Research on human immunodeficiency virus (HIV) in Malawi: the Johns Hopkins University- Ministry of Health (JHU-MOH) project

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Intravaginal and Menstrual Practices among Women Working in Food and Recreational Facilities in Mwanza, Tanzania: Implications for Microbicide Trials

Intravaginal and menstrual practices may potentially influence results of trials of microbicides for HIV prevention through effects on the vaginal environment and on adherence to microbicide and placebo products. As part of the feasibility study for the Microbicides Development Programme Phase 3 trial of a vaginal microbicide in Mwanza, a variety of quantitative and qualitative methods were used to describe these practices, associations with behaviour and underlying social norms among women working in food and recreational facilities. Intravaginal cleansing by inserting fingers and either water alone or soap and water was thought necessary to remove “uchafu” (dirt), referring to vaginal secretions, including menstrual blood and post-coital discharge. Vaginal cleansing was carried out within 2 hours after 45% of sex acts. Sexual enhancement practices were less common. Intravaginal and menstrual practices and associated behaviours and demographic factors should be measured and monitored throughout microbicide trials to enable analyses of their impacts on microbicide effectiveness

Socioeconomic status and risk of HIV infection in an urban population in Kenya.

OBJECTIVE: To examine the relationship between socioeconomic status (SES), risk factors for HIV infection and HIV status in an urban population with high prevalence of HIV infection in sub-Saharan Africa. METHODS: Cross-sectional population survey of adults from the city of Kisumu, Kenya, in 1996. Around 1000 men and 1000 women aged 15-49 years were interviewed using a structured questionnaire, and most gave a venous blood sample for HIV testing. SES was represented by a composite variable of educational status, occupation and household utilities. Multiple regression was used to examine whether SES was associated with HIV infection or with risk factors for HIV infection. RESULTS: Human immunodeficiency virus prevalence was 19.8% in males and 30.2% in females. Higher SES was associated with a more mobile lifestyle, later sexual debut and marriage among both sexes, and with circumcision among men aged 25-49 and condom use among women aged 25-49. Higher levels of alcohol consumption were associated with an increased risk of HIV infection and were more common amongst those of higher SES. HSV-2 infection was strongly associated with an increased risk of HIV infection and was more common among those of lower SES. HIV was associated with a lower SES among females aged 15-24 whereas in males aged 15-24 and females aged 25-49 there was some indication that it was associated with higher SES. Among males aged 25-49 there was no association between HIV infection and SES. CONCLUSIONS: Risk of infection was high among groups of all SES. Risk profiles suggested men and women of lower SES maybe at greater risk of newly acquired HIV infection. New infections may now be occurring fastest among young women of the lowest SES

Using urinary leucocyte esterase tests as an indicator of infection with gonorrhoea or chlamydia in asymptomatic males in a primary health care setting

To evaluate a leucocyte esterase test as a predictor of gonorrhoea or chlamydia in asymptomatic Aboriginal males at the Central Australian Aboriginal Congress Male Clinic (Ingkintja), first-void urine samples and clinical information were collected from consecutive asymptomatic males presenting to the Ingkintja in Alice Springs between March 2008 and December 2009. Urine was tested immediately with a leucocyte esterase test dipstick and then by polymerase chain reaction for gonorrhoea and chlamydia. Among the 292 specimens from asymptomatic males, 15.4% were positive for gonorrhoea or chlamydia. In this group, compared with polymerase chain reaction result for gonorrhoea or chlamydia, leucocyte esterase test alone and in combination with age =35 years showed sensitivities of 66.7% and 60%, specificities of 90.7% and 94.7%, positive predictive values of 56.6% and 67.5%, negative predictive values of 93.7% and 92.8% and the area under receiver operating characteristics curve values of 0.79 and 0.85, respectively. Leucocyte esterase tests can reasonably be used as a basis for immediate empirical treatment for gonorrhoea or chlamydia in asymptomatic central Australian Aboriginal men under 35 years of age. © The Author(s) 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav

Economy, Migrant Labour and Sex Work: Interplay of Hiv Epidemic Drivers in Zimbabwe over Three Decades

Background: HIV took off rapidly in Zimbabwe during the 1980s. Yet, between 1998 and 2003, as the economy faltered, HIV prevalence declined abruptly and without clear explanation.Methods: We reviewed epidemiological, behavioural, and economic data over three decades to understand changes in economic conditions, migrant labour and sex work that may account for observed fluctuations in Zimbabwe’s HIV epidemic. Potential biases related to changing epidemic paradigms and data sources were examined.Results: Early studies describe rural poverty, male migrant labour and sex work as conditions facilitating HIV/STI transmission. By the mid-1990s, as Zimbabwe’s epidemic became more generalized, research focus shifted to general population household surveys. Yet, less than half as many men than women were found at home during surveys in the 1990s, increasing to 80% during the years of economic decline. Other studies suggest that male demand for sex work fell abruptly as migrant workers were laid off, picking up again when the economy rebounded after 2009. Numbers of clients reported by sex workers, and their STI rates, followed similar patterns reaching a nadir in the early 2000s. Studies from 2009 describe a return to more active sex work, linked to increasing client demand, as well as a revitalized programme reaching sex workers.Conclusion: The importance of the downturn in migrant labour and resultant changes in sex work may be underestimated as drivers of Zimbabwe’s rapid HIV incidence and prevalence declines. Household surveys underrepresent populations at the highest risk of HIV/STI acquisition and transmission, and these biases vary with changing economic conditions.</p

Educational attainment and HIV-1 infection in developing countries: a systematic review.

OBJECTIVES: To assess whether educational status is associated with HIV-1 infection in developing countries by conducting a systematic review of published literature. METHODS: Articles were identified through electronic databases and hand searching key journals. Studies containing appropriately analysed individual level data on the association between educational attainment and HIV-1 status in general population groups were included. RESULTS: Twenty-seven articles with appropriately analysed results from general population groups in developing countries were identified, providing information on only six countries. Large studies in four areas in Africa showed an increased risk of HIV-1 infection among the more educated, whilst among 21-year-old Thai army conscripts, longer duration of schooling was strongly protective against HIV infection. The association between education and schooling in Africa was stronger in rural areas and in older cohorts, but was similar in men and women. Serial prevalence studies showed little change in the association between schooling and HIV over time in Tanzania, but greater decreases in HIV prevalence among the more educated in Uganda, Zambia and Thailand. CONCLUSIONS: In Africa, higher educational attainment is often associated with a greater risk of HIV infection. However, the pattern of new HIV infections may be changing towards a greater burden among less educated groups. In Thailand those with more schooling remain at lower risk of HIV infection