The relationship between age of coital debut and HIV seroprevalence among women in Durban, South Africa: a cohort study

objectives: To investigate the impact of early sexual debut on HIV seroprevalence and incidence rates among a cohort of women. Design: Prospective study. Setting: KwaZulu-Natal, South Africa. Participants: A total of 3492 sexually active women who consented to screen a HIV prevention trial during September 2002 to September 2005; a total of 1485 of them were followed for approximately 24 months. Primary and secondary outcome measures: HIV seroprevalence among those who were screened for the trial and HIV seroconversion among those who seroconverted during the study. Results: Lowest quintiles of age at sexual debut, less than high school education, a higher number of lifetime sexual partners and lack of cohabitation, being diagnosed as having herpes simplex virus 2 and other sexually transmitted infections were all significantly associated with prevalent HIV infection in multivariate analysis. During follow-up, 148 (6.8 per 100 person years, 95% CI 5.8 to 8.0) women seroconverted. Highest seroconversion rate was observed among women who had reported having had sex 15 years or younger (12.0 per 100 person-years, 95% CI 8.0 to 18.0). Overall, impact of risk factors considered in this study was associated with considerable potential reductions in HIV prevalence and incidence rates (population attributable risk: 85%, 95% CI 84% to 87% and population attributable risk: 77%, 95% CI 72% to 82%, respectively). Conclusions: The association of HIV status with younger age at sexual debut may likely due to an increased number of lifetime partners. This increase could result from a longer duration of sexual life. Prevention of HIV infection should include efforts to delay age at first sex in young women

Studies on the mechanisms of proteinuria in kidney diseases of childhood.

Doctoral Degree. University of KwaZulu-Natal, Durban.Abstract available in PDF.Publications on page vi. Presentations on page vii-viii

Geoadditive models to assess spatial variation of HIV infections among women in Local communities of Durban, South Africa

<p>Abstract</p> <p>Background</p> <p>The severity of the HIV/AIDS epidemic in South Africa varies between and within provinces, with differences noted even at the suburban scale. We investigated the geographical variability of HIV infection in rural areas of the eThekwini Metropolitan Municipality in KwaZulu-Natal province, South Africa.</p> <p>Method</p> <p>We used geoadditive models to assess nonlinear geographical variation in HIV prevalence while simultaneously controlling for important demographic and sexual risk factors. A total of 3,469 women who were screened for a Phase-III randomized trial were included in the current analysis.</p> <p>Results</p> <p>We found significant spatial patterns that could not be explained by demographic and sexual risk behaviors. In particular, the epidemic was determined to be much worse 44 km south of Durban after controlling for all demographic and sexual risk behaviors.</p> <p>Conclusion</p> <p>The study revealed significant geographic variability in HIV infection in the eThekwini Metropolitan Municipality in KwaZulu-Natal, South Africa.</p

High risk sexual behaviors are associated with sexual violence among a cohort of women in Durban, South Africa

BACKGROUND: Studies show Gender Based Violence (GBV) to be significantly associated with risky sexual behaviour. In South Africa the incidence of GBV is reportedly high, and there is a strong argument for GBV to be a driver of HIV infection rates. This study describes the prevalence of Forced Sex (FS) experiences of women who enrolled into an HIV biomedical intervention study, and its association with risky sexual behaviour. FINDINGS: In this study, sociodemographic and behavioural data from women enrolled in the Carraguard™ trial, were assessed in relation to FS using logistic regression. The results indicated that 193/1485 (13%) of women reported ever experiencing FS at the screening visit. Women who were 30 years and older; reported having sex for cash; multiple partners; changing partners during the trial; inconsistent condom use during the trial; and 3 or more sex acts in the 2 weeks prior to screening, were significantly more likely to have experienced forced sex. CONCLUSIONS: The results of this study are broadly consistent with those found in other studies and are similar in profile to women at higher risk for HIV acquisition in our setting. This study indicates a need for GBV prevention to be integrated with HIV prevention programmes

South Africa's Experience of the Closure of the Cellulose Sulphate Microbicide Trial

The researchers who conducted the cellulose sulphate microbicide trial share the lessons they learned from the trial's early closure

Participant verification: Prevention of co-enrolment in clinical trials in South Africa

Background. As KwaZulu-Natal Province is the epicentre of the HIV epidemic in both South Africa (SA) and globally, it is an ideal location to conduct HIV prevention and therapeutic trials. Numerous prevention trials are currently being conducted here; the potential for participant co-enrolment may compromise the validity of these studies and is therefore of great concern.Aim. To report the development and feasibility of a digital, fingerprint-based participant identification method to prevent co-enrolment at multiple clinical trial sites.Methods. The Medical Research Council (MRC) HIV Prevention Research Unit (HPRU) developed the Biometric Co-enrolment Prevention System (BCEPS), which uses fingerprint-based biometric technology to identify participants. A trial website was used to determine the robustness and usability of the system. After successful testing, the BCEPS was piloted in July 2010 across 7 HPRU clinical research sites. The BCEPS was pre-loaded with study names and clinical trial sites, with new participant information loaded at first visit to a trial site.Results. We successfully implemented the BCEPS at the 7 HPRU sites. Using the BCEPS, we performed real-time ‘flagging’ of women who were already enrolled in another study as they entered a trial at an HPRU site and, where necessary, excluded them from participation on site. Conclusion. This system has promise in reducing co-enrolment in clinical trials and represents a valuable tool for future implementation by all groups conducting trials. The MRC is currently co-ordinating this effort with clinical trial sites nationally

Microbicides 2006 conference

Current HIV/AIDS statistics show that women account for almost 60% of HIV infections in Sub-Saharan Africa. HIV prevention tools such as male and female condoms, abstinence and monogamy are not always feasible options for women due to various socio-economic and cultural factors. Microbicides are products designed to be inserted in the vagina or rectum prior to sex to prevent HIV acquisition. The biannual Microbicides conference took place in Cape Town, South Africa from 23–26 April 2006. The conference was held for the first time on the African continent, the region worst affected by the HIV/AIDS pandemic. The conference brought together a record number of 1,300 scientists, researchers, policy makers, healthcare workers, communities and advocates. The conference provided an opportunity for an update on microbicide research and development as well as discussions around key issues such as ethics, acceptability, access and community involvement. This report discusses the current status of microbicide research and development, encompassing basic and clinical science, social and behavioural science, and community mobilisation and advocacy activities

Microbicides 2008 conference: From discovery to advocacy

Recently revised statistics show the number of individuals living with HIV at over 33 million worldwide, with 68% being in sub-Saharan Africa. Current HIV prevention methods, such as condom use, monogamy and abstinence, are not always feasible. The need for improved HIV preventative technologies remains urgent. Of these, microbicides represent a promising female-initiated preventative method. Microbicides are designed to be applied vaginally to prevent HIV and STI acquisition. Research is also being undertaken to assess the safety of the product during rectal application