGRAPHIC FACTORS | POPULATION | REPRODUCTIVE TRACT INFECTIONS | INFECTIONS | DISEASES | BEHAVIOR | EVALUATION | EDUCATION | LABORATORY EXAMINATIONS AND DIAGNOSES | EXAMINATIONS AND DIAGNOSES | MEDICAL PROCEDURES | MEDICINE | HEALTH SERVICES | DELIVERY OF HEALTH CARE | HEALTH |