Sexual behavior, sexually transmitted diseases, male circumcision and risk of HIV infection among women in Nairobi, Kenya

Brigham and Women's Hospital, Boston, Massachusetts, United States
AIDS (Impact Factor: 5.55). 02/1994; 8(1):93-9. DOI: 10.1097/00002030-199401000-00014
Source: PubMed


To study risk factors for HIV infection among women in Nairobi, Kenya, as the epidemic moves beyond high-risk groups.
A cross-sectional case-control study among women attending two peri-urban family planning clinics.
A total of 4404 women were enrolled after giving written informed consent. Information on risk factors was obtained by interview using a structured questionnaire. Blood was taken for HIV and syphilis testing, and genital specimens for gonorrhea and trichomoniasis screening.
Two hundred and sixteen women (4.9%; 95% confidence interval, 4.3-5.5) were HIV-1-positive. Although risk of HIV was significantly increased among unmarried women and among women with multiple sex partners, most seropositive women were married and reported only a single sex partner in the last year. Women with a history or current evidence of sexually transmitted disease were at significantly increased risk; however, the prevalence of these exposures was low. Women whose husband or usual sex partner was uncircumcised had a threefold increase in risk of HIV, and this risk was present in almost all strata of potential confounding factors. Only 5.2% of women reported ever having used a condom.
These data suggest that, among women who are not in high-risk groups, risk of HIV infection is largely determined by their male partner's behavior and circumcision status. Interventions designed to change male sexual behavior are urgently needed.

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    • "The risk of contracting HIV among women in a non-high risk group has been found to be largely determined by their male partner’s behaviour [29]. In PNG it is assumed that most transmission is from husbands to wives. "
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    ABSTRACT: Lack of male involvement and support for sexual and reproductive health services is seen by many Papua New Guinean women as a barrier to accessing services. Poor utilization of services by both men and women is reflected in high maternal mortality and high rates of HIV/AIDS and sexually transmitted infections in the Southern Highlands Province. It is therefore important to understand the type of services provided, men's perceptions of these services and the Health Sector's capacity to involve men in its programs. Information from interviews of married men, officers in charge of health facilities, and information from a focus group discussion with village leaders was collected to assess possible constraints to reproductive and sexual health care delivery. Although many men had heard about antenatal care, supervised births, family planning and sexually transmitted infections including, HIV/AIDS, many were unaware of their importance and of the types of services provided to address these issues. There was a very strong association between men's literacy and their knowledge of Sexual and Reproductive Health (SRH) issues, their discussion of these issues with their wives and their wives' utilisation of sexual and reproductive health services.. Some men considered SRH services to be important but gave priority to social obligations. Although men made most decisions for sexual and reproductive issues, pregnancy, child birth and rearing of children were regarded as women's responsibilities. Knowledge of HIV/AIDS appeared to have changed sexual behaviour in some men. Services for men in this rural setting were inadequate and service providers lacked the capacity to involve men in reproductive health issues. Poor knowledge, socio-cultural factors and inadequate and inappropriate services for men hampered utilization of services and impaired support for their wives' service utilization. Programmatic and policy initiatives should focus on improving service delivery to accommodate men in sexual and reproductive health.
    Full-text · Article · Sep 2013 · Reproductive Health
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    • "and income / occupation separately . Comparing those cross - sectional studies that looked only at female educational level ( with or without partner ' s SES measured ) and those that examined educational level and / or employment status , of those that looked just at female ' s educational or literacy level ( n=10 ) , seven found no association ( Hunter et al . , 1994 ; Mati et al . , 1995 ; Gregson et al . , 1995 , 1996 , 2002 ; Auvert et al . , 2001b ; Kapiga et al . , 2002 ) , one found a positive association ( Fylkesnes et al . , 1997 ) and two found a negative association ( Fylkesnes et al . , 2001 ; Kapiga & Lugalla , 2002 ) . In contrast , of those cross - sectional studies that examined occup"
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    ABSTRACT: This is a critical, systematic review of the relationship between socioeconomic status (SES) and HIV infection in women in Southern, Central and Eastern Africa. In light of the interest in micro-credit programmes and other HIV prevention interventions structured to empower women through increasing women's access to funds and education, this review examines the epidemiological and public health literature, which ascertains the association between low SES using different measurements of SES and risk of HIV infection in women. Also, given the focus on structural violence and poverty as factors driving the HIV epidemic at a structural/ecological level, as advocated by Paul Farmer and others, this study examines the extent to which differences in SES between individuals in areas with generalized poverty affect risk for SES. Out of 71 studies retrieved, 36 studies met the inclusion criteria including 30 cross-sectional, one case-control and five prospective cohort or nested case-control studies. Thirty-five studies used at least one measurement of female's SES and fourteen also included a measurement of partner's SES. Studies used variables measuring educational level, household income and occupation or employment status at the individual and neighbourhood level to ascertain SES. Of the 36 studies, fifteen found no association between SES and HIV infection, twelve found an association between high SES and HIV infection, eight found an association between low SES and HIV infection and one was mixed. In interpreting these results, this review examines the role of potential confounders and effect modifiers such as history of STDs, number of partners, living in urban or rural areas and time and location of study in sub-Saharan Africa. It is argued that STDs and number of partners are on the causal pathway under investigation between HIV and SES and should not be adjusted as confounders in any analysis. In conclusion, it is argued that in low-income sub-Saharan Africans countries, where poverty is widespread, increasing access to resources for women may initially increase risk of HIV or have no effect on risk-taking behaviours. In some parts of Southern Africa where per capita income is higher and within-country inequalities in wealth are greater, studies suggest that increasing SES may decrease risk. This review concludes that increased SES may have differential effects on married and unmarried women and further studies should use multiple measures of SES. Lastly, it is suggested that the partner's SES (measured by education or income/employment) may be a stronger predictor of female HIV serostatus than measures of female SES.
    Preview · Article · Feb 2005 · Journal of Biosocial Science
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    • "A low population-attributable risk was found and the authors suggested that behaviour change messages directed to women had a low potential for preventing STDs. Also in Nairobi, Hunter et al. (1994) found that among women who are not in the high-risk groups, risk of HIV infection was largely determined by their male partner's behaviour and circumcision status. A study of male factory workers in Harare, Zimbabwe (Mbizvo et al. 1994) established that few married men, who tested positive for HTV infection, used condoms with their wives although they reported using them with other sexual partners. "
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    ABSTRACT: Reproduction is a dual commitment, but so often in much of the world, it is seen as wholly the woman's responsibility. She bears the burden not only of pregnancy and childbirth but also the threats from excessive child bearing, some responsibility for contraception, infertility investigation and often undiagnosed sexually transmitted diseases (STDs) including AIDS. Failure to target men in reproductive health interventions has weakened the impact of reproductive health care programmes. The paper proposes that sophisticated and dynamic strategies in Africa and elsewhere which target women's reproductive health and research (such as control of STDs including AIDS, family planning, infertility investigation) require complementary linkage to the study and education of men. Men's perceptions, as well as determinants of sexual behavioural change and the socioeconomic context in which STDs, including AIDS, become rife, should be reviewed. There is a need to study and foster change to reduce or prevent poor reproductive health outcomes; to identify behaviours which could be adversely affecting women's reproductive health. Issues of gender, identity and tolerance as expressed through sexuality and procreation need to be amplified in the context of present risks in reproductive health. Researchers and providers often ignore the social significance of men. This paper reviews the impact of male dominance, as manifested through reproductive health and sexual decisions, against the background of present reproductive health problems. A research agenda should define factors at both macro and micro levels that interact to adversely impinge on reproductive health outcomes. This should be followed up by well-developed causal models of the determinants of positive reproductive health-promoting behaviours. Behaviour specific influences in sexual partnership include the degree of interpersonal support towards prevention, for example, of STDs, unwanted pregnancy or maternal deaths. Perceived efficacy and situational variables influencing male compliance in, say, condom use, form part of the wider study that addresses men. Thus preventive reproductive health initiatives and information should move from the female alone to both sexes. Women need men as partners in reproductive health who understand the risks they might be exposed to and strategies for their prevention.
    Preview · Article · Apr 1996 · Health Policy and Planning
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