Determinants of Fertility Desires and Intentions among HIV Infected and Uninfected Women and Contraceptive use among HIV-infected women in the study at Six hospitals in two regions of Kenya

HIV epidemic in Kenya is geographically diverse ranging from a prevalence of 26 percent and 0.4 percent. Evidence indicates that a higher proportion of HIV infected women are more likely to be associated with unintended pregnancies.Despite this evidence, little is known about determinants of fertility desires and intentions of HIVinfectedand HIV-uninfected women in Kenya. 437 HIV-infected and 365 HIV-uninfected women were enrolled in the study. Using a cross-sectional mixed method, the study sought to investigate determinants of fertility desires and intentions among HIV-infected and uninfected women, and further determined factors associated with desire and intention to use contraceptives among HIV-infected women. Focus group discussions and key informant interviews were conducted with HIV-infected and uninfected women and Health providers respectively. Sampling was proportionate to the size based on client volumes at each study hospital. Similar factors including; age, region ofresidence, place of residence, level of education, employment and marital status were found to significantly influence desire and intention to have children among HIV-infected and uninfected women. Older women were more likely to desire or intend to have more children P<0.001), marital status was the only factor that influenced desire and intention to utilize contraceptives among HIV-infected women. Myths and misconception and poor provider -client interactions on family planning methods were some of the demand and supply system gaps that hinder utilization of family planning methods Innovative approaches are required to promote use of contraceptives among HIV infected women to reduce maternal morbidity, mortality and vertical transmission of HIV

Evidence for population level declines in adult HIV prevalence in Kenya

The HIV/AIDS epidemic in Kenya has been tracked through annual sentinel surveillance in antenatal clinics since 1990. The system started with 13 sites and now has over 35. Behaviours have been measured through national Demographic and Health Surveys in 1993, 1998, and 2003. The surveillance data indicate that prevalence has declined substantially starting in 1998 in five of the original 13 sites and starting in 2000 in another four sites. No decline is evident in the other five original sites although the 2004 estimate is the lowest recorded. Nationally, adult prevalence has declined from 10% in the late 1990s to under 7% today. Surveys indicate that both age at first sex and use of condoms are rising and that the percentage of adults with multiple partners is falling. It is clear that HIV prevalence is now declining in Kenya in a pattern similar to that seen in Uganda but seven or eight years later. Although the coverage of preventive interventions has expanded rapidly since 2000 this expansion was too late to account for the beginnings of the decline in prevalence. More work is needed to understand fully the causes of this decline, but it is encouraging to see Kenya join the small list of countries experiencing significant declines in HIV prevalence

MICRONUTRIENT ZINC DEFICIENCY AS A POSSIBLE CO-FACTOR IN THE TRANSMISSION AND PROGRESSION OF HIV/AIDS IN KENYA

Thirty-four HIV/AIDS patients at various stages of disease progression volunteered to manage their health using a nutritional supplement that contained several micronutrients that included a 15 mg daily dose of elemental zinc. This initial publication only focuses on trends in the serum zinc levels and the observed biochemical changes following intervention, considering the critical role this trace element plays in human immunity. At baseline and after 30 months of follow-up, the patients\' serum zinc levels were determined as was their clinical status. Four women who were found to be HIV negative at baseline and who had lost their husbands to HIV/AIDS, yet they had regularly had un-protected sex with them, had a mean serum zinc level of 116.2 + 32.7 mcg/100 ml. The serum zinc levels of asymptomatic, moderately symptomatic and severely symptomatic HIV/AIDS patients in the cohort reduced from baseline to post intervention levels of 92.5+12.1 to 78.0 + 8.2 mcg/100 ml (P = 0.056); 81.9+ 17.6 to 73.2 + 12.2 mcg/100 ml (P = 0.267) and 72.7+ 8.0 to 66.8 + 14.3 mcg/100 ml (P = 0.022), respectively, all being far below the mean serum zinc level of 120.0 + 22.0 mcg/100 ml reported in normal control subjects in Western literature. For all patients combined, the serum zinc levels fell from 79.2 + 14.5 to 71.0 + 13.0 mcg/100 ml (P= 0.016) notwithstanding that the patients had used zinc supplements at recommended daily allowances (RDA) over a period of 30 months. Notably, micronutrient zinc sufficiency plays a key role in promoting cell-mediated immunity and it is probably partly due to this reason that the high-risk women in this study, who also had comparably high serum zinc levels, remained negative for HIV antibodies despite repeated exposure to the virus. Thus, from this preliminary data that shows HIV/AIDS patients to be deficient in zinc in a manner consistent with their status of disease progression and considering that this trace element is recognized to possess antiviral and antibacterial properties, it is now apparently evident that zinc supplementation may play a key role in the fight against HIV/AIDS not only in Kenya but also in other African countries where this disease has reached epidemic proportions against a background of rampant malnutrition. Key Words: Micronutrient zinc, underutilized arsenal, combating, HIV/AIDS, Sub-Saharan Africa DEFICIENCE EN MICRONUTRIMENTS DE ZINC EN TANT QUE CO-FACTEUR POTENTIEL DE TRANSMISSION ET DE PROPAGATION DU VIH/SIDA AU KENYA NOTE DE SYNTHESE Trente-quatre patients du VIH/SIDA se trouvant à divers stades de progression de la maladie ont accepté de prendre en charge leur santé en utilisant un supplément alimentaire contenant plusieurs micro-substances nutritives dont 15 mg de dose quotidienne de zinc élémentaire. Ces informations initiales se portent seulement sur les tendances dans les niveaux de sérum de zinc et les changements biochimiques observés à la suite de l\'intervention, étant donné le rôle critique que jouent ces oligo-éléments dans l\'immunité humaine. A la situation de départ et après 30 mois de suivi, des tests ont été faits pour faire état des niveaux de sérum de zinc ainsi que de l\'état clinique des patients. Quatre femmes qui au départ ont un statut sérologique négatif par rapport au VIH et qui ont perdu leurs maris au VIH/SIDA, mais qui ont toutefois eu régulièrement des rapports sexuels non-protégés avec ces derniers, ont présenté un niveau de sérum de zinc moyen de 116,2 + 32,7 mcg/100 ml. Les niveaux de sérum de zinc chez la cohorte de malades asymptomatiques, modérément symptomatiques et sévèrement symptomatiques du VIH/SIDA ont diminué de la situation de base jusqu\'après les interventions de respectivement 92,5+12,1 à 78,0 + 8,2 mcg/100 ml (P = 0,056); 81,9 + 17,6 à 73,2 + 12,2 mcg/100ml (P=0,267) et 72,7 + 8,0 à 66,8 + 14,3 mcg/100ml (P=0,022). Tous ces niveaux sont de loin inférieurs au niveau moyen de sérum de zinc de 120,0 + 22,0 mcg/100ml de l\'échantillon témoin des sujets annoncés dans la littérature Occidentale. Pour l\'ensemble des malades, les niveaux de sérum de zinc ont chuté de 79,2 + 14,5 à 71,0 + 13,0 mcg/100 ml (P=0,016) bien que les malades aient pris pendant 30 mois la dose journalière recommandée de suppléments de zinc. La quantité suffisante de micro-nutriments de zinc joue un rôle essentiel dans la promotion de l\'immunité catalysée par la cellule. C\'est probablement à cause en partie de cette raison que les femmes à haut risque de cette étude, qui ont également des niveaux comparativement élevés de sérum de zinc, sont restées séronégatives aux anticorps VIH, malgré le contact répété avec le virus. Ainsi, si l\'on considère ces données préliminaires qui montrent des patients de VIH/SIDA, déficients en zinc d\'une manière que l\'on peut associer à leur statut par rapport à la progression de la maladie et si l\'on considère aussi que cet oligo-élément est reconnu pour ses propriétés antivirales et antibactériennes, il est maintenant évident que le supplément de zinc peut jouer un rôle important dans la lutte contre le VIH/SIDA non seulement au Kenya, mais aussi dans d\'autres pays africains où cette maladie a atteint des dimensions épidémiques dans un contexte de sous-alimentation généralisée. Mots-clés: Micronutriment de zinc; arsenal sous-exploité; lutte; VIH/SIDA; Afrique subsaharienne AJFAND Vol.4(2) 200