AIDS virus infection in Nairobi prostitutes: Spread of the epidemic to East Africa.New England Journal of Medicine, 314, 414-418

New England Journal of Medicine (Impact Factor: 55.87). 03/1986; 314(7):414-8.
Source: PubMed


The acquired immunodeficiency syndrome (AIDS) is epidemic in Central Africa. To determine the prevalence of AIDS virus infection in East Africa, we studied 90 female prostitutes, 40 men treated at a clinic for sexually transmitted diseases, and 42 medical personnel in Nairobi, Kenya. Antibody to human T-cell lymphotropic virus Type III (HTLV-III) was detected in the serum of 66 percent of prostitutes of low socioeconomic status, 31 percent of prostitutes of higher socioeconomic status, 8 percent of the clinic patients, and 2 percent of the medical personnel. The presence of the antibody was associated with both immunologic and clinical abnormalities. The mean T-cell helper/suppressor ratio was 0.92 in seropositive prostitutes and 1.82 in seronegative prostitutes (P less than 0.0001). Generalized lymphadenopathy was present in 54 percent of seropositive prostitutes and 10 percent of seronegative prostitutes (P less than 0.0001). No constitutional symptoms, opportunistic infections, or cases of Kaposi's sarcoma were present. Our results indicate that the epidemic of AIDS virus infection has, unfortunately, spread extensively among urban prostitutes in Nairobi, Kenya. Sexual exposure to men from Central Africa was significantly associated with HTLV-III antibody among prostitutes, suggesting transcontinental spread of the epidemic.

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    • "While global media and health authorities were focussed on stigmatized " risk groups " in North America, largely heterosexuallytransmitted epidemics were already well established throughout sub-Saharan Africa by the time the human immunodeficiency virus (HIV) was discovered in 1983. A cohort-based study of commercial sex workers (CSW) in Nairobi, Kenya found that HIV prevalence increased from 4% to over 60% between 1981 and 1985 [2]. Follow-up work identified a subgroup of CSW who were never infected with HIV despite years of exposure, one of the earliest described examples of highly HIV-exposed seronegative (HESN) individuals in the world [3]. "
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    ABSTRACT: Immune activation is increasingly recognized as a critical element of HIV infection and pathogenesis, causing expansion of virus founder populations at the mucosal port of entry and eventual exhaustion of cellular immune effectors. HIV susceptibility is well known to be influenced by concurrent sexually transmitted infections; however, the role of commensal vaginal microbiota is poorly characterized. Bacterial vaginosis (BV) is a risk factor for HIV acquisition in studies worldwide; however, the etiology of BV remains enigmatic, and the mechanisms by which BV increases HIV susceptibility are not fully defined. A model of how vaginal microbiota influences HIV transmission is considered in the context of a well-established cohort of HIV-exposed seronegative (HESN) commercial sex workers (CSW) in Nairobi, Kenya, many of whom have increased levels of anti-inflammatory factors in vaginal secretions and reduced peripheral immune activation (immune quiescence). Elucidation of the relationship between complex microbial communities and inflammatory mucosal responses underlying HIV infection should be a priority for future prevention-focussed research.
    03/2012; 2012(24):131243. DOI:10.1155/2012/131243
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    • "P. Anglewicz (*) School of Public Health and Tropical Medicine, Department of Global Health Systems and Development, Tulane University, 1440 Canal Street, Suite 2200, New Orleans, LA 70112-2737, USA e-mail: epidemic (Kreiss et al. 1986; Mann et al. 1986 "
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    ABSTRACT: Research on the relationship between migration and HIV infection in sub-Saharan Africa often suggests that migrants are at higher risk of HIV infection because they are more likely to engage in HIV risk behaviors than nonmigrants, and they tend to move to areas with a relatively higher HIV prevalence. Although migration may be a risk factor for HIV infection, I instead focus on the possibility that the HIV positive are more likely to migrate. Using a longitudinal data set of permanent rural residents and migrants from Malawi, I find that migrants originating from rural areas are indeed more likely than nonmigrants to be HIV positive and to have engaged in HIV risk behaviors. The increased HIV risk among migrants may be due to the selection of HIV-positive individuals into migration; I find that HIV-positive individuals are more likely to migrate than those who are HIV negative. The explanation for this phenomenon appears to be marital instability, which occurs more frequently among HIV-positive individuals and leads to migration after marital change.
    Demography 11/2011; 49(1):239-65. DOI:10.1007/s13524-011-0072-x · 1.93 Impact Factor
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    • "Over the last few years concern has increasingly been voiced over the extent to which prostitution may be significant in the spread of HIV infection. This concern is fuelled in part by a recognition of the key role which prostitution appears to play in the transmission of HIV infection in Sub-Saharan Africa, (D'Costa et al 1985, Kreiss et al 1986). However, a characteristic feature of HIV is its differential appearance and spread across even neighbouring geographical areas (Des Jarlais and Friedman 1987). "
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    ABSTRACT: In this paper we provide an early report of two continuing ethnographic studies of prostitution. We compare female streetworking prostitutes and male rent boys in Glasgow in terms of risks of HIV infection and practice of safer sex. It is shown that a considerable proportion of streetworking female prostitutes in Glasgow were injecting drug users but that drug use was much less common among rent boys. Although condom use appeared to be widespread amongst the women it was less common among the rent boys. We then examine the nature of the relationship established with clients. It is shown that the rent boys were much less directive in relation to clients - much less likely to insist on safer sexual practices than were the female prostitutes. It is suggested that this lack of directiveness is associated with retrospective payment - payment after the commercial sex act takes place. In a final section we look at the policy implications of our work.
    Sociology of Health & Illness 06/2008; 12(3):274 - 292. DOI:10.1111/1467-9566.ep11347163 · 1.88 Impact Factor
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