This paper examines two key dimensions of HIV and AIDS in sub-Saharan Africa, namely poverty and gender, within the particular context of informal settlements. The study, conducted in five informal settlements of Nairobi, Kenya explored the challenges facing women living with HIV and AIDS (WLWA) in informal settlements in Nairobi in terms of the specific risk environments of informal settlements, the support they receive and their perceptions of their future. The data were gathered through an interviewer-based questionnaire administered to 390 WLWA and 20 key informant interviews with Kenya Network of Women with AIDS (KENWA) project personnel. The results show that for WLWA in informal settlements, poverty and poor living conditions combine to increase the risk environment for HIV infection and other opportunistic infections and that the WLWA then face HIV- and AIDS-related problems that are exacerbated by poverty and by the poor living environments. In response, the WLWA had devised coping strategies that were largely centred on survival, including commercial sex work and the sale of illicit liquor, thus increasing their susceptibility to re-infections. Insecurity in informal settlements curtailed their participation in income generating activities (IGAs) and increased their risk of rape and HIV re-infection. Recognising the disadvantaged position of communities in informal settlements, the non-governmental organizations (NGOs), community-based organizations (CBOs) and faith-based organizations (FBOs) provide a range of services including HIV and AIDS information and therapy. Paradoxically, living in urban informal settlements was found to increase WLWA's access to HIV and AIDS prevention and treatment services through NGOs and social networks that are not found in more established residential areas. The sustainability of these services is, however, questioned, given the lack of local resources, weak state support and high donor dependency. We suggest that the economic and tenure insecurity found among WLWA demands in response consistent support through comprehensive, sustainable HIV and AIDS services complemented by social networks and community sensitisation against stigma and discrimination. Fundamentally, the upgrading of informal settlements would address the wider risk environments that exacerbate the poor health of the WLWA who line in them.
IntroductionWe evaluated predictors of consistent condom use among female sex workers (FSWs), a core group for controlling the spread of HIV.MethodsIn an analysis of data collected in 2004–2005 from 140 Kenyan FSWs who completed questionnaires administered during a baseline study visit and three bimonthly follow-up visits, we used a case-crossover design to identify predictors of consistent condom use during all coital acts in the preceding 2 weeks, overall and by partner type.ResultsParticipants (n=140) completed the baseline visit and 390 bimonthly follow-up visits. Alcohol use during sex was negatively associated with consistent condom use with helping partners (defined as regular sex partners to whom the woman could go for help or support if needed) (adjusted odds ratio [AOR], 2.6, 95% confidence interval [CI] 1.0–6.5) but not associated with condom use with other partners. Coital frequency was associated with condom use with other partners only. Women who reported 1–5 (AOR 11.0, 95% CI 4.3–28.3) or 6–9 recent coital acts (AOR 3.8, 95% CI 1.7–8.8) with other partners were more likely to report consistent condom use with those partners than were women who reported ≥10 acts. Having a recent partner delay payment was inversely associated with consistent condom use with helping, other, or all partners.ConclusionCorrelates of consistent condom use differed by partner type. By using a case-crossover design, we were able to identify potentially modifiable factors associated with consistent condom use by FSWs who used condoms consistently with a given partner type during some periods but not others.
IntroductionWe evaluated predictors of consistent condom use among female sex workers (FSWs), a core group for controlling the spread of HIV.MethodsIn an analysis of data collected in 2004–2005 from 140 Kenyan FSWs who completed questionnaires administered during a baseline study visit and three bimonthly follow-up visits, we used a case-crossover design to identify predictors of consistent condom use during all coital acts in the preceding 2 weeks, overall and by partner type.ResultsParticipants (n=140) completed the baseline visit and 390 bimonthly follow-up visits. Alcohol use during sex was negatively associated with consistent condom use with helping partners (defined as regular sex partners to whom the woman could go for help or support if needed) (adjusted odds ratio [AOR], 2.6, 95% confidence interval [CI] 1.0–6.5) but not associated with condom use with other partners. Coital frequency was associated with condom use with other partners only. Women who reported 1–5 (AOR 11.0, 95% CI 4.3–28.3) or 6–9 recent coital acts (AOR 3.8, 95% CI 1.7–8.8) with other partners were more likely to report consistent condom use with those partners than were women who reported ≥10 acts. Having a recent partner delay payment was inversely associated with consistent condom use with helping, other, or all partners.ConclusionCorrelates of consistent condom use differed by partner type. By using a case-crossover design, we were able to identify potentially modifiable factors associated with consistent condom use by FSWs who used condoms consistently with a given partner type during some periods but not others.
-114 and 2014-109. The modelled Ct incidence for 2015 increased to 114/1000 py. The screening rate fell from a high of 85% in 2011 to a low of 71% in 2012, with subsequent improvement to 81% in 2015. Conclusion Reported Ct incidence in Army women is related to the actual infection rate and the percentage of at-risk women screened. Ct surveillance programs must review medical report and screening data to improve burden estimates. Incidence projections help assess the magnitude of observed surveillance changes and identify the probable number of missed infections. Introduction Syndromic management of sexually transmitted infections (STIs), as practised in most poorly resourced countries misses out asymptomatic infections. Affordable nucleic acid amplification tests (NAATs) are needed for accurate STI diagnosis and treatment. Methods As part of a cohort study assessing a diagnostic STI care model among young South African women presenting for syndromic care, we evaluated the clinic-based point-of-care (POC) tests Xpert CT/NG and OSOM Trichomonas Rapid Test against the laboratory-based Anyplex II STI-7, a multiplex real-time PCR assay which detects Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Trichomonas vaginalis (TV), M. genitalium (MG), M. hominis (MH), U. urealyticum (UU) and U. parvum (UP) in a single reaction. All positive and discordant results were confirmed with a third molecular assay, the FTD STD9. Results Vaginal swabs taken from 247 women were assessed in parallel. 238 of 247 (96.4%) results were in agreement comparing Xpert and Anyplex. All nine discrepant results were positive for CT on Xpert but negative on Anyplex. FTD STD9 confirmed three positive and six negative results. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of Xpert for CT against the two assays was 100%, 97.1%, 86.0%, 100%, respectively; and for NG 100%, 99.6%, 92.3%, 100%. The sensitivity, specificity, PPV and NPV of OSOM for TV against the two assays was 77.8%, 100%, 100%, 99.2%. In addition to the CT, NG and TV detection, the Anyplex identified a prevalence of 4.8% MG, 33.5% MH, 19.1% UU and 51.4% UP in this population. Conclusion The overall performance of Xpert CT/NG against laboratory-based assays was comparable. A lower PPV may lead to some overtreatment, however, in a high burden STI and HIV region, where STIs are often asymptomatic, the high sensitivity and specificity are reassuring. The widened spectrum of Anyplex targets highlights the high burden of Ureaplasma and Mycoplasma species in this setting, whose clinical significance need further exploration. P3.168
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