A randomized, placebo-controlled trial of monthly azithromycin prophylaxis to prevent sexually transmitted infections and HIV-1 in Kenyan sex workers: study design and baseline findings

Abstract

Our objectives were to describe the baseline findings of a trial of antibiotic prophylaxis to prevent sexually transmitted infections (STIs) and HIV-1 in a cohort of Nairobi female sex workers (FSWs). A questionnaire was administered and a medical examination was performed. HIV-negative women were randomly assigned to either one gram azithromycin or placebo monthly. Mean age of the 318 women was 32 years, mean duration of sex work 7 years and mean number of clients was 4 per day. High-risk behaviour was frequent: 14% practised anal intercourse, 23% sex during menses, and 3% used intravenous drugs. While 20% reported condom use with all clients, 37% never use condoms. However, STI prevalence was relatively low: HIV-1 27%, bacterial vaginosis 46%, Trichomonas vaginalis 13%, Neisseria gonorrhoeae 8%, Chlamydia trachomatis 7%, syphilis 6% and cervical intraepithelial neoplasia (CIN) 3%. It appears feasible to access a population of high-risk FSWs in Nairobi with prevention programmes, including a proposed trial of HIV prevention through STI chemoprophylaxis.

Effects of Micro-Enterprise Services on HIV Risk Behaviour Among Female Sex Workers in Kenya’s Urban Slums

“…Kenya's real gross domestic product (GDP) growth rose from 2.8% in 2003 to 5.8% in 2005 and to around 6.0% in the subsequent 2 years, but incidence of absolute poverty has remained significant, affecting at least 29% of the urban population (GOK 2007;UNDP 2006). Among women of low socio-economic status engaged in sex work in Nairobi, HIV prevalence over thrice the national prevalence has been found, confirming that sex work heightens women's risks for HIV in Kenya as elsewhere (Fonck et al 2000;Simonsen et al 1990). In addition, recent work has pointed towards continued concentrated epidemics in female sex workers (FSWs) and their clients and the need for targeted interventions in these groups (Morris and Ferguson 2006;Ferguson and Morris 2007).…”

Effectiveness of interventions for the prevention of HIV and other sexually transmitted infections in female sex workers in resource poor setting: a systematic review

“…The groups in Nairobi (Fonck et al 2000;Kaul et al 2002Kaul et al , 2004 and Benin ⁄ Ghana (Labbe et al 2003) looked at the effect of PPT while the group in Cote d'Ivoire (Ghys et al 2001) tested regular screening for STIs. Neither the Cote d'Ivoire nor the Nairobi studies found a difference in HIV incidence between the arms.…”

Baseline survey of sexually transmitted infections in a cohort of female bar workers in Mbeya Region, Tanzania

“…10 11 The prevalence of STI among the women in the cohort generally lies within the range of prevalences reported from studies among sex workers in other countries in sub-Saharan Africa in recent years. For example, in Nairobi, Kenya, 5 and Kwa Zulu Natal, South Africa 7 genital ulcers have been observed in 2.7% and 12.7% of sex workers respectively, active syphilis in 8.8% and 12.7%, N gonorrhoeae in 10.5% and 14.3%, C trachomatis in 9.1% and 16.7%, T vaginalis in 13% and 40.8%, and bacterial vaginosis in 46% and 71%. HSV-2 antibodies were found in around 80% of sex workers in Zimbabwe, 12 Eritrea, 13 and Nigeria.…”