Matthew Shaw

Medical Research Council Unit, The Gambia Unit, Bakau, Banjul, Gambia

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Publications (6)13.33 Total impact

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    ABSTRACT: To determine risk factors for herpes simplex 2 (HSV2) infection in women in a polygynous rural Gambian population. Data from women who participated in a cross-sectional survey of reproductive health were matched to their own and, for women who had been or were married (ever-married), their spouses' data collected in a cross-sectional survey of fertility interests, including information on marital histories. Data were available on 150 never-married and 525 ever-married women. HSV2 prevalence was 16% amongst never-married women and 36% amongst ever-married women. For ever-married women, their own personal characteristics (age, ethnicity and genital cutting status) and events from their husbands' marriage history were important determinants of HSV2 infection. Women whose husbands married for the first time over age 35 were at greater risk than women whose husbands married by age 24 [odds ratio (OR) 2.72, 95% confidence interval (CI) 1.20-6.10]. Women whose husband reported interest in a new marriage were more likely to be HSV2 positive (OR 1.91, 95% CI 1.18-3.09). Women whose husbands were currently monogamous but had had previous marriages (OR 2.76, 95% CI 1.30-5.88) and women in currently polygynous marriages (OR 2.88, 95% CI 1.66-5.01) were three times as likely to be HSV2 positive as women who were their husband's only wife ever. Much transmission of HSV2 in this setting occurs within marriage where opportunity for personal protection is limited. High levels of transmission within marriage may undermine the impact of sexual behaviour change programmes aiming to reduce HSV2 and HIV incidence and complicate their evaluation.
    AIDS 02/2003; 17(1):97-103. DOI:10.1097/01.aids.0000042937.55529.05 · 6.56 Impact Factor
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    ABSTRACT: Community-based behavioural interventions aimed at reducing risky sexual behaviour have yet to be shown to be effective in the developing world. Stepping Stones is a participatory STI/ HIV prevention workshop programme based on empowerment techniques, which has been adapted to an infertility prevention framework for The Gambia. This paper describes a preliminary evaluation in two villages where the intervention was carried out compared to two control villages. Methods used include: participatory evaluation; 84 in-depth interviews; seven focus group discussions; a knowledge, attitudes and practice questionnaire administered to a random sample of 25% of the adult population at three time points; and monitoring of condom supply. The structure of the evaluation is based on the themes derived from the qualitative data. The infertility prevention approach made it possible to overcome resistance to discussing the topics of sexual and reproductive health. An atmosphere of trust was created and men were persuaded to participate in the programme as they felt that their own needs were being addressed. Participants enjoyed the programme and found the content relevant. Knowledge of the modes of transmission of HIV and sexually transmitted infections and levels of risk awareness increased. The value of condoms in particular situations was recognised: for sex before marriage, within marriage (when the woman is breastfeeding) and with non-marital partners. Women reported that they would insist on condom use outside marriage and even ask their husbands to use condoms for non-marital sex. Condom monitoring data suggested that condom uptake had increased. It was reported that there was significant increase in dialogue within marriage with the consequence that there were fewer disagreements and incidents of domestic violence. Diffusion of the messages of Stepping Stones appeared to have taken place with non-participants including children. The evaluation techniques used can now be refined in order to generate further evidence on a larger scale and over a longer period.
    African Journal of AIDS Research 01/2002; DOI:10.2989/16085906.2002.9626543 · 0.61 Impact Factor
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    ABSTRACT: In the Gambia, sexually transmitted infections (STIs) and their complications are a major health problem and although the prevalence of HIV-1 in the Gambia is currently low, it is increasing. Relatively little is known about the sexual health treatment-seeking behaviours of young people in West Africa. This information is vital to target resources appropriately. To investigate this concept, twelve single-sex focus group discussions (FGDs), within three rural villages, elicited the views, opinions, attitudes and experiences of 49 young men (mean age 17.4 years; range 15-21) and 48 young women (mean age 18.2 years; range 15-25). The participants talked openly about sexual activity within their peer communities. Six major themes were identified from the FGDs: (1) groups perceived to be at risk of acquiring STIs; (2) STI transmission and classification; (3) treatment-seeking behaviours; (4) barriers to treatment; (5) consequences of non-treatment; and (6) problem resolution strategies. The study concludes that whilst there may be barriers to improving sexual and reproductive health, young people in rural West Africa have enthusiasm for and commitment to finding solutions to the problems that local communities face.
    Journal of Adolescence 01/2002; 24(6):753-64. DOI:10.1006/jado.2001.0442 · 2.05 Impact Factor
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    ABSTRACT: To estimate prevalence and risk factors for herpes simplex 2 (HSV2) positivity, syphilis and Chlamydia trachomatis infection among rural people aged 15-34 in the Gambia. Questionnaires and serum samples were collected from 1076 men and women aged 15-34 during a cross sectional prevalence survey in a rural area of the Gambia. Sera were screened for antibodies to herpes simplex virus type 2 (HSV2), and for syphilis using Treponema pallidum haemagglutination assay (TPHA) and rapid plasma reagin (RPR) tests. Urine was tested by polymerase chain reaction (PCR) for C trachomatis infection. 28% of women and 5% of men were HSV2 ELISA positive; 10% of women and 2% of men were TPHA positive; and 7% of women and 1% of men were both RPR and TPHA positive. Out of 1030 urine sample tested only six were positive for C trachomatis. 7% of those who reported never having sex were positive for one or other of these tests. Prevalences of all STIs increased with age and were higher in women than men. Women were much less likely than men to seek treatment for STI symptoms at a health centre. Married people were at increased risk of an STI compared with single people. Jola and Fula women had a higher prevalence of HSV2 than women from other ethnic groups, and Fulas also had a higher prevalence of RPR/TPHA positivity. The limited number of sexual behaviour questions were not significantly associated with STIs after adjustment for age, marital status, and ethnic group. The prevalences of the ulcerative infections HSV2 and syphilis in this population are a cause for concern. In a setting where HIV1 prevalence remains low this indicates an urgent need for STI control and behaviour change programmes to prevent an HIV epidemic. Concerns about the validity of reported sexual behaviour data high light the necessity of biological markers in the evaluation of behaviour change programmes.
    Sexually Transmitted Infections 11/2001; 77(5):358-65. DOI:10.1136/sti.77.5.358 · 3.08 Impact Factor
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    ABSTRACT: This study aimed to describe the quality and costs of sexually transmitted disease (STD) case management in urban pharmacies in The Gambia, and explore pharmacy workers' (PWs) willingness to improve the STD care they provide. PWs from 24 registered pharmacies were interviewed in order to collect information on their knowledge and practices regarding management of STDs. The same pharmacies were visited by a male 'simulated client' (SC) to ascertain how urethral discharge syndrome (UDS) cases were managed in practice. Fifteen (63%) pharmacies were equipped for treatment of UDS, pelvic inflammatory disease (PID) and genital ulcer syndrome (GUS), according to national guidelines. Appropriate syndromic management for UDS was mentioned by 11% of PWs but actually given to 4.4% of the SC visits. None of the PID or GUS cases would be treated correctly. Forty-two per cent of PWs advised on partner notification, 38% on safe sex and 29% on treatment compliance in the SC visits. The reported costs for treatment of UDS, PID and GUS ranged from $2.5-$15.0. The cost of treatment actually purchased by the SC averaged $3.5 (range $1.5-$9.6) for UDS. Excluding the pharmacy sector from interventions will limit the impact of STD control measures. Regular training in syndromic management and rational drug use, with a concise manual for reference are recommended. Strategies to lower the cost of drugs should be explored.
    International Journal of STD & AIDS 08/2001; 12(7):444-52. DOI:10.1258/0956462011923471 · 1.04 Impact Factor
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    Matthew Shaw, Michelle Jawo
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    ABSTRACT: The Gambia is an Islamic, Anglophone country situated in the middle of Senegal in West Africa. Its population is about 1.1 million, spread along the banks of the River Gambia. The main economic activity is subsistence agriculture (groundnuts, millet, livestock) and fishing. HIV prevalence is quite low at about 2% of the population and as yet no-one has publicly declared themselves to be HIV positive. Therefore many people are doubtful that HIV really exists. Moreover, many men are suspicious of Family Planning (including condoms) and this view is strongly supported by some Muslim clerics who believe it to be against the Koran. For economic reasons, men like to have many children, if they live in a rural area. In one area, the total fertility rate for men is 12.0 compared with 6.8 for women; men achieve this impressive fertility through polygamy (Hill and Ratcliffe, 1998-9). The practice of male and female circumcision is widely practised, as in other North African countries. For women, this usually consists of a type 2 circumcision, where the clitoris, clitoral hood and labia minora are removed without closure of the vagina. What is Stepping Stones ? The 'Stepping Stones Gambia' project is a collaboration between five organisations; The Gambian Department of State for Health, ActionAid -The Gambia (AATG), Gambian Family Planning Association (GFPA), Medical Research Council (MRC) -UK and the World Wide Evangelisation for Christ Mission (WEC). The partnership began in 1997 to adapt, implement and evaluate the original Stepping Stones workshop programme (Welbourn 1995). This is a manual describing a series of participatory exercises designed to facilitate HIV prevention by encouraging a gender analysis of sex and its context. The workshops then move into assertiveness training, encouraging participants to be assertive about their feelings and dialogue with their partners, focusing on communication and relationship skills. It was originally designed for use in Sub-Saharan Africa, although has since been adapted and used in many different countries across the world. It operates around a workshop structure, with separate peer age and gender groups.