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: 322078 Human papillomavirus detection by penile site in young men from Kenya. Author: Smith JS; Moses S; Hudgens MG; Agot K; Franceschi S Source: Sexually Transmitted Diseases. 2007 Nov;34(11):928-934. Abstract: Limited data are available on whether sampling from the penile shaft or urethra increases detection of penile HPV infection in men beyond that found in the glans and coronal sulcus. Within a randomized clinical trial, a validation study of penile sampling was conducted in Kisumu, Kenya. Young men (18-24 years) were invited to provide penile exfoliated cells using prewetted Dacron swabs to determine the best site for HPV detection. beta-Globin gene PCR and HPV DNA type GP5+/6+ PCR status were ascertained from 3 anatomical sites. A total of 98 young HIV-seronegative, uncircumcised men participated. Penile HPV prevalence varied by anatomical site: 50% in penile exfoliated cells from the glans, coronal sulcus, and inner foreskin tissue; 43% in the shaft and external foreskin tissue; and 18% in the urethra (P less than 0.0001). For each anatomical site, over 87% of samples were beta-globin positive. Beyond that found in the glans/coronal sulcus, urethral sampling resulted in no increase in HPV positivity andshaft sampling resulted in an additional 7.3% of overall HPV positivity. The prevalence of high-risk HPV positivity varied by anatomical site: 39% in glans/coronal sulcus, 31% in shaft, and 13% in the urethra (P less than 0.0001). HPV 16 was the most common type identified. Penile HPV prevalence was approximately 50% among young men in Kisumu, Kenya. Urethral sampling for HPV detection in men added no sensitivity for HPV detection over that found from sampling the glans/coronal sulcus and penile shaft. These data will help inform studies on HPV transmission dynamics, and on the efficacy of HPV prophylactic vaccines on penile HPV carriage in men. (author's) Language: English Keywords: KENYA | RESEARCH REPORT | CLINICAL TRIALS | MEN | HPV | PREVALENCE | TRANSMISSION | GENITALIA, MALE | RISK FACTORS | DEVELOPING COUNTRIES | AFRICA, EASTERN | AFRICA, SUB SAHARAN | AFRICA | CLINICAL RESEARCH | RESEARCH METHODOLOGY | DEMOGRAPHIC FACTORS | POPULATION | VIRAL DISEASES | DISEASES | MEASUREMENT | INFECTIONS | GENITALIA | UROGENITAL SYSTEM | PHYSIOLOGY | BIOLOGY Document Number: 321672 Female sex workers and unsafe sex in urban and rural Nyanza, Kenya: regular partners may contribute more to HIV transmission than clients. Author: Voeten HA; Egesah OB; Varkevisser CM; Habbema JD Source: Tropical Medicine and International Health. 2007 Feb;12(2):174-182. Abstract: The objectives were to compare the sexual behaviour of female sex workers in urban and rural areas in Nyanza province in Kenya, and to compare their unsafe sex with clients and with regular partners. In a cross-sectional study among 64 sex workers (32/32 in urban/rural areas), sex workers kept a sexual diary for 14 days after being interviewed face-to-face. Most sex workers were separated/divorced and had one or two regular partners, who were mostly married to someone else. Sex workers in Kisumu town were younger, had started sex work at an earlier age, and had more clients in the past 14 days than rural women (6.6 vs. 2.4). Both groups had an equal number of sex contacts with regular partners (4.7). With clients, condom use was fairly frequent (75%) but with regular partners, it was rather infrequent (< 40%). For both urban and rural areas, the mean number of sex acts in which no condom was used was greater for regular partners (3.2 and 2.8 respectively) than for clients (1.9 and 1.0 respectively). Sex workers in urban and rural areas of Nyanza province practise more unsafe sex with regular partners than with clients. Interventions for sex workers should also focus on condom use in regular partnerships. (author's) Language: English Keywords: KENYA | RESEARCH REPORT | KAP SURVEYS | COMPARATIVE STUDIES | SEX WORKERS | SEXUAL PARTNERS | RURAL POPULATION | URBAN POPULATION | WOMEN IN DEVELOPMENT | SEX BEHAVIOR | RISK ASSESSMENT | AGE FACTORS | MARITAL STATUS | RISK FACTORS | CONDOM USE | AFRICA, EASTERN | AFRICA SOUTH OF THE SAHARA | AFRICA | DEVELOPING COUNTRIES | SURVEYS | SAMPLING STUDIES | STUDIES | RESEARCH METHODOLOGY | BEHAVIOR | POPULATION CHARACTERISTICS | DEMOGRAPHIC FACTORS | POPULATION | ECONOMIC DEVELOPMENT | ECONOMIC FACTORS | EVALUATION | NUPTIALITY | BIOLOGY | RISK REDUCTION BEHAVIOR Document Number: 312140 Kenya's mixed HIV / AIDS response. Author: Wakabi W Source: Lancet. 2007 Jan 6;369(9555):17-18. Abstract: Government delays providing audited accounts to the Global Fund to Fight AIDS, Tuberculosis, and Malaria, could harm Kenya's anti-AIDS efforts, say some faith-based groups. But the government insists its strict procedures ensure money is well spent. Wairagala Wakabi reports. Kenya says though it has managed a small reduction in HIV/AIDS prevalence rate over the past year, delays by donors like the Global Fund for HIV/ AIDS, Tuberculosis, and Malaria to release funds could harm the country's anti-AIDS campaign. In November, Kenya received an additional US$70 million from the Global Fund to support its fight against tuberculosis and HIV/AIDS. The release of the funds came after months of wrangles between government and faith-based agencies, which have accused authorities of failing to account for Global Fund monies and jeopardising Kenya's chances of receiving more funds. Until a few years ago, the country had kept its AIDS problem under wraps for fear of scaring away tourists, given that tourism is the country's highest foreign exchange earner. (excerpt) Language: English Keywords: KENYA | PROGRESS REPORT | EVALUATION | FAITH-BASED ORGANIZATION | GOVERNMENT | TUBERCULOSIS | MALARIA | FINANCING, GOVERNMENT | FUNDS | HIV PREVENTION | FOREIGN AID | EXPENDITURES | PREVALENCE | STIGMA | ANTIRETROVIRAL THERAPY | AFRICA, EASTERN | AFRICA, SUB SAHARAN | AFRICA | DEVELOPING COUNTRIES | ORGANIZATIONS | POLITICAL FACTORS | SOCIOCULTURAL FACTORS | INFECTIONS | DISEASES | PARASITIC DISEASES | FINANCIAL ACTIVITIES | ECONOMIC FACTORS | HIV INFECTIONS | VIRAL DISEASES | MEASUREMENT | RESEARCH METHODOLOGY | SOCIAL PROBLEMS | HIV Document Number: 310737 Female genital cutting and HIV / AIDS among Kenyan women. Author: Yount KM; Abraham BK Source: Studies in Family Planning. 2007 Jun;38(2):73-88. Abstract: Female genital cutting (FGC) and HIV/AIDS are both highly prevalent in sub-Saharan Africa, and researchers have speculated that the association may be more than coincidental. Data from 3,167 women aged 15-49 who participated in the 2003 Kenya Demographic and Health Survey (KDHS) are used to test the direct and indirect associations of FGC with HIV. Our adjusted models suggest that FGC is not associated directly with HIV, but is associated indirectly through several pathways. Cut women are 1.72 times more likely than uncut women to have older partners, and women with older partners are 2.65 times more likely than women with younger partners to test positive for HIV. Cut women have 1.94 times higher odds than uncut women of initiating sexual intercourse before they are 20, and women who experience their sexual debut before age 20 have 1.73 times higher odds than those whose sexual debut comes later of testing positive for HIV. Cut women have 27 percent lower odds of having at least one extra-union partner, and women with an extra-union partner have 2.63 times higher odds of testing positive for HIV. Therefore, in Kenya, FGC may be an early life-course event that indirectly alters women's odds of becoming infected with HIV through protective and harmful practices in adulthood. (author's) Language: English Keywords: KENYA | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | DEMOGRAPHIC AND HEALTH SURVEYS | WOMEN IN DEVELOPMENT | HIV POSITIVE PERSONS | SEXUAL PARTNERS | MULTIPLE PARTNERS | FEMALE GENITAL CUTTING | PREVALENCE | RISK BEHAVIOR | AGE FACTORS | HIV TRANSMISSION | EXTRAMARITAL SEX BEHAVIOR | SEX BEHAVIOR | AFRICA, EASTERN | AFRICA SOUTH OF THE SAHARA | AFRICA | DEVELOPING COUNTRIES | RESEARCH METHODOLOGY | DEMOGRAPHIC SURVEYS | POPULATION DYNAMICS | DEMOGRAPHIC FACTORS | POPULATION | ECONOMIC DEVELOPMENT | ECONOMIC FACTORS | PERSONS LIVING WITH HIV/AIDS | HIV INFECTIONS | VIRAL DISEASES | DISEASES | BEHAVIOR | HARMFUL TRADITIONAL PRACTICES | TRADITIONAL HEALTH PRACTICES | CULTURE | SOCIOCULTURAL FACTORS | MEASUREMENT | POPULATION CHARACTERISTICS Document Number: 313583 Male circumcision for HIV prevention: The research evidence and some critical responses. Source: Reproductive Health Matters. 2007 May;15(29):9-10. Abstract: Three randomised clinical trials, in South Africa, Uganda and Kenya, have shown a substantial reduction in female-to-male transmission of HIV to men who had been circumcised as compared to men who had not, during a follow-up period of up to 24 months. The question of what to do with this evidence is currently being debated around the world. WHO and UNAIDS took the lead by developing technical, policy and programmatic guidance following a series of consultations with a range of stakeholders in the field, using the research evidence as the basis. Consensus on many aspects of this matter is far from being achieved, however. Many questions and different points of view are emerging - clinical, public health, sociological, anthropological and cultural; in relation to priority setting in HIV prevention and delivery of health services; and in relation to sexuality, ethics, gender and rights. On 28 March 2007, WHO and UNAIDS published a set of conclusions and recommendations regarding the research implications for HIV policy and programming. The introduction and excerpts from these follow below. They are, in turn, followed by a roundtable of nine papers which contain a range of critical thinking and analysis of these issues. Male circumcision is generating debate across the globe. This can only be a good thing, as it is a complex matter and far more than a straightforward public health intervention. We hope these papers will help to inform that debate. (author's) Language: English Keywords: KENYA | SOUTH AFRICA | UGANDA | RESEARCH REPORT | CLINICAL TRIALS | MEN | MALE CIRCUMCISION | GENDER ISSUES | SEXUALITY | SAFER SEX | HIV TRANSMISSION | HEALTH POLICY | HIV PREVENTION | PROGRAM EVALUATION | AFRICA, EASTERN | AFRICA SOUTH OF THE SAHARA | AFRICA | DEVELOPING COUNTRIES | AFRICA, SOUTHERN | CLINICAL RESEARCH | RESEARCH METHODOLOGY | DEMOGRAPHIC FACTORS | POPULATION | MEDICAL PROCEDURES | MEDICINE | HEALTH SERVICES | DELIVERY OF HEALTH CARE | HEALTH | SOCIOCULTURAL FACTORS | PERSONALITY | PSYCHOLOGICAL FACTORS | BEHAVIOR | SEX BEHAVIOR | HIV INFECTIONS | VIRAL DISEASES | DISEASES | POLICY | POLITICAL FACTORS | PROGRAMS | ORGANIZATION AND ADMINISTRATION Document Number: 316690 Sex with an Ugly Man: Cleansing Widows in the Era of HIV/AIDS in Siaya District, Kenya. Author: Ambasa-Shisanya C., Institution: Kenyatta University, School of Humanities & Social Sciences, Philosophy & Religious Studies Department, Nairobi, Kenya Abstract: This paper presents findings of a study that investigated the implications of widowhood rites on the socio-economic development of Siaya District, Kenya. The objective of the paper is to provide insights into reasons for continuity of widowhood rites and consequences of the cleansing ritual on the socio-economic development of Siaya District. The paper addresses the following questions: Why do some widows engage in an apparent life threatening cleansing ritual? What are the qualities and socio-economic status of widows and professional cleansers who engage in this ritual? Do widows have alternative coping mechanisms? What are the effects of the widow cleansing ritual on the socio-economic development of Siaya District? Data were collected from 2003 to 2004 in three divisions of Siaya District: Boro, Ukwala and Yala. The data were mainly qualitative and were generated using focus group discussions (FGDs) and in-depth interviews. Eight FGDs were conducted with youth, adults and elderly respondents of varied sex in each division, giving a total of twenty four sessions. Additionally, twenty in-depth interviews were conducted with key respondents and widows. Data were analyzed using content analysis. Results revealed that Luo widows are believed to acquire contagious cultural impurity "chira" after the death of spouses. Widows are perceived as a source of danger to offspring and the community. To neutralize this impure state, Luo widows are expected to observe cleansing rites involving a sexual component. In the indigenous setting, the ritual was observed by a brother-in-law or cousin to the deceased through a guardianship institution. However, with the emergence of HIV/AIDS, professional cleansers are hired to perform the sex ritual. Professional cleansers usually look ugly, drunken, poor and dirty. If the deceased spouses were HIV/AIDS seropositive, the cleansing ritual places professional cleansers at risk of infection. Thereafter, they could act as a bridge for HIV/ AIDS transmission to other widows and to the general population thereby increasing morbidity, mortality and slowing down socio-economic development. However, some widows use Christianity, education and economic empowerment as coping mechanisms to shield themselves from cultural violence against widows through mandatory cleansing ritual. Others propose condom use, though most cleansers reject them because of myths about condoms and excessive alcohol use. Some cleansed widows engage in sexual relationships for survival. These findings call for efforts to increase awareness about the widows' rights, window period, condom myths, alcohol abuse, re-evaluation of widowhood rites and reduction of poverty as risk factors for HIV/AIDS transmission. Keywords: COPING MECHANISMS| CULTURAL| VIOLENCE AGAINST WIDOWS| HIV/AID5| PROFESSIONAL SEX CLEANSERS| WIDOWS' RIGHTS. Male circumcision for HIV prevention: A prospective study of complications in clinical and traditional settings in Bungoma, Kenya. Author: Bailey RC; Egesah O; Rosenberg S. DP: 2008 Abstract: Male circumcision reduces the risk of HIV acquisition by approximately 60%. Male circumcision services are now being introduced in selected populations in sub-Saharan Africa and further interventions are being planned. A serious concern is whether male circumcision can be provided safely to large numbers of adult males in developing countries. This prospective study was conducted in the Bungoma district, Kenya, where male circumcision is universally practised. Young males intending to undergo traditional or clinical circumcision were identified by a two-stage cluster sampling method. During the July-August 2004 circumcision season, 1007 males were interviewed 30-89 days post- circumcision. Twenty-four men were directly observed during and 3, 8, 30 and 90 days post-circumcision, and 298 men underwent clinical exams 45-89 days post-procedure. Twenty-one traditional and 20 clinical practitioners were interviewed to assess their experience and training. Inventories of health facilities were taken to assess the condition of instruments and supplies necessary for performing safe circumcisions. Of 443 males circumcised traditionally, 156 (35.2%) experienced an adverse event compared with 99 of 559 (17.7%) circumcised clinically (odds ratio: 2.53; 95% confidence interval: 1.89-3.38). Bleeding and infection were the most common adverse effects, with excessive pain, lacerations, torsion and erectile dysfunction also observed. Participants were aged 5 to 21 years and half were sexually active before circumcision. Practitioners lacked knowledge and training. Proper instruments and supplies were lacking at most health facilities. Extensive training and resources will be necessary in sub-Saharan Africa before male circumcision can be aggressively promoted for HIV prevention. Two-thirds of African men are circumcised, most by traditional or unqualified practitioners in informal settings. Safety of circumcision in communities where it is already widely practised must not be ignored. (author's) : Male circumcision reduces the risk of HIV acquisition by approximately 60%. Male circumcision services are now being introduced in selected populations in sub-Saharan Africa and further interventions are being planned. A serious concern is whether male circumcision can be provided safely to large numbers of adult males in developing countries. This prospective study was conducted in the Bungoma district, Kenya, where male circumcision is universally practised. Young males intending to undergo traditional or clinical circumcision were identified by a two-stage cluster sampling method. During the July-August 2004 circumcision season, 1007 males were interviewed 30-89 days post- circumcision. Twenty-four men were directly observed during and 3, 8, 30 and 90 days post-circumcision, and 298 men underwent clinical exams 45-89 days post-procedure. Twenty-one traditional and 20 clinical practitioners were interviewed to assess their experience and training. Inventories of health facilities were taken to assess the condition of instruments and supplies necessary for performing safe circumcisions. Of 443 males circumcised traditionally, 156 (35.2%) experienced an adverse event compared with 99 of 559 (17.7%) circumcised clinically (odds ratio: 2.53; 95% confidence interval: 1.89-3.38). Bleeding and infection were the most common adverse effects, with excessive pain, lacerations, torsion and erectile dysfunction also observed. Participants were aged 5 to 21 years and half were sexually active before circumcision. Practitioners lacked knowledge and training. Proper instruments and supplies were lacking at most health facilities. Extensive training and resources will be necessary in sub-Saharan Africa before male circumcision can be aggressively promoted for HIV prevention. Two-thirds of African men are circumcised, most by traditional or unqualified practitioners in informal settings. Safety of circumcision in communities where it is already widely practised must not be ignored. (author's) Language: English Keywords: KENYA | RESEARCH REPORT | PROSPECTIVE STUDIES | CLINICAL RESEARCH | MEN | MALE CIRCUMCISION | TRADITIONAL HEALTH PRACTICES | COMPLICATIONS | HIV PREVENTION | HEALTH SERVICES EVALUATION | AFRICA, EASTERN | AFRICA, SUB SAHARAN | AFRICA | DEVELOPING COUNTRIES | STUDIES | RESEARCH METHODOLOGY | DEMOGRAPHIC FACTORS | POPULATION | MEDICAL PROCEDURES | MEDICINE | HEALTH SERVICES | DELIVERY OF HEALTH CARE | HEALTH | CULTURE | SOCIOCULTURAL FACTORS | DISEASES | HIV INFECTIONS | VIRAL DISEASES | PROGRAM EVALUATION | PROGRAMS | ORGANIZATION AND ADMINISTRATION Document Number: 328092 HIV testing and counselling for women attending child health clinics: An opportunity for entry to prevent mother-to-child transmission and HIV treatment. Author: Chersich MF; Luchters SM; Othigo MJ; Yard E; Mandaliya K Source: International Journal of STD and AIDS. 2008 Jan Abstract: This study assessed the potential for HIV testing at child health clinics to increase knowledge of HIV status, and entry to infant feeding counselling and HIV treatment. At a provincial hospital in Mombasa, Kenya, HIV testing and counselling were offered to women bringing their child for immunization or acute care services. Most women said HIV testing should be offered in these clinics (472/493, 95.7%), with many citing the benefits of regular testing and entry to prevent mother-to-child transmission. Of 500 women, 416 (83.4%) received test results, 97.6% on the same day. After 50 participants, point-of-care testing replaced laboratory-based rapid testing. Uptake increased 2.6 times with point-of-care testing (95% confidence interval = 1.4-5.1; P = 0.003). Of 124 women who had not accessed HIV testing during pregnancy, 98 tested in the study (79.0%). Measured by uptake and attitudes, HIV testing in child health clinics is acceptable. This could optimize entry into HIV treatment, infant feeding counselling and family planning services. (author's) Langauage: English Keywords: KENYA | RESEARCH REPORT | SURVEYS | MOTHERS | INFANT | PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | HIV TESTING | COUNSELING | CHILD HEALTH SERVICES | HIV INFECTIONS | TREATMENT | BREASTFEEDING | DEVELOPING COUNTRIES | AFRICA, EASTERN | AFRICA, SUB SAHARAN | AFRICA | SAMPLING STUDIES | STUDIES | RESEARCH METHODOLOGY | PARENTS | FAMILY RELATIONSHIPS | FAMILY CHARACTERISTICS | FAMILY AND HOUSEHOLD | SOCIOCULTURAL FACTORS | YOUTH | AGE FACTORS | POPULATION CHARACTERISTICS | DEMOGRAPHIC FACTORS | POPULATION | DISEASE TRANSMISSION CONTROL | PREVENTION AND CONTROL | DISEASES | LABORATORY EXAMINATIONS AND DIAGNOSES | EXAMINATIONS AND DIAGNOSES | MEDICAL PROCEDURES | MEDICINE | HEALTH SERVICES | DELIVERY OF HEALTH CARE | HEALTH | CLINIC ACTIVITIES | PROGRAM ACTIVITIES | PROGRAMS | ORGANIZATION AND ADMINISTRATION | MATERNAL-CHILD HEALTH SERVICES | PRIMARY HEALTH CARE | VIRAL DISEASES | INFANT NUTRITION | NUTRITION |