No Association between HIV and Intimate Partner Violence among Women in 10 Developing Countries

Intimate Partner Violence (IPV) has been reported to be a determinant of women's risk for HIV. We examined the relationship between women's self-reported experiences of IPV in their most recent relationship and their laboratory-confirmed HIV serostatus in ten low- to middle-income countries.Data for the study came from the most recent Demographic and Health Surveys conducted in Dominican Republic, Haiti, India, Kenya, Liberia, Malawi, Mali, Rwanda, Zambia and Zimbabwe. Each survey population was a cross-sectional sample of women aged 15-49 years. Information on IPV was obtained by a face-to-face interview with the mother with an 81.1% response rate; information on HIV serostatus was obtained from blood samples with an 85.3% response rate. Demographic and socioeconomic variables were considered as potentially confounding covariates. Logistic regression models accounting for multi-stage survey design were estimated individually for each country and as a pooled total with country fixed effects (n = 60,114). Country-specific adjusted odds ratios (OR) for physical or sexual IPV compared to neither ranged from 0.45 [95% confidence interval (CI): 0.23-0.90] in Haiti to 1.35 [95% CI: 0.95-1.90] in India; the pooled association was 1.03 [95% CI: 0.94-1.13]. Country-specific adjusted ORs for physical and sexual IPV compared to no sexual IPV ranged from 0.41 [95% CI: 0.12-1.36] in Haiti to 1.41 [95% CI: 0.26-7.77] in Mali; the pooled association was 1.05 [95% CI: 0.90-1.22].IPV and HIV were not found to be consistently associated amongst ever-married women in national population samples in these lower income countries, suggesting that IPV is not consistently associated with HIV prevalence worldwide. More research is needed to understand the circumstances in which IPV and HIV are and are not associated with one another

Improving Outcomes in Infants of HIV-Infected Women in a Developing Country Setting

Since 1999 GHESKIO, a large voluntary counseling and HIV testing center in Port-au-Prince, Haiti, has had an ongoing collaboration with the Haitian Ministry of Health to reduce the rate of mother to child HIV transmission. There are limited data on the ability to administer complex regimens for reducing mother to child transmission and on risk factors for continued transmission and infant mortality within programmatic settings in developing countries.We analyzed data from 551 infants born to HIV-infected mothers seen at GHESKIO, between 1999 and 2005. HIV-infected mothers and their infants were given "short-course" monotherapy with antiretrovirals for prophylaxis; and, since 2003, highly active antiretroviral therapy (HAART) when clinical or laboratory indications were met. Infected women seen in the pre-treatment era had 27% transmission rates, falling to 10% in this cohort of 551 infants, and to only 1.9% in infants of women on HAART. Mortality rate after HAART introduction (0.12 per year of follow-up [0.08-0.16]) was significantly lower than the period before the availability of such therapy (0.23 [0.16-0.30], P<0.0001). The effects of maternal health, infant feeding, completeness of prophylaxis, and birth weight on mortality and transmission were determined using univariate and multivariate analysis. Infant HIV-1 infection and low birth weight were associated with infant mortality in less than 15 month olds in multivariate analysis.Our findings demonstrate success in prevention of mother-to-child HIV transmission and mortality in a highly resource constrained setting. Elements contributing to programmatic success include provision of HAART in the context of a comprehensive program with pre and postnatal care for both mother and infant

Health equity issues at the local level: Socio-geography, access, and health outcomes in the service area of the Hôpital Albert Schweitzer-Haiti

<p>Abstract</p> <p>Background</p> <p>Although health equity issues at regional, national and international levels are receiving increasing attention, health equity issues at the local level have been virtually overlooked. Here, we describe here a comprehensive equity assessment carried out by the Hôpital Albert Schweitzer-Haiti (HAS) in 2003. HAS has been operating health and development programs in the Artibonite Valley of Haiti for 50 years.</p> <p>Methods</p> <p>We reviewed all available information arising from a comprehensive evaluation of the programs of HAS carried out in 1999 and 2000. As part of this evaluation, two demographic and health surveys were carried out. We carried out exit interviews with clients receiving primary health care, observations within health facilities, interviews with households related to quality of care, and focus group discussions with community-based health workers. A special study was carried out in 2003 to assess factors determining the use of prenatal care services. Finally, selected findings were obtained from the HAS information system.</p> <p>Results</p> <p>We found markedly reduced access to health services in the peripheral mountainous areas compared to the central plains. The quality of services was more deficient and the coverage of key services was lower in the mountains. Finally, health status, as measured by under-five mortality rates and levels of childhood malnutrition, was also worse in the mountains.</p> <p>Conclusion</p> <p>These findings indicate that local health programs need to give attention to monitoring the health status as well as the quality and coverage of basic services among marginalized groups within the program service area. Health inequities will not be overcome until such monitoring occurs and leaders of health programs ensure that inequities identified are addressed in the local programming of activities. It is quite likely that, within relatively small geographic areas in resource-poor settings around the world, similar, if not even greater, levels of health inequities exist. These inequities need to be measured and addressed in order for health programs to achieve equity and maximum improvement in health status within the population.</p

Final report / Tuberculosis (Haiti)

Titre restitu

Séroprévalence de l'infection au VIH-1 chez les femmes qui viennet d'accoucher

Abstract provided in EnglishThe table of contents for this item can be shared with the requester. The requester may then choose one chapter, up to 10% of the item, as per the Fair Dealing provision of the Canadian Copyright ActLes objectifs de cette recherche étaient donc d'estimer le taux d'infection au VIH-1 chez les femmes haïtiennes qui viennent d'accoucher dans la zone métropolitaine et dans le reste du pays ainsi qu'à l'échelle nationale. Un deuxième objectif était de valider un nouveau test sur papier filtre "l'immunodot dipstick test" développé par le laboratoire Programme for Appropriate Technology in Health (PATH). Cette étude a été réalisée par l'INSTITUT HAÏTIEN DE L'ENFANCE en collaboration avec le CENTRE D'ÉTUDES SUR LE SIDA DE MONTRÉAL au cours des années 91-92. Un plan d'échantillonage stratifiée par grappe a été utilisé. L'échantillon comprenait 60 grappes réparties en deux grandes strates définies sur une base géographique : une métropolitaine, une extra métropolitaine (le reste du pays). Le critère de sélection utilisé pour inclure des femmes dans cette enquête était qu'elles devaient avoir accouché durant l'année précédant le passage de l'enquête. L'échantillon comprenait mille deux cent quarante-cinq (1 245) femmes dont six cent douze (612) en strate métropolitaine et six cent trente-trois (633) en strate extra métropolitaine. Il s'agissait d'une enquête anonyme où les femmes pouvaient librement accepter d'y participer ou non. L'étude a été entreprise avec l'accord des comités d'éthique des différents organismes qui ont collaboré à cette recherche.After making its first appearance in Haiti in 1979, AIDS rapidly became a major public health problem. Initially confined to the male population, HIV infection spread quickly to women and subsequently to their newborns. The extent and severity of HIV disease dictated the urgent need to estimate the prevalence of HIV infection among women of childbearing age. The objectives of this study were to estimate HIV-1 infection rates in metropolitan areas, extra-metropolitan areas, and at the country level among Haitian women who had recently given birth. A second objective was to assess the test performance characteristics of the immunodot dipstick test developed by the Program for Appropriate Technology in Health (PATH). The study was undertaken in 1991-92 by the lnstitut haïtien de l'Enfance in collaboration with the Centre for AIDS Studies in Montreal. A cluster sampling strategy was used. The overall sample included 60 clusters divided among two geographically defined strata: metropolitan and extra-metropolitan (the rest of the country). The only selection criteria used to include women in the study was that of having given birth in the prior twelve months. The total sample size was 1,245 women of whom 612 were located in the metropolitan stratum and 633 in the extra-metropolitan stratum. Women were free to either accept or refuse participation in this anonymous unlinked study. Ethical approval was sought and provided by the ethics committees of the various organizations collaborating in this research..

Mechanistic changeover for the water substitution on fac-[(CO)(3)Re(H(2)O)(3)](+) revealed by high-pressure NMR

Copyright © 2004 American Chemical SocietyPascal V. Grundler, Bernadette Salignac, Sonia Cayemittes, Roger Alberto, and André E. Merbac