Background
Uganda has long been successful in controlling the HIV epidemic but there is evidence that HIV prevalence and incidence are increasing again. Data on the HIV/STI epidemic among sex workers are so far lacking from Uganda. This paper describes the baseline epidemiology of HIV/STI in a newly-established cohort of women involved in high risk sexual behaviour in Kampala, Uganda.
Methods
Women were recruited from red-light-areas in Kampala. Between April 2008-May 2009, 1027 eligible women were enrolled. Socio-demographic and behavioural information was collected; blood and genital samples were tested for HIV/STI. Risk factors for HIV-infection were examined using multivariable logistic regression.
Results
HIV seroprevalence was 37%. The prevalence of N. gonorrhoea (NG) was 13%, C. trachomatis (CT) 9%, T. vaginalis (TV) 17%, bacterial vaginosis (BV) 56% and 11% had candida infection. 80% had HSV-2 antibodies, 21% were TPHA -positive and 10% had active syphilis (RPR+TPHA+). In 3% of the genital ulcers, T. pallidum (TP) was identified, H. ducreyi (HD) in 6% and HSV-2 in 35%. Prevalent HIV was independently associated with older age, being widowed, lack of education, sex work as sole income, street based sex work, not knowing HIV-status, using alcohol and intravaginal cleansing with soap. HIV-infection was associated with NG, TV, BV, HSV-2 seropositivity and active syphilis.
Conclusions
Prevalence of HIV/STI is high among women involved in high risk sexual behaviour in Kampala. Targeted HIV prevention interventions including regular STI screening, VCT, condom promotion and counselling for reducing alcohol use are urgently needed in this population.
COVID-19 measures that restrict movement may negatively impact access to HIV care and treatment. To contribute to the currently limited evidence, we used telephone interviews with quantitative and qualitative questions to examine how clients perceived COVID-19 and its effect on their HIV care and ART adherence. One hundred (n = 100) Ugandan adults on ART from an existing study were randomly selected and enrolled. Interviews were recorded, transcribed, and analyzed using descriptive statistics and rapid content analyses. 76% of clients indicated that COVID-19 negatively impacted travel to HIV clinics; 54% perceived that coming to the clinic increased their risk of acquiring COVID-19; and 14% said that COVID-19 had negatively impacted their ART adherence. Qualitative feedback suggests that fear of COVID-19 infection discouraged clinic attendance while stay-at-home orders helped routinize ART adherence and employ new community-based approaches for HIV care. Addressing negative unintended consequences of COVID-19 lockdowns on HIV care is urgently needed.
The burden of drug resistance in previously treated patients with TB in Uganda is sizeable, and the risk of generating additional drug resistance is significant. There is an urgent need to improve the treatment for such patients in low-income countries.
M. genitalium is likely to persist and recur in the female genital tract. Because of the urogenital tract morbidity caused by the infection and the observed association with HIV acquisition, further research is needed to define screening modalities, especially in populations at high risk for HIV, and to optimize effective and affordable treatment options.
Prospective evaluation of the effectiveness of the WHO-recommended standardized retreatment regimen for tuberculosis by Edward Jones-López and colleagues reveals an unacceptable proportion of unsuccessful outcomes.
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