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					                             STIs, HIV and AIDS: 2005 - 2008


HIV testing and counselling for women attending child health clinics:
An opportunity for entry to prevent mother-to-child transmission and
HIV treatment.

Author:     Chersich MF; Luchters SM; Othigo MJ; Yard E; Mandaliya K

Source:     International Journal of STD and AIDS. 2008 Jan;19(1):42-46.

Abstract:   This study assessed the potential for HIV testing at child health clinics to increase
            knowledge of HIV status, and entry to infant feeding counselling and HIV
            treatment. At a provincial hospital in Mombasa, Kenya, HIV testing and
            counselling were offered to women bringing their child for immunization or
            acute care services. Most women said HIV testing should be offered in these
            clinics (472/493, 95.7%), with many citing the benefits of regular testing and
            entry to prevent mother-to-child transmission. Of 500 women, 416 (83.4%)
            received test results, 97.6% on the same day. After 50 participants, point-of-care
            testing replaced laboratory-based rapid testing. Uptake increased 2.6 times with
            point-of-care testing (95% confidence interval = 1.4-5.1; P = 0.003). Of 124 women
            who had not accessed HIV testing during pregnancy, 98 tested in the study
            (79.0%). Measured by uptake and attitudes, HIV testing in child health clinics is
            acceptable. This could optimize entry into HIV treatment, infant feeding
            counselling and family planning services. (author's)

Language:   English

Keywords:   KENYA | RESEARCH REPORT | SURVEYS | MOTHERS | INFANT |
            PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | HIV TESTING
            | COUNSELING | CHILD HEALTH SERVICES | HIV INFECTIONS |
            TREATMENT | BREASTFEEDING | DEVELOPING COUNTRIES |
            AFRICA, EASTERN | AFRICA, SUB SAHARAN | AFRICA | SAMPLING
            STUDIES | STUDIES | RESEARCH METHODOLOGY | PARENTS |
            FAMILY RELATIONSHIPS | FAMILY CHARACTERISTICS | FAMILY AND
            HOUSEHOLD | SOCIOCULTURAL FACTORS | YOUTH | AGE FACTORS
            | POPULATION CHARACTERISTICS | DEMOGRAPHIC FACTORS |
            POPULATION | DISEASE TRANSMISSION CONTROL | PREVENTION
            AND CONTROL | DISEASES | LABORATORY EXAMINATIONS AND
            DIAGNOSES | EXAMINATIONS AND DIAGNOSES | MEDICAL
            PROCEDURES | MEDICINE | HEALTH SERVICES | DELIVERY OF
            HEALTH CARE | HEALTH | CLINIC ACTIVITIES | PROGRAM
            ACTIVITIES | PROGRAMS | ORGANIZATION AND ADMINISTRATION
            | MATERNAL-CHILD HEALTH SERVICES | PRIMARY HEALTH CARE |
            VIRAL DISEASES | INFANT NUTRITION | NUTRITION


Document Number: 324667




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                            STIs, HIV and AIDS: 2005 - 2008


Morbidity in the first year postpartum among HIV-infected women in
Kenya.

Author:     Chersich MF; Luchters SM; Yard E; Othigo JM; Kley N

Source:     International Journal of Gynecology and Obstetrics. 2008 Jan;100(1):45-51.

Abstract:   The objective was to assess the effects of HIV infection on morbidity and the
            needs of infected women for services in the first year postpartum. A cross-
            sectional study with 500 women attending a child-health clinic in Mombasa,
            Kenya. Postpartum duration was a median of 3.3 months (interquartile range,
            1.9-6.1 months). The 54 HIV-infected women had a lower income and less
            financial support than the uninfected women, and they were more likely to
            experience fever, dyspnea, and dysuria, and to have genital warts (odds ratio
            [OR], 9.6; 95% confidence interval [CI], 2.6-35.6; P less than 0.001), candidiasis
            (OR, 2.9; 95% CI, 1.2-6.8; P=0.012), and bacterial vaginosis (OR, 1.8; 95% CI, 0.95-
            3.3; P=0.066). Six (nearly 15%) of the HIV-infected women had low- or high-
            grade squamous intraepithelial lesions, and 21 (42%) had an unmet need for
            contraception. More than half of all women were anemic, and normocytic anemia
            was predominant among the HIV infected. Compared with uninfected women,
            morbidity was increased for HIV-infected women during the year following
            delivery. This period could be used to offer these, and all-women, family
            planning services, cervical cancer screening, and treatment for anemia and
            reproductive tract infections. (author's)

Language:   English

Keywords:   KENYA | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS |
            POSTPARTUM WOMEN | PERSONS LIVING WITH HIV/AIDS |
            MORBIDITY | ANEMIA | POSTPARTUM PROGRAMS | DEVELOPING
            COUNTRIES | AFRICA, EASTERN | AFRICA, SUB SAHARAN | AFRICA |
            RESEARCH METHODOLOGY | PUERPERIUM | REPRODUCTION | HIV
            INFECTIONS | VIRAL DISEASES | DISEASES | FAMILY PLANNING
            PROGRAMS | FAMILY PLANNING


Document Number: 323762


HIV, hepatitis B and hepatitis C coinfection in Kenya.
Author:     Harania RS; Karuru J; Nelson M; Stebbing J

Source:     AIDS. 2008 Jun 19;22(10):1221-1222.




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                            STIs, HIV and AIDS: 2005 - 2008

Abstract:   There are few data regarding hepatitis and HIV coinfection in Africa. In 378 HIV
            seropositive individuals in Nairobi, 23 (6%) were hepatitis B virus (HBV) and
            HIV coinfected, four (1%) were hepatitis C virus (HCV) and HIV coinfected and
            one patient was infected with all three viruses. Coinfected individuals were more
            likely to be men and older; a lack of HBV vaccination was a risk factor for
            HIV/HBV coinfection (P = 0.001) and tenofovir containing regimens appeared
            most effective at reducing HBV viral load. (excerpt)

Language:   English

Keywords:   KENYA | RESEARCH REPORT | CLINICAL RESEARCH |
            EPIDEMIOLOGIC METHODS | HIV POSITIVE PERSONS | HIV
            INFECTIONS | HEPATITIS | COMPLICATIONS | SEX FACTORS | AGE
            FACTORS | IMMUNIZATION | ANTIBIOTICS | PREVALENCE |
            DEVELOPING COUNTRIES | AFRICA, EASTERN | AFRICA, SUB
            SAHARAN | AFRICA | RESEARCH METHODOLOGY | PERSONS LIVING
            WITH HIV/AIDS | VIRAL DISEASES | DISEASES | POPULATION
            CHARACTERISTICS | DEMOGRAPHIC FACTORS | POPULATION |
            PRIMARY HEALTH CARE | HEALTH SERVICES | DELIVERY OF HEALTH
            CARE | HEALTH | DRUGS | TREATMENT | MEDICAL PROCEDURES |
            MEDICINE | MEASUREMENT


Document Number: 308638


HIV-neutralizing immunoglobulin A and HIV-specific proliferation are
independently associated with reduced HIV acquisition in Kenyan sex
workers.
Author:     Hirbod T; Kaul R; Reichard C; Kimani J; Ngugi E

Source:     AIDS. 2008 Mar 30;22(6):727-735.

Abstract:   HIV-neutralizing immunoglobulin A (IgA) and HIV-specific cellular immunity
            have been described in highly exposed, persistently seronegative (HEPS)
            individuals, but well controlled studies have not been performed. We performed
            a prospective, nested case-control study to examine the association of genital IgA
            and systemic cellular immune responses with subsequent HIV acquisition in
            high-risk Kenyan female sex workers (FSWs). A randomized trial of monthly
            antibiotic prophylaxis to prevent sexually transmitted disease/HIV infection was
            performed from 1998 to 2002 in HIV-uninfected Kenyan FSWs. After the
            completion of trial, FSWs who had acquired HIV (cases) were matched 1 : 4 with
            persistently uninfected controls based on study arm, duration of HIV-
            seronegative follow-up, and time of cohort enrolment. Blinded investigators
            assayed the ability at enrolment of genital IgA to neutralize primary HIV isolates
            as well as systemic HIV-specific cellular IFNy-modified enzyme-linked


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                            STIs, HIV and AIDS: 2005 - 2008

            immunospot and proliferativeresponses. The study cohort comprised 113 FSWs:
            24 cases who acquired HIV and 89 matched controls. Genital HIV-neutralizing
            IgA was associated with reduced HIV acquisition (P = 0.003), as was HIV-specific
            proliferation (P = 0.002), and these associations were additive. HIV-specific IFNg
            production did not differ between case and control groups. In multivariable
            analysis, HIV-neutralizing IgA and HIV-specific proliferation each remained
            independently associated with lack of HIV acquisition. Genital herpes (HSV2)
            was associated with increased HIV risk and with reduced detection of HIV-
            neutralizing IgA. Genital HIV-neutralizing IgA and systemic HIV-specific
            proliferative responses, assayed by blinded investigators, were prospectively
            associated with HIV nonacquisition. The induction of these immune responses
            may be an important goal for HIV vaccines. (author's)

Language:   English

Keywords:   KENYA | RESEARCH REPORT | PROSPECTIVE STUDIES | SEX
            WORKERS | HIV | BLOOD | LABORATORY PROCEDURES | EXPOSURE
            | AUTOIMMUNE RESPONSE | DEVELOPING COUNTRIES | AFRICA,
            EASTERN | AFRICA, SUB SAHARAN | AFRICA | STUDIES | RESEARCH
            METHODOLOGY | SEX BEHAVIOR | BEHAVIOR | HIV INFECTIONS |
            VIRAL DISEASES | DISEASES | HEMIC SYSTEM | PHYSIOLOGY |
            BIOLOGY | LABORATORY EXAMINATIONS AND DIAGNOSES |
            EXAMINATIONS AND DIAGNOSES | MEDICAL PROCEDURES |
            MEDICINE | HEALTH SERVICES | DELIVERY OF HEALTH CARE |
            HEALTH | RISK FACTORS | ANTIBODIES | IMMUNOLOGIC FACTORS
            | IMMUNITY | IMMUNE SYSTEM


Document Number: 325533


Engendering health sector responses to sexual violence and HIV in
Kenya: Results of a qualitative study.
Author:     Kilonzo N; Taegtmeyer M; Molyneux C; Kibaru J; Kimonji V

Source:     AIDS Care. 2008 Feb;20(2):188-190.

Abstract:   In Kenya many people who have been affected by sexual violence turn to the
            health sector for clinical treatment and preventive therapies. This interface
            provides a vital opportunity to impact on
            the dual epidemics of HIV and sexual violence. Despite this, the uptake of post-
            rape care services in health facilities as low and health care providers felt ill-
            prepared to deal with the consequences of sexual violence. A qualitative study
            was conducted to better understand the reasons for the low uptake of services
            and to establish perceptions of sexual violence in Kenya. Thirty-four key
            informants were interviewed and sixteen focus group discussions with women


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                            STIs, HIV and AIDS: 2005 - 2008

            and men were held in three districts in Kenya. Blurred boundaries between
            forced and consensual sex emerged. Important implications for the delivery of
            HIV post exposure prophylaxis (PEP) after sexual violence include the need for
            gender-aware patient-centred training for health providers and for HIV PEP
            interventions to strengthen on-going HIV-prevention counselling efforts. Further
            research needs to determine the feasibility of on-going risk reduction measures
            in the context of PEP delivery. (author's)

Language:   English

Keywords:   KENYA | RESEARCH REPORT | QUALITATIVE RESEARCH |
            INTERVIEWS | FOCUS GROUPS | SEXUAL ABUSE | RAPE | GENDER
            ISSUES | HIV | HEALTH PERSONNEL | HEALTH SERVICES |
            AWARENESS | DEVELOPING COUNTRIES | AFRICA, EASTERN |
            AFRICA, SUB SAHARAN | AFRICA | RESEARCH METHODOLOGY |
            DATA COLLECTION | CRIME | SOCIAL PROBLEMS | SOCIOCULTURAL
            FACTORS | HIV INFECTIONS | VIRAL DISEASES | DISEASES |
            DELIVERY OF HEALTH CARE | HEALTH | KNOWLEDGE


Document Number: 324185

Reduced rates of HIV acquisition during unprotected sex by Kenyan
female sex workers predating population declines in HIV prevalence.
Author:     Kimani J; Kaul R; Nagelkerke NJ; Luo M; MacDonald KS

Source:     AIDS. 2008 Jan 2;22(1):131-137.

Abstract:   Female sex workers (FSWs) form a core group at high risk of both sexual HIV
            acquisition and secondary transmission. The magnitude of these risks may vary
            by sexual risk taking, partner HIV prevalence, host immune factors and genital
            co-infections. We examined temporal trends in HIV prevalence and per-act
            incidence, adjusted for behavioral and other variables, in FSWs from Nairobi,
            Kenya. An open cohort of FSWs followed since 1985. Behavioral and clinical data
            were collected six monthly from 1985 to 2005, and sexually transmitted infection
            (STI) diagnostics and HIV serology performed. A Cox proportional hazards
            model with time-dependent covariables was used to estimate infection risk as a
            function of calendar time. HIV prevalence in new FSW enrollees peaked at 81%
            in 1986, and was consistently below 50% after 1997. Initially uninfected FSWs
            remained at high risk of acquiring HIV throughout the study period, but the rate
            of HIV acquisition during unprotected sex with a casual client declined by
            overfour-fold. This reduction correlated closely with decreases in gonorrhea
            prevalence, and predated reductions in the Kenyan HIV population prevalence
            by over a decade. The per-act rate of HIV acquisition in high-risk Nairobi FSWs
            fell dramatically between 1985 and 2005. This decline may represent the impact
            of improved STI prevention/therapy, immunogenetic shifts in at-risk women, or


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                            STIs, HIV and AIDS: 2005 - 2008

            changes in the proportion of HIV exposures occurring with clients who had
            acute HIV infection. Declining HIV incidence in high-risk cohorts may predict
            and/or be causally related to future reductions in population prevalence.
            (author's)

Language:   English

Keywords:   KENYA | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | COHORT
            ANALYSIS | MATHEMATICAL MODEL | LONGITUDINAL STUDIES |
            SEX WORKERS | WOMEN IN DEVELOPMENT | HIV POSITIVE PERSONS
            | HIV INFECTIONS | SEX BEHAVIOR | RISK BEHAVIOR | PREVALENCE
            | Developing Countries | Africa, Eastern | Africa, Sub Saharan | Africa |
            Research Methodology | Models, Theoretical | Studies | Behavior |
            Economic Development | Economic Factors | Persons Living With HIV/AIDS
            | Viral Diseases | Diseases | Measurement

Document Number: 322747


Provider characteristics among staff providing care to sexually
transmitted infection self-medicating patients in retail pharmacies in
Kibera Slum, Nairobi, Kenya.
Author:     Kwena Z; Sharma A; Wamae N; Muga C; Bukusi E

Source:     Sexually Transmitted Diseases. 2008 May;35(5):480-483.

Abstract:   The objectives were to evaluate the characteristics of providers in management of
            STI self-medicating patients in retail pharmacies within the largest informal
            settlement in Kenya. We collected sociodemographic, training, and work history
            attributes among pharmacy staff from a convenience sample of 50 retail
            pharmacies in Kibera slum using a self-administered questionnaire. We gathered
            the required data in 8 weeks, collecting completed self-administered
            questionnaires within 7 to 14 days after distribution. Two data collectors
            subsequently presented at these pharmacies as mystery patients seeking care for
            symptoms of genital ulcer disease and gonorrhea and completed a structured
            observation form within 10 minutes of leaving the pharmacy. Approximately
            half the respondents were men aged less than 28 years. Over 90% had 12 years of
            formal education and an additional 3 years of medical professional training. Two
            thirds (66%) had been trained in Government institutions. About 65% reported
            that patients presented without prescriptions, and 45% noted that patients
            requested specific medicines but were open to advice. One-third (36%) of the
            patients used the pharmacy as their first point of care. Using mystery patients to
            evaluate syndromic management of gonorrhea and genital ulcer disease, only
            10% offered appropriate treatment per the Kenya Ministry of Health STI
            syndromic management guidelines. Although the majority of the pharmacy staff



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                            STIs, HIV and AIDS: 2005 - 2008

            in this informal settlement have some medical training and some experience, a
            very low proportion offered adequate treatment for 2 common STIs. (author's)

Language:   English

Keywords:   KENYA | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS |
            QUESTIONNAIRES | PROVIDERS WITH CLIENTS | PHARMACIES |
            TRAINING PROGRAMS | SEXUALLY TRANSMITTED DISEASES |
            GONORRHEA | SIGNS AND SYMPTOMS | ANTIBIOTICS |
            ADMINISTRATION AND DOSAGE | DEVELOPING COUNTRIES |
            AFRICA, EASTERN | AFRICA, SUB SAHARAN | AFRICA | RESEARCH
            METHODOLOGY | HEALTH SERVICES | DELIVERY OF HEALTH CARE |
            HEALTH | HEALTH FACILITIES | EDUCATION | REPRODUCTIVE
            TRACT INFECTIONS | INFECTIONS | DISEASES | DRUGS |
            TREATMENT | MEDICAL PROCEDURES | MEDICINE


Document Number: 326476


Associations of human leukocyte antigen DRB with resistance or
susceptibility to HIV-1 infection in the Pumwani Sex Worker Cohort.
Author:     Lacap PA; Huntington JD; Luo M; Nagelkerke NJ; Bielawny T

Source:     AIDS.2008;22(9):1029-1038.

Abstract:   A group of commercial sex workers in the Pumwani Sex Worker Cohort,
            established in 1985 in Nairobi, Kenya, remain HIV-1 uninfected despite heavy
            exposure to HIV-1 through active sex work. Previous studies showed that this
            resistance is associated with a strong CD4+ T-cell response, which suggested that
            human leukocyte antigen class II antigens are important in
            resistance/susceptibility to HIV-1 infection. DRB1 is the most polymorphic locus
            among class II genes and forms haplotypes with DRB3, DRB4 and DRB5. The
            aim of this study is to investigate the role of DRB alleles/haplotypes on
            resistance/susceptibility to HIV-1 infection. In total, 1090 women enrolled in the
            Pumwani cohort were genotyped for DRB1, DRB3, DRB4 and DRB5 using a
            high-resolution sequence-based method. Allele/ haplotype frequencies were
            compared between HIV-positive women and women who have remained HIV
            negative for more than 3 years despite frequent exposure. Human leukocyte
            antigen DRB genes were amplified, sequenced and genotyped using a two-step
            sequence-based method. Allele/haplotype frequencies were determined using
            PyPop32-0.6.0. Statistical analysis was conducted using SPSS 11.0 for Windows.
            Three DRB1 alleles were associated with resistance: DRB1 010101 (P = 0.016; odd
            ratio (OR): 2.55; 95% confidence interval (CI): 1.16-5.61), DRB1 010201 (P = 0.019;
            OR: 1.86; 95% CI: 1.10-3.15), and DRB1 1102 (P = 0.025; OR: 1.72; 95% CI: 1.07-
            2.78). DRB1 030201 (P = 0.038; OR: 0.48; 95% CI: 0.23-0.98), DRB1 070101 (P =


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                            STIs, HIV and AIDS: 2005 - 2008

            0.035; OR: 0.54; 95% CI: 0.30-0.97), DRB1 1503 (P = 0.0004; OR: 0.34; 95% CI: 0.19-
            0.64), and DRB5 010101 (P = 0.001; OR: 0.37; 95% CI: 0.20-0.67) were associated
            with susceptibility. The haplotype DRB1 1102-DRB3 020201 was associated with
            HIV-1 resistance (P = 0.041; OR: 1.68; 95% CI: 1.02-2.78), whereas the haplotypes
            DRB1 070101-DRB4 01010101 (P = 0.041; OR: 0.52; 95% CI: 0.28-0.98) and DRB1
            1503-DRB5 01010101 (P = 0.0002; OR: 0.30; 95% CI: 0.15-0.58) were associated
            with susceptibility. These associations with resistance/susceptibility to HIV-1
            were independent of previously reported alleles HLA-DRB1 01 and HLA-A 2301.
            Our findings indicate that human leukocyte antigen DRB-specific CD4+ T-cell
            responses are an important factor in resistance/susceptibility to HIV-1 infection.
            (author's)

Language:   English

Keywords:   KENYA | RESEARCH REPORT | GENETIC TECHNICS | SEX WORKERS |
            WOMEN | PERSONS LIVING WITH HIV/AIDS | IMMUNITY, NATURAL |
            LABORATORY PROCEDURES | DEVELOPING COUNTRIES | AFRICA,
            EASTERN | AFRICA, SUB SAHARAN | AFRICA | LABORATORY
            EXAMINATIONS AND DIAGNOSES | EXAMINATIONS AND
            DIAGNOSES | MEDICAL PROCEDURES | MEDICINE | HEALTH
            SERVICES | DELIVERY OF HEALTH CARE | HEALTH | SEX BEHAVIOR |
            BEHAVIOR | DEMOGRAPHIC FACTORS | POPULATION | HIV
            INFECTIONS | VIRAL DISEASES | DISEASES | IMMUNITY | IMMUNE
            SYSTEM | PHYSIOLOGY | BIOLOGY


Document Number: 327151


Early effects of antiretroviral therapy on work performance: Preliminary
results from a cohort study of Kenyan agricultural workers.
Author:     Larson BA; Fox MP; Rosen S; Bii M; Sigei C

Source:     AIDS, 2008 Jan 30;22(3):421-425.

Abstract:   This paper estimates the impact of antiretroviral therapy (ART) on days
            harvesting tea per month for tea-estate workers in Kenya. Such information is
            needed to assess the potential economic benefits of providing treatment to
            working adults. Data for this analysis come from company payroll records for 59
            HIV-infected workers and a comparison group of all workers assigned to the
            same work teams (reference group, n = 1992) for a period covering 2 years before
            and 1 year after initiating ART. Mean difference tests were used to obtain overall
            trends in days harvesting tea by month. A difference in difference approach was
            used to estimate the impact of HIV/AIDS on days working in the pre-ART
            period. Information on likely trends in the absence of the therapy was used to
            estimate the positive impacts on days harvesting tea over the initial 12 months on


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                            STIs, HIV and AIDS: 2005 - 2008

            ART. No significant difference existed in days plucking tea each month until the
            ninth month before initiating ART, when workers worked -2.79 fewer days than
            references (15% less). This difference grew to 5.09 fewer days (27% less) in the
            final month before initiating ART. After 12 months on ART, we conservatively
            estimate that workers worked at least twice as many days in the month than they
            would have in the absence of ART. Treatment had a large, positive impact on the
            ability of workers to undertake their primary work activity, harvesting tea, in the
            first year on ART. (author's)

Language:   English

Keywords:   KENYA | RESEARCH REPORT | COHORT ANALYSIS | AGRICULTURAL
            WORKERS | PERSONS LIVING WITH HIV/AIDS | ANTIRETROVIRAL
            THERAPY | PERFORMANCE IMPROVEMENT | TREATMENT | COST
            EFFECTIVENESS | DEVELOPING COUNTRIES | AFRICA, EASTERN |
            AFRICA, SUB SAHARAN | AFRICA | RESEARCH METHODOLOGY |
            LABOR FORCE | HUMAN RESOURCES | ECONOMIC FACTORS | HIV
            INFECTIONS | VIRAL DISEASES | DISEASES | HIV | MANAGEMENT |
            ORGANIZATION AND ADMINISTRATION | MEDICAL PROCEDURES |
            MEDICINE | HEALTH SERVICES | DELIVERY OF HEALTH CARE |
            HEALTH | EVALUATION INDEXES | QUANTITATIVE EVALUATION |
            EVALUATION


Document Number: 308615


HIV-1 persists in breast milk cells despite antiretroviral treatment to
prevent mother-to-child transmission.
Author:     Lehman DA; Chung MH; John-Stewart GC; Richardson BA; Kiarie J

Source:     AIDS. 2008 Jul;22(12):1475-1485.

Abstract:   The effects of short-course antiretrovirals given to reduce mother-to-child
            transmission (MTCT) on temporal patterns of cell-associated HIV-1 RNA and
            DNA in breast milk are not well defined. Women in Kenya received short-course
            zidovudine (ZDV), single-dose nevirapine (sdNVP), combination ZDV/sdNVP
            or short-course highly active antiretroviral therapy (HAART). Breast milk
            samples were collected two to three times weekly for 4-6 weeks. HIV-1 DNA was
            quantified by real-time PCR. Cell-free and cellassociated RNA levels were
            quantified by the Gen-Probe HIV-1 viral load assay. Cell-free HIV-1 RNA levels
            in breast milk were significantly suppressed by sdNVP, ZDV/sdNVP or HAART
            therapy compared with ZDV between day 3 and week 4 postpartum (P < or =
            0.03). Breast milk HIV-1 DNA levels (infected cell levels) were not significantly
            different between treatment arms at any timepoint during the 4-6-week follow-
            up. At 3 weeks postpartum, when the difference in cell-free RNA levels was the


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                            STIs, HIV and AIDS: 2005 - 2008

            greatest comparing HAART directly with ZDV (P=0.0001), median log10 HIV-1
            DNA copies per 1_106 cells were 2.78, 2.54, 2.69, and 2.31 in the ZDV, sdNVP,
            ZDV/sdNVP and HAART arms, respectively (P=0.23). Cell-associated HIV-1
            RNA levels were modestly suppressed in HAART versus ZDV/sdNVP during
            week 3 (3.37 versus 4.02, P=0.04), as well as over time according to a linear
            mixed-effects model. Cell-free and, to a lesser extent, cell-associated HIV-1 RNA
            levels in breast milk were suppressed by antiretroviral regimens used to prevent
            MTCT. However, even with HAART, there was no significant reduction in the
            reservoir of infected cells, which could contribute to breast milk HIV-1
            transmission. (author's)

Language:   English

Keywords:   KENYA | RESEARCH REPORT | CLINICAL RESEARCH | MOTHERS |
            PERSONS LIVING WITH HIV/AIDS | BREASTFEEDING | PREVENTION
            OF MOTHER-TO-CHILD TRANSMISSION | ANTIRETROVIRAL
            THERAPY | DEVELOPING COUNTRIES | AFRICA, EASTERN | AFRICA,
            SUB SAHARAN | AFRICA | RESEARCH METHODOLOGY | PARENTS |
            FAMILY RELATIONSHIPS | FAMILY CHARACTERISTICS | FAMILY AND
            HOUSEHOLD | SOCIOCULTURAL FACTORS | HIV INFECTIONS |
            VIRAL DISEASES | DISEASES | INFANT NUTRITION | NUTRITION |
            HEALTH | DISEASE TRANSMISSION CONTROL | PREVENTION AND
            CONTROL | HIV


Document Number: 327563


Economic status, informal exchange, and sexual risk in Kisumu, Kenya.

Author:     Luke N

Source:     Economic Development and Cultural Change. 2008 Jan;56(2):375-396.

Abstract:   Despite the escalating attention focused on the role of informal exchange in
            fueling the HIV/AIDS epidemic in Africa, there has been no empirical
            investigation of the connection between economic status, transfers, and sexual
            risk behavior. One potential reason for the paucity of studies examining these
            important linkages is the lack of quality data on economic status in African
            populations and transfers within sexual partnerships. I overcome this
            shortcoming by using survey data I collected in urban Kisumu that contain
            information on the economic status of working-age men and sexual risk behavior
            in their nonmarital partnerships. Mine is also one of the only existing surveys to
            collect detailed data on men's involvement in informal exchange relationships
            and the value of transfers given to their partners. In this article, I investigate
            various mechanisms through which economic status is associated with sexual
            risk behavior, as measured by the nonuse of condoms within sexual


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                            STIs, HIV and AIDS: 2005 - 2008

            partnerships, to shed light on the role that wealthy men play in spreading
            infection in a high HIV/AIDS environment. (excerpt)

Language:   English

Keywords:   KENYA | RESEARCH REPORT | SURVEYS | MEN | INCOME | SEX
            BEHAVIOR | RISK BEHAVIOR | CONDOM USE | HIV TRANSMISSION |
            ECONOMIC FACTORS | SUGAR DADDIES | DEVELOPING COUNTRIES
            | AFRICA, EASTERN | AFRICA, SUB SAHARAN | AFRICA | SAMPLING
            STUDIES | STUDIES | RESEARCH METHODOLOGY | DEMOGRAPHIC
            FACTORS | POPULATION | SOCIOECONOMIC FACTORS | BEHAVIOR
            | RISK REDUCTION BEHAVIOR | HIV INFECTIONS | VIRAL DISEASES
            | DISEASES


Document Number: 314018


A prospective study of risk factors for bacterial vaginosis in HIV-1-
seronegative African women.
Author:     McClelland RS; Richardson BA; Graham SM; Masese LN; Gitau R

Source:     Sexually Transmitted Diseases. 2008 Jun;35(6):617-623.

Abstract:   Bacterial vaginosis (BV) is common and has been associated with increased HIV-
            1 susceptibility. The objective of this study was to identify risk factors for BV in
            African women at high risk for acquiring HIV-1. We conducted a prospective
            study among 151 HIV-1-seronegative Kenyan female sex workers. Nonpregnant
            women were eligible if they did not have symptoms of abnormal vaginal itching
            or discharge at the time of enrollment. At monthly follow-up, a vaginal
            examination and laboratory testing for genital tract infections were performed.
            Multivariate Andersen-Gill proportional hazards analysis was used to identify
            correlates of BV. Participants completed a median of 378 (interquartile range 350-
            412) days of follow-up. Compared with women reporting no vaginal washing,
            those who reported vaginal washing 1 to 14 [adjusted hazard ratio (aHR) 1.29,
            95% confidence interval (CI) 0.88-1.89], 15 to 28 (aHR 1.60, 95% CI 0.98 -2.61), and
            greater than 28 times/wk (aHR 2.39, 95% CI 1.35-4.23) were at increased risk of
            BV. Higher BV incidence was also associated with the use of cloth for
            intravaginal cleansing (aHR 1.48, 95% CI 1.06 -2.08) and with recent unprotected
            intercourse (aHR 1.75, 95% CI 1.47-2.08). Women using depot
            medroxyprogesterone acetate contraception were at lower risk for BV (aHR 0.59,
            95% CI 0.48-0.73). Vaginal washing and unprotected intercourse were associated
            with increased risk of BV. These findings could help to inform the development
            of novel vaginal health approaches for HIV-1 risk reduction in women. (author's)




                                             11
                             STIs, HIV and AIDS: 2005 - 2008

Language:    English

Keywords:    KENYA | RESEARCH REPORT | PROSPECTIVE STUDIES | SEX
             WORKERS | VAGINOSIS | RISK FACTORS | LABORATORY
             EXAMINATIONS AND DIAGNOSES | SEX BEHAVIOR | HYGIENE |
             DEPO-PROVERA | DEVELOPING COUNTRIES | AFRICA, EASTERN |
             AFRICA, SUB SAHARAN | AFRICA | STUDIES | RESEARCH
             METHODOLOGY | BEHAVIOR | VAGINAL ABNORMALITIES |
             DISEASES | BIOLOGY | EXAMINATIONS AND DIAGNOSES | MEDICAL
             PROCEDURES | MEDICINE | HEALTH SERVICES | DELIVERY OF
             HEALTH CARE | HEALTH | PUBLIC HEALTH |
             MEDROXYPROGESTERONE ACETATE | CONTRACEPTIVE AGENTS,
             PROGESTIN | CONTRACEPTIVE AGENTS, FEMALE | CONTRACEPTIVE
             AGENTS | CONTRACEPTION | FAMILY PLANNING


Document Number: 327423


An outcome assessment of an ABC-based HIV peer education intervention among Kenyan
university students.

Author:      Miller AN; Mutungi M; Facchini E; Barasa B; Ondieki W

Source:      Journal of Health Communication. 2008 Jun;13(4):345-356.

Abstract:    This study reports an outcome assessment on an HIV peer education
             intervention at the main campus of Kenyatta University in Nairobi, Kenya. A
             quasiexperimental separate sample pretest-posttest design was used. Campus-
             wide baseline and endline surveys were conducted with 632 and 746 students,
             respectively, soliciting information on HIV-related knowledge, attitudes, and
             behavior. After 2 years of on-campus intervention, no changes in behavior were
             evident with respect to either abstinence or number of sexual partners. Small but
             statistically significant changes were found in condom attitudes and behavior,
             and a large increase in HIV testing was evident. It is recommended that future
             research more specifically compare abstinence versus multiple option peer
             education programs, giving special attention to the role of peer educators as
             models. (author's)

Language:    English

Keywords:    KENYA | RESEARCH REPORT | PRE-POST TESTS | STUDENTS | HIV
             PREVENTION | PEER EDUCATORS | INTERVENTIONS | PROGRAM
             EVALUATION | PROGRAM EFFECTIVENESS | HIV TESTING |
             CONDOM USE | BEHAVIOR CHANGE | ABSTINENCE | MULTIPLE
             PARTNERS | DEVELOPING COUNTRIES | AFRICA, EASTERN | AFRICA,
             SUB SAHARAN | AFRICA | PROGRAMS | ORGANIZATION AND
             ADMINISTRATION | EDUCATION | HIV INFECTIONS | VIRAL


                                             12
                            STIs, HIV and AIDS: 2005 - 2008

            DISEASES | DISEASES | LABORATORY EXAMINATIONS AND
            DIAGNOSES | EXAMINATIONS AND DIAGNOSES | MEDICAL
            PROCEDURES | MEDICINE | HEALTH SERVICES | DELIVERY OF
            HEALTH CARE | HEALTH | RISK REDUCTION BEHAVIOR | BEHAVIOR
            | FAMILY PLANNING, BEHAVIORAL METHODS | FAMILY PLANNING |
            SEXUAL PARTNERS | SEX BEHAVIOR


Document Number: 327076


AIDS and kitchen gardens: insights from a village in western Kenya.
Author:     Murphy LL

Source:     Population and Environment. 2008 May;29(3-5):133-161.

Abstract:   In rural Africa, indigenous farming and natural resource management systems
            exemplified by kitchen gardens are being reshaped by the HIV/AIDS epidemic
            and its negative impacts (illness, stigma and mortality, and economic costs) and
            positive opportunities (organizational responses to the epidemic). Subtle changes
            in crops and farm techniques can be traced to these diverse influences of HIV+
            infection, illness, mortality, widowhood, foster child care, and AIDS support
            groups, as well as the organizations, ideas, and flow of funding from outside.
            These findings draw on original field data: a village census, in-depth interviews
            with gardeners, and group discussions in a village in Bungoma District (in 2005
            and 2007). This part of western Kenya is a typical small-farm zone that has faced
            a moderate HIV/AIDS epidemic since the 1990s, following decades of
            demographic, environmental, technological, and institutional changes.
            Implications of this case study for further research on HIV/AIDS and on micro-
            level population-environment change suggest that households are useful but
            imperfect analytical units and are best seen as part of complex social networks,
            shaping connections to markets. These important "mediating institutions" link
            AIDS as a demographic and economic force with environmental outcomes in
            cultivated landscapes. (Author's)

Language:   English

Keywords:   KENYA | RESEARCH REPORT | INTERVIEWS | HIV INFECTIONS |
            EPIDEMICS | RURAL POPULATION | AGRICULTURAL DEVELOPMENT
            | LIVELIHOOD | HOUSEHOLDS | SOCIAL NETWORKS | AFRICA,
            EASTERN | AFRICA, SUB SAHARAN | AFRICA | DEVELOPING
            COUNTRIES | DATA COLLECTION | RESEARCH METHODOLOGY |
            VIRAL DISEASES | DISEASES | POPULATION CHARACTERISTICS |
            DEMOGRAPHIC FACTORS | POPULATION | RURAL DEVELOPMENT |
            ECONOMIC FACTORS | RESOURCES | ORGANIZATION AND
            ADMINISTRATION | FAMILY AND HOUSEHOLD | SOCIOCULTURAL



                                            13
                            STIs, HIV and AIDS: 2005 - 2008

            FACTORS | FRIENDS AND RELATIVES

Document Number: 327913


Sexual risk behaviour and HAART: A comparative study of HIV-
infected persons on HAART and on preventive therapy in Kenya.

Author:     Sarna A; Luchters SM; Geibel S; Kaai S; Munyao P

Source:     International Journal of STD and AIDS. 2008 Feb;19(2):85-89.

Abstract:   Unprotected sex (UPS) among persons receiving highly active antiretroviral
            therapy (HAART) remains a concern because of the risk of HIV-transmission. A
            cross-sectional study comparing the sexual risk behaviour of 179 people living
            with HIV/AIDS (PLHA) receiving HAART with that of 143 PLHA receiving
            preventive therapy (PT) with cotrimoxazole/isoniazid was conducted in
            Mombasa, Kenya. Forty-five percent of all participants were sexually active in
            the last six months. Participants receiving PT were more likely to report greater
            than or equal to 2 partners (13% vs. 1%; P = 0.006). Participants receiving PT
            reported more UPS with regular partners (odds ratio [OR]: 3.9; 95% confidence
            interval [CI]: 1.8-8.4) and also more sexually transmitted infections (STI)
            symptoms (OR: 1.7; 95% CI: 1.0-2.8; P = 0.059). More than 40% of all participants
            did not know the HIV-status of regular partners. Therefore, HAART was not
            associated with increased sexual risk behaviours though considerable risk of
            HIV-transmission remains. HIV-care services need to emphasize partner testing
            and consistent condom use with all partners. (author's)

Language:   English

Keywords:   KENYA | RESEARCH REPORT | COMPARATIVE STUDIES | CROSS
            SECTIONAL ANALYSIS | HIV POSITIVE PERSONS | SEX BEHAVIOR |
            RISK BEHAVIOR | SEXUALLY TRANSMITTED DISEASES | HIV
            INFECTIONS | ANTIRETROVIRAL THERAPY | TREATMENT | HIV
            PREVENTION | DEVELOPING COUNTRIES | AFRICA, EASTERN |
            AFRICA, SUB SAHARAN | AFRICA | STUDIES | RESEARCH
            METHODOLOGY | PERSONS LIVING WITH HIV/AIDS | VIRAL
            DISEASES | DISEASES | BEHAVIOR | REPRODUCTIVE TRACT
            INFECTIONS | INFECTIONS | HIV | MEDICAL PROCEDURES |
            MEDICINE | HEALTH SERVICES | DELIVERY OF HEALTH CARE |
            HEALTH


Document Number: 325330




                                            14
                            STIs, HIV and AIDS: 2005 - 2008


Sexual identity and risk of HIV / STI among men who have sex with men
in Nairobi.
Author:     Sharma A; Bukusi E; Gorbach P; Cohen CR; Muga C

Source:     Sexually Transmitted Diseases. 2008 Apr;35(4):352-354.

Abstract:   Although there is great regional variation, a significant proportion of those with
            human immunodeficiency virus (HIV/ AIDS) globally are men who have sex
            with men (MSM) due to the high efficiency of transmission via anal intercourse.
            This relatively small number of individuals may be disproportionately at risk of
            HIV transmission vis-a-vis the wider population, particularly in countries where
            social or legal retribution accompanies public disclosure. Recent short-term
            estimates suggest that of the approximately 82,300 new HIV infections in Kenya
            in 2005, 4.5% were in MSM. The incidence among these men may be even higher,
            as the models assumed that only 1% of the male population had sex with men
            and did not account for male sex workers in this population. The success of
            HIV/sexually transmitted infections (STI) education, prevention and treatment
            programs for MSM will depend on understanding the diversity of identities,
            roles, and situations in this subpopulation. By the late 1990s, a growing body of
            scientific literature revealed that some men in Africa had sexual intercourse with
            men, that some of these men also had sex with women and that these men were
            at significant risk for HIV/ STI. In Kenya, researchers lamented the lack of data
            on MSM and suggested that in the absence of social sanction or legal rights,
            MSM in Kenya would deny having male sexual partners, engage in clandestine
            sex, and take social cover in marriage. (excerpt)

Language:   English

Keywords:   KENYA | RESEARCH REPORT | SAMPLING STUDIES | KAP SURVEYS |
            EPIDEMIOLOGIC METHODS | MEN HAVING SEX WITH MEN | URBAN
            POPULATION | SEXUALITY | ANAL SEX | HIV TRANSMISSION | RISK
            BEHAVIOR | SEX BEHAVIOR | UTILIZATION OF HEALTH CARE |
            DEVELOPING COUNTRIES | AFRICA, EASTERN | AFRICA, SUB
            SAHARAN | AFRICA | STUDIES | RESEARCH METHODOLOGY |
            SURVEYS | BEHAVIOR | POPULATION CHARACTERISTICS |
            DEMOGRAPHIC FACTORS | POPULATION | PERSONALITY |
            PSYCHOLOGICAL FACTORS | HIV INFECTIONS | VIRAL DISEASES |
            DISEASES | HEALTH SERVICES | DELIVERY OF HEALTH CARE |
            HEALTH

Document Number: 325578




                                            15
                            STIs, HIV and AIDS: 2005 - 2008


Working with risk: Occupational safety issues among healthcare workers
in Kenya.

Author:     Taegtmeyer M; Suckling RM; Nguku PM; Meredith C; Kibaru J

Source:     AIDS Care. 2008 Mar;20(3):304-310.

Abstract:   The objective of this study was to explore knowledge of, attitudes towards and
            practice of post-exposure prophylaxis (PEP) among healthcare workers (HCWs)
            in the Thika district, Kenya. We used site and population-based surveys,
            qualitative interviews and operational research with 650 staff at risk of
            needlestick injuries (NSIs). Research was conducted over a 5-year period in five
            phases: (1) a bio-safety assessment; (2) a staff survey: serum drawn for
            anonymous HIV testing; (3) interventions: biosafety measures, antiretrovirals for
            PEP and hepatitis B vaccine; (4) a repeat survey to assess uptake and
            acceptability of interventions; in-depth group and individual interviews were
            conducted; and (5) health system monitoring outside a research setting. The main
            outcome measures were bio-safety standards in clinical areas, knowledge,
            attitudes and practice as regards to PEP, HIV-sero-prevalence in healthcare
            workers, uptake of interventions, reasons for poor uptake elucidated and
            sustainability indicators. Results showed that HCWs had the same HIV sero-
            prevalence as the general population but were at risk from poor bio-safety. The
            incidence of NSIs was 0.97 per healthcare worker per year. Twenty-one percent
            had had an HIV test in the last year. After one year there was a significant drop
            in the number of NSIs (OR: 0.4; CI: 0.3-0.6; p less than 0.001) and a significant
            increase in the number of HCWs accessing HIV testing (OR: 1.55; CI: 1.2-2.1; p =
            0.003). In comparison to uptake of hepatitis B vaccination (88% of those requiring
            vaccine) the uptake of PEP was low (4% of those who had NSIs). In-depth
            interviews revealed this was due to HCWs fear of HIV testing and their
            perception of NSIs as low risk. We concluded that Bio-safety remains the most
            significant intervention through reducing the number of NSIs. Post-exposure
            prophylaxis can be made readily available in a Kenyan district. However, where
            HIV testing remains stigmatised uptake will be limited*particularly in the initial
            phases of a programme. (author's)

Language:   English

Keywords:   KENYA | ADMINISTRATIVE DISTRICTS | RESEARCH REPORT | KAP
            SURVEYS | EPIDEMIOLOGIC METHODS | OPERATIONS RESEARCH |
            FOCUS GROUPS | HEALTH PERSONNEL | OCCUPATIONAL HEALTH |
            SAFETY | NEEDLE PIERCING | ACCIDENTS AND INJURIES | HIV
            TESTING | HIV TRANSMISSION | PREVALENCE | DEVELOPING
            COUNTRIES | AFRICA, EASTERN | AFRICA, SUB SAHARAN | AFRICA |
            GEOGRAPHIC FACTORS | POPULATION | SURVEYS | SAMPLING
            STUDIES | STUDIES | RESEARCH METHODOLOGY | PROGRAM
            EVALUATION | PROGRAMS | ORGANIZATION AND



                                            16
                             STIs, HIV and AIDS: 2005 - 2008

            ADMINISTRATION | DATA COLLECTION | DELIVERY OF HEALTH
            CARE | HEALTH | PUBLIC HEALTH | RISK BEHAVIOR | BEHAVIOR |
            LABORATORY EXAMINATIONS AND DIAGNOSES | EXAMINATIONS
            AND DIAGNOSES | MEDICAL PROCEDURES | MEDICINE | HEALTH
            SERVICES | HIV INFECTIONS | VIRAL DISEASES | DISEASES |
            MEASUREMENT


Document Number: 325502


Reasons for unsatisfactory acceptance of antiretroviral treatment in the
urban Kibera slum, Kenya.

Author:     Unge C; Johansson A; Zachariah R; Some D; Van Engelgem I

Source:     AIDS Care. 2008 Feb;20(2):146-149.

Abstract:   The aim of this study was to explore why patients in the urban Kibera slum,
            Nairobi, Kenya, offered free antiretroviral treatment (ART) at the Medecins Sans
            Frontiers (MSF) clinic, choose not to be treated despite signs of AIDS. Qualitative
            semi-structured interviews were conducted with 26 patients, 9 men and 17
            women. Six main reasons emerged for not accepting ART: a) fear of taking
            medication on an empty stomach due to lack of food; b) fear that side-effects
            associated with ART would make one more ill; c) fear of disclosure and its
            possible negative repercussions; d) concern for continuity of treatment and care;
            e) conflicting information from religious leaders and community, and seeking
            alternative care (e.g. traditional medicine); f) illiteracy making patients unable to
            understand the information given by health workers. (author's)

Language:   English

Keywords:   KENYA | RESEARCH REPORT | KAP SURVEYS | PERSONS LIVING
            WITH HIV/AIDS | URBAN POPULATION | SLUMS | ANTIRETROVIRAL
            THERAPY | USER COMPLIANCE | FEAR | SIDE EFFECTS | SOCIAL
            DISCRIMINATION | RELIGIOUS ASPECTS | TRADITIONAL HEALTH
            PRACTICES | ILLITERACY | BELIEFS | DEVELOPING COUNTRIES |
            AFRICA, EASTERN | AFRICA, SUB SAHARAN | AFRICA | SURVEYS |
            SAMPLING STUDIES | STUDIES | RESEARCH METHODOLOGY | HIV
            INFECTIONS | VIRAL DISEASES | DISEASES | POPULATION
            CHARACTERISTICS | DEMOGRAPHIC FACTORS | POPULATION |
            URBANIZATION | URBAN POPULATION DISTRIBUTION |
            POPULATION DISTRIBUTION | GEOGRAPHIC FACTORS | HIV |
            BEHAVIOR | EMOTIONS | PSYCHOLOGICAL FACTORS | TREATMENT
            | MEDICAL PROCEDURES | MEDICINE | HEALTH SERVICES |
            DELIVERY OF HEALTH CARE | HEALTH | SOCIAL PROBLEMS |
            SOCIOCULTURAL FACTORS | RELIGION | CULTURE | EDUCATIONAL


                                             17
                             STIs, HIV and AIDS: 2005 - 2008

            STATUS | SOCIOECONOMIC STATUS | SOCIOECONOMIC FACTORS |
            ECONOMIC FACTORS

Document Number: 324765


HIV testing and counselling for women attending child health clinics:
An opportunity for entry to prevent mother-to-child transmission and
HIV treatment.

Author:     Chersich MF; Luchters SM; Othigo MJ; Yard E; Mandaliya K

Source:     International Journal of STD and AIDS. 2008 Jan;19(1):42-46.

Abstract:   This study assessed the potential for HIV testing at child health clinics to increase
            knowledge of HIV status, and entry to infant feeding counselling and HIV
            treatment. At a provincial hospital in Mombasa, Kenya, HIV testing and
            counselling were offered to women bringing their child for immunization or
            acute care services. Most women said HIV testing should be offered in these
            clinics (472/493, 95.7%), with many citing the benefits of regular testing and
            entry to prevent mother-to-child transmission. Of 500 women, 416 (83.4%)
            received test results, 97.6% on the same day. After 50 participants, point-of-care
            testing replaced laboratory-based rapid testing. Uptake increased 2.6 times with
            point-of-care testing (95% confidence interval = 1.4-5.1; P = 0.003). Of 124 women
            who had not accessed HIV testing during pregnancy, 98 tested in the study
            (79.0%). Measured by uptake and attitudes, HIV testing in child health clinics is
            acceptable. This could optimize entry into HIV treatment, infant feeding
            counselling and family planning services. (author's)

Language:   English

Keywords:   KENYA | RESEARCH REPORT | SURVEYS | MOTHERS | INFANT |
            PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | HIV TESTING
            | COUNSELING | CHILD HEALTH SERVICES | HIV INFECTIONS |
            TREATMENT | BREASTFEEDING | DEVELOPING COUNTRIES |
            AFRICA, EASTERN | AFRICA, SUB SAHARAN | AFRICA | SAMPLING
            STUDIES | STUDIES | RESEARCH METHODOLOGY | PARENTS |
            FAMILY RELATIONSHIPS | FAMILY CHARACTERISTICS | FAMILY AND
            HOUSEHOLD | SOCIOCULTURAL FACTORS | YOUTH | AGE FACTORS
            | POPULATION CHARACTERISTICS | DEMOGRAPHIC FACTORS |
            POPULATION | DISEASE TRANSMISSION CONTROL | PREVENTION
            AND CONTROL | DISEASES | LABORATORY EXAMINATIONS AND
            DIAGNOSES | EXAMINATIONS AND DIAGNOSES | MEDICAL
            PROCEDURES | MEDICINE | HEALTH SERVICES | DELIVERY OF
            HEALTH CARE | HEALTH | CLINIC ACTIVITIES | PROGRAM
            ACTIVITIES | PROGRAMS | ORGANIZATION AND ADMINISTRATION



                                             18
                            STIs, HIV and AIDS: 2005 - 2008

            | MATERNAL-CHILD HEALTH SERVICES | PRIMARY HEALTH CARE |
            VIRAL DISEASES | INFANT NUTRITION | NUTRITION


Document Number: 324667


Reduced rates of HIV acquisition during unprotected sex by Kenyan
female sex workers predating population declines in HIV prevalence.
Author:     Kimani J; Kaul R; Nagelkerke NJ; Luo M; MacDonald KS

Source:     AIDS. 2008 Jan 2;22(1):131-137.

Abstract:   Female sex workers (FSWs) form a core group at high risk of both sexual HIV
            acquisition and secondary transmission. The magnitude of these risks may vary
            by sexual risk taking, partner HIV prevalence, host immune factors and genital
            co-infections. We examined temporal trends in HIV prevalence and per-act
            incidence, adjusted for behavioral and other variables, in FSWs from Nairobi,
            Kenya. An open cohort of FSWs followed since 1985. Behavioral and clinical data
            were collected six monthly from 1985 to 2005, and sexually transmitted infection
            (STI) diagnostics and HIV serology performed. A Cox proportional hazards
            model with time-dependent covariables was used to estimate infection risk as a
            function of calendar time. HIV prevalence in new FSW enrollees peaked at 81%
            in 1986, and was consistently below 50% after 1997. Initially uninfected FSWs
            remained at high risk of acquiring HIV throughout the study period, but the rate
            of HIV acquisition during unprotected sex with a casual client declined by
            overfour-fold. This reduction correlated closely with decreases in gonorrhea
            prevalence, and predated reductions in the Kenyan HIV population prevalence
            by over a decade. The per-act rate of HIV acquisition in high-risk Nairobi FSWs
            fell dramatically between 1985 and 2005. This decline may represent the impact
            of improved STI prevention/therapy, immunogenetic shifts in at-risk women, or
            changes in the proportion of HIV exposures occurring with clients who had
            acute HIV infection. Declining HIV incidence in high-risk cohorts may predict
            and/or be causally related to future reductions in population prevalence.
            (author's)

Language:   English

Keywords:   KENYA | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | COHORT
            ANALYSIS | MATHEMATICAL MODEL | LONGITUDINAL STUDIES |
            SEX WORKERS | WOMEN IN DEVELOPMENT | HIV POSITIVE PERSONS
            | HIV INFECTIONS | SEX BEHAVIOR | RISK BEHAVIOR | PREVALENCE
            | DEVELOPING COUNTRIES | AFRICA, EASTERN | AFRICA, SUB
            SAHARAN | AFRICA | RESEARCH METHODOLOGY | MODELS,
            THEORETICAL | STUDIES | BEHAVIOR | ECONOMIC DEVELOPMENT |
            ECONOMIC FACTORS | PERSONS LIVING WITH HIV/AIDS | VIRAL


                                              19
                            STIs, HIV and AIDS: 2005 - 2008

            DISEASES | DISEASES | MEASUREMENT

Document Number: 322747


Lessons learned in the conduct, validation, and interpretation of national
population based HIV surveys.
Author:     Garcia Calleja JM; Marum LH; Carcamo CP; Kaetano L; Muttunga J

Source:     AIDS. 2005 May;19 Suppl 2:S9-S17.

Abstract:   In the past few years several countries have conducted national population-
            based HIV surveys. Survey methods, levels of participation bias from absence or
            refusal and lessons learned conducting such surveys are compared in four
            national population surveys: Mali, Kenya, Peru and Zambia. In Mali, Zambia,
            and Kenya, HIV testing of adult women and men was included in the national-
            level demographic and health surveys carried out regularly in these countries,
            whereas in Peru the national HIV survey targeted young people in 24 cities with
            populations over 50 000. The household response rate was above 90% in all
            countries, but some individuals were absent for interviews. HIV testing rates
            were between 70 and 79% of those eligible, with higher test rates for women.
            Three critical questions in this type of survey need to be answered: who did the
            surveys miss; how much it matters that they were missed; and what can be done
            to increase the participation of respondents so the coverage rates are adequate.
            The level of representativeness of the populations tested was adequate in each
            survey to provide a reliable national estimate of HIV prevalence that
            complements other methods of HIV surveillance. Different lessons were learned
            from each survey. These population-based HIV seroprevalence surveys
            demonstrate that reliable and useful results can be obtained, although they
            require careful planning and increased financial and human resource investment
            to maximize responses at the household and individual level, which are key
            elements to validate survey results. This review was initiated through an
            international meeting on 'New strategies for HIV/ AIDS Surveillance in
            Resource-constrained Countries' held in Addis Ababa on 26--30 January 2004 to
            share and develop recommendations to guide future surveys. (author's)

Language:   English

Keywords:   MALI | KENYA | PERU | ZAMBIA | METHODOLOGICAL STUDIES |
            DEMOGRAPHIC AND HEALTH SURVEYS | EPIDEMIOLOGIC METHODS
            | HOUSEHOLDS | HIV INFECTIONS | PREVALENCE | DATA QUALITY
            | AFRICA, WESTERN | AFRICA SOUTH OF THE SAHARA | AFRICA |
            DEVELOPING COUNTRIES | AFRICA, EASTERN | SOUTH AMERICA,
            WESTERN | SOUTH AMERICA | LATIN AMERICA | AMERICAS |
            AFRICA, SOUTHERN | DEMOGRAPHIC SURVEYS | POPULATION
            DYNAMICS | DEMOGRAPHIC FACTORS | POPULATION | RESEARCH



                                           20
                            STIs, HIV and AIDS: 2005 - 2008

            METHODOLOGY | FAMILY AND HOUSEHOLD | SOCIOCULTURAL
            FACTORS | VIRAL DISEASES | DISEASES | MEASUREMENT | DATA
            ANALYSIS


Document Number: 306899


Prevention of mother-to-child transmission and voluntary counseling
and testing programme data: What is their utility for HIV surveillance?

Author:     Hladik W; Masupu K; Roels T; Plipat T; Kaharuza F

Source:     AIDS. 2005 May;19 Suppl 2:S19-S24.

Abstract:   Antenatal clinic (ANC)-based surveillance through unlinked anonymous testing
            (UAT) for HIV without informed consent provides solid long-term trend data in
            resource-constrained countries with generalized epidemics. The rapid expansion
            of the prevention of mother-to-child transmission (PMTCT) and voluntary
            counseling and testing (VCT) programmes prompts the question regarding their
            utility for HIV surveillance and their potential to replace UAT-based ANC
            surveillance. Four presentations on the use of PMTCT or VCT data for HIV
            surveillance were presented at a recent international conference. The main
            findings are presented in this paper, and the operational and epidemiological
            aspects of using PMTCT or VCT data for surveillance are considered. VCT data
            in Uganda confirm the falling trend in HIV prevalence observed in ANC
            surveillance. Thailand, a country with nationwide PMTCT coverage and a very
            high acceptance of HIV testing, has replaced UAT data in favor of PMTCT data
            for surveillance. Studies from Botswana and Kenya showed that PMTCT-based
            HIV prevalences was similar, but the quality and availability of the PMTCT data
            varied. The strength of UAT lies in the absence of selection bias and the
            availability of individual data. Conversely, the quantity of VCT and PMTCT
            programme testing data often exceed those in UAT, but may be subject to bias
            due to self-selection or test refusal. When using VCT or PMTCT data for
            surveillance, investigators must consider these caveats, as well as their varying
            data quality, accessibility, and availability of individual records. (author's)

Language:   English

Keywords:   UGANDA | THAILAND | BOTSWANA | KENYA | METHODOLOGICAL
            STUDIES | EPIDEMIOLOGIC METHODS | MOTHERS | INFANT |
            MOTHER-TO-CHILD TRANSMISSION | HIV PREVENTION | DATA
            QUALITY | BIAS | VOLUNTARY COUNSELING AND TESTING |
            ANTENATAL CARE | DEVELOPING COUNTRIES | AFRICA, EASTERN |
            AFRICA SOUTH OF THE SAHARA | AFRICA | ASIA, SOUTHEASTERN |
            ASIA | AFRICA, SOUTHERN | RESEARCH METHODOLOGY | PARENTS
            | FAMILY RELATIONSHIPS | FAMILY CHARACTERISTICS | FAMILY


                                            21
                            STIs, HIV and AIDS: 2005 - 2008

            AND HOUSEHOLD | SOCIOCULTURAL FACTORS | YOUTH | AGE
            FACTORS | POPULATION CHARACTERISTICS | DEMOGRAPHIC
            FACTORS | POPULATION | TRANSMISSION | INFECTIONS |
            DISEASES | HIV INFECTIONS | VIRAL DISEASES | DATA ANALYSIS |
            ERROR SOURCES | MEASUREMENT | HIV TESTING | LABORATORY
            EXAMINATIONS AND DIAGNOSES | EXAMINATIONS AND
            DIAGNOSES | MEDICAL PROCEDURES | MEDICINE | HEALTH
            SERVICES | DELIVERY OF HEALTH CARE | HEALTH | MATERNAL
            HEALTH SERVICES | MATERNAL-CHILD HEALTH SERVICES |
            PRIMARY HEALTH CARE

Document Number: 306900


Prevalence of HCV and HCV / HIV co-infection among in-patients at the
Kenyatta National Hospital.
Author:     Karuru JW; Lule GN; Joshi M; Anzala O

Source:     East African Medical Journal. 2005 Apr;82(4):170-172.

Abstract:   The objective was to determine the prevalence of HCV and HCV/HIV co-
            infection among medical in-patients at the Kenyatta National Hospital. Design:
            Prospective cross-sectional descriptive study. Setting: Kenyatta National
            Hospital, a tertiary referral and teaching hospital, in-patient department Subjects:
            HIV/AIDS and HIV negative in-patients at KNH medical wards. Among 458
            HIV/AIDS medical in-patients, the prevalence of HCV was 3.7% while in the 518
            HIV negative patients, it was 4.4%. The prevalence of co-infection with HCV and
            HIV was 3.7%. The incidence of risk factors in persons with HCV and/ or HIV
            infection(s) was low. This study found the prevalence of HCV infection among
            medical in-patients to be similar in HIV positive and HIV negative group of
            patients. The co-infection rates were low, as were the risk factors for transmission
            of these infections. (author's)

Language:   English

Keywords:   KENYA | RESEARCH REPORT | CLINICAL RESEARCH | CROSS
            SECTIONAL ANALYSIS | CLIENTS | HOSPITALS | HEPATITIS | HIV
            INFECTIONS | PREVALENCE | RISK FACTORS | AFRICA, EASTERN |
            AFRICA SOUTH OF THE SAHARA | AFRICA | DEVELOPING
            COUNTRIES | RESEARCH METHODOLOGY | PROGRAM ACTIVITIES |
            PROGRAMS | ORGANIZATION AND ADMINISTRATION | HEALTH
            FACILITIES | DELIVERY OF HEALTH CARE | HEALTH | VIRAL
            DISEASES | DISEASES |


Document Number: 293551


                                             22
                            STIs, HIV and AIDS: 2005 - 2008




Prevalence of HCV and HIV / HCV co-infection among volunteer blood
donors and VCT clients.

Author:     Karuru JW; Lule GN; Joshi M; Anzala O

Source:     East African Medical Journal. 2005 Apr;82(4):166-169.

Abstract:   The objective was to determine the prevalence of HCV infection and HCV/HIV
            co-infection among voluntary blood donors at the National Blood Transfusion
            Centre and clients at the Kenyatta National Hospital HIV-Voluntary Counselling
            and Testing (VCT) Centre. Design: A prospective cross-sectional descriptive
            study. Setting: Kenyatta National Hospital, a tertiary referral and teaching
            hospital and the National Blood Transfusion Services Centre, Nairobi. Subjects:
            Volunteer blood donors and VCT attendants. The prevalence of HCV/HIV co-
            infection among 6154 blood donors in the NBTSC was very low, at 0.02. The HIV
            prevalence among the 353 KNH HIV-VCT clients was 9.3%, none of the clients
            tested positive for HCV. The incidence of risk factors in the persons with HCV
            and/or HIV infection(s) was low. The prevalence of HCV infection among pre-
            screened volunteer blood donors was low. However the current practice of
            screening all donated blood for HCV remains indispensable to prevent its

Language:   English

Keywords:   KENYA | RESEARCH REPORT | PROSPECTIVE STUDIES | PREVALENCE
            | INCIDENCE | HIV POSITIVE PERSONS | CLIENTS | BLOOD DONORS
            | VOLUNTARY COUNSELING AND TESTING | HIV INFECTIONS |
            AFRICA, EASTERN | AFRICA SOUTH OF THE SAHARA | AFRICA |
            DEVELOPING COUNTRIES | STUDIES | RESEARCH METHODOLOGY |
            MEASUREMENT | PERSONS LIVING WITH HIV/AIDS | VIRAL
            DISEASES | DISEASES | PROGRAM ACTIVITIES | PROGRAMS |
            ORGANIZATION AND ADMINISTRATION | BLOOD SUPPLY |
            EQUIPMENT AND SUPPLIES | MEDICAL PROCEDURES | MEDICINE |
            HEALTH SERVICES | DELIVERY OF HEALTH CARE | HEALTH | HIV
            TESTING | LABORATORY EXAMINATIONS AND DIAGNOSES |
            EXAMINATIONS AND DIAGNOSES


Document Number: 293571




                                           23
                            STIs, HIV and AIDS: 2005 - 2008


High probability of female-to-male HIV-1 transmission for
uncircumcised men with multiple partners.
Author:     Crabb C

Source:     AIDS. 2005;19(10):N1. Notes and Quotes

Abstract:   Compared to circumcised men, uncircumcised men are more than twice as likely
            to acquire HIV-1 each time they have unprotected sex with an infected woman,
            according to a team of researchers in the US and Kenya. The study----the first to
            measure infectivity, or the probability of HIV-1 transmission per sex act, in a
            context of multiple partnerships----also found that infectivity among men,
            whether circumcised or not, who have several female partners is many fold
            higher than estimates based on monogamous HIV-1 discordant couples. Jared
            Baeten of the University of Washington in Seattle and his colleagues calculated
            infectivity from data collected during a 4-year prospective study of 745 male
            employees of six trucking companies in Mombasa, Kenya. Ninety-five of the men
            were uncircumcised. In quarterly check-ups at a mobile research clinic that
            visited the companies on a weekly basis, each participant reported his sexual
            behavior with wives, casual partners and prostitutes during the previous 3
            months. (excerpt)

Language:   English

Keywords:   UNITED STATES | KENYA | RESEARCH REPORT | PROSPECTIVE
            STUDIES | MEN | WOMEN | HIV TRANSMISSION | MALE
            CIRCUMCISION | MULTIPLE PARTNERS | RISK FACTORS | CONDOM
            USE | NORTH AMERICA | AMERICAS | DEVELOPED COUNTRIES |
            AFRICA, EASTERN | AFRICA, SUB SAHARAN | AFRICA | DEVELOPING
            COUNTRIES | STUDIES | RESEARCH METHODOLOGY |
            DEMOGRAPHIC FACTORS | POPULATION | HIV INFECTIONS | VIRAL
            DISEASES | DISEASES | MEDICAL PROCEDURES | MEDICINE |
            HEALTH SERVICES | DELIVERY OF HEALTH CARE | HEALTH | SEXUAL
            PARTNERS | SEX BEHAVIOR | BEHAVIOR | BIOLOGY | RISK
            REDUCTION BEHAVIOR


Document Number: 306908


Mortality among married men in rural Kenya and Malawi.

Author:     Doctor HV; Weinreb AA

Source:     African Population Studies/Etude de la Population Africaine. 2005;20(2):165-177.




                                           24
                            STIs, HIV and AIDS: 2005 - 2008

Abstract:   Using prospective longitudinal data, this article describes recent changes in the
            levels of adult mortality among married men aged 20-59 in selected rural areas of
            Malawi and Kenya, and in the age pattern of their mortality. Sampled areas have,
            respectively, moderate and high HIV prevalence. The observed annual
            probability of dying for males interviewed in an initial wave of each study and
            then reported as deceased in follow-up interviews is 0.031 in Nyanza and 0.016
            in Malawi. Compared to life table estimates for equivalent age groups generated
            from Kenya's 1989 census and Malawi's 1987 census, these results represent a 3-
            fold increase over 1980s census levels. These changes have reduced life
            expectancy at age 20 by about 14 years in Nyanza and 7 years in Malawi.
            Observed mortality is consistent with a younger age of HIV infection in Nyanza.
            Sample characteristics suggest that these levels underestimate the total effect of
            AIDS on mortality. (author's)

Language:   English

Keywords:   MALAWI | KENYA | RESEARCH REPORT | LONGITUDINAL STUDIES |
            PROSPECTIVE STUDIES | MEN | RURAL POPULATION | CURRENTLY
            MARRIED | MORTALITY | AGE SPECIFIC DEATH RATE | DEATH RATE
            | LIFE EXPECTANCY | AIDS | AGE FACTORS | AFRICA, SOUTHERN |
            AFRICA, SUB SAHARAN | AFRICA | DEVELOPING COUNTRIES |
            AFRICA, EASTERN | STUDIES | RESEARCH METHODOLOGY |
            DEMOGRAPHIC FACTORS | POPULATION | POPULATION
            CHARACTERISTICS | MARITAL STATUS | NUPTIALITY | POPULATION
            DYNAMICS | LENGTH OF LIFE | HIV INFECTIONS | VIRAL DISEASES |
            DISEASES


Document Number: 311125


Vitamin A, mastitis, and mother-to-child transmission of HIV-1 through
breast-feeding: current information and gaps in knowledge.
Author:     Dorosko SM

Source:     Nutrition Reviews. 2005 Oct;63(10):332-346.

Abstract:   Mastitis has been implicated as a risk factor for mother-to-child transmission
            (MTCT) of HIV-1 through breast-feeding. Maternal vitamin A deficiency is also
            associated with increased MTCT, as well as with episodes of mastitis in lactating
            animals. This review describes the complex interrelationship between vitamin A,
            mastitis, and MTCT of HIV-1 via mothers' milk. Current gaps in knowledge, as
            well as recommendations for future research efforts, are also discussed.
            (author's)




                                            25
                            STIs, HIV and AIDS: 2005 - 2008

Language:   English

Keywords:   DEVELOPING COUNTRIES | KENYA | RESEARCH REPORT | MOTHERS
            | MOTHER-TO-CHILD TRANSMISSION | HIV INFECTIONS |
            BREASTFEEDING | VITAMIN A | BREAST EXAM | MAMMARY GLAND
            EFFECTS | AFRICA, EASTERN | AFRICA SOUTH OF THE SAHARA |
            AFRICA | PARENTS | FAMILY RELATIONSHIPS | FAMILY
            CHARACTERISTICS | FAMILY AND HOUSEHOLD | SOCIOCULTURAL
            FACTORS | TRANSMISSION | INFECTIONS | DISEASES | VIRAL
            DISEASES | INFANT NUTRITION | NUTRITION | HEALTH | VITAMINS
            AND MINERALS | PHYSIOLOGY | BIOLOGY | PHYSICAL
            EXAMINATIONS AND DIAGNOSES | EXAMINATIONS AND
            DIAGNOSES | MEDICAL PROCEDURES | MEDICINE | HEALTH
            SERVICES | DELIVERY OF HEALTH CARE


Document Number: 305136


Lessons learned in the conduct, validation, and interpretation of national
population based HIV surveys.

Author:     Garcia Calleja JM; Marum LH; Carcamo CP; Kaetano L; Muttunga J

Source:     AIDS. 2005 May;19 Suppl 2:S9-S17.

Abstract:   In the past few years several countries have conducted national population-
            based HIV surveys. Survey methods, levels of participation bias from absence or
            refusal and lessons learned conducting such surveys are compared in four
            national population surveys: Mali, Kenya, Peru and Zambia. In Mali, Zambia,
            and Kenya, HIV testing of adult women and men was included in the national-
            level demographic and health surveys carried out regularly in these countries,
            whereas in Peru the national HIV survey targeted young people in 24 cities with
            populations over 50 000. The household response rate was above 90% in all
            countries, but some individuals were absent for interviews. HIV testing rates
            were between 70 and 79% of those eligible, with higher test rates for women.
            Three critical questions in this type of survey need to be answered: who did the
            surveys miss; how much it matters that they were missed; and what can be done
            to increase the participation of respondents so the coverage rates are adequate.
            The level of representativeness of the populations tested was adequate in each
            survey to provide a reliable national estimate of HIV prevalence that
            complements other methods of HIV surveillance. Different lessons were learned
            from each survey. These population-based HIV seroprevalence surveys
            demonstrate that reliable and useful results can be obtained, although they
            require careful planning and increased financial and human resource investment
            to maximize responses at the household and individual level, which are key
            elements to validate survey results. This review was initiated through an


                                           26
                            STIs, HIV and AIDS: 2005 - 2008

            international meeting on 'New strategies for HIV/ AIDS Surveillance in
            Resource-constrained Countries' held in Addis Ababa on 26--30 January 2004 to
            share and develop recommendations to guide future surveys. (author's)

Language:   English

Keywords:   MALI | KENYA | PERU | ZAMBIA | METHODOLOGICAL STUDIES |
            DEMOGRAPHIC AND HEALTH SURVEYS | EPIDEMIOLOGIC METHODS
            | HOUSEHOLDS | HIV INFECTIONS | PREVALENCE | DATA QUALITY
            | AFRICA, WESTERN | AFRICA SOUTH OF THE SAHARA | AFRICA |
            DEVELOPING COUNTRIES | AFRICA, EASTERN | SOUTH AMERICA,
            WESTERN | SOUTH AMERICA | LATIN AMERICA | AMERICAS |
            AFRICA, SOUTHERN | DEMOGRAPHIC SURVEYS | POPULATION
            DYNAMICS | DEMOGRAPHIC FACTORS | POPULATION | RESEARCH
            METHODOLOGY | FAMILY AND HOUSEHOLD | SOCIOCULTURAL
            FACTORS | VIRAL DISEASES | DISEASES | MEASUREMENT | DATA
            ANALYSIS


Document Number: 306899


The HIV / AIDS epidemic in Kenya. HIV / AIDS policy fact sheet.
Author:     Kates J; Leggoe AW

Source:     Menlo Park, California, Henry J. Kaiser Family Foundation, 2005 Oct. [2] p. (HIV
            / AIDS Policy Fact Sheet)

Abstract:   Kenya has more than one million people estimated to be living with HIV/AIDS
            (1.2 million as of the end of 2003). Kenya's HIV/AIDS prevalence rate (the
            percent of people living with the disease) is just below that of the sub-Saharan
            African region overall (6.7% compared to 7.5%). Recent data indicate that the
            country's HIV prevalence rate may be on the decline in some areas. However, the
            HIV/AIDS epidemic poses significant challenges to this low-income country.
            The Government of Kenya first established a National AIDS Control Council
            (NACC) in 1999, and has a National Strategic Framework for HIV/AIDS for
            2005-2010. (excerpt)

Language:   English

Keywords:   KENYA | SUMMARY REPORT | PREVALENCE | PERSONS LIVING WITH
            HIV/AIDS | YOUTH | HIV | AIDS | KNOWLEDGE | INTERNATIONAL
            AGENCIES | INFORMATION SOURCES | FINANCIAL ACTIVITIES |
            FOREIGN AID | ANTIRETROVIRAL THERAPY | GOVERNMENT
            PROGRAMS | AFRICA, EASTERN | AFRICA SOUTH OF THE SAHARA |
            AFRICA | DEVELOPING COUNTRIES | MEASUREMENT | RESEARCH



                                           27
                            STIs, HIV and AIDS: 2005 - 2008

            METHODOLOGY | HIV INFECTIONS | VIRAL DISEASES | DISEASES |
            AGE FACTORS | POPULATION CHARACTERISTICS | DEMOGRAPHIC
            FACTORS | POPULATION | SOCIOCULTURAL FACTORS |
            ORGANIZATIONS | POLITICAL FACTORS | INFORMATION |
            ECONOMIC FACTORS | PROGRAMS | ORGANIZATION AND
            ADMINISTRATION


Document Number: 309697


Prospects for financial sustainability of scaling up antiretroviral therapy
programs.
Author:     Kyomuhangi L

Source:     Health Policy and Development. 2005 Aug;3(2):154-164.

Abstract:   The program costs of antiretroviral therapy (ART) were analyzed using the Cape
            Town Antiretroviral Costing Model (Boulle, et al, (2004). The total ART costs by
            end of 2008 for starting 18,500 patients in Senegal, 82,000 patients in Uganda and
            165,000 in Kenya were estimated at US$ 20.5 million, US$ 68 million and US$ and
            US$ 126 million respectively. The lifetime costs per patient on treatment were
            estimated at US$ 5,015 for Uganda, US$ 5,782 for Senegal, and US$ 6,186 for
            Kenya. The available funds for ART are about US$ 79 million for Senegal, US$ 74
            million for Uganda and US$ 94 million for Kenya. Senegal has committed about
            US$ 13.3 million from its domestic budget and acquired a loan of US$ 40 million
            from the World Bank for ART services. Kenya has so far allocated only US$ 1.4
            million from the national budget for its ART services. There are no funds from
            the government budget directed for the ART program in Uganda. The three
            countries are mainly depending on donor funding. The study concludedthat
            ART services in Uganda and Kenya might not be financially sustainable whereas
            Senegal may be able to financially its ART program if the current low prevalence
            levels and political and financial commitment prevail. (author's)

Language:   English

Keywords:   SENEGAL | UGANDA | KENYA | CROSS SECTIONAL ANALYSIS | HIV
            POSITIVE PERSONS | GOVERNMENT | ANTIRETROVIRAL THERAPY |
            ECONOMIC FACTORS | CAPACITY BUILDING | PROGRAM
            SUSTAINABILITY | DEVELOPING COUNTRIES | AFRICA, WESTERN |
            AFRICA, SUB SAHARAN | AFRICA | AFRICA, EASTERN | RESEARCH
            METHODOLOGY | PERSONS LIVING WITH HIV/AIDS | HIV
            INFECTIONS | VIRAL DISEASES | DISEASES | POLITICAL FACTORS |
            SOCIOCULTURAL FACTORS | HIV | PROGRAMS | ORGANIZATION
            AND ADMINISTRATION



                                            28
                            STIs, HIV and AIDS: 2005 - 2008



Document Number: 319828


HIV / AIDS and sexually transmitted infection in Kenya. Behavioural
surveillance survey 2002.
Author:     Kenya. Ministry of Health. National AIDS / STI Control Program

Source:     Nairobi, Kenya, Ministry of Health, National AIDS / STI Control Program, 2005.
            [65] p. (USAID Development Experience Clearinghouse DocID / Order No. PC-
            AAB-540)
Abstract:   The government of Kenya through the National AIDS/STI Control Program
            (NASCOP) of the Ministry of Health in collaboration with Family Health
            International (FHI), the Centers for Disease Control and Prevention (CDC), and
            the Central Bureau of Statistics (CBS) conducted a national behavioural
            surveillance survey of HIV/AIDS and sexually transmitted infection in Kenya in
            late 2002 in order to understand the behaviour dynamics driving the HIV
            epidemic. The behavioural surveillance survey is a monitoring and evaluation
            tool to track trends in HIV/AIDS knowledge, attitudes and behaviour in
            populations at particular risk of HIV infection, such as youth, female sex workers
            and migrant men. It is envisaged that this survey will be repeated every two or
            three years to monitor trends and changes in HIV and sexually transmitted
            infection risky behaviour in the country. The populations selected to participate
            in the first round of the national behavioural surveillance survey were out-of-
            school youth, youth in school, female sex workers, women in low-income
            settings, matatu or mini-van drivers and their touts or helpers, bodaboda or
            bicycle taxi cyclists, policemen, and men in large worksites. Questionnaires were
            developed in both English and Kiswahili. They were administered to
            respondents in the selected groups by trained interviewers under close
            supervision of a team of supervisors. High standards of conducting the survey
            were adhered to in terms of a well-planned data collection strategy and a
            commitment to establish high-quality data systems. EpiData software was used
            for data entry and processing, and a statistical software package for social
            sciences was used for data analysis. (excerpt)

Language:   English

Keywords:   KENYA | SUMMARY REPORT | INTERVIEWS | MULTIPLE PARTNERS |
            SEXUAL PARTNERS | SEX WORKERS | POLICE | YOUTH | HIV
            INFECTIONS | AIDS | SEXUALLY TRANSMITTED DISEASES |
            KNOWLEDGE | RISK BEHAVIOR | SEX BEHAVIOR | CONDOM |
            BEHAVIOR CHANGE | AFRICA, EASTERN | AFRICA SOUTH OF THE
            SAHARA | AFRICA | DEVELOPING COUNTRIES | DATA COLLECTION
            | RESEARCH METHODOLOGY | BEHAVIOR | CORRECTIONS
            OFFICERS | GOVERNMENT | POLITICAL FACTORS | SOCIOCULTURAL
            FACTORS | AGE FACTORS | POPULATION CHARACTERISTICS |


                                            29
                            STIs, HIV and AIDS: 2005 - 2008

            DEMOGRAPHIC FACTORS | POPULATION | VIRAL DISEASES |
            DISEASES | REPRODUCTIVE TRACT INFECTIONS | INFECTIONS |
            BARRIER METHODS | CONTRACEPTIVE METHODS |
            CONTRACEPTION | FAMILY PLANNING

Document Number: 315319


Dual infection with HIV and malaria fuels the spread of both diseases in
sub-Saharan Africa.

Author:     Abu-Raddad LJ

Source:     Science. 2006 Dec 8;314(5805):1603-1606.

Abstract:   Mounting evidence has revealed pathological interactions between HIV and
            malaria in dually infected patients, but the public health implications of the
            interplay have remained unclear. A transient almost one-log elevation in HIV
            viral load occurs during febrile malaria episodes; in addition, susceptibility to
            malaria is enhanced in HIV-infected patients. A mathematical model applied to a
            setting in Kenya with an adult population of roughly 200,000 estimated that,
            since 1980, the disease interaction may have been responsible for 8,500 excess
            HIV infections and 980,000 excess malaria episodes. Co-infection might also have
            facilitated the geographic expansion of malaria in areas where HIV prevalence is
            high. Hence, transient and repeated increases in HIV viral load resulting from
            recurrent co-infection with malaria may be an important factor in promoting the
            spread of HIV in sub-Saharan Africa. (author's)

Language:   English

Keywords:   AFRICA SOUTH OF THE SAHARA | KENYA | RESEARCH REPORT |
            EPIDEMIOLOGIC METHODS | MATHEMATICAL MODEL |
            ESTIMATION TECHNICS | HIV POSITIVE PERSONS | MALARIA | HIV
            INFECTIONS | COMPLICATIONS | FEVER | INCIDENCE | HUMAN
            GEOGRAPHY | DEVELOPING COUNTRIES | AFRICA | AFRICA,
            EASTERN | RESEARCH METHODOLOGY | MODELS, THEORETICAL |
            PERSONS LIVING WITH HIV/AIDS | VIRAL DISEASES | DISEASES |
            PARASITIC DISEASES | BODY TEMPERATURE | PHYSIOLOGY |
            BIOLOGY | MEASUREMENT | GEOGRAPHY | SOCIAL SCIENCES |
            SCIENCE | SOCIOCULTURAL FACTORS


Document Number: 314802




                                            30
                            STIs, HIV and AIDS: 2005 - 2008


Characteristics of HIV infected patients cared for at "academic model for
the prevention and treatment of HIV / AIDS" clinics in western Kenya.

Author:     Diero LO; Shaffer D; Kimaiyo S; Siika AM; Rotich JK

Source:     East African Medical Journal. 2006 Aug;83(8):424-433.

Abstract:   With the new initiatives to treat large numbers of HIV infected individuals in
            sub-Saharan Africa, policy makers require accurate estimates of the numbers and
            characteristics of patients likely to seek treatment in these countries. The
            objective was to describe characteristics of adults receiving care in two Kenyan
            public HIV clinics. Design: Cross-sectional cohort analysis of data extracted from
            an electronic medical records system. Setting: Academic Model for the
            Prevention and Treatment of HIV/AIDS (AMPATH) HIV clinics in Kenya's
            second national referral (urban) hospital and a nearby rural health center.
            Subjects: Adult patients presenting for care at HIV clinics. Main outcome
            measures: Gender and inter-clinic stratified comparisons of demographic,
            clinical, and treatment data. In the first nineteen months, 790 adults visited the
            urban clinic and 294 the rural clinic. Mean age was 36±9 (SD) years. Two-thirds
            were women; a quarter had spouses who had died of acquired immune
            deficiency syndrome (AIDS). HIV/AIDS behavioural risk factors (multiple
            sexual partners, rare condom use) and constitutional symptoms (fatigue, weight
            loss, cough, fever, chills) were common. Rural patients had more symptoms and
            less prior and current tuberculosis. Men more commonly presented with
            symptoms than women. The cohort CD4 count was low (223 ± 197mm3), with
            men having significantly lower CD4 count than women (185 ± 175 vs 242 ± 205 p
            = 0.0007). Eighteen percent had an infiltrate on chest radiograph. Five percent
            (most often men) had received prior antiretroviral drug therapy, (7% in urban
            and 1% in rural patients, p = 0.0006). Overall, 393 (36%) received antiretroviral
            drugs, 89% the combination of lamivudine, stavudine, and nevirapine. Half
            received prophylaxis for tuberculosis and Pneumocystis jirovecii. Men were
            sicker and more often received antiretroviral drugs. Patients presenting to two
            Kenyan HIV clinics were predominantly female, ill and naive to retroviral
            therapy with substantial differences by clinic site and gender. Behavioural risk
            factors for HIV/AIDS were common. A thorough understanding of clinical and
            behavioural characteristics can help target prevention and treatment strategies.
            (author's)

Language:   English

Keywords:   KENYA | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS |
            COHORT ANALYSIS | PERSONS LIVING WITH HIV/AIDS | CLINICS |
            RISK BEHAVIOR | SEX BEHAVIOR | ANTIRETROVIRAL THERAPY |
            AFRICA, EASTERN | AFRICA, SUB SAHARAN | AFRICA | DEVELOPING
            COUNTRIES | RESEARCH METHODOLOGY | HIV INFECTIONS | VIRAL




                                            31
                            STIs, HIV and AIDS: 2005 - 2008

            DISEASES | DISEASES | HEALTH FACILITIES | DELIVERY OF HEALTH
            CARE | HEALTH | BEHAVIOR | HIV


Document Number: 308129


Outcomes of HIV-infected orphaned and non-orphaned children on
antiretroviral therapy in western Kenya.

Author:     Nyandiko WM; Ayaya S; Nabakwe E; Tenge C; Sidle JE

Source:     JAIDS. Journal of Acquired Immune Deficiency Syndromes. 2006 Dec 1;43(4):418-
            425.

Abstract:   The objectives were to determine outcome differences between orphaned and
            non-orphaned children receiving antiretroviral therapy (ART). Design:
            Retrospective review of prospectively recorded electronic data. Setting: Nine
            HIV clinics in western Kenya. Population: 279 children on ART enrolled between
            August 2002 and February 2005. Main Measures: Orphan status, CD4%, sex- and
            age-adjusted height (HAZ) and weight (WAZ) z scores, ART adherence,
            mortality. Median follow-up was 34 months. Cohort included 51% males and
            54% orphans. At ART initiation (baseline), 71% of children had CDC clinical
            stage B or C disease. Median CD4% was 9% and increased dramatically the first
            30 weeks of therapy, then leveled off. Parents and guardians reported perfect
            adherence at every visit for 75% of children. Adherence and orphan status were
            not significantly associated with CD4% response. Adjusted for baseline age,
            follow-up was significantly shorter among orphaned children (median 33 vs. 41
            weeks, P = 0.096). One-year mortality was 7.1% for orphaned and 6.6% for non-
            orphaned children (P = 0.836). HAZ and WAZ were significantly below norm in
            both groups. With ART, HAZ remained stable, while WAZ tended to increase
            toward the norm, especially among non-orphans. Orphans showed identical
            weight gains as non-orphans the first 70 weeks after start of ART but experienced
            reductions afterwards. Good ART adherence is possible in western rural Kenya.
            ART for HIV-infected children produced substantial and sustainable CD4%
            improvement. Orphan status was not associated with worse short-term outcomes
            but may be a factor for long-term therapy response. ART alone may not be
            sufficient to reverse significant developmental lags in the HIV-positive pediatric
            population. (author's)

Language:   English

Keywords:   KENYA | RESEARCH REPORT | RETROSPECTIVE STUDIES | CHILD |
            ORPHANS AND VULNERABLE CHILDREN | HIV POSITIVE PERSONS |
            HIV | ANTIRETROVIRAL THERAPY | TREATMENT | AFRICA, EASTERN
            | AFRICA SOUTH OF THE SAHARA | AFRICA | DEVELOPING



                                            32
                            STIs, HIV and AIDS: 2005 - 2008

            COUNTRIES | STUDIES | RESEARCH METHODOLOGY | YOUTH | AGE
            FACTORS | POPULATION CHARACTERISTICS | DEMOGRAPHIC
            FACTORS | POPULATION | PERSONS LIVING WITH HIV/AIDS | HIV
            INFECTIONS | VIRAL DISEASES | DISEASES | MEDICAL PROCEDURES
            | MEDICINE | HEALTH SERVICES | DELIVERY OF HEALTH CARE |
            HEALTH | FAMILY AND HOUSEHOLD


Document Number: 309400


Maternal knowledge on mother-to-child transmission of HIV and
breastmilk alternatives for HIV positive mothers in Homa Bay District
Hospital, Kenya.
Author:     Omwega AM; Oguta TJ; Sehmi JK

Source:     East African Medical Journal. 2006 Nov;83(11):610-618.

Abstract:   Mother-to-Child Transmission (MTCT) of HIV is a relatively new concept in
            rural populations and despite the huge amount of work that has been done on
            the HIV/AIDS, there still remains a dearth of information in knowledge of
            mothers on this concept especially in areas related to appropriate feeding
            methods for infants born to mothers infected with the virus. The objectives were
            to determine maternal knowledge on MTCT of HIV in the rural setting and to
            examine viable breastmilk alternatives for mothers who would be HIV positive.
            The design used was a cross-sectional study, supported by an observational
            study. The setting was a rural district community and Homa-Bay District
            Hospital in South Western Kenya. The subjects for the study were one-hundred
            and twelve non-tested mothers having infants aged 0-12 months in the
            community and a sub-group (10%) of HIV positive mothers from the District
            Hospital. Maternal knowledge on MTCT of HIV was as low as 8.9% in the study
            area. The MTCT knowledge was found to influence the alternative feeding choice
            as mentioned by the non-tested mothers (p = 0.001; OR = l.41; 95%CI, 1.04-3.86).
            Those with high MTCT knowledge tended to be more receptive and considered
            feeding alternatives other than cowmilk like expressed breastmilk (p = 0.l 5),
            formula (p = 0.036; OR = 2.44; 95%CI, 1.66-6.04) and milk from milk bank (p =
            0.0l5; OR = l.34; 95%CI, 1.13-5.50) than their counterparts with low MTCT
            knowledge. Cowmilk, formula and wet-nursing were the three feeding
            alternatives that were viable with varying socio-cultural, economic and/or
            nutritional constraints. Maternal MTCT knowledge influences the choice of
            alternative infant feeding option but not breastfeeding practices. Cowmilk is the
            most common, socio-culturally acceptable and accessible breastmilk alternative
            in this community. It is recommended that in order to improve MTCT
            knowledge, health education and nutrition counselling be intensified in PMTCT
            programmes, VCT centers and ANC clinics. Concurrently, effort should be made



                                           33
                            STIs, HIV and AIDS: 2005 - 2008

            to increase the supply of cowmilk within the community so as to make it more
            readily available and affordable. (author's)

Language:   English

Keywords:   KENYA | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS |
            PERSONS LIVING WITH HIV/AIDS | WOMEN | INFANT | HIV
            INFECTIONS | MOTHER-TO-CHILD TRANSMISSION | KNOWLEDGE |
            HUMAN MILK | INFANT NUTRITION | SOCIOCULTURAL FACTORS |
            DEVELOPING COUNTRIES | AFRICA, EASTERN | AFRICA, SUB
            SAHARAN | AFRICA | RESEARCH METHODOLOGY | VIRAL DISEASES
            | DISEASES | DEMOGRAPHIC FACTORS | POPULATION | YOUTH |
            AGE FACTORS | POPULATION CHARACTERISTICS | TRANSMISSION |
            INFECTIONS | LACTATION | MATERNAL PHYSIOLOGY |
            PHYSIOLOGY | BIOLOGY | NUTRITION | HEALTH


Document Number: 319527


Initial strategy for antiretroviral-naive patients.
Author:     Abgrall S

Source:     Lancet. 2006 Dec 16;368(9553):2107-2109.

Abstract:   In today's Lancet, the CPCRA 058 FIRST trial is reported. Earlier this year, in The
            Lancet, the INITIO trial was reported. Both trials attempted to define the best
            antiretroviral strategy for drug-naive HIV-infected patients with moderate
            immunosuppression, assessed clinically and immunologically in FIRST and
            virologically in INITIO (table). The first question was: what is the best third drug
            (protease inhibitor or non-nucleoside reversetranscriptase inhibitor [NNRTI]) to
            add to two nucleoside reverse-transcriptase inhibitors (NRTI) in a two-class
            initial antiretroviral regimen? The second question was: is there a three-class
            (mainly four-drug) regimen more potent than the two-class and three-drug
            standard one? Changes in CD4 cell counts best predict clinical outcome in the
            short to mid term. Nevertheless, virological failure jeopardises further treatment
            efficacy with acquisition of resistance mutations and compromises long-term
            immunological and clinical outcome when prolonged. (excerpt)

Language:   English

Keywords:   DEVELOPING COUNTRIES | RECOMMENDATIONS | CLINICAL TRIALS
            | PERSONS LIVING WITH HIV/AIDS | ANTIRETROVIRAL THERAPY |
            USER COMPLIANCE | AIDS PREVENTION | IMMUNITY, CELLULAR |
            ADMINISTRATION AND DOSAGE | CLINICAL RESEARCH | RESEARCH
            METHODOLOGY | HIV INFECTIONS | VIRAL DISEASES | DISEASES |



                                             34
                            STIs, HIV and AIDS: 2005 - 2008

            HIV | BEHAVIOR | AIDS | IMMUNITY | IMMUNE SYSTEM |
            PHYSIOLOGY | BIOLOGY | DRUGS | TREATMENT | MEDICAL
            PROCEDURES | MEDICINE | HEALTH SERVICES | DELIVERY OF
            HEALTH CARE | HEALTH


Document Number: 310956


The role of health care in the spread of HIV / AIDS in Africa: evidence
from Kenya.
Author:     Deuchert E; Brody S

Source:     International Journal of STD and AIDS. 2006 Nov;17(11):749-752.

Abstract:   It is commonly asserted that the sub-Saharan African HIV/AIDS epidemic is
            predominantly due to heterosexual transmission. However, recent reexamination
            of the available evidence strongly suggests that unsafe health care is the more
            likely vector. The present report adds to the evidence for health-care
            transmission by showing that Kenyan women who received prophylactic tetanus
            toxoid injections during pregnancy are 1.89 times (95% confidence interval [CI]:
            1.03--3.47) more likely to be HIV-1 seropositive than women who did not receive
            this vaccination. In contrast, recent sexual behaviour (condom use, number of
            partners) was not related to HIV status. The findings are unconfounded by
            reverse causality (all injections were purely prophylactic rather than for
            treatment of any HIV-related illnesses, and none of the women reported
            knowing that she was HIV seropositive). Focus on a specific injection may have
            improved participant recall. The results are consistent with health care being a
            very important vector for HIV in sub-Saharan Africa. It is recommended that
            there be a reallocation of resources to address healthcare transmission of
            HIV/AIDS. (author's)

Language:   English

Keywords:   AFRICA SOUTH OF THE SAHARA | KENYA | RESEARCH REPORT |
            DEMOGRAPHIC AND HEALTH SURVEYS | PERSONS LIVING WITH
            HIV/AIDS | PREGNANT WOMEN | HEALTH PERSONNEL | HIV
            TRANSMISSION | NEEDLE PIERCING | VACCINATION | QUALITY OF
            HEALTH CARE | SAFETY | AFRICA | DEVELOPING COUNTRIES |
            AFRICA, EASTERN | DEMOGRAPHIC SURVEYS | POPULATION
            DYNAMICS | DEMOGRAPHIC FACTORS | POPULATION | HIV
            INFECTIONS | VIRAL DISEASES | DISEASES | POPULATION
            CHARACTERISTICS | DELIVERY OF HEALTH CARE | HEALTH | RISK
            BEHAVIOR | BEHAVIOR | IMMUNIZATION | PRIMARY HEALTH CARE
            | HEALTH SERVICES | HEALTH SERVICES EVALUATION | PROGRAM
            EVALUATION | PROGRAMS | ORGANIZATION AND


                                           35
                            STIs, HIV and AIDS: 2005 - 2008

            ADMINISTRATION | PUBLIC HEALTH


Document Number: 309321


Characteristics of HIV infected patients cared for at "academic model for
the prevention and treatment of HIV / AIDS" clinics in western Kenya.

Author:     Diero LO; Shaffer D; Kimaiyo S; Siika AM; Rotich JK

Source:     East African Medical Journal. 2006 Aug;83(8):424-433.

Abstract:   With the new initiatives to treat large numbers of HIV infected individuals in
            sub-Saharan Africa, policy makers require accurate estimates of the numbers and
            characteristics of patients likely to seek treatment in these countries. The
            objective was to describe characteristics of adults receiving care in two Kenyan
            public HIV clinics. Design: Cross-sectional cohort analysis of data extracted from
            an electronic medical records system. Setting: Academic Model for the
            Prevention and Treatment of HIV/AIDS (AMPATH) HIV clinics in Kenya's
            second national referral (urban) hospital and a nearby rural health center.
            Subjects: Adult patients presenting for care at HIV clinics. Main outcome
            measures: Gender and inter-clinic stratified comparisons of demographic,
            clinical, and treatment data. In the first nineteen months, 790 adults visited the
            urban clinic and 294 the rural clinic. Mean age was 36±9 (SD) years. Two-thirds
            were women; a quarter had spouses who had died of acquired immune
            deficiency syndrome (AIDS). HIV/AIDS behavioural risk factors (multiple
            sexual partners, rare condom use) and constitutional symptoms (fatigue, weight
            loss, cough, fever, chills) were common. Rural patients had more symptoms and
            less prior and current tuberculosis. Men more commonly presented with
            symptoms than women. The cohort CD4 count was low (223 ± 197mm3), with
            men having significantly lower CD4 count than women (185 ± 175 vs 242 ± 205 p
            = 0.0007). Eighteen percent had an infiltrate on chest radiograph. Five percent
            (most often men) had received prior antiretroviral drug therapy, (7% in urban
            and 1% in rural patients, p = 0.0006). Overall, 393 (36%) received antiretroviral
            drugs, 89% the combination of lamivudine, stavudine, and nevirapine. Half
            received prophylaxis for tuberculosis and Pneumocystis jirovecii. Men were
            sicker and more often received antiretroviral drugs. Patients presenting to two
            Kenyan HIV clinics were predominantly female, ill and naive to retroviral
            therapy with substantial differences by clinic site and gender. Behavioural risk
            factors for HIV/AIDS were common. A thorough understanding of clinical and
            behavioural characteristics can help target prevention and treatment strategies.
            (author's)

Language:   English




                                            36
                            STIs, HIV and AIDS: 2005 - 2008

Keywords:   KENYA | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS |
            COHORT ANALYSIS | PERSONS LIVING WITH HIV/AIDS | CLINICS |
            RISK BEHAVIOR | SEX BEHAVIOR | ANTIRETROVIRAL THERAPY |
            AFRICA, EASTERN | AFRICA, SUB SAHARAN | AFRICA | DEVELOPING
            COUNTRIES | RESEARCH METHODOLOGY | HIV INFECTIONS | VIRAL
            DISEASES | DISEASES | HEALTH FACILITIES | DELIVERY OF HEALTH
            CARE | HEALTH | BEHAVIOR | HIV


Document Number: 308129


Absorptive capacity and disbursements by the Global Fund to Fight
AIDS, Tuberculosis and Malaria: analysis of grant implementation.
Author:     Lu C; Michaud CM; Khan K; Murray CJ

Source:     Lancet. 2006 Aug 5;368(9534):483-488.

Abstract:   The Global Fund to Fight AIDS, Tuberculosis and Malaria was launched in 2002
            to attract and rapidly disburse money to fight these diseases. However, some
            commentators believe that poor countries cannot effectively use such resources
            to increase delivery of their health programmes--referred to as a lack of
            absorptive capacity. We aimed to investigate the major determinants of grant
            implementation in developing countries. With information available publicly on
            the Global Fund's website, we did random-effects analysis to investigate the
            effect of grant characteristics, types of primary recipient and local fund agent,
            and country attributes on disbursements that were made between 2003 and 2005
            (phase one of Global Fund payments). To check the robustness of findings,
            regression results from alternative estimation methods and model specifications
            were also tested. Grant characteristics--such as size of commitment, lag time
            between signature and first disbursement, and funding round--had significant
            effects on grant implementation. Enhanced political stability was associated with
            high use of grants. Low-income countries, and those with less-developed health
            systems for a given level of income, were more likely to have a higher rate of
            grant implementation than nations with higher incomes or more-developed
            health systems. The higher rate of grant implementation seen in countries with
            low income and low health-spending lends support to proponents of major
            increases in health assistance for the poorest countries and argues that focusing
            resources on low-income nations, particularly those with political stability, will
            not create difficulties of absorptive capacity. Our analysis was restricted to grant
            implementation, which is one part of the issue of absorptive capacity. In the
            future, assessment of the effect of Global Fund grants on intervention coverage
            will be vital. (author's)

Language:   English



                                             37
                            STIs, HIV and AIDS: 2005 - 2008

Keywords:   DEVELOPING COUNTRIES | RESEARCH REPORT | EVALUATION |
            NONGOVERNMENTAL ORGANIZATIONS | LOW INCOME
            POPULATION | AIDS | TUBERCULOSIS | MALARIA | PREVENTION
            AND CONTROL | GRANTS | DELIVERY OF HEALTH CARE | PROGRAM
            EFFECTIVENESS | ORGANIZATIONS | POLITICAL FACTORS |
            SOCIOCULTURAL FACTORS | SOCIAL CLASS | SOCIOECONOMIC
            STATUS | SOCIOECONOMIC FACTORS | ECONOMIC FACTORS | HIV
            INFECTIONS | VIRAL DISEASES | DISEASES | INFECTIONS |
            PARASITIC DISEASES | FINANCIAL ACTIVITIES | HEALTH |
            PROGRAM EVALUATION | PROGRAMS | ORGANIZATION AND
            ADMINISTRATION


Document Number: 306303


Sexual abstinence, contraception, and condom use by young African
women: a secondary analysis of survey data.

Author:     Cleland J; Ali MM

Source:     Lancet. 2006 Nov 18;368(9549):1788-1793.

Abstract:   Drug therapy for people with AIDS is a humanitarian priority but prevention of
            HIV infection remains essential. Focusing on young single African women, we
            aimed to assess trends in a set of behaviours -- sexual abstinence, contraceptive
            use, and condom use -- that are known to affect the rates of HIV transmission.
            We did a secondary analysis of public-access data sets in 18 African countries
            (132 800 women), and calculated changes in a set of behavioural indicators over
            time. We standardised these trends from nationally representative surveys to
            adjust for within-country changes in age, education, and type of residential
            location. Between about 1993 and 2001, the percentage of women reporting no
            sexual experience changed little. During the same period, the percentage of
            sexually experienced women who reported no sexual intercourse in the previous
            3 months (secondary abstinence) rose significantly in seven of 18 countries and
            the median for all 18 countries increased from 43.8% to 49.2%. Use of condoms
            for pregnancy prevention rose significantly in 13 of 18 countries and the median
            proportion increased from 5.3% to 18.8%. The median rate of annual increase of
            condom use was 1.41 percentage points (95% CI 1.12-2.25). In the 13 countries
            with available data, condom use at most recent coitus rose from a median of
            19.3% to 28.4%. Over half (58.5%) of condom users were motivated, at least in
            part, by a wish to avoid pregnancy. Condom promotion campaigns in sub-
            Saharan Africa have affected the behaviour of young single women; the pace of
            change has matched the rise in contraceptive use by married couples in
            developing countries over recent decades. Thus continuing efforts to promote




                                            38
                            STIs, HIV and AIDS: 2005 - 2008

            condom use with emphasis on pregnancy prevention are justified. (author's)

Language:   English

Keywords:   AFRICA | RESEARCH REPORT | DATA ANALYSIS | WOMEN | SEX
            BEHAVIOR | ABSTINENCE, BE FAITHFUL, CONDOM USE | CONDOM
            USE | CONTRACEPTIVE USAGE | CONDOM | PROMOTION |
            CAMPAIGNS | HIV PREVENTION | PREGNANCY | PREVENTION AND
            CONTROL | DEVELOPING COUNTRIES | RESEARCH METHODOLOGY
            | DEMOGRAPHIC FACTORS | POPULATION | BEHAVIOR | RISK
            REDUCTION BEHAVIOR | CONTRACEPTION | FAMILY PLANNING |
            BARRIER METHODS | CONTRACEPTIVE METHODS | MARKETING |
            ECONOMIC FACTORS | COMMUNICATION PROGRAMS |
            COMMUNICATION | HIV INFECTIONS | VIRAL DISEASES | DISEASES
            | REPRODUCTION


Document Number: 309666


The role of health care in the spread of HIV / AIDS in Africa: evidence
from Kenya.

Author:     Deuchert E; Brody S

Source:     International Journal of STD and AIDS. 2006 Nov;17(11):749-752.

Abstract:   It is commonly asserted that the sub-Saharan African HIV/AIDS epidemic is
            predominantly due to heterosexual transmission. However, recent reexamination
            of the available evidence strongly suggests that unsafe health care is the more
            likely vector. The present report adds to the evidence for health-care
            transmission by showing that Kenyan women who received prophylactic tetanus
            toxoid injections during pregnancy are 1.89 times (95% confidence interval [CI]:
            1.03--3.47) more likely to be HIV-1 seropositive than women who did not receive
            this vaccination. In contrast, recent sexual behaviour (condom use, number of
            partners) was not related to HIV status. The findings are unconfounded by
            reverse causality (all injections were purely prophylactic rather than for
            treatment of any HIV-related illnesses, and none of the women reported
            knowing that she was HIV seropositive). Focus on a specific injection may have
            improved participant recall. The results are consistent with health care being a
            very important vector for HIV in sub-Saharan Africa. It is recommended that
            there be a reallocation of resources to address healthcare transmission of
            HIV/AIDS. (author's)

Language:   English




                                           39
                           STIs, HIV and AIDS: 2005 - 2008

Keywords:   AFRICA SOUTH OF THE SAHARA | KENYA | RESEARCH REPORT |
            DEMOGRAPHIC AND HEALTH SURVEYS | PERSONS LIVING WITH
            HIV/AIDS | PREGNANT WOMEN | HEALTH PERSONNEL | HIV
            TRANSMISSION | NEEDLE PIERCING | VACCINATION | QUALITY OF
            HEALTH CARE | SAFETY | AFRICA | DEVELOPING COUNTRIES |
            AFRICA, EASTERN | DEMOGRAPHIC SURVEYS | POPULATION
            DYNAMICS | DEMOGRAPHIC FACTORS | POPULATION | HIV
            INFECTIONS | VIRAL DISEASES | DISEASES | POPULATION
            CHARACTERISTICS | DELIVERY OF HEALTH CARE | HEALTH | RISK
            BEHAVIOR | BEHAVIOR | IMMUNIZATION | PRIMARY HEALTH CARE
            | HEALTH SERVICES | HEALTH SERVICES EVALUATION | PROGRAM
            EVALUATION | PROGRAMS | ORGANIZATION AND
            ADMINISTRATION | PUBLIC HEALTH


Document Number: 309321


Male circumcision for HIV prevention: Research implications for policy
and programming WHO / UNAIDS technical consultation 6 -- 8 March
2007 conclusions and recommendations (excerpts).
Source:     Reproductive Health Matters. 2007 May;15(29):11-14.

Abstract:   A number of observational studies indicate that circumcised men have lower
            levels of HIV infection than uncircumcised men. On 13 December 2006, the US
            National Institutes of Health announced that two trials assessing the impact of
            male circumcision on HIV risk would be stopped on the recommendation of the
            Data Safety and Monitoring Board. The trials being carried out in Kisumu,
            Kenya, and Rakai District, Uganda revealed at least a 53% and 51% reduction in
            risk of acquiring HIV infection, respectively. These results support findings
            published in 2005 from the South Africa Orange Farm Intervention Trial,
            sponsored by the French National Agency for Research on AIDS, which
            demonstrated at least a 60% reduction in HIV infection among men who were
            circumcised. WHO and UNAIDS convened an international consultation to
            review the results of the three randomised controlled trials and other evidence
            on male circumcision and HIV prevention, to discuss the policy and programme
            implications, and to make recommendations regarding public health issues. This
            document summarizes the principal conclusions and recommendations of the
            meeting. The international consultation was attended by experts representing a
            wide range of stakeholders, including government representatives, researchers,
            civil society representatives, gender experts, human rights and women's health
            advocates, young people, funding agencies and implementing partners. (excerpt)

Language:   English




                                           40
                            STIs, HIV and AIDS: 2005 - 2008

Keywords:   KENYA | UGANDA | RESEARCH REPORT | TECHNICAL ASSISTANCE |
            MEN | MALE CIRCUMCISION | HIV PREVENTION |
            RECOMMENDATIONS | PROGRAM EVALUATION | AFRICA, EASTERN
            | AFRICA, SUB SAHARAN | AFRICA | DEVELOPING COUNTRIES |
            PROGRAMS | ORGANIZATION AND ADMINISTRATION |
            DEMOGRAPHIC FACTORS | POPULATION | MEDICAL PROCEDURES |
            MEDICINE | HEALTH SERVICES | DELIVERY OF HEALTH CARE |
            HEALTH | HIV INFECTIONS | VIRAL DISEASES | DISEASES


Document Number: 316691


Male circumcision for HIV prevention: The research evidence and some
critical responses.
Source:     Reproductive Health Matters. 2007 May;15(29):9-10.

Abstract:   Three randomised clinical trials, in South Africa, Uganda and Kenya, have
            shown a substantial reduction in female-to-male transmission of HIV to men
            who had been circumcised as compared to men who had not, during a follow-up
            period of up to 24 months. The question of what to do with this evidence is
            currently being debated around the world. WHO and UNAIDS took the lead by
            developing technical, policy and programmatic guidance following a series of
            consultations with a range of stakeholders in the field, using the research
            evidence as the basis. Consensus on many aspects of this matter is far from being
            achieved, however. Many questions and different points of view are emerging -
            clinical, public health, sociological, anthropological and cultural; in relation to
            priority setting in HIV prevention and delivery of health services; and in relation
            to sexuality, ethics, gender and rights. On 28 March 2007, WHO and UNAIDS
            published a set of conclusions and recommendations regarding the research
            implications for HIV policy and programming. The introduction and excerpts
            from these follow below. They are, in turn, followed by a roundtable of nine
            papers which contain a range of critical thinking and analysis of these issues.
            Male circumcision is generating debate across the globe. This can only be a good
            thing, as it is a complex matter and far more than a straightforward public health
            intervention. We hope these papers will help to inform that debate. (author's)

Language:   English

Keywords:   KENYA | SOUTH AFRICA | UGANDA | RESEARCH REPORT | CLINICAL
            TRIALS | MEN | MALE CIRCUMCISION | GENDER ISSUES |
            SEXUALITY | SAFER SEX | HIV TRANSMISSION | HEALTH POLICY |
            HIV PREVENTION | PROGRAM EVALUATION | AFRICA, EASTERN |
            AFRICA SOUTH OF THE SAHARA | AFRICA | DEVELOPING
            COUNTRIES | AFRICA, SOUTHERN | CLINICAL RESEARCH |
            RESEARCH METHODOLOGY | DEMOGRAPHIC FACTORS |


                                            41
                            STIs, HIV and AIDS: 2005 - 2008

            POPULATION | MEDICAL PROCEDURES | MEDICINE | HEALTH
            SERVICES | DELIVERY OF HEALTH CARE | HEALTH |
            SOCIOCULTURAL FACTORS | PERSONALITY | PSYCHOLOGICAL
            FACTORS | BEHAVIOR | SEX BEHAVIOR | HIV INFECTIONS | VIRAL
            DISEASES | DISEASES | POLICY | POLITICAL FACTORS | PROGRAMS
            | ORGANIZATION AND ADMINISTRATION


Document Number: 316690


Putting on a brave face: the experiences of women living with HIV and
AIDS in informal settlements of Nairobi, Kenya.
Author:     Amuyunzu-Nyamongo M; Okeng'o L; Wagura A; Mwenzwa E

Source:     AIDS Care. 2007 Feb;19 Suppl 1:S25-S34.

Abstract:   This paper examines two key dimensions of HIV and AIDS in sub-Saharan
            Africa, namely poverty and gender, within the particular context of informal
            settlements. The study, conducted in five informal settlements of Nairobi, Kenya
            explored the challenges facing women living with HIV and AIDS (WLWA) in
            informal settlements in Nairobi in terms of the specific risk environments of
            informal settlements, the support they receive and their perceptions of their
            future. The data were gathered through an interviewer-based questionnaire
            administered to 390 WLWA and 20 key informant interviews with Kenya
            Network of Women with AIDS (KENWA) project personnel. The results show
            that for WLWA in informal settlements, poverty and poor living conditions
            combine to increase the risk environment for HIV infection and other
            opportunistic infections and that the WLWA then face HIV- and AIDS-related
            problems that are exacerbated by poverty and by the poor living environments.
            In response, the WLWA had devised coping strategies that were largely centred
            on survival, including commercial sex work and the sale of illicit liquor, thus
            increasing their susceptibility to re-infections. Insecurity in informal settlements
            curtailed their participation in income generating activities (IGAs) and increased
            their risk of rape and HIV reinfection. Recognising the disadvantaged position of
            communities in informal settlements, the non-governmental organizations
            (NGOs), community-based organizations (CBOs) and faith-based organizations
            (FBOs) provide a range of services including HIV and AIDS information and
            therapy. Paradoxically, living in urban informal settlements was found to
            increase WLWA's access to HIV and AIDS prevention and treatment services
            through NGOs and social networks that are not found in more established
            residential areas. The sustainability of these services is, however, questioned,
            given the lack of local resources, weak state support and high donor
            dependency. We suggest that the economic and tenure insecurity found among
            WLWA demands in response consistent support through comprehensive,
            sustainable HIV and AIDS services complemented by social networks and


                                             42
                            STIs, HIV and AIDS: 2005 - 2008

            community sensitisation against stigma and discrimination. Fundamentally, the
            upgrading of informal settlements would address the wider risk environments
            that exacerbate the poor health of the WLWA who line in them. (author's)

Language:   English

Keywords:   KENYA | RESEARCH REPORT | KAP SURVEYS | PERSONS LIVING
            WITH HIV/AIDS | WOMEN IN DEVELOPMENT | SLUMS |
            ORGANIZATIONS | HIV INFECTIONS | PSYCHOLOGICAL FACTORS |
            PSYCHOSOCIAL FACTORS | POVERTY | GENDER ISSUES | QUALITY
            OF LIFE | RISK BEHAVIOR | DEVELOPING COUNTRIES | AFRICA,
            EASTERN | AFRICA, SUB SAHARAN | AFRICA | SURVEYS | SAMPLING
            STUDIES | STUDIES | RESEARCH METHODOLOGY | VIRAL DISEASES
            | DISEASES | ECONOMIC DEVELOPMENT | ECONOMIC FACTORS |
            URBANIZATION | URBAN POPULATION DISTRIBUTION |
            POPULATION DISTRIBUTION | GEOGRAPHIC FACTORS |
            POPULATION | POLITICAL FACTORS | SOCIOCULTURAL FACTORS |
            BEHAVIOR | SOCIOECONOMIC FACTORS | SOCIAL WELFARE


Document Number: 308461


Clinical screening for HIV in a health centre setting in urban Kenya: An
entry point for voluntary counselling, HIV testing and early diagnosis of
Author:     Arendt V; Mossong J; Zachariah R; Inwani C; Farah B

Source:     Tropical Doctor. 2007 Jan;37(1):45-47.

Abstract:   A study was conducted among patients attending a public health centre in
            Nairobi, Kenya in order to (a) verify the prevalence of HIV, (b) identify clinical
            risk factors associated with HIV and (c) determine clinical markers for clinical
            screening of HIV infection at the health centre level. Of 304 individuals involved
            in the study, 107 (35%) were HIV positive. A clinical screening algorithm based
            on four clinical markers, namely oral thrush, past or present TB, past or present
            herpes zoster and prurigo would pick out 61 (57%) of the 107 HIV-positive
            individuals. In a resource-poor setting, introducing a clinical screening algorithm
            for HIV at the health centre level could provide an opportunity for targeting
            voluntary counselling and HIV testing, and early access to a range of prevention
            and care interventions. (author's)

Language:   English

Keywords:   KENYA | RESEARCH REPORT | PREVALENCE | URBAN AREAS |
            CLIENTS | VOLUNTARY COUNSELING AND TESTING | HIV TESTING |
            HIV INFECTIONS | EXAMINATIONS AND DIAGNOSES | SCREENING |


                                            43
                            STIs, HIV and AIDS: 2005 - 2008

            AFRICA, EASTERN | AFRICA SOUTH OF THE SAHARA | AFRICA |
            DEVELOPING COUNTRIES | MEASUREMENT | RESEARCH
            METHODOLOGY | GEOGRAPHIC FACTORS | POPULATION |
            PROGRAM ACTIVITIES | PROGRAMS | ORGANIZATION AND
            ADMINISTRATION | LABORATORY EXAMINATIONS AND
            DIAGNOSES | MEDICAL PROCEDURES | MEDICINE | HEALTH
            SERVICES | DELIVERY OF HEALTH CARE | HEALTH | VIRAL DISEASES
            | DISEASES


Document Number: 316511


Relationship between markers of HIV-1 disease progression and serum
beta-carotene concentrations in Kenyan women.

Author:     Baeten JM; McClelland RS; Wener MH; Bankson DD; Lavreys L

Source:     International Journal of STD and AIDS. 2007 Mar;18(3):202-206.

Abstract:   Observational studies have suggested that low serum ß-carotene concentrations
            may influence HIV-1 disease progression. However, randomized trials have not
            demonstrated beneficial effects of ß-carotene supplementation. To understand
            this discrepancy, we conducted a cross-sectional study among 400 HIV-1-
            seropositive women in Mombasa, Kenya, to correlate serum ß-carotene
            concentrations with several measures of HIV-1 disease severity. ß-Carotene
            concentrations were significantly associated with biologic markers of HIV-1
            disease progression (CD4 count, HIV-1 plasma viral load, serum C-reactive
            protein [CRP] concentration, and serum albumin level). In multivariate analysis,
            ß-carotene concentrations below the median were associated with elevated CRP
            (>10 mg/l, adjusted odds ratio [aOR] 3.32, 95% confidence interval [CI] 1.99-5.53,
            P < 0.001) and higher HIV-1 plasma viral load (for each log10 copies/mL
            increase, aOR 1.38, 95% CI 1.01-1.88, P = 0.04). In the context of negative findings
            from randomized trials of ß-carotene supplementation in HIV-1-seropositive
            individuals, these results suggest that low ß-carotene concentrations primarily
            reflect more active HIV-1 infection rather than a deficiency amenable to
            intervention. (author's)

Language:   English

Keywords:   KENYA | RESEARCH REPORT | CLINICAL TRIALS | CROSS SECTIONAL
            ANALYSIS | HIV POSITIVE PERSONS | WOMEN | SOCIOECONOMIC
            STATUS | VITAMIN A | DEFICIENCY DISEASES | NUTRITION INDEXES
            | FOOD SUPPLEMENTATION | IMMUNITY, CELLULAR | AFRICA,
            EASTERN | AFRICA SOUTH OF THE SAHARA | AFRICA | DEVELOPING
            COUNTRIES | CLINICAL RESEARCH | RESEARCH METHODOLOGY |
            PERSONS LIVING WITH HIV/AIDS | HIV INFECTIONS | VIRAL


                                             44
                             STIs, HIV and AIDS: 2005 - 2008

            DISEASES | DISEASES | DEMOGRAPHIC FACTORS | POPULATION |
            SOCIOECONOMIC FACTORS | ECONOMIC FACTORS | VITAMINS AND
            MINERALS | PHYSIOLOGY | BIOLOGY | NUTRITION DISORDERS |
            NUTRITION | HEALTH | NUTRITION PROGRAMS | PRIMARY HEALTH
            CARE | HEALTH SERVICES | DELIVERY OF HEALTH CARE |
            IMMUNITY | IMMUNE SYSTEM


Document Number: 315856

High uptake of postpartum hormonal contraception among HIV-1-
seropositive women in Kenya.

Author:     Balkus J; Bosire R; John-Stewart G; Mbori-Ngacha D

Source:     Sexually Transmitted Diseases. 2007 Jan;34(1):25-29.

Abstract:   The objectives of this study were to determine patterns of contraceptive
            utilization among sexually active HIV-1-seropositive women postpartum and to
            identify correlates of hormonal contraception uptake. The goal of this study was
            to improve delivery of family planning services to HIV-1-infected women in
            resource-limited settings. HIV-1-infected pregnant women were followed
            prospectively in a perinatal HIV-1 transmission study. Participants were referred
            to local clinics for contraceptive counseling and management. Among 319 HIV-1-
            infected women, median time to sexual activity postpartum was 2 months and
            231 (72%) women used hormonal contraception for at least 2 months during
            follow-up, initiating use at approximately 3 months postpartum (range, 1-11
            months). Overall, 101 (44%) used DMPA, 71 (31%) oral contraception, and 59
            (25%) switched methods during follow-up. Partner notification, infant mortality,
            and condom use were similar between those using and not using contraception.
            Using existing the healthcare infrastructure, it is possible to achieve high levels of
            postpartum hormonal contraceptive utilization among HIV-1-seropositive
            women. (author's)

Language:   English

Keywords:   KENYA | RESEARCH REPORT | PROSPECTIVE STUDIES | KAP
            SURVEYS | CONTRACEPTIVE PREVALENCE SURVEYS | POSTPARTUM
            WOMEN | WOMEN IN DEVELOPMENT | HIV POSITIVE PERSONS |
            POSTPARTUM | CONTRACEPTIVE USAGE | TIME FACTORS | DEPO-
            PROVERA | ORAL CONTRACEPTIVES | CONTRACEPTIVE METHOD
            SWITCHING | PARTNER COMMUNICATION | AFRICA, EASTERN |
            AFRICA SOUTH OF THE SAHARA | AFRICA | DEVELOPING
            COUNTRIES | STUDIES | RESEARCH METHODOLOGY | SURVEYS |
            SAMPLING STUDIES | FAMILY PLANNING SURVEYS | FAMILY
            PLANNING | PUERPERIUM | REPRODUCTION | ECONOMIC
            DEVELOPMENT | ECONOMIC FACTORS | PERSONS LIVING WITH


                                             45
                            STIs, HIV and AIDS: 2005 - 2008

            HIV/AIDS | HIV INFECTIONS | VIRAL DISEASES | DISEASES |
            CONTRACEPTION | POPULATION DYNAMICS | DEMOGRAPHIC
            FACTORS | POPULATION | MEDROXYPROGESTERONE ACETATE |
            CONTRACEPTIVE AGENTS, PROGESTIN | CONTRACEPTIVE AGENTS,
            FEMALE | CONTRACEPTIVE AGENTS | CONTRACEPTIVE METHODS |
            INTERPERSONAL RELATIONS | BEHAVIOR


Document Number: 310729

Polymorphisms in IRF-1 associated with resistance to HIV-1 infection in
highly exposed uninfected Kenyan sex workers.
Author:     Ball TB; Ji H; Kimani J; McLaren P; Marlin C

Source:     AIDS. 2007 May 31;21(9):1091-1101.

Abstract:   The objective was to determine the correlation between polymorphisms in the IL-
            4 gene cluster and resistance to HIV-1 infection. A cross-sectional genetic
            analysis of polymorphisms within the IL-4 gene cluster was conducted in a well-
            described female sex worker cohort from Nairobi, Kenya, known to exhibit
            differential susceptibility to HIV-1 infection. Microsatellite genotyping was used
            to screen six microsatellite markers in the IL-4 gene cluster for associations with
            HIV-1 resistance. Further analysis of the interferon regulatory factor 1 (IRF-1)
            gene was conducted by genomic sequencing. Associations between IRF-1 gene
            polymorphisms and the HIV-1 resistance phenotype were determined using the
            chi-square test and Kaplan-Meier survival analysis. The functional consequence
            of IRF-1 polymorphism was conducted by quantitative Western blot. Three
            polymorphisms in IRF-1, located at 619, the microsatellite region and 6516 of the
            gene, showed associations with resistance to HIV-1 infection. The 619A, 179at
            IRF-1 microsatellite and 6516G alleles were associated with the HIV-1-resistant
            phenotype and a reduced likelihood of seroconversion. Peripheral blood
            mononuclear cells from patients with protective IRF-1 genotypes exhibited
            significantly lower basal IRF-1 expression and reduced responsiveness to
            exogenous IFN-t stimulation. Polymorphisms in the IRF-1 gene are associated
            with resistance to infection by HIV-1 and a lowered level of IRF-1 protein
            expression. This study adds IRF-1, a transcriptional immunoregulatory gene, to
            the list of genetic correlates of altered susceptibility to HIV-1. This is the first
            report suggesting that a viral transcriptional regulator might contribute to
            resistance to HIV-1. Further functional analysis on the role of IRF-1
            polymorphisms and HIV-1 resistance is underway. (author's)

Language:   English

Keywords:   KENYA | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | SEX
            WORKERS | WOMEN | HIV INFECTIONS | GENETICS | LABORATORY
            PROCEDURES | IMMUNITY | HIV PREVENTION | AFRICA, EASTERN |


                                             46
                            STIs, HIV and AIDS: 2005 - 2008

            AFRICA SOUTH OF THE SAHARA | AFRICA | DEVELOPING
            COUNTRIES | RESEARCH METHODOLOGY | SEX BEHAVIOR |
            BEHAVIOR | DEMOGRAPHIC FACTORS | POPULATION | VIRAL
            DISEASES | DISEASES | BIOLOGY | LABORATORY EXAMINATIONS
            AND DIAGNOSES | EXAMINATIONS AND DIAGNOSES | MEDICAL
            PROCEDURES | MEDICINE | HEALTH SERVICES | DELIVERY OF
            HEALTH CARE | HEALTH | IMMUNE SYSTEM | PHYSIOLOGY


Document Number: 313499


Male circumcision for HIV prevention in young men in Kisumu, Kenya:
a randomised controlled trial.

Author:     Balley RC; Moses S; Parker CB; Agot K; Maclean I

Source:     Lancet. 2007 Feb 24;369(9562):643-656.

Abstract:   Male circumcision could provide substantial protection against acquisition of
            HIV-1 infection. Our aim was to determine whether male circumcision had a
            protective effect against HIV infection, and to assess safety and changes in sexual
            behaviour related to this intervention. We did a randomised controlled trial of
            2784 men aged 18-24 years in Kisumu, Kenya. Men were randomly assigned to
            an intervention group (circumcision; n = 1391) or a control group (delayed
            circumcision, 1393), and assessed by HIV testing, medical examinations, and
            behavioural interviews during follow-ups at 1, 3, 6, 12, 18, and 24 months. HIV
            seroincidence was estimated in an intention-to-treat analysis. This trial is
            registered with ClinicalTrials.gov, with the number NCT00059371. The trial was
            stopped early on December 12, 2006, after a third interim analysis reviewed by
            the data and safety monitoring board. The median length of follow-up was 24
            months. Follow-up for HIV status was incomplete for 240 (8.6%) participants. 22
            men in the intervention group and 47 in the control group had tested positive for
            HIV when the study was stopped. The 2-year HIV incidence was 2.1% (95% CI
            1.2-3.0) in the circumcision group and 4.2% (3.0-5.4) in the control group (p =
            0.0065); the relative risk of HIV infection in circumcised men was 0.47 (0.28-0.78),
            which corresponds to a reduction in the risk of acquiring an HIV infection of 53%
            (22-72). Adjusting for non-adherence to treatment and excluding four men found
            to be seropositive at enrolment, the protective effect of circumcision was 60% (32-
            77). Adverse events related to the intervention (21 events in 1.5% of those
            circumcised) resolved quickly. No behavioural risk compensation after
            circumcision was observed. Male circumcision significantly reduces the risk of
            HIV acquisition in young men in Africa. Where appropriate, voluntary, safe, and
            affordable circumcision services should be integrated with other HIV preventive
            interventions and provided as expeditiously as possible. (author's)




                                             47
                            STIs, HIV and AIDS: 2005 - 2008

Language:   English

Keywords:   KENYA | RESEARCH REPORT | CLINICAL TRIALS | CONTROL GROUPS
            | INCIDENCE | MEN | HIV TESTING | MALE CIRCUMCISION |
            EXAMINATIONS AND DIAGNOSES | HIV PREVENTION | PROGRAM
            EFFECTIVENESS | DEVELOPING COUNTRIES | AFRICA, EASTERN |
            AFRICA SOUTH OF THE SAHARA | AFRICA | CLINICAL RESEARCH |
            RESEARCH METHODOLOGY | MEASUREMENT | DEMOGRAPHIC
            FACTORS | POPULATION | LABORATORY EXAMINATIONS AND
            DIAGNOSES | MEDICAL PROCEDURES | MEDICINE | HEALTH
            SERVICES | DELIVERY OF HEALTH CARE | HEALTH | HIV INFECTIONS
            | VIRAL DISEASES | DISEASES | PROGRAM EVALUATION |
            PROGRAMS | ORGANIZATION AND ADMINISTRATION

Document Number: 312757


Self-reported adherence to single dose nevirapine in the prevention of
mother to child transmission of HIV at Kitale District Hospital.
Author:     Bii SC; Otieno-Nyunya B; Siika A; Rotich JK

Source:     East African Medical Journal. 2007 Dec;84(12):571-576.

Abstract:   Objectives:
            To evaluate the uptake and adherence to single dose nevirapine among HIV
            positive mothers.

            Design:
            Descriptive cross-sectional study. Setting: The maternal and child health and
            family planning (MCH-FP) clinics in Kitale district hospital, Western Kenya.
            Subjects: HIV positive postnatal women attending MCH-FP clinic who had gone
            through the PMTCT programme.

            Results:
            A total of 146 respondents were recruited for this study. Most (90%) of them
            reported swallowing their nevirapine tablets, however only 55 swallowed their
            tablets within 4-12 hours before delivery. The most important factor affecting
            nevirapine adherence was place or delivery (p<0.05). Most (71%) of mothers who
            did not swallow their nevirapine delivered at home. Women attending ANC for
            two times or less young women under 20 years of age and single women were
            also less likely to swallow their nevirapine (p < 0.05). Most (91%) of the babies
            received their nevirapine syrup with 98% of them getting it within 72 hours of
            delivery. Eighty eight percent of babies who did not take their nevirapine were
            delivered at home. Babies whose mothers did not take their nevirapine were also
            more likely to miss it.



                                            48
                            STIs, HIV and AIDS: 2005 - 2008

            Conclusions:
            Self reported adherence to take home nevirapine is high. However mothers who
            deliver in a health facility were more likely to access nevirapine both for
            themselves and their babies than those delivering at home. (author's)

Language:   English

Keywords:   KENYA | RESEARCH REPORT | KAP SURVEYS | PERSONS LIVING
            WITH HIV/AIDS | WOMEN IN DEVELOPMENT | PREGNANT WOMEN |
            INFANT | ANTIRETROVIRAL DRUGS | USER COMPLIANCE |
            PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | HIV
            PREVENTION | ANTENATAL CARE | AGE FACTORS | CHILDBIRTH |
            TIME FACTORS | DEVELOPING COUNTRIES | AFRICA, EASTERN |
            AFRICA, SUB SAHARAN | AFRICA | SURVEYS | SAMPLING STUDIES |
            STUDIES | RESEARCH METHODOLOGY | HIV INFECTIONS | VIRAL
            DISEASES | DISEASES | ECONOMIC DEVELOPMENT | ECONOMIC
            FACTORS | POPULATION CHARACTERISTICS | DEMOGRAPHIC
            FACTORS | POPULATION | YOUTH | TREATMENT | MEDICAL
            PROCEDURES | MEDICINE | HEALTH SERVICES | DELIVERY OF
            HEALTH CARE | HEALTH | BEHAVIOR | DISEASE TRANSMISSION
            CONTROL | PREVENTION AND CONTROL | MATERNAL HEALTH
            SERVICES | MATERNAL-CHILD HEALTH SERVICES | PRIMARY
            HEALTH CARE | PREGNANCY OUTCOMES | PREGNANCY |
            REPRODUCTION | POPULATION DYNAMICS


Document Number: 325870


Correlation of CD4 counts and CD4 / CD8 ratio with HIV-infection
associated oral manifestations.
Author:     Butt FM; Vaghela VP; Chindia ML

Source:     East African Medical Journal. 2007 Aug;84(8):383-388.

Abstract:   Background:
            The relationship between oral lesions arising from HIV infection and CD4/CD8
            cell ratios is of relevance in clinical assessment of immune suppression.

            Objective:
            To correlate the prevalence of oral manifestations arising from HIV infection and
            the levels of CD4/CD8 cell ratios.

            Design:
            A cross-sectional study. Setting: Kenyatta National Hospital, Nairobi, Kenya.




                                            49
                            STIs, HIV and AIDS: 2005 - 2008

            Subjects:
            Two hundred and seven HIV-infected patients in medical wards were recruited
            in the study.

            Results:
            Seventy eight (37.7%) were male and 129 (62.3%) female, with an age range of 18-
            73 years (mean = 34.81 years). Oral manifestations encountered with highest
            prevalence in the oral cavity included: hyperplastic candidosis (labial mucosa)
            15%, erythematous candidosis (gingival) 5%, angular cheilitis 32.4%, herpes
            simplex(corner of the mouth) 0.5%, persistent oral ulceration (labial mucosa)
            0.5%, Parotid enlargement 2% and Kaposi's sarcoma (hard/soft palate) 2.9%.

            Conclusion:
            The prevalence of oral manifestations was higher with low CD4 count <200
            cell/mm3 and mean CD4/CD8<0.39(95%CI 0.32-0.48). (author's)

Language:   English

Keywords:   KENYA | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS |
            CLIENTS | HIV POSITIVE PERSONS | ORAL EFFECTS | BACTERIAL
            AND FUNGAL DISEASES | HIV INFECTIONS | DEVELOPING
            COUNTRIES | AFRICA, EASTERN | AFRICA, SUB SAHARAN | AFRICA |
            RESEARCH METHODOLOGY | PROGRAM ACTIVITIES | PROGRAMS |
            | PERSONS LIVING WITH HIV/AIDS | VIRAL DISEASES | DISEASES |


Document Number: 308881


Heavy episodic drinking among Kenyan female sex workers is
associated with unsafe sex, sexual violence and sexually transmitted
infections.
Author:     Chersich MF; Luchters SM; Malonza IM; Mwarogo P; King’ola N

Source:     International Journal of STD and AIDS. 2007 Nov;18(11):764-769.

Abstract:   This study examined patterns of alcohol use and its association with unsafe sex
            and related sequelae among female sex workers in Mombasa, Kenya. A
            community-based cross-sectional study was conducted using snowball sampling.
            Binge drinkers (>/= 5 alcoholic drinks on >/= 1 occasion in the previous month)
            were compared with non-binge drinkers. Of 719 participants, 22.4% were
            lifetime-alcohol abstainers, 44.7% non-binge and 33.0% binge drinkers.
            Compared with non-binge drinkers, binge drinkers were more likely to report
            unprotected sex (adjusted odds ratio (AOR) = 1.59, 95% confidence interval [CI]
            = 1.00-2.53; P = 0.047) and sexual violence (AOR = 1.85, 95% CI = 1.27-2.71; P =
            0.001) and to have either syphilis, Neisseria gonorrhoeae or Trichomonas


                                           50
                            STIs, HIV and AIDS: 2005 - 2008

            vaginalis infection (AOR = 1.56, 95% CI = 1.00-2.41; P = 0.048). HIV prevalence
            was higher among women having ever drunk (39.9%) than lifetime abstainers
            (23.2%; P < 0.001), but was not associated with drinking patterns. Interventions
            are needed to assist female sex workers adopt safer drinking patterns.
            Investigation is needed for the effectiveness of such interventions in reducing
            unprotected sex, sexual violence and sexually transmitted infections. (author's)

Language:   English

Keywords:   KENYA | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | SEX
            WORKERS | WOMEN | ALCOHOL USE AND ABUSE |
            SOCIOECONOMIC FACTORS | SEX BEHAVIOR | RISK BEHAVIOR |
            VIOLENCE | HIV INFECTIONS | SEXUALLY TRANSMITTED DISEASES |
            DEVELOPING COUNTRIES | AFRICA, EASTERN | AFRICA, SUB
            SAHARAN | AFRICA | RESEARCH METHODOLOGY | BEHAVIOR |
            DEMOGRAPHIC FACTORS | POPULATION | ECONOMIC FACTORS |
            VIRAL DISEASES | DISEASES | REPRODUCTIVE TRACT INFECTIONS |
            INFECTIONS

Document Number: 321629


Mycoplasma genitalium infection and persistence in a cohort of female
sex workers in Nairobi, Kenya.
Author:     Cohen CR; Nosek M; Meier A; Astete SG; Iverson-Cabral S

Source:     Sexually Transmitted Diseases. 2007 May;34(5):274-279.

Abstract:   The objective of this study was to assess the risk factors for and persistence of
            Mycoplasma genitalium (MG) in a highly exposed female population in Kenya.
            Two hundred fifty-eight sex workers in Nairobi, Kenya, 18 to 35 years of age,
            were enrolled. Every 2 months, cervical samples were collected for MG,
            Chlamydia trachomatis (CT), and Neisseria gonorrhoeae (GC) testing by
            polymerase chain reaction. At enrollment, 16% were infected with MG. Seventy-
            seven subjects acquired 107 MG infections, giving an incidence of 22.7 per 100
            women-years. Incident CT (adjusted hazard ratio [HR] = 2.4; 95% confidence
            interval [CI] = 1.5- 4.0), GC (HR = 2.0; 95% CI =1.2-3.5), and HIV infection
            (adjusted HR = 2.2; 95% CI = 1.3-3.7) were associated with an increased risk of
            MG. Seventeen percent, 9%, and 21% of MG infections persisted 3, 5, and greater
            than or equal to 7 months, respectively. The high incidence of MG, greater than
            that for both CT (14.0%) and GC (8%), association with common sexually
            transmitted infection risk factors, and persistence in the female genital tract
            supports its role as a common sexually transmitted infection in Kenyan women.
            (author's)




                                            51
                            STIs, HIV and AIDS: 2005 - 2008

Language:   English

Keywords:   KENYA | RESEARCH REPORT | CLINICAL RESEARCH | COHORT
            ANALYSIS | SEX WORKERS | WOMEN | SEXUALLY TRANSMITTED
            DISEASES | UROGENITAL EFFECTS | PREVALENCE | AFRICA,
            EASTERN | AFRICA SOUTH OF THE SAHARA | AFRICA | DEVELOPING
            COUNTRIES | RESEARCH METHODOLOGY | SEX BEHAVIOR |
            BEHAVIOR | DEMOGRAPHIC FACTORS | POPULATION |
            REPRODUCTIVE TRACT INFECTIONS | INFECTIONS | DISEASES |
            UROGENITAL SYSTEM | PHYSIOLOGY | BIOLOGY | MEASUREMENT


Document Number: 313478



Infectious correlates of HIV-1 shedding in the female upper and lower
genital tracts.
Author:     Coleman JS; Hitti J; Bukusi EA; Mwachari C; Muliro A

Source:     AIDS. 2007 Mar 30;21(6):755-759.

Abstract:   The objectives were to determine the effects of vaginal, cervical, and endometrial
            infections on shedding of HIV-1 RNA in the female genital tract. Design: Cross-
            sectional. Antiretroviral-naive women from Nairobi, Kenya with CD4 cell counts
            >/= 350 cells/microliter had plasma and endocervical wick samples collected for
            HIV quantification by real-time RNA reverse transcriptase-polymerase chain
            reaction. Vaginal and cervical Gram stains and endometrial biopsies were
            obtained. Vaginal Gram stain was used to diagnose bacterial vaginosis and to
            quantify Lactobacillus levels. Twenty-six of 50 (52%) women had detectable
            endocervical HIV-1 RNA with a median endocervical viral load of 1760
            copies/ml (range: undetectable to 1 030 000 copies/ml). Women with decreased
            Lactobacillus had 15.8-fold [95% confidenceinterval (CI), 2.0-123] greater
            endocervical HIV-1 RNA than women with normal Lactobacillus levels. Women
            with plasma cell (PC) endometritis [>/= 1 PC/ high-power field (hpf)] had a
            15.8-fold (95% CI, 2.0-120) higher endocervical HIV RNA level than women
            without PC endometritis. Both these associations remained after controlling for
            plasma viral load. Cervicitis (>/= 30 polymorphonuclear leukocytes/hpf),
            however, was not associated with endocervical HIV-1 RNA shedding (P=0.81). In
            HIV-1-infected, antiretroviral-naive women without symptoms of pelvic
            inflammatory disease infection, abnormal vaginal flora and inflammatory cells in
            the endometrium affected HIV-1 shedding from the lower genital tract. These
            data suggest that both the upper and lower genital tracts contribute to female
            HIV-1 genital shedding. (author's)




                                            52
                            STIs, HIV and AIDS: 2005 - 2008

Language:   English

Keywords:   KENYA | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS |
            WOMEN | HIV POSITIVE PERSONS | IMMUNITY, CELLULAR |
            LABORATORY PROCEDURES | GENITAL EFFECTS, FEMALE |
            ENDOMETRITIS | VAGINOSIS | PELVIC INFLAMMATORY DISEASE |
            SEXUALLY TRANSMITTED DISEASES | AFRICA, EASTERN | AFRICA
            SOUTH OF THE SAHARA | AFRICA | DEVELOPING COUNTRIES |
            RESEARCH METHODOLOGY | DEMOGRAPHIC FACTORS |
            POPULATION | PERSONS LIVING WITH HIV/AIDS | HIV INFECTIONS |
            VIRAL DISEASES | DISEASES | IMMUNITY | IMMUNE SYSTEM |
            PHYSIOLOGY | BIOLOGY | LABORATORY EXAMINATIONS AND
            DIAGNOSES | EXAMINATIONS AND DIAGNOSES | MEDICAL
            PROCEDURES | MEDICINE | HEALTH SERVICES | DELIVERY OF
            HEALTH CARE | HEALTH | GENITALIA, FEMALE | GENITALIA |
            UROGENITAL SYSTEM | REPRODUCTIVE TRACT INFECTIONS |
            INFECTIONS | VAGINAL ABNORMALITIES


Document Number: 315497


Market incentives, human lives, and AIDS vaccines.
Author:     Craddock S

Source:     Social Science and Medicine. 2007 Mar;64(5):1042-1056.

Abstract:   For many, an AIDS vaccine holds the promise of intervening in a widespread
            epidemic because it is not predicated on changing economic structures and social
            contexts underlying vulnerability to HIV for millions of individuals. Yet 20 years
            into the AIDS epidemic, there is still no vaccine. Based on interviews of AIDS
            vaccine researchers, watchdog organizations, and ethics groups from the United
            States, South Africa, and Kenya conducted between August and December of
            2003, this paper explores possible answers to the question of why there is no
            vaccine, looking in particular at contradictions between a biomedical research
            industry increasingly driven by market incentives and a disease that primarily
            affects individuals living in low-income countries with little vaccine purchasing
            power. Producing a vaccine that could be effective in low-income regions
            requires new kinds of initiatives that can coordinate research nationally and
            globally, and circumvent current regulatory mechanisms that dictate against the
            development and dissemination of low-profit medical technologies. Until such
            initiatives are supported, however, vaccine research will continue at a
            devastatingly slow pace at the cost of millions of lives annually. (author's)

Language:   English




                                            53
                            STIs, HIV and AIDS: 2005 - 2008

Keywords:   UNITED STATES | SOUTH AFRICA | KENYA | RESEARCH REPORT |
            RESEARCH AND DEVELOPMENT | VACCINES | PHARMACY
            DISTRIBUTION | AIDS | MEDICINE | ECONOMIC FACTORS | NORTH
            AMERICA | AMERICAS | DEVELOPED COUNTRIES | AFRICA,
            SOUTHERN | AFRICA SOUTH OF THE SAHARA | AFRICA |
            DEVELOPING COUNTRIES | AFRICA, EASTERN | TECHNOLOGY |
            MEDICAL PROCEDURES | HEALTH SERVICES | DELIVERY OF HEALTH
            CARE | HEALTH | NONCLINICAL DISTRIBUTION | DISTRIBUTIONAL
            ACTIVITIES | PROGRAM ACTIVITIES | PROGRAMS | ORGANIZATION
            AND ADMINISTRATION | HIV INFECTIONS | VIRAL DISEASES |
            DISEASES


Document Number: 312042


Urban-rural differences in the socioeconomic deprivation -- Sexual
behavior link in Kenya.
Author:     Dodoo FN; Zulu EM; Ezeh AC

Source:     Social Science and Medicine. 2007 Mar;64(5):1019-1031.

Abstract:   We compare the impact of socioeconomic deprivation on risky sexual outcomes
            in rural and urban Kenya. Quantitative data are drawn from the Demographic &
            Health Surveys (DHS) and qualitative data from the Sexual Networking and
            Associated Reproductive and Social Health Concerns study. Using two separate
            indicators of deprivation we show that, although poverty is significantly
            associated with the examined sexual outcomes in all settings, the urban poor are
            significantly more likely than their rural counterparts to have an early sexual
            debut and a greater incidence of multiple sexual partnerships. The disadvantage
            of the urban poor is accentuated for married women; those in Nairobi's slums are
            at least three times as likely to have multiple sexual partners as their rural
            counterparts. The implications of these findings are discussed. (author's)

Language:   English

Keywords:   KENYA | RESEARCH REPORT | COMPARATIVE STUDIES | RURAL
            AREAS | URBAN AREAS | MULTIPLE PARTNERS | SEXUAL PARTNERS
            | SEX BEHAVIOR | CONDOM USE | POVERTY | SOCIOECONOMIC
            FACTORS | AFRICA, EASTERN | AFRICA SOUTH OF THE SAHARA |
            AFRICA | DEVELOPING COUNTRIES | STUDIES | RESEARCH
            METHODOLOGY | GEOGRAPHIC FACTORS | POPULATION |
            BEHAVIOR | RISK REDUCTION BEHAVIOR | ECONOMIC FACTORS


Document Number: 312040


                                           54
                            STIs, HIV and AIDS: 2005 - 2008


Sero-discordant couples in five African countries: Implications for
prevention strategies.

Author:     De Walque D

Source:     Population and Development Review. 2007 Sep;33(3):501-523.

Abstract:   THE HIV/AIDS EPIDEMIC is one of the greatest challenges facing Africa.
            According to UNAIDS (2006), as of December 2006, between 21.8 and 27.7
            million people in sub-Saharan Africa were infected by HIV/AIDS. This
            represents around 62.5 percent of the estimated worldwide total and implies that
            between 5.2 and 6.7 percent of adults living in that region are HIV positive.
            Between 1.8 and 2.4 million sub-Saharan Africans died from the virus in 2006
            and between 2.4 and 3.2 million became newly infected. Only recently have
            individual-level data, including HIV test results, become available for nationally
            representative samples in Africa and other developing regions. Previously,
            studies of the HIV epidemic relied either on aggregate data or on HIV status data
            from nonrepresentative samples or on data from self-reported sexual behavior.
            The new wave of Demographic and Health Surveys (DHS), which include HIV
            status, now permits analysis of the socioeconomic determinants of HIV infection
            for nationally representative samples. The present study of sero-discordant
            couples uses an additional feature of the data available in the Demographic and
            Health Surveys. The data make it possible to assess the HIV status of cohabiting
            couples (formally married or not) and to compare sexual behavior reported by
            the man and the woman. (excerpt)

Language:   English

Keywords:   CAMEROON | KENYA | TANZANIA | BURKINA FASO | GHANA |
            RESEARCH REPORT | DEMOGRAPHIC AND HEALTH SURVEYS |
            PERSONS LIVING WITH HIV/AIDS | COUPLES | HIV PREVENTION |
            HIV TRANSMISSION | EXTRAMARITAL SEX BEHAVIOR |
            DEVELOPING COUNTRIES | AFRICA, WESTERN | AFRICA, SUB
            SAHARAN | AFRICA | AFRICA, EASTERN | DEMOGRAPHIC SURVEYS |
            POPULATION DYNAMICS | DEMOGRAPHIC FACTORS | POPULATION
            | HIV INFECTIONS | VIRAL DISEASES | DISEASES | FAMILY
            CHARACTERISTICS | FAMILY AND HOUSEHOLD | SOCIOCULTURAL
            FACTORS | SEX BEHAVIOR | BEHAVIOR


Document Number: 320253




                                            55
                            STIs, HIV and AIDS: 2005 - 2008


Orphans and schooling in Africa: A longitudinal analysis.
Author:     Evans DK; Miguel E

Source:     Demography. 2007 Feb;44(1):35-57.

Abstract:   AIDS deaths could have a major impact on economic development by affecting
            the human capital accumulation of the next generation. We estimate the impact
            of parent death on primary school participation using an unusual five-year panel
            data set of over 20,000 Kenyan children. There is a substantial decrease in school
            participation following a parent death and a smaller drop before the death
            (presumably due to pre-death morbidity). Estimated impacts are smaller in
            specifications without individual fixed effects, suggesting that estimates based
            on cross-sectional data are biased toward zero. Effects are largest for children
            whose mothers died and, in a novel finding, for those with low baseline
            academic performance. (author's)

Language:   English

Keywords:   KENYA | RESEARCH REPORT | LONGITUDINAL STUDIES | SURVEYS |
            ORPHANS AND VULNERABLE CHILDREN | PARENTS | MORTALITY |
            AIDS | RURAL AREAS | PRIMARY SCHOOLS | SOCIOECONOMIC
            STATUS | EDUCATIONAL STATUS | DEVELOPING COUNTRIES |
            AFRICA, EASTERN | AFRICA, SUB SAHARAN | AFRICA | STUDIES |
            RESEARCH METHODOLOGY | SAMPLING STUDIES | YOUTH | AGE
            FACTORS | POPULATION CHARACTERISTICS | DEMOGRAPHIC
            FACTORS | POPULATION | FAMILY RELATIONSHIPS | FAMILY
            CHARACTERISTICS | FAMILY AND HOUSEHOLD | SOCIOCULTURAL
            FACTORS | POPULATION DYNAMICS | HIV INFECTIONS | VIRAL
            DISEASES | DISEASES | GEOGRAPHIC FACTORS | SCHOOLS |
            EDUCATION | SOCIOECONOMIC FACTORS | ECONOMIC FACTORS


Document Number: 313230


Validity of self-reported "safe sex" among female sex workers in
Mombasa, Kenya -- PSA analysis.
Author:     Gall MF; Behets FM; Steiner MJ; Thomsen SC; Ombidi W

Source:     International Journal of STD and AIDS. 2007 Jan;18(1):33-38.

Abstract:   We assessed the validity of self-reported sex and condom use by comparing self-
            reports with prostate-specific antigen (PSA) detection in a prospective study of
            210 female sex workers in Mombasa, Kenya. Participants were interviewed on
            recent sexual behaviours at baseline and 12-month follow-up visits. At both


                                            56
                             STIs, HIV and AIDS: 2005 - 2008

            visits, a trained nurse instructed participants to self-swab to collect vaginal fluid
            specimens, which were tested for PSA using enzyme-linked immunosorbent
            assay (ELISA). Eleven percent of samples (n¼329) from women reporting no
            unprotected sex for the prior 48 hours tested positive for PSA. The proportions of
            women with this type of discordant self-reported and biological data did not
            differ between the enrolment and 12-month visit (odds ratio [OR] 1.1; 95%
            confidence interval [CI] 0.99, 1.2). The study found evidence that participants
            failed to report recent unprotected sex. Furthermore, because PSA begins to clear
            immediately after exposure, our measures of misreported semen exposure likely
            are underestimations. (author's)

Language:   English

Keywords:   KENYA | RESEARCH REPORT | PROSPECTIVE STUDIES | SEX
            WORKERS | WOMEN | LABORATORY EXAMINATIONS AND
            DIAGNOSES | ANTIGENS | IMMUNOLOGIC FACTORS | SELF-
            PERCEPTION | POSTCOITAL DOUCHING | SAFER SEX | CONDOM USE
            | AFRICA, EASTERN | AFRICA SOUTH OF THE SAHARA | AFRICA |
            DEVELOPING COUNTRIES | STUDIES | RESEARCH METHODOLOGY |
            SEX BEHAVIOR | BEHAVIOR | DEMOGRAPHIC FACTORS |
            POPULATION | EXAMINATIONS AND DIAGNOSES | MEDICAL
            PROCEDURES | MEDICINE | HEALTH SERVICES | DELIVERY OF
            HEALTH CARE | HEALTH | IMMUNITY | IMMUNE SYSTEM |
            PHYSIOLOGY | BIOLOGY | PERCEPTION | PSYCHOLOGICAL FACTORS
            | FERTILITY CONTROL, POSTCOITAL | FAMILY PLANNING | RISK
            REDUCTION BEHAVIOR


Document Number: 315842


'Are you on the market?': A capture -- recapture enumeration of men who
sell sex to men in and around Mombasa, Kenya.
Author:     Geibel S; van der Elst EM; King'ola N; Luchters S; Davies A

Source:     AIDS. 2007 Jun;21(10):1349-1354.

Abstract:   Men who have sex with men (MSM) are highly vulnerable to HIV infection, but
            this population can be particularly difficult to reach in sub-Saharan Africa. We
            aimed to estimate the number of MSM who sell sex in and around Mombasa,
            Kenya, in order to plan HIV prevention research. We identified 77 potential
            MSM contact locations, including public streets and parks, brothels, bars and
            nightclubs, in and around Mombasa and trained 37 MSM peer leader
            enumerators to extend a recruitment leaflet to MSM who were identified as 'on
            the market', that is, a man who admitted to selling sex to men. We captured men
            on two consecutive Saturdays, 1 week apart. A record was kept of when, where


                                             57
                            STIs, HIV and AIDS: 2005 - 2008

            and by whom the invitation was extended and received, and of refusals. The
            total estimate of MSM who sell sex was derived from capture-recapture
            calculation. Capture 1 included 284 men (following removal of 15 duplicates); 89
            men refused to participate. Capture 2 included 484 men (following removal of 35
            duplicates); 75 men refused to participate. Of the 484 men in capture 2, 186 were
            recaptures from capture 1, resulting in a total estimate of 739 (95% confidence
            interval, 690-798) MSM who sell sex in the study area. We estimated that 739
            MSM sell sex in and around Mombasa. Of these, 484 were contacted through
            trained peer enumerators in a single day. MSM who sell sex in and around
            Mombasa represent a sizeable population who urgently need to be targeted by
            HIV prevention strategies. (author's)

Language:   English

Keywords:   KENYA | RESEARCH REPORT | EPIDEMIOLOGIC METHODS |
            INDIRECT ESTIMATION TECHNICS | MEN HAVING SEX WITH MEN |
            SEX WORKERS | INFLUENTIALS | HIV PREVENTION | SEX BEHAVIOR
            | AFRICA, EASTERN | AFRICA, SUB SAHARAN | AFRICA |
            DEVELOPING COUNTRIES | RESEARCH METHODOLOGY |
            ESTIMATION TECHNICS | BEHAVIOR | KNOWLEDGE SOURCES |
            COMMUNICATION | HIV INFECTIONS | VIRAL DISEASES | DISEASES


Document Number: 313574


Total lymphocyte count as a surrogate marker for CD4+ T cell count in
initiating antiretroviral therapy at Kenyatta National Hospital, Nairobi.

Author:     Gitura B; Joshi MD; Lule GN; Anzala O

Source:     East African Medical Journal. 2007 Oct;84(10):466-473.

Abstract:    Objective:
            To evaluate the utility of Total Lymphocyte Count (TLC) as a surrogate marker
            for CD4 + T cell count in antiretroviral (ARV) treatment initiation in a Kenyan
            population of HIV seropositive patients at Kenyatta National Hospital.

            Design:
            Cross-sectional descriptive study. Setting: Kenyatta National Hospital, HIV
            treatment and follow-up outpatient facility; Comprehensive Care Centre,
            Nairobi, Kenya. Subjects: Two hundred and twenty five HIV Elisa positive, ARV
            naive patients visiting the Comprehensive Care Centre between January 2006 to
            March 2006.




                                            58
                            STIs, HIV and AIDS: 2005 - 2008

            Results:
            A significant linear correlation was found between TLC and CD4 cell count for
            the whole group with a Spearman rank correlation of 0.761 (p < 0.01); and was
            also independently observed in the four WHO clinical stages. The classification
            utility of TLC 1200 cells/mm3 cut-off was suboptimal; sensitivity 37% specificity
            of 99% and the NPV of 56%. The receiver operator characteristics (ROC) curve
            generated an optimal TLC cut-off of 1900 cells/mm3 cut-off to be of greatest
            utility with a sensitivity of 81.1%, specificity of 90.3%, PPV of 90.8% and NPV of
            80.2%. This implies that a TLC cut-off of 1900 cells/mm3 correctly classify eight
            out of ten HIV positive patients as having a CD4 < 200 cells/mm3 and only
            misclassify two such patients. Serial CD4 testing can then be performed on the
            minority of patients who despite a TLC >or= 1900 cells/mm3 are, on basis of
            clinical data, suspect of more advanced disease warranting ARV therapy. This
            would reduce the number of patients tested for and focus the application of CD4
            testing and thus reduce attendant cost in care provision in CD4 resource poor
            settings.

            Conclusion:
            Our data showed a good positive correlation between TLC and CD4 cell count,
            however the WHO recommended TLC cut-off of 1200/mm3 was found to be of
            low sensitivity in classifying patients as having a CD4 counts < 200 cells/mm3.
            This would result in underestimation of advanced stage of disease and to
            withholding ARVs treatment to persons who need treatment. We recommend a
            TLC cut-off of 1900 cells/mm3 for our population to classify patients as either
            above or below the CD4 count cut-off of 200 cells/mm3 as an indicator of when
            to start antiretroviral therapy. (author's)

Language:   English

Keywords:   KENYA | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | HIV
            POSITIVE PERSONS | CLIENTS | ANTIRETROVIRAL THERAPY |
            ANTIRETROVIRAL DRUGS | AUTOIMMUNE RESPONSE | TREATMENT
            | LABORATORY PROCEDURES | TESTING | TIME FACTORS |
            RECOMMENDATIONS | DEVELOPING COUNTRIES | AFRICA,
            EASTERN | AFRICA, SUB SAHARAN | AFRICA | RESEARCH
            METHODOLOGY | PERSONS LIVING WITH HIV/AIDS | HIV
            INFECTIONS | VIRAL DISEASES | DISEASES | PROGRAM ACTIVITIES
            | PROGRAMS | ORGANIZATION AND ADMINISTRATION | HIV |
            MEDICAL PROCEDURES | MEDICINE | HEALTH SERVICES | DELIVERY
            OF HEALTH CARE | HEALTH | ANTIBODIES | IMMUNOLOGIC
            FACTORS | IMMUNITY | IMMUNE SYSTEM | PHYSIOLOGY | BIOLOGY
            | LABORATORY EXAMINATIONS AND DIAGNOSES | EXAMINATIONS
            AND DIAGNOSES | MEASUREMENT | POPULATION DYNAMICS |
            DEMOGRAPHIC FACTORS | POPULATION


Document Number: 324127



                                            59
                            STIs, HIV and AIDS: 2005 - 2008


Associations between intravaginal practices and bacterial vaginosis in
Kenyan female sex workers without symptoms of vaginal infections.

Author:     Hassan WM; Lavreys L; Chohan V; Richardson BA; Mandaliya K

Source:     Sexually Transmitted Diseases. 2007 Jun;34(6):384-388.

Abstract:   Bacterial vaginosis (BV) is highly prevalent among African women and has been
            associated with adverse pregnancy outcomes, sexually transmitted diseases, and
            HIV-1. The goal of this study was to analyze the relationship among intravaginal
            practices, bathing, and BV. The authors conducted a cross-sectional study of
            HIV-1-seronegative Kenyan female sex workers without symptoms of vaginal
            infections. Of 237 women enrolled, 206 (87%) reported vaginal washing using
            either a finger or cloth. Increasing frequency of vaginal washing was associated
            with a higher likelihood of BV (x/2 test for trend, P = 0.05). In multivariate
            analysis, vaginal lubrication with petroleum jelly (odds ratio [OR] = 2.8, 95%
            confidence interval [CI] = 1.4 -5.6), lubrication with saliva (OR = 2.3, 95% CI =
            1.1-4.8), and bathing less than the median for the cohort (14 times/week; OR =
            4.6, 95% CI = 1.2-17.5) were associated with a significantly higher likelihood of
            BV. Modification of intravaginal and general hygiene practices should be
            evaluated as potential strategies for reducing the risk of BV. (author's)

Language:   English

Keywords:   KENYA | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | SEX
            WORKERS | WOMEN | VAGINOSIS | BACTERIAL AND FUNGAL
            DISEASES | SIGNS AND SYMPTOMS | SEX BEHAVIOR | HYGIENE |
            RISK FACTORS | AFRICA, EASTERN | AFRICA SOUTH OF THE SAHARA
            | AFRICA | DEVELOPING COUNTRIES | RESEARCH METHODOLOGY |
            BEHAVIOR | DEMOGRAPHIC FACTORS | POPULATION | VAGINAL
            ABNORMALITIES | DISEASES | INFECTIONS | PUBLIC HEALTH |
            HEALTH | BIOLOGY


Document Number: 317219


Cohabitation, marriage, and "sexual monogamy" in Nairobi's slums.

Author:     Hattori MK; Dodoo FN

Source:     Social Science and Medicine. 2007 Mar;64(5):1067-1078.

Abstract:   The current study investigates the extent to which sexual exclusivity--the
            restriction of one's sexual engagements to a single partner--prevails across
            various marital status, union type, and co-residence categories among Nairobi's


                                            60
                            STIs, HIV and AIDS: 2005 - 2008

            poorest residents, slum dwellers. This question is central to the spread of HIV in
            the increasingly urban and poor, high prevalence countries of sub-Saharan
            Africa, where transmission is primarily via heterosexual sex. In many circles,
            sexual exclusivity is considered a prominent feature of the marriage institution.
            Yet, marriage and cohabitation are often not easily distinguishable in sub-
            Saharan Africa, meaning that the frequent use, as a proxy, of the ''in union''
            category, which includes married as well as cohabiting persons can, at best, be
            considered tenuous. Using the 2000 Nairobi Cross-Sectional Slum Survey
            (NCSS), this paper confirms that marriage is associated with higher reports of
            sexual exclusivity even in settings where poverty provokes risky behavior. The
            finding, here, is of lower risk of HIV infection for married respondents, with a
            smaller effect observed among non-married cohabiters. Converse to the implied
            benefits of marriage, though, women with co-wives are more likely to report
            multiple partners. The implications of these findings are discussed. (author's)

Language:   English

Keywords:   KENYA | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | SLUMS
            | URBAN AREAS | LOW INCOME POPULATION | POVERTY |
            MARRIAGE | MONOGAMY | HIV INFECTIONS | AIDS | AFRICA,
            EASTERN | AFRICA SOUTH OF THE SAHARA | AFRICA | DEVELOPING
            COUNTRIES | RESEARCH METHODOLOGY | URBANIZATION |
            URBAN POPULATION DISTRIBUTION | POPULATION DISTRIBUTION |
            GEOGRAPHIC FACTORS | POPULATION | SOCIAL CLASS |
            SOCIOECONOMIC STATUS | SOCIOECONOMIC FACTORS |
            ECONOMIC FACTORS | NUPTIALITY | DEMOGRAPHIC FACTORS |
            MARRIAGE PATTERNS | VIRAL DISEASES | DISEASES


Document Number: 312044


Clinical and laboratory characteristics of hospitalised patients with
neurological manifestations of HIV / AIDS at the Nairobi Hospital.

Author:     Jowi JO; Mativo PM; Musoke SS

Source:     East African Medical Journal. 2007 Feb;84(2):67-76.

Abstract:   The objective was to determine the profile of clinical and laboratory
            characteristics of hospitalised HIV positive patients with neurological
            complications at a private hospital in Nairobi, Kenya from January 2000 to June
            2005. The design used was a retrospective observational study. The Nairobi
            Hospital, Nairobi, Kenya was the setting. One hundred and fifty hospitalised
            patients were the subjects used in the study. Records of 708 HIV positive
            hospitalised patients were reviewed, 150 patients had neurological



                                            61
                            STIs, HIV and AIDS: 2005 - 2008

            complications; giving a six-year point prevalence of 21.2%. Males were 86 (57.3%)
            and females 64 (42.7%) M: F ratio = 1.3:1. Mean age was 38.84 years. The five
            commonest neurological complications were; cryptococcal meningitis 33 (22%),
            encephalitis 28 (18.7%), cerebral toxoplasmosis 19 (12.7%), stroke 19 (12.7%) and
            tuberculous meningitis 16 (10.7%). Overall, 72 patients (63%) had CD4+ counts
            done. Cryptococcal meningitis patients' CD4+ count, (mean 60, median 17, range
            1-273/cmm). Encephalitis patients' CD4+count, (mean 82, median 54, range 3-
            495/cmm). Cerebral toxoplasmosis patients' CD4+count, (mean 59, median 58,
            range 11-120 /cmm). Stroke patients' CD4+ count, (mean 120, median 30, range
            15-394/cmm) and Tuberculous meningitis patients' CD4+ count, (mean 67,
            median 62 and range 12-1 54/cmm). The other rare neurological manifestations
            included peripheral neuropathy, HIV associated dementia (HAD), myelopathy
            and myopathy amongst others. One hundred and eight (72%) patients were on
            anti-retroviral therapy. The commonest drugs used in various regimen
            combinations included efavirenz and combivir. Fourteen (9.3%) patients died
            while in hospital; eight of them were among those with the top five neurological
            complications. The findings show that patients come to hospital when severely
            immune compromised and hence have overwhelming opportunistic infections.
            The profile of opportunistic infection is comparable to that observed in studies
            elsewhere. Some of the facts observed here may not reflect the situation in public
            health institutions where resources are scarce. Recommendation: To do a multi-
            centre prospective study of neurological manifestations of HIV/ AIDS. (author's)

Language:   English

Keywords:   KENYA | RESEARCH REPORT | RETROSPECTIVE STUDIES | CLIENTS |
            HIV POSITIVE PERSONS | HOSPITALS | NEUROLOGIC EFFECTS |
            LABORATORY PROCEDURES | DEVELOPING COUNTRIES | AFRICA,
            EASTERN | AFRICA, SUB SAHARAN | AFRICA | STUDIES | RESEARCH
            METHODOLOGY | PROGRAM ACTIVITIES | PROGRAMS |
            ORGANIZATION AND ADMINISTRATION | PERSONS LIVING WITH
            HIV/AIDS | HIV INFECTIONS | VIRAL DISEASES | DISEASES | HEALTH
            FACILITIES | DELIVERY OF HEALTH CARE | HEALTH | PHYSIOLOGY |
            BIOLOGY | LABORATORY EXAMINATIONS AND DIAGNOSES |
            EXAMINATIONS AND DIAGNOSES | MEDICAL PROCEDURES |
            MEDICINE | HEALTH SERVICES


Document Number: 319368


Risk factors for treatment denial and loss to follow-up in an
antiretroviral treatment cohort in Kenya.
Author:     Karcher H; Omondi A; Odera J; Kunz A; Harms G




                                            62
                            STIs, HIV and AIDS: 2005 - 2008

Source:     Tropical Medicine and International Health. 2007 May;12(5):687-694.

Abstract:   The objectives were to evaluate risk factors for treatment denial and loss to
            follow-up in an antiretroviral treatment (ART) cohort in a rural African setting in
            western Kenya. Sociodemographic and clinical data of patients enrolled in an
            ART cohort were collected within 18 months of an observational longitudinal
            study and analysed by logistic and Cox regression models. Of 159 patients with
            treatment indication 35 (22%) never started ART. Pregnancy [adjusted odds ratio
            (AOR) 3.60, 95% confidence interval (CI) 1.10-11.8; P = 0.035] and lower level of
            education (AOR 3.80, 95% CI 1.14-12.7; P = 0.03) were independently associated
            with treatment denial. The incidence of total loss of patients under therapy was
            43.2 per 100 person years (pys) (mortality rate 19.2 per 100 pys plus drop out rate
            24 per 100 pys). Older age [adjusted hazard ratio (AHR) 1.06, 95% CI 1.01-1.12; P
            = 0.04], AIDS before starting treatment (AHR 5.83, 95% CI 1.15-29.5; P = 0.03) and
            incomplete adherence to treatment (AHR 1.05, 95% CI 1.03-1.07; P < 0.001) were
            independent risk factors for death. Incomplete adherence also independently
            predicted drop out because of other reasons (AHR 1.06, 95% CI 1.04-1.09; P <
            0.001). Pregnancy and lower level of education, higher age, advanced AIDS stage
            and impaired compliance to ART were identified as risk factors for treatment
            denial and death, respectively. Adequate counselling strategies for patients with
            these characteristics could help to improve adherence and outcome of treatment
            programmes in resource-limited settings. (author's)

Language:   English

Keywords:   KENYA | RESEARCH REPORT | COHORT ANALYSIS | LONGITUDINAL
            STUDIES | HIV POSITIVE PERSONS | ANTIRETROVIRAL THERAPY |
            TREATMENT | DROPOUTS | PREGNANCY | EDUCATION | AGE
            FACTORS | MORTALITY | AFRICA, EASTERN | AFRICA, SUB SAHARAN
            | AFRICA | DEVELOPING COUNTRIES | RESEARCH METHODOLOGY |
            STUDIES | PERSONS LIVING WITH HIV/AIDS | HIV INFECTIONS |
            VIRAL DISEASES | DISEASES | HIV | MEDICAL PROCEDURES |
            MEDICINE | HEALTH SERVICES | DELIVERY OF HEALTH CARE |
            HEALTH | PROGRAMS | ORGANIZATION AND ADMINISTRATION |
            REPRODUCTION | POPULATION CHARACTERISTICS |
            DEMOGRAPHIC FACTORS | POPULATION | POPULATION DYNAMICS


Document Number: 313410


Determinants of tuberculosis diagnosis and the role of counselling.
Author:     Kivihya-Ndugga L; van Cleeff M; Nyamwaya J; Miheso B; Ndalo E

Source:     East African Medical Journal. 2007 Feb;84(2):77-82.




                                            63
                            STIs, HIV and AIDS: 2005 - 2008

Abstract:   The objective was to study patient determinants that may affect completion of
            the diagnostic process in tuberculosis control, highlighting the role of
            counselling. Cross-sectional study was the design used. All of the subjects used
            in the study were TB patients. The setting for the study was the Rhodes Chest
            Clinic, Nairobi, City Council. Ninety five percent of the suspects delivered three
            sputum samples but only 27% consented to a HIV test; several determinants for
            none consenting were mentioned. On average US$2.27 was spent for one clinic
            visit and US$8.62 for following the entire diagnostic process. Cost factors
            included transport, loss of income and food. Individual pre-test counselling
            seems important for obtaining three sputum specimens. It takes time and for
            settings with a large number of suspects, alternative methods may be required.
            To obtain consensus for a HIV test in a TB clinic is complicated. Costs spent on
            transport and loss in income are important determinants and may contribute to
            poor patient adherence to the diagnostic process. (author's)

Language:   English

Keywords:   KENYA | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS |
            CLIENTS | TUBERCULOSIS | EXAMINATIONS AND DIAGNOSES |
            COUNSELING | HIV TESTING | FEES | OBSTACLES | DEVELOPING
            COUNTRIES | AFRICA, EASTERN | AFRICA, SUB SAHARAN | AFRICA |
            RESEARCH METHODOLOGY | PROGRAM ACTIVITIES | PROGRAMS |
            ORGANIZATION AND ADMINISTRATION | INFECTIONS | DISEASES |
            MEDICAL PROCEDURES | MEDICINE | HEALTH SERVICES | DELIVERY
            OF HEALTH CARE | HEALTH | CLINIC ACTIVITIES | LABORATORY
            EXAMINATIONS AND DIAGNOSES | FINANCIAL ACTIVITIES |
            ECONOMIC FACTORS


Document Number: 319369


Social networks and HIV / AIDS risk perceptions.

Author:     Kohler H; Behrman JR; Watkins SC

Source:     Demography. 2007 Feb;44(1):1-33.

Abstract:   Understanding the determinants of individuals' perceptions of their risk of
            becoming infected with HIV and their perceptions of acceptable strategies of
            prevention is an essential step toward curtailing the spread of this disease. We
            focus in this article on learning and decision-making about AIDS in the context of
            high uncertainty about the disease and appropriate behavioral responses. We
            argue that social interactions are important for both. Using longitudinal survey
            data from rural Kenya and Malawi, we test this hypothesis. We investigate
            whether social interactions--and especially the extent to which social network
            partners perceive themselves to be at risk--exert causal influences on


                                            64
                            STIs, HIV and AIDS: 2005 - 2008

            respondents' risk perceptions and on one approach to prevention, spousal
            communication about the threat of AIDS to the couple and their children. The
            study explicitly allows for the possibility that important characteristics, such as
            unobserved preferences or community characteristics, determine not only the
            outcomes of interest but also the size and composition of networks. The most
            important empirical result is that social networks have significant and substantial
            effects on risk perceptions and the adoption of new behaviors even after we
            control for unobserved factors. (author's)

Language:   English

Keywords:   KENYA | MALAWI | RESEARCH REPORT | SURVEYS | LONGITUDINAL
            STUDIES | SEXUAL PARTNERS | SEX BEHAVIOR | SOCIAL NETWORKS
            | PERCEPTION | RISK FACTORS | HIV TRANSMISSION | AIDS |
            DEVELOPING COUNTRIES | AFRICA, EASTERN | AFRICA, SUB
            SAHARAN | AFRICA | AFRICA, SOUTHERN | SAMPLING STUDIES |
            STUDIES | RESEARCH METHODOLOGY | BEHAVIOR | FRIENDS AND
            RELATIVES | FAMILY AND HOUSEHOLD | SOCIOCULTURAL FACTORS
            | PSYCHOLOGICAL FACTORS | BIOLOGY | HIV INFECTIONS | VIRAL
            DISEASES | DISEASES


Document Number: 313229


A nested case -- control study of sexual practices and risk factors for
prevalent HIV-1 infection among young men in Kisumu, Kenya.

Author:     Mattson CL; Bailey RC; Agot K; Ndinya-Achola JO; Moses S

Source:     Sexually Transmitted Diseases. 2007 Oct;34(10):731-736.

Abstract:   The objectives were to investigate sexual practices and risk factors for prevalent
            HIV infection among young men in Kisumu, Kenya. Goal: The goal of this study
            was to identify behaviors associated with HIV in Kisumu to maximize the
            effectiveness of future prevention programs. Lifetime sexual histories were
            collected from a nested sample of 1337 uncircumcised participants within the
            context of a randomized controlled trial of male circumcision to reduce HIV
            incidence. Sixty-five men (5%) tested positive for HIV. Multiple logistic
            regression revealed the following independent predictors of HIV: older age, less
            education, being married, being Catholic, >4 lifetime sex partners, prior
            treatment for an STI, sex during partner's menstruation, ever practicing
            bloodletting, and receipt of a medical injection in the last 6 months. Prior HIV
            testing and postcoital cleansing were protective. This analysis confirms the
            importance of established risk factors for HIV and identifies practices that




                                            65
                            STIs, HIV and AIDS: 2005 - 2008

            warrant further investigation. (author's)

Language:   English

Keywords:   KENYA | RESEARCH REPORT | CASE CONTROL STUDIES | MEN |
            YOUTH | SEX BEHAVIOR | RISK BEHAVIOR | RISK FACTORS | HIV
            TRANSMISSION | MALE CIRCUMCISION | DEVELOPING COUNTRIES
            | AFRICA, EASTERN | AFRICA, SUB SAHARAN | AFRICA | STUDIES |
            RESEARCH METHODOLOGY | DEMOGRAPHIC FACTORS |
            POPULATION | AGE FACTORS | POPULATION CHARACTERISTICS |
            BEHAVIOR | BIOLOGY | HIV INFECTIONS | VIRAL DISEASES |
            DISEASES | MEDICAL PROCEDURES | MEDICINE | HEALTH SERVICES
            | DELIVERY OF HEALTH CARE | HEALTH


Document Number: 320815



HIV-1 infection in high risk men who have sex with men in Mombasa,
Kenya.

Author:     Sanders EJ; Graham SM; Okuku HS; van der Elst EM; Muhaari A

Source:     AIDS. 2007 Nov 30;21(18):2513-2520.

Abstract:   The role of homosexuality and anal sex practices in the African HIV -1 epidemic
            is not well described. We aimed to assess the risk factors for prevalent HIV-1
            infection among men who have sex with men (MSM) to guide HIV-1 prevention
            efforts. Socio-behavioural characteristics, signs and symptoms of sexually
            transmitted diseases (STD), and serological evidence of HIV-1 were determined
            for 285MSM at enrolment into a vaccine preparedness cohort study. We used
            multivariate logistic regression to assess risk factors for prevalent HIV-1
            infection. HIV-1 prevalence was 43.0% [49/114, 95% confidence interval (CI), 34-
            52%] for men who reported sex with men exclusively (MSME), and 12.3%
            (21/171, 95% CI, 7-17%) for men who reported sex with both men and women
            (MSMW). Eighty-six (75%) MSME and 69 (40%) MSMW reported recent
            receptive anal sex. Among 174 MSM sexually active in the last week, 44%
            reported no use of condoms with casual partners. In the previous 3 months, 210
            MSM (74%) reported payment for sex, andmost clients (93%) were local
            residents. Prevalent HIV-1 infection was associated with recent receptive anal sex
            [odds ratio (OR), 6.1; 95% CI, 2.4-16], exclusive sex with men (OR, 6.3; 95% CI,
            2.3-17), and increasing age (OR, 1.1 per year; 95% CI, 1.04-1.12). Only four MSM
            reported injecting drug use. The high prevalence of HIV-1 in Kenyan MSM is
            probably attributable to unprotected receptive anal sex. There is an urgent need
            for HIV-1 prevention programmes to deliver targeted risk-reduction




                                            66
                            STIs, HIV and AIDS: 2005 - 2008

            interventions and STD services to MSM in Kenya. (author's)

Language:   English

Keywords:   KENYA | RESEARCH REPORT | EPIDEMIOLOGIC METHODS |
            MULTIVARIATE ANALYSIS | HIV POSITIVE PERSONS | MEN HAVING
            SEX WITH MEN | MULTIPLE PARTNERS | IV DRUG USERS | HIV
            INFECTIONS | ANAL SEX | RISK FACTORS | SEX BEHAVIOR |
            CONDOM USE | PREVALENCE | AGE FACTORS | DEVELOPING
            COUNTRIES | AFRICA, EASTERN | AFRICA, SUB SAHARAN | AFRICA |
            RESEARCH METHODOLOGY | DATA ANALYSIS | PERSONS LIVING
            WITH HIV/AIDS | VIRAL DISEASES | DISEASES | BEHAVIOR | SEXUAL
            PARTNERS | DRUG USE AND ABUSE | BIOLOGY | RISK REDUCTION
            BEHAVIOR | MEASUREMENT | POPULATION CHARACTERISTICS |
            DEMOGRAPHIC FACTORS | POPULATION


Document Number: 322762


Identification of novel risks for nonulcerative sexually transmitted
infections among young men in Kisumu, Kenya.

Author:     Mehta SD; Moses S; Ndinya-Achola JO; Agot K; Maclean I

Source:     Sexually Transmitted Diseases. 2007 Nov;34(11):892-899.

Abstract:   STI prevention interventions often aim to reduce HIV incidence. Understanding
            STI risks may lead to more effective HIV prevention. The goal was to identify STI
            risks among men aged 18-24 in Kisumu, Kenya. We analyzed baseline data from
            a randomized trial of male circumcision. Participants were interviewed for
            sociodemographic and behavioral risks. Neisseria gonorrhoeae (NG) and
            Chlamydia trachomatis (CT) were diagnosed by polymerase chain reaction assay
            and Trichomonas vaginalis (TV) by culture. The outcome for logistic regression
            analysis was infection with NG, CT, or TV. Among 2743 men, 214 (7.8%; 95% CI:
            6.8%-8.8%) were infected with any STI. In multivariable analysis, statistically
            significant risks for infection were: living one's whole life in Kisumu (OR = 1.50;
            95% CI: 1.12-2.01), preferring "dry" sex (OR = 1.47; 95% CI: 1.05-2.07), HSV-2
            seropositivity (OR = 1.37; 95% CI: 1.01-1.86), and inability to ejaculate during sex
            (OR = 2.04; 95% CI: 1.15-3.62). Risk decreased with increasing age and education,
            and cleaning one's penis less than 1 hour after sex (OR = 0.51; 95% CI: 0.33-0.80).
            Understanding how postcoital cleaning, "dry" sex, and sexual dysfunction relate
            to STI acquisition may improve STI and HIV prevention. (author's)

Language:   English




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                            STIs, HIV and AIDS: 2005 - 2008

Keywords:   KENYA | RESEARCH REPORT | INTERVIEWS | MULTIVARIATE
            ANALYSIS | MEN | SEXUALLY TRANSMITTED DISEASES | RISK
            BEHAVIOR | SEX BEHAVIOR | RISK ASSESSMENT | SEX EDUCATION |
            RISK REDUCTION BEHAVIOR | LABORATORY PROCEDURES |
            DEVELOPING COUNTRIES | AFRICA, EASTERN | AFRICA, SUB
            SAHARAN | AFRICA | DATA COLLECTION | RESEARCH
            METHODOLOGY | DATA ANALYSIS | DEMOGRAPHIC FACTORS |
            POPULATION | REPRODUCTIVE TRACT INFECTIONS | INFECTIONS |
            DISEASES | BEHAVIOR | EVALUATION | EDUCATION | LABORATORY
            EXAMINATIONS AND DIAGNOSES | EXAMINATIONS AND
            DIAGNOSES | MEDICAL PROCEDURES | MEDICINE | HEALTH
            SERVICES | DELIVERY OF HEALTH CARE | HEALTH


Document Number: 322078

Human papillomavirus detection by penile site in young men from
Kenya.

Author:     Smith JS; Moses S; Hudgens MG; Agot K; Franceschi S

Source:     Sexually Transmitted Diseases. 2007 Nov;34(11):928-934.

Abstract:   Limited data are available on whether sampling from the penile shaft or urethra
            increases detection of penile HPV infection in men beyond that found in the
            glans and coronal sulcus. Within a randomized clinical trial, a validation study of
            penile sampling was conducted in Kisumu, Kenya. Young men (18-24 years)
            were invited to provide penile exfoliated cells using prewetted Dacron swabs to
            determine the best site for HPV detection. beta-Globin gene PCR and HPV DNA
            type GP5+/6+ PCR status were ascertained from 3 anatomical sites. A total of 98
            young HIV-seronegative, uncircumcised men participated. Penile HPV
            prevalence varied by anatomical site: 50% in penile exfoliated cells from the
            glans, coronal sulcus, and inner foreskin tissue; 43% in the shaft and external
            foreskin tissue; and 18% in the urethra (P less than 0.0001). For each anatomical
            site, over 87% of samples were beta-globin positive. Beyond that found in the
            glans/coronal sulcus, urethral sampling resulted in no increase in HPV positivity
            andshaft sampling resulted in an additional 7.3% of overall HPV positivity. The
            prevalence of high-risk HPV positivity varied by anatomical site: 39% in
            glans/coronal sulcus, 31% in shaft, and 13% in the urethra (P less than 0.0001).
            HPV 16 was the most common type identified. Penile HPV prevalence was
            approximately 50% among young men in Kisumu, Kenya. Urethral sampling for
            HPV detection in men added no sensitivity for HPV detection over that found
            from sampling the glans/coronal sulcus and penile shaft. These data will help
            inform studies on HPV transmission dynamics, and on the efficacy of HPV
            prophylactic vaccines on penile HPV carriage in men. (author's)




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                            STIs, HIV and AIDS: 2005 - 2008

Language:   English

Keywords:   KENYA | RESEARCH REPORT | CLINICAL TRIALS | MEN | HPV |
            PREVALENCE | TRANSMISSION | GENITALIA, MALE | RISK FACTORS
            | DEVELOPING COUNTRIES | AFRICA, EASTERN | AFRICA, SUB
            SAHARAN | AFRICA | CLINICAL RESEARCH | RESEARCH
            METHODOLOGY | DEMOGRAPHIC FACTORS | POPULATION | VIRAL
            DISEASES | DISEASES | MEASUREMENT | INFECTIONS | GENITALIA |
            UROGENITAL SYSTEM | PHYSIOLOGY | BIOLOGY


Document Number: 321672


Female sex workers and unsafe sex in urban and rural Nyanza, Kenya:
regular partners may contribute more to HIV transmission than clients.

Author:     Voeten HA; Egesah OB; Varkevisser CM; Habbema JD

Source:     Tropical Medicine and International Health. 2007 Feb;12(2):174-182.

Abstract:   The objectives were to compare the sexual behaviour of female sex workers in
            urban and rural areas in Nyanza province in Kenya, and to compare their unsafe
            sex with clients and with regular partners. In a cross-sectional study among 64
            sex workers (32/32 in urban/rural areas), sex workers kept a sexual diary for 14
            days after being interviewed face-to-face. Most sex workers were
            separated/divorced and had one or two regular partners, who were mostly
            married to someone else. Sex workers in Kisumu town were younger, had
            started sex work at an earlier age, and had more clients in the past 14 days than
            rural women (6.6 vs. 2.4). Both groups had an equal number of sex contacts with
            regular partners (4.7). With clients, condom use was fairly frequent (75%) but
            with regular partners, it was rather infrequent (< 40%). For both urban and rural
            areas, the mean number of sex acts in which no condom was used was greater for
            regular partners (3.2 and 2.8 respectively) than for clients (1.9 and 1.0
            respectively). Sex workers in urban and rural areas of Nyanza province practise
            more unsafe sex with regular partners than with clients. Interventions for sex
            workers should also focus on condom use in regular partnerships. (author's)

Language:   English

Keywords:   KENYA | RESEARCH REPORT | KAP SURVEYS | COMPARATIVE
            STUDIES | SEX WORKERS | SEXUAL PARTNERS | RURAL POPULATION
            | URBAN POPULATION | WOMEN IN DEVELOPMENT | SEX BEHAVIOR
            | RISK ASSESSMENT | AGE FACTORS | MARITAL STATUS | RISK
            FACTORS | CONDOM USE | AFRICA, EASTERN | AFRICA SOUTH OF
            THE SAHARA | AFRICA | DEVELOPING COUNTRIES | SURVEYS |
            SAMPLING STUDIES | STUDIES | RESEARCH METHODOLOGY |


                                           69
                            STIs, HIV and AIDS: 2005 - 2008

            BEHAVIOR | POPULATION CHARACTERISTICS | DEMOGRAPHIC
            FACTORS | POPULATION | ECONOMIC DEVELOPMENT | ECONOMIC
            FACTORS | EVALUATION | NUPTIALITY | BIOLOGY | RISK
            REDUCTION BEHAVIOR


Document Number: 312140


Kenya's mixed HIV / AIDS response.

Author:     Wakabi W

Source:     Lancet. 2007 Jan 6;369(9555):17-18.

Abstract:   Government delays providing audited accounts to the Global Fund to Fight
            AIDS, Tuberculosis, and Malaria, could harm Kenya's anti-AIDS efforts, say
            some faith-based groups. But the government insists its strict procedures ensure
            money is well spent. Wairagala Wakabi reports. Kenya says though it has
            managed a small reduction in HIV/AIDS prevalence rate over the past year,
            delays by donors like the Global Fund for HIV/ AIDS, Tuberculosis, and Malaria
            to release funds could harm the country's anti-AIDS campaign. In November,
            Kenya received an additional US$70 million from the Global Fund to support its
            fight against tuberculosis and HIV/AIDS. The release of the funds came after
            months of wrangles between government and faith-based agencies, which have
            accused authorities of failing to account for Global Fund monies and
            jeopardising Kenya's chances of receiving more funds. Until a few years ago, the
            country had kept its AIDS problem under wraps for fear of scaring away
            tourists, given that tourism is the country's highest foreign exchange earner.
            (excerpt)

Language:   English

Keywords:   KENYA | PROGRESS REPORT | EVALUATION | FAITH-BASED
            ORGANIZATION | GOVERNMENT | TUBERCULOSIS | MALARIA |
            FINANCING, GOVERNMENT | FUNDS | HIV PREVENTION | FOREIGN
            AID | EXPENDITURES | PREVALENCE | STIGMA | ANTIRETROVIRAL
            THERAPY | AFRICA, EASTERN | AFRICA, SUB SAHARAN | AFRICA |
            DEVELOPING COUNTRIES | ORGANIZATIONS | POLITICAL FACTORS
            | SOCIOCULTURAL FACTORS | INFECTIONS | DISEASES | PARASITIC
            DISEASES | FINANCIAL ACTIVITIES | ECONOMIC FACTORS | HIV
            INFECTIONS | VIRAL DISEASES | MEASUREMENT | RESEARCH
            METHODOLOGY | SOCIAL PROBLEMS | HIV


Document Number: 310737




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                            STIs, HIV and AIDS: 2005 - 2008


Female genital cutting and HIV / AIDS among Kenyan women.

Author:     Yount KM; Abraham BK

Source:     Studies in Family Planning. 2007 Jun;38(2):73-88.

Abstract:   Female genital cutting (FGC) and HIV/AIDS are both highly prevalent in sub-
            Saharan Africa, and researchers have speculated that the association may be
            more than coincidental. Data from 3,167 women aged 15-49 who participated in
            the 2003 Kenya Demographic and Health Survey (KDHS) are used to test the
            direct and indirect associations of FGC with HIV. Our adjusted models suggest
            that FGC is not associated directly with HIV, but is associated indirectly through
            several pathways. Cut women are 1.72 times more likely than uncut women to
            have older partners, and women with older partners are 2.65 times more likely
            than women with younger partners to test positive for HIV. Cut women have
            1.94 times higher odds than uncut women of initiating sexual intercourse before
            they are 20, and women who experience their sexual debut before age 20 have
            1.73 times higher odds than those whose sexual debut comes later of testing
            positive for HIV. Cut women have 27 percent lower odds of having at least one
            extra-union partner, and women with an extra-union partner have 2.63 times
            higher odds of testing positive for HIV. Therefore, in Kenya, FGC may be an
            early life-course event that indirectly alters women's odds of becoming infected
            with HIV through protective and harmful practices in adulthood. (author's)

Language:   English

Keywords:   KENYA | RESEARCH REPORT | EPIDEMIOLOGIC METHODS |
            DEMOGRAPHIC AND HEALTH SURVEYS | WOMEN IN DEVELOPMENT
            | HIV POSITIVE PERSONS | SEXUAL PARTNERS | MULTIPLE
            PARTNERS | FEMALE GENITAL CUTTING | PREVALENCE | RISK
            BEHAVIOR | AGE FACTORS | HIV TRANSMISSION | EXTRAMARITAL
            SEX BEHAVIOR | SEX BEHAVIOR | AFRICA, EASTERN | AFRICA
            SOUTH OF THE SAHARA | AFRICA | DEVELOPING COUNTRIES |
            RESEARCH METHODOLOGY | DEMOGRAPHIC SURVEYS |
            POPULATION DYNAMICS | DEMOGRAPHIC FACTORS | POPULATION
            | ECONOMIC DEVELOPMENT | ECONOMIC FACTORS | PERSONS
            LIVING WITH HIV/AIDS | HIV INFECTIONS | VIRAL DISEASES |
            DISEASES | BEHAVIOR | HARMFUL TRADITIONAL PRACTICES |
            TRADITIONAL HEALTH PRACTICES | CULTURE | SOCIOCULTURAL
            FACTORS | MEASUREMENT | POPULATION CHARACTERISTICS


Document Number: 313583




                                            71
                            STIs, HIV and AIDS: 2005 - 2008


Male circumcision for HIV prevention: The research evidence and some
critical responses.

Source:     Reproductive Health Matters. 2007 May;15(29):9-10.

Abstract:   Three randomised clinical trials, in South Africa, Uganda and Kenya, have
            shown a substantial reduction in female-to-male transmission of HIV to men
            who had been circumcised as compared to men who had not, during a follow-up
            period of up to 24 months. The question of what to do with this evidence is
            currently being debated around the world. WHO and UNAIDS took the lead by
            developing technical, policy and programmatic guidance following a series of
            consultations with a range of stakeholders in the field, using the research
            evidence as the basis. Consensus on many aspects of this matter is far from being
            achieved, however. Many questions and different points of view are emerging -
            clinical, public health, sociological, anthropological and cultural; in relation to
            priority setting in HIV prevention and delivery of health services; and in relation
            to sexuality, ethics, gender and rights. On 28 March 2007, WHO and UNAIDS
            published a set of conclusions and recommendations regarding the research
            implications for HIV policy and programming. The introduction and excerpts
            from these follow below. They are, in turn, followed by a roundtable of nine
            papers which contain a range of critical thinking and analysis of these issues.
            Male circumcision is generating debate across the globe. This can only be a good
            thing, as it is a complex matter and far more than a straightforward public health
            intervention. We hope these papers will help to inform that debate. (author's)

Language:   English

Keywords:   KENYA | SOUTH AFRICA | UGANDA | RESEARCH REPORT | CLINICAL
            TRIALS | MEN | MALE CIRCUMCISION | GENDER ISSUES |
            SEXUALITY | SAFER SEX | HIV TRANSMISSION | HEALTH POLICY |
            HIV PREVENTION | PROGRAM EVALUATION | AFRICA, EASTERN |
            AFRICA SOUTH OF THE SAHARA | AFRICA | DEVELOPING
            COUNTRIES | AFRICA, SOUTHERN | CLINICAL RESEARCH |
            RESEARCH METHODOLOGY | DEMOGRAPHIC FACTORS |
            POPULATION | MEDICAL PROCEDURES | MEDICINE | HEALTH
            SERVICES | DELIVERY OF HEALTH CARE | HEALTH |
            SOCIOCULTURAL FACTORS | PERSONALITY | PSYCHOLOGICAL
            FACTORS | BEHAVIOR | SEX BEHAVIOR | HIV INFECTIONS | VIRAL
            DISEASES | DISEASES | POLICY | POLITICAL FACTORS | PROGRAMS
            | ORGANIZATION AND ADMINISTRATION


Document Number: 316690




                                            72
                               STIs, HIV and AIDS: 2005 - 2008


Sex with an Ugly Man: Cleansing Widows in the Era of HIV/AIDS in
Siaya District, Kenya.
Author:        Ambasa-Shisanya C.,

Institution:   Kenyatta University, School of Humanities & Social Sciences, Philosophy &
               Religious Studies Department, Nairobi, Kenya

Abstract:      This paper presents findings of a study that investigated the implications of
               widowhood rites on the socio-economic development of Siaya District, Kenya.
               The objective of the paper is to provide insights into reasons for continuity of
               widowhood rites and consequences of the cleansing ritual on the socio-economic
               development of Siaya District. The paper addresses the following questions: Why
               do some widows engage in an apparent life threatening cleansing ritual? What
               are the qualities and socio-economic status of widows and professional cleansers
               who engage in this ritual? Do widows have alternative coping mechanisms?
               What are the effects of the widow cleansing ritual on the socio-economic
               development of Siaya District?

               Data were collected from 2003 to 2004 in three divisions of Siaya District: Boro,
               Ukwala and Yala. The data were mainly qualitative and were generated using
               focus group discussions (FGDs) and in-depth interviews. Eight FGDs were
               conducted with youth, adults and elderly respondents of varied sex in each
               division, giving a total of twenty four sessions. Additionally, twenty in-depth
               interviews were conducted with key respondents and widows. Data were
               analyzed using content analysis.

               Results revealed that Luo widows are believed to acquire contagious cultural
               impurity "chira" after the death of spouses. Widows are perceived as a source of
               danger to offspring and the community. To neutralize this impure state, Luo
               widows are expected to observe cleansing rites involving a sexual component. In
               the indigenous setting, the ritual was observed by a brother-in-law or cousin to
               the deceased through a guardianship institution. However, with the emergence
               of HIV/AIDS, professional cleansers are hired to perform the sex ritual.
               Professional cleansers usually look ugly, drunken, poor and dirty. If the deceased
               spouses were HIV/AIDS seropositive, the cleansing ritual places professional
               cleansers at risk of infection. Thereafter, they could act as a bridge for HIV/
               AIDS transmission to other widows and to the general population thereby
               increasing morbidity, mortality and slowing down socio-economic development.

               However, some widows use Christianity, education and economic
               empowerment as coping mechanisms to shield themselves from cultural violence
               against widows through mandatory cleansing ritual. Others propose condom
               use, though most cleansers reject them because of myths about condoms and
               excessive alcohol use. Some cleansed widows engage in sexual relationships for
               survival. These findings call for efforts to increase awareness about the widows'



                                                73
                            STIs, HIV and AIDS: 2005 - 2008

            rights, window period, condom myths, alcohol abuse, re-evaluation of
            widowhood rites and reduction of poverty as risk factors for HIV/AIDS
            transmission.

Keywords:   COPING MECHANISMS| CULTURAL| VIOLENCE AGAINST WIDOWS|
            HIV/AID5| PROFESSIONAL SEX CLEANSERS| WIDOWS' RIGHTS.


Male circumcision for HIV prevention: A prospective study of
complications in clinical and traditional settings in Bungoma, Kenya.
Author:     Bailey RC; Egesah O; Rosenberg S. DP: 2008

Abstract:   Male circumcision reduces the risk of HIV acquisition by approximately 60%.
            Male circumcision services are now being introduced in selected populations in
            sub-Saharan Africa and further interventions are being planned. A serious
            concern is whether male circumcision can be provided safely to large numbers of
            adult males in developing countries. This prospective study was conducted in
            the Bungoma district, Kenya, where male circumcision is universally practised.
            Young males intending to undergo traditional or clinical circumcision were
            identified by a two-stage cluster sampling method. During the July-August 2004
            circumcision season, 1007 males were interviewed 30-89 days post- circumcision.
            Twenty-four men were directly observed during and 3, 8, 30 and 90 days post-
            circumcision, and 298 men underwent clinical exams 45-89 days post-procedure.
            Twenty-one traditional and 20 clinical practitioners were interviewed to assess
            their experience and training. Inventories of health facilities were taken to assess
            the condition of instruments and supplies necessary for performing safe
            circumcisions. Of 443 males circumcised traditionally, 156 (35.2%) experienced
            an adverse event compared with 99 of 559 (17.7%) circumcised clinically (odds
            ratio: 2.53; 95% confidence interval: 1.89-3.38). Bleeding and infection were the
            most common adverse effects, with excessive pain, lacerations, torsion and
            erectile dysfunction also observed. Participants were aged 5 to 21 years and half
            were sexually active before circumcision. Practitioners lacked knowledge and
            training. Proper instruments and supplies were lacking at most health facilities.
            Extensive training and resources will be necessary in sub-Saharan Africa before
            male circumcision can be aggressively promoted for HIV prevention. Two-thirds
            of African men are circumcised, most by traditional or unqualified practitioners
            in informal settings. Safety of circumcision in communities where it is already
            widely practised must not be ignored. (author's)
            : Male circumcision reduces the risk of HIV acquisition by approximately 60%.
            Male circumcision services are now being introduced in selected populations in
            sub-Saharan Africa and further interventions are being planned. A serious
            concern is whether male circumcision can be provided safely to large numbers of
            adult males in developing countries. This prospective study was conducted in
            the Bungoma district, Kenya, where male circumcision is universally practised.
            Young males intending to undergo traditional or clinical circumcision were
            identified by a two-stage cluster sampling method. During the July-August 2004


                                             74
                             STIs, HIV and AIDS: 2005 - 2008

            circumcision season, 1007 males were interviewed 30-89 days post- circumcision.
            Twenty-four men were directly observed during and 3, 8, 30 and 90 days post-
            circumcision, and 298 men underwent clinical exams 45-89 days post-procedure.
            Twenty-one traditional and 20 clinical practitioners were interviewed to assess
            their experience and training. Inventories of health facilities were taken to assess
            the condition of instruments and supplies necessary for performing safe
            circumcisions. Of 443 males circumcised traditionally, 156 (35.2%) experienced
            an adverse event compared with 99 of 559 (17.7%) circumcised clinically (odds
            ratio: 2.53; 95% confidence interval: 1.89-3.38). Bleeding and infection were the
            most common adverse effects, with excessive pain, lacerations, torsion and
            erectile dysfunction also observed. Participants were aged 5 to 21 years and half
            were sexually active before circumcision. Practitioners lacked knowledge and
            training. Proper instruments and supplies were lacking at most health facilities.
            Extensive training and resources will be necessary in sub-Saharan Africa before
            male circumcision can be aggressively promoted for HIV prevention. Two-thirds
            of African men are circumcised, most by traditional or unqualified practitioners
            in informal settings. Safety of circumcision in communities where it is already
            widely practised must not be ignored. (author's)

Language:   English

Keywords:   KENYA | RESEARCH REPORT | PROSPECTIVE STUDIES | CLINICAL
            RESEARCH | MEN | MALE CIRCUMCISION | TRADITIONAL HEALTH
            PRACTICES | COMPLICATIONS | HIV PREVENTION | HEALTH
            SERVICES EVALUATION | AFRICA, EASTERN | AFRICA, SUB SAHARAN
            | AFRICA | DEVELOPING COUNTRIES | STUDIES | RESEARCH
            METHODOLOGY | DEMOGRAPHIC FACTORS | POPULATION |
            MEDICAL PROCEDURES | MEDICINE | HEALTH SERVICES | DELIVERY
            OF HEALTH CARE | HEALTH | CULTURE | SOCIOCULTURAL FACTORS
            | DISEASES | HIV INFECTIONS | VIRAL DISEASES | PROGRAM
            EVALUATION | PROGRAMS | ORGANIZATION AND
            ADMINISTRATION

Document Number: 328092


HIV testing and counselling for women attending child health clinics:
An opportunity for entry to prevent mother-to-child transmission and
HIV treatment.
Author:     Chersich MF; Luchters SM; Othigo MJ; Yard E; Mandaliya K

Source:     International Journal of STD and AIDS. 2008 Jan

Abstract:   This study assessed the potential for HIV testing at child health clinics to increase
            knowledge of HIV status, and entry to infant feeding counselling and HIV
            treatment. At a provincial hospital in Mombasa, Kenya, HIV testing and


                                             75
                             STIs, HIV and AIDS: 2005 - 2008

             counselling were offered to women bringing their child for immunization or
             acute care services. Most women said HIV testing should be offered in these
             clinics (472/493, 95.7%), with many citing the benefits of regular testing and
             entry to prevent mother-to-child transmission. Of 500 women, 416 (83.4%)
             received test results, 97.6% on the same day. After 50 participants, point-of-care
             testing replaced laboratory-based rapid testing. Uptake increased 2.6 times with
             point-of-care testing (95% confidence interval = 1.4-5.1; P = 0.003). Of 124 women
             who had not accessed HIV testing during pregnancy, 98 tested in the study
             (79.0%). Measured by uptake and attitudes, HIV testing in child health clinics is
             acceptable. This could optimize entry into HIV treatment, infant feeding
             counselling and family planning services. (author's)

Langauage:   English

Keywords:    KENYA | RESEARCH REPORT | SURVEYS | MOTHERS | INFANT |
             PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | HIV TESTING
             | COUNSELING | CHILD HEALTH SERVICES | HIV INFECTIONS |
             TREATMENT | BREASTFEEDING | DEVELOPING COUNTRIES |
             AFRICA, EASTERN | AFRICA, SUB SAHARAN | AFRICA | SAMPLING
             STUDIES | STUDIES | RESEARCH METHODOLOGY | PARENTS |
             FAMILY RELATIONSHIPS | FAMILY CHARACTERISTICS | FAMILY AND
             HOUSEHOLD | SOCIOCULTURAL FACTORS | YOUTH | AGE FACTORS
             | POPULATION CHARACTERISTICS | DEMOGRAPHIC FACTORS |
             POPULATION | DISEASE TRANSMISSION CONTROL | PREVENTION
             AND CONTROL | DISEASES | LABORATORY EXAMINATIONS AND
             DIAGNOSES | EXAMINATIONS AND DIAGNOSES | MEDICAL
             PROCEDURES | MEDICINE | HEALTH SERVICES | DELIVERY OF
             HEALTH CARE | HEALTH | CLINIC ACTIVITIES | PROGRAM
             ACTIVITIES | PROGRAMS | ORGANIZATION AND ADMINISTRATION
             | MATERNAL-CHILD HEALTH SERVICES | PRIMARY HEALTH CARE |
             VIRAL DISEASES | INFANT NUTRITION | NUTRITION


Document Number: 324667


Dihydrofolate reductase I164L mutations in Plasmodium falciparum
isolates: Clinical outcome of 14 Kenyan adults infected with parasites
harbouring the I164L mutation.
Author:      Hamel MJ; Poe A; Bloland P; McCollum A; Zhou Z

Source:      Transactions of the Royal Society of Tropical Medicine and Hygiene. 2008 Apr

Abstract:    Recently, Plasmodium falciparum bearing dihydrofolate reductase (DHFR) I164L
             was isolated from Africa. Quadruple mutations containing I164L confer high-
             level resistance to antifolate antimalarials. We prospectively measured the effect


                                             76
                             STIs, HIV and AIDS: 2005 - 2008

             of co-trimoxazole (CTX) prophylaxis on P. falciparum antifolate resistance
             development among HIV-infected persons. HIV-positive patients with CD4 cell
             count less than 350 cells/microl (n = 692) received CTX; HIV-positive patients
             with CD4 cell count greater than or equal to 350 cells/microl (n = 336) and HIV-
             negative patients (n = 132) received multivitamins. Malaria microscopy-positive
             samples (n = 413) and selected microscopy-negative/PCR-positive samples (n =
             76) were analysed for DHFR mutations at baseline and during six months follow
             up. We identified I164L in 14 patients. Seven were malaria microscopy-positive:
             two failed sulfadoxine-pyrimethamine (SP). Among seven microscopynegative/
             PCR-positive patients, none developed patent infections with I164L. I164L
             wasnot associated with high-level SP resistance or poor outcome among adults
             living where malaria is highly endemic. Surveillance to monitor spread of I164L
             is critical, especially among children and pregnant women, who are potentially a
             source for I164L amplification. (author's)

Langauage:   English

Keywords:    KENYA | RESEARCH REPORT | CLINICAL RESEARCH | ADULTS | HIV
             POSITIVE PERSONS | PARASITES | MALARIA | ANTIMALARIAL
             DRUGS | DRUG RESISTANCE | VITAMINS AND MINERALS |
             DEVELOPING COUNTRIES | AFRICA, EASTERN | AFRICA, SUB
             SAHARAN | AFRICA | RESEARCH METHODOLOGY | AGE FACTORS |
             POPULATION CHARACTERISTICS | DEMOGRAPHIC FACTORS |
             POPULATION | PERSONS LIVING WITH HIV/AIDS | HIV INFECTIONS |
             VIRAL DISEASES | DISEASES | BIOLOGY | PARASITIC DISEASES |
             TREATMENT | MEDICAL PROCEDURES | MEDICINE | HEALTH
             SERVICES | DELIVERY OF HEALTH CARE | HEALTH | PHYSIOLOGY


Document Number: 325272


HIV-neutralizing immunoglobulin A and HIV-specific proliferation are
independently associated with reduced HIV acquisition in Kenyan sex
workers.

Author:      Hirbod T; Kaul R; Reichard C; Kimani J; Ngugi. DP: 2008 Mar 30

Abstract:    HIV-neutralizing immunoglobulin A (IgA) and HIV-specific cellular immunity
             have been described in highly exposed, persistently seronegative (HEPS)
             individuals, but well controlled studies have not been performed. We performed
             a prospective, nested case-control study to examine the association of genital IgA
             and systemic cellular immune responses with subsequent HIV acquisition in
             high-risk Kenyan female sex workers (FSWs). A randomized trial of monthly
             antibiotic prophylaxis to prevent sexually transmitted disease/HIV infection was
             performed from 1998 to 2002 in HIV-uninfected Kenyan of genital IgA to



                                             77
                             STIs, HIV and AIDS: 2005 - 2008

             neutralize primary HIV isolates as well as systemic HIV-specific cellular IFNy-
             modified enzyme-linked immunospot and proliferativeresponses. The study
             cohort comprised 113 FSWs: 24 cases who acquired HIV and 89 matched
             controls. Genital HIV-neutralizing IgA was associated with reduced HIV
             acquisition (P = 0.003), as was HIV-specific proliferation (P = 0.002), and these
             associations were additive. HIV-specific IFNg production did not differ between
             case and control groups. In multivariable analysis, HIV-neutralizing IgA and
             HIV-specific proliferation each remained independently associated with lack of
             HIV acquisition. Genital herpes (HSV2) FSWs. After the completion of trial,
             FSWs who had acquired HIV (cases) were matched 1 : 4 with persistently
             uninfected controls based on study arm, duration of HIV-seronegative follow-up,
             and time of cohort enrolment. Blinded investigators assayed the ability at
             enrolment was associated with increased HIV risk and with reduced detection of
             HIV-neutralizing IgA. Genital HIV-neutralizing IgA and systemic HIV-specific
             proliferative responses, assayed by blinded investigators, were prospectively
             associated with HIV nonacquisition. The induction of these immune responses
             may be an important goal for HIV vaccines. (author's)

Langauage:   English

Keywords:    KENYA | RESEARCH REPORT | PROSPECTIVE STUDIES | SEX
             WORKERS | HIV | BLOOD | LABORATORY PROCEDURES | EXPOSURE
             | AUTOIMMUNE RESPONSE | DEVELOPING COUNTRIES | AFRICA,
             EASTERN | AFRICA, SUB SAHARAN | AFRICA | STUDIES | RESEARCH
             METHODOLOGY | SEX BEHAVIOR | BEHAVIOR | HIV INFECTIONS |
             VIRAL DISEASES | DISEASES | HEMIC SYSTEM | PHYSIOLOGY |
             BIOLOGY | LABORATORY EXAMINATIONS AND DIAGNOSES |
             EXAMINATIONS AND DIAGNOSES | MEDICAL PROCEDURES |
             MEDICINE | HEALTH SERVICES | DELIVERY OF HEALTH CARE |
             HEALTH | RISK FACTORS | ANTIBODIES | IMMUNOLOGIC FACTORS
             | IMMUNITY | IMMUNE SYSTEM


Document Number: 325533


The impact of maternal HIV status on infant feeding patterns in Nakuru,
Kenya.
Author:      Kamau-Mbuthia E; Elmadfa I; Mwonya R

Source:      Journal of Human Lactation

Abstract:    The aim of the study was to assess the impact of maternal HIV status on infant
             feeding patterns. Two hundred eighty mothers (205 HIV uninfected, 75 infected)
             and their infants were recruited from the Provincial General Hospital, Nakuru,
             Kenya, from delivery and were followed for 14 weeks. From the feeding


                                            78
                             STIs, HIV and AIDS: 2005 - 2008

             patterns, HIV-infected mothers were more likely to exclusively breastfeed in
             week 1 than HIV-uninfected mothers (71.7% vs 56.3%, P = .001), but there were
             no differences by week 14 (9.8% vs 4.8% P = .212). Mixed feeding increased for
             both groups from weeks 1 to 14. In multivariate logistic regression analysis,
             maternal age (younger mothers, P less than .05) was associated with exclusive
             breastfeeding in the 6th week and infant birth weight (greater than mean birth
             weight, P less than .05) in the 10th week. The results indicate a need to reassess
             adherence to infant feeding recommendations irrespective of maternal HIV
             status and also the infant feeding counseling process in the hospital. (author's)
             The aim of the study was to assess the impact of maternal HIV status on infant
             feeding patterns. Two hundred eighty mothers (205 HIV uninfected, 75 infected)
             and their infants were recruited from the Provincial General Hospital, Nakuru,
             Kenya, from delivery and were followed for 14 weeks. From the feeding
             patterns, HIV-infected mothers were more likely to exclusively breastfeed in
             week 1 than HIV-uninfected mothers (71.7% vs 56.3%, P = .001), but there were
             no differences by week 14 (9.8% vs 4.8% P = .212). Mixed feeding increased for
             both groups from weeks 1 to 14. In multivariate logistic regression analysis,
             maternal age (younger mothers, P less than .05) was associated with exclusive
             breastfeeding in the 6th week and infant birth weight (greater than mean birth
             weight, P less than .05) in the 10th week. The results indicate a need to reassess
             adherence to infant feeding recommendations irrespective of maternal HIV
             status and also the infant feeding counseling process in the hospital. (author's)
             The aim of the study was to assess the impact of maternal HIV status on infant
             feeding patterns. Two hundred eighty mothers (205 HIV uninfected, 75 infected)
             and their infants were recruited from the Provincial General Hospital, Nakuru,
             Kenya, from delivery and were followed for 14 weeks. From the feeding
             patterns, HIV-infected mothers were more likely to exclusively breastfeed in
             week 1 than HIV-uninfected mothers (71.7% vs 56.3%, P = .001), but there were
             no differences by week 14 (9.8% vs 4.8% P = .212). Mixed feeding increased for
             both groups from weeks 1 to 14. In multivariate logistic regression analysis,
             maternal age (younger mothers, P less than .05) was associated with exclusive
             breastfeeding in the 6th week and infant birth weight (greater than mean birth
             weight, P less than .05) in the 10th week. The results indicate a need to reassess
             adherence to infant feeding recommendations irrespective of maternal HIV
             status and also the infant feeding counseling process in the hospital. (author's)

Langauage:   English

Keywords:    KENYA | RESEARCH REPORT | INTERVIEWS | QUESTIONNAIRES |
             MOTHERS | INFANT | HIV | INFANT NUTRITION | BREASTFEEDING,
             EXCLUSIVE | SUPPLEMENTARY FEEDING | SOCIOECONOMIC STATUS
             | DEVELOPING COUNTRIES | AFRICA, EASTERN | AFRICA, SUB
             SAHARAN | AFRICA | DATA COLLECTION | RESEARCH
             METHODOLOGY | PARENTS | FAMILY RELATIONSHIPS | FAMILY
             CHARACTERISTICS | FAMILY AND HOUSEHOLD | SOCIOCULTURAL
             FACTORS | YOUTH | AGE FACTORS | POPULATION
             CHARACTERISTICS | DEMOGRAPHIC FACTORS | POPULATION | HIV



                                             79
                             STIs, HIV and AIDS: 2005 - 2008

             INFECTIONS | VIRAL DISEASES | DISEASES | NUTRITION | HEALTH |
             BREASTFEEDING | SOCIOECONOMIC FACTORS | ECONOMIC
             FACTORS


Document Number: 325533

Human immunodeficiency virus (HIV) type 1 proviral hypermutation
correlates with CD4 count in HIV-infected women from Kenya.
Author:      Land AM; Ball TB; Luo M; Pilon R; Sandstrom P; Embree JE; Wachihi C; Kimani
             J; Plummer FA

Source:      Journal of Virology. 2008 Aug

Abstract:    APOBEC3G is an important innate immune molecule that causes human
             immunodeficiency virus type 1 (HIV-1) hypermutation, which can result in
             detrimental viral genome mutations. The Vif protein of wild-type HIV-1
             counteracts APOBEC3G activity by targeting it for degradation and inhibiting its
             incorporation into viral particles. Additional APOBEC cytidine deaminases have
             been identified, such as APOBEC3F, which has a similar mode of action but
             different sequence specificity. A relationship between APOBEC3F/G and HIV
             disease progression has been proposed. During HIV-1 sequence analysis of the
             vpu/env region of 240 HIV-infected subjects from Nairobi, Kenya, 13 drastically
             hypermutated proviral sequences were identified. Sequences derived from
             plasma virus, however, lacked hypermutation, as did proviral vif. When
             correlates of disease progression were examined, subjects with hypermutated
             provirus were found to have significantly higher CD4 counts than the other
             subjects. Furthermore, hypermutation as estimated by elevated adenine content
             positively correlated with CD4 count for all 240 study subjects. The sequence
             context of the observed hypermutation was statistically associated with
             APOBEC3F/G activity. In contrast to previous studies, this study demonstrates
             that higher CD4 counts correlate with increased hypermutation in the absence of
             obvious mutations in the APOBEC inhibiting Vif protein. This strongly suggests
             that host factors, such as APOBEC3F/G, are playing a protective role in these
             patients, modulating viral hypermutation and host disease progression. These
             findings support the potential of targeting APOBEC3F/G for therapeutic
             purposes. (author's)

Langauage:   English

Keywords:    KENYA | RESEARCH REPORT | CLINICAL RESEARCH | WOMEN |
             PERSONS LIVING WITH HIV/AIDS | HIV INFECTIONS | IMMUNE
             SYSTEM | IMMUNOLOGIC FACTORS | GENETICS | CYTOLOGY |
             AFRICA, EASTERN | AFRICA, SUB SAHARAN | AFRICA | DEVELOPING
             COUNTRIES | RESEARCH METHODOLOGY | DEMOGRAPHIC



                                             80
                             STIs, HIV and AIDS: 2005 - 2008

             FACTORS | POPULATION | VIRAL DISEASES | DISEASES |
             PHYSIOLOGY | BIOLOGY | IMMUNITY

Document Number: 328351



Safer sexual behaviors after 12 months of antiretroviral treatment in
Mombasa, Kenya: a prospective cohort.
Author:      Luchters S; Sarna A; Geibel S; Chersich MF; Munyao P

Source:      AIDS Patient Care and STDs. 2008 Jul

Abstract:    Roll-out of antiretroviral treatment (ART) raises concerns about the potential for
             unprotected sex if sexual activity increases with well-being, resulting in
             continued HIV spread. Beliefs about reduced risk for HIV transmission with
             ART may also influence behavior. From September 2003 to November 2004, 234
             adults enrolled in a trial assessing the efficacy of modified directly observed
             therapy in improving adherence to ART. Unsafe sexual behavior (unprotected
             sex with an HIV-negative or unknown status partner) before starting ART and 12
             months thereafter was compared. Participants were a mean 37.2 years (standard
             deviation [SD] = 7.9 years) and 64% (149/234) were female. Nearly half (107/225)
             were sexually active in the 12 months prior to ART, the majority (96/107)
             reporting one sexual partner. Unsafe sex was reported by half of those sexually
             active in the 12 months before ART (54/107), while after 12 months ART, this
             reduced to 28% (30/107). Unsafe sex was associated with nondisclosure of HIV
             status to partner; recent HIV diagnosis; not being married or cohabiting; stigma;
             depression and body mass index <18.5 kg/m(2). ART beliefs, adherence, and
             viral suppression were not associated with unsafe sex. After adjusting for gender
             and stigma, unsafe sex was 0.59 times less likely after 12 months ART than before
             initiation (95% confidence interval [CI] = 0.37-0.94; p = 0.026). In conclusion,
             although risky sexual behaviors had decreased, a considerable portion do not
             practice safe sex. Beliefs about ART's effect on transmission, viral load, and
             adherence appear not to influence sexual behavior but require long-term
             surveillance. Positive prevention interventions for those receiving ART must
             reinforce safer sex practices and partner disclosure. (author's)

Langauage:   English

Keywords:    KENYA | RESEARCH REPORT | PROSPECTIVE STUDIES | COHORT
             ANALYSIS | ADULTS | ANTIRETROVIRAL THERAPY | SAFER SEX | SEX
             BEHAVIOR | KNOWLEDGE | ATTITUDE | RISK FACTORS | TIME
             FACTORS | USER COMPLIANCE | INTERVENTIONS | PROGRAM
             EFFECTIVENESS | AFRICA, EASTERN | AFRICA, SUB SAHARAN |
             AFRICA | DEVELOPING COUNTRIES | STUDIES | RESEARCH
             METHODOLOGY | AGE FACTORS | POPULATION CHARACTERISTICS



                                             81
                            STIs, HIV and AIDS: 2005 - 2008

            | DEMOGRAPHIC FACTORS | POPULATION | HIV | HIV INFECTIONS |
            VIRAL DISEASES | DISEASES | BEHAVIOR | SOCIOCULTURAL
            FACTORS | PSYCHOLOGICAL FACTORS | BIOLOGY | POPULATION
            DYNAMICS | PROGRAMS | ORGANIZATION AND ADMINISTRATION
            | PROGRAM EVALUATION


Document Number: 328319



Maternal HLA homozygosity and mother-child HLA concordance
increase the risk of vertical transmission of HIV-1.
Author:     Mackelprang RD; John-Stewart G; Carrington M; Richardson B; Rowland-Jones S

Source:     Journal of Infectious Diseases. 2008

Abstract:   Mother-child human leukocyte antigen (HLA) concordance and maternal HLA
            homozygosity may increase the risk of vertical transmission of human
            immunodeficiency virus type 1 (HIV-1) risk by reducing infant immune
            responses. We analyzed mother-child HLA concordance and maternal HLA
            homozygosity in a Kenyan perinatal cohort receiving antenatal zidovudine. HLA
            concordance was scored as the number of shared class I alleles, and relative risk
            estimates were adjusted for maternal HIV-1 load. Among 277 mother-infant
            pairs, HIV-1 transmission occurred in 58 infants (21%), with in utero
            transmission in 21 (36%), peripartum transmission in 26 (45%), and transmission
            via breast-feeding in 11 (19%). With increased concordance, we observed a
            significant increase in the risk of transmission overall (adjusted hazard ratio
            [aHR], 1.3 [95% confidence interval {CI}, 1.0 -1.7]; P = .04), in utero (adjusted
            odds ratio, 1.72 [95% CI, 1.0 -1.7]; P = .04), and via breast-feeding (aHR, 1.6 [95%
            CI, 1.0 -2.5]; P = .04). Women with homozygosity had higher plasma HIV-1 RNA
            levels at 32 weeks of gestation (5.1 vs. 4.8 log10 copies/mL; P = .03) and an
            increased risk of transmission overall (aHR, 1.7 [95% CI, 1.1-2.7]; P = .03) and via
            breast-feeding (aHR, 5.8 [95% CI, 1.9 -17.7]; P = .002). The risks of overall, in
            utero, and breast milk HIV-1 transmission increased with HLA concordance and
            homozygosity. The increased risk may be due to reduced alloimmunity or less
            diverse protective immune responses. (author'sMother-child human leukocyte
            antigen (HLA) concordance and maternal HLA homozygosity may increase the
            risk of vertical transmission of human immunodeficiency virus type 1 (HIV-1)
            risk by reducing infant immune responses. We analyzed mother-child HLA
            concordance and maternal HLA homozygosity in a Kenyan perinatal cohort
            receiving antenatal zidovudine. HLA concordance was scored as the number of
            shared class I alleles, and relative risk estimates were adjusted for maternal HIV-
            1 load. Among 277 mother-infant pairs, HIV-1 transmission occurred in 58
            infants (21%), with in utero transmission in 21 (36%), peripartum transmission in
            26 (45%), and transmission via breast-feeding in 11 (19%). With increased



                                             82
                              STIs, HIV and AIDS: 2005 - 2008

             concordance, we observed a significant increase in the risk of transmission
             overall (adjusted hazard ratio [aHR], 1.3 [95% confidence interval {CI}, 1.0 -1.7]; P
             = .04), in utero (adjusted odds ratio, 1.72 [95% CI, 1.0 -1.7]; P = .04), and via
             breast-feeding (aHR, 1.6 [95% CI, 1.0 -2.5]; P = .04). Women with homozygosity
             had higher plasma HIV-1 RNA levels at 32 weeks of gestation (5.1 vs. 4.8 log10
             copies/mL; P = .03) and an increased risk of transmission overall (aHR, 1.7 [95%
             CI, 1.1-2.7]; P = .03) and via breast-feeding (aHR, 5.8 [95% CI, 1.9 -17.7]; P = .002).
             The risks of overall, in utero, and breast milk HIV-1 transmission increased with
             HLA concordance and homozygosity. The increased risk may be due to reduced
             alloimmunity or less diverse protective immune responses. (author's

Langauage:   English

Keywords:    KENYA | RESEARCH REPORT | COHORT ANALYSIS | MOTHER-TO-
             CHILD TRANSMISSION | HIV INFECTIONS | RISK FACTORS |
             AUTOIMMUNE RESPONSE | PREVENTION OF MOTHER-TO-CHILD
             TRANSMISSION | EXPOSURE | HUMAN MILK | DEVELOPING
             COUNTRIES | AFRICA, EASTERN | AFRICA, SUB SAHARAN | AFRICA |
             RESEARCH METHODOLOGY | TRANSMISSION | INFECTIONS |
             DISEASES | VIRAL DISEASES | BIOLOGY | ANTIBODIES |
             IMMUNOLOGIC FACTORS | IMMUNITY | IMMUNE SYSTEM |
             PHYSIOLOGY | DISEASE TRANSMISSION CONTROL | PREVENTION
             AND CONTROL | LACTATION | MATERNAL PHYSIOLOGY

Document Number: 325945


Risk compensation is not associated with male circumcision in Kisumu,
Kenya: A multi-faceted assessment of men enrolled in a randomized
controlled trial.

Author:      Mattson CL; Campbell RT; Bailey RC; Agot K; Ndinya-Achola JO

Source:      PLoS One. 2008 Jun

Abstract:    Three randomized controlled trials (RCTs) have confirmed that male
             circumcision (MC) significantly reduces acquisition of HIV-1 infection among
             men. The objective of this study was to perform a comprehensive, prospective
             evaluation of risk compensation, comparing circumcised versus uncircumcised
             controls in a sample of RCT participants. Between March 2004 and September
             2005, we systematically recruited men enrolled in a RCT of MC in Kenya.
             Detailed sexual histories were taken using a modified Timeline Follow-back
             approach trichomoniasis between circumcised and uncircumcised men. These
             results are based on the most comprehensive analysis of risk compensation yet
             done. In the context of a RCT, circumcision did not result in increased HIV risk
             behavior. Continued monitoring and evaluation of risk compensation associated



                                               83
                             STIs, HIV and AIDS: 2005 - 2008

             with circumcision is needed as evidence supporting its' efficacy is disseminated
             and MC is widely promoted for HIV prevention. (author's)

Langauage:   English

Keywords:    KENYA | RESEARCH REPORT | CLINICAL TRIALS | MALE
             CIRCUMCISION | HIV PREVENTION | RISK BEHAVIOR | SEXUALLY
             TRANSMITTED DISEASES | INCIDENCE | DEVELOPING COUNTRIES |
             AFRICA, EASTERN | AFRICA, SUB SAHARAN | AFRICA | CLINICAL
             RESEARCH | RESEARCH METHODOLOGY | MEDICAL PROCEDURES |
             MEDICINE | HEALTH SERVICES | DELIVERY OF HEALTH CARE |
             HEALTH | HIV INFECTIONS | VIRAL DISEASES | DISEASES |
             BEHAVIOR | REPRODUCTIVE TRACT INFECTIONS | INFECTIONS |
             MEASUREMENT

Document Number: 327077


The influence and benefits of controlling for inflammation on plasma
ferritin and hemoglobin responses following a multi-micronutrient
supplement in apparently healthy, HIV+ Kenyan adults.
Author:      Mburu AS; Thurnham DI; Mwaniki DL; Muniu EM; Alumasa F

Source:      Journal of Nutrition

Abstract:    Hemoglobin and ferritin are important biomarkers of iron status but are both
             altered by inflammation. We used the inflammation biomarkers C-reactive
             protein (CRP) and alpha1-acid glycoprotein (AGP) to adjust hemoglobin and
             ferritin concentrations to clarify interpretation of iron status. Apparently healthy
             adults who tested positive twice for HIV but who had not reached stage IV or
             clinical AIDS were randomly allocated to receive a food supplement (n = 17 and
             21) or the food plus a micronutrient capsule (MN; 10 men and 34 women,
             respectively) containing 30 mg iron/d. Hemoglobin, ferritin, CRP, and AGP
             concentrations were measured at baseline and 3 mo and subjects were divided
             into 4 groups (reference, no inflammation; incubating, raised CRP; early
             convalescence, raised AGP and CRP; and late convalescence, raised AGP).
             Correction factors (the ratios of the median for the reference group over each
             inflammatory group) improved the consistency of the ferritin but not the
             hemoglobin results. After correction, ferritin (but not hemoglobin) increased in
             both men (48 microg/L; P = 0.02) and women (12 microg/L; P = 0.04) who
             received MN but not in the food-only group. However, hemoglobin did improve
             in subjects who showed no inflammation both at baseline and mo 3 (P = 0.019),
             but ferritin did not increase in this group. In conclusion, ferritin concentrations
             were more closely linked to current inflammation than hemoglobin; hence,
             correction by inflammation biomarkers improved data consistency. However,



                                              84
                             STIs, HIV and AIDS: 2005 - 2008

             low hemoglobin concentrations were the consequence of long-term chronic
             inflammation and improvements in response to MN supplements were only
             detected in subjects with no inflammation. (author's)

Langauage:   English
Keywords:    KENYA | RESEARCH REPORT | CLINICAL RESEARCH | COMPARATIVE
             STUDIES | ADULTS | HIV POSITIVE PERSONS | HIV INFECTIONS |
             HEMOGLOBIN LEVEL | SERUM IRON LEVEL | FOOD
             SUPPLEMENTATION | VITAMINS AND MINERALS |
             ADMINISTRATION AND DOSAGE | HISTOCHEMICAL EFFECTS |
             DEVELOPING COUNTRIES | AFRICA, EASTERN | AFRICA, SUB
             SAHARAN | AFRICA | RESEARCH METHODOLOGY | STUDIES | AGE
             FACTORS | POPULATION CHARACTERISTICS | DEMOGRAPHIC
             FACTORS | POPULATION | PERSONS LIVING WITH HIV/AIDS | VIRAL
             DISEASES | DISEASES | HEMIC SYSTEM | PHYSIOLOGY | BIOLOGY |
             NUTRITION PROGRAMS | PRIMARY HEALTH CARE | HEALTH
             SERVICES | DELIVERY OF HEALTH CARE | HEALTH | DRUGS |
             TREATMENT | MEDICAL PROCEDURES | MEDICINE | CYTOLOGIC
             EFFECTS


Document Number: 324775


Improvement of vaginal health for Kenyan women at risk for acquisition
of human immunodeficiency virus type 1: Results of a randomized trial.
Author:      McClelland RS; Richardson BA; Hassan WM; Chohan V; Lavreys L

Source:      Journal of Infectious Diseases

Abstract:    Vaginal infections are common and have been associated with increased risk for
             acquisition of human immunodeficiency virus type 1 (HIV-1). We conducted a
             randomized trial of directly observed oral treatment administered monthly to
             reduce vaginal infections among Kenyan women at risk for HIV-1 acquisition. A
             trial intervention of 2 g of metronidazole plus 150 mg of fluconazole was
             compared with metronidazole placebo plus fluconazole placebo. The primary
             end points were bacterial vaginosis (BV), vaginal candidiasis, trichomoniasis
             vaginalis (hereafter, "trichomoniasis"), and colonization with Lactobacillus
             organisms. Of 310 HIV-1-seronegative female sex workers enrolled (155 per
             arm), 303 were included in the primary end points analysis. A median of 12
             follow-up visits per subject were recorded in both study arms (P = .8). Compared
             with control subjects, women receiving the intervention had fewer episodes of
             BV (hazard ratio [HR], 0.55; 95% confidence interval [CI], 0.49-0.63) and more
             frequent vaginal colonization with any Lactobacillus species (HR, 1.47; 95% CI,
             1.19 -1.80) and H2O2-producing Lactobacillus species (HR, 1.63; 95% CI, 1.16 -
             2.27). The incidences of vaginal candidiasis (HR, 0.84; 95% CI, 0.67-1.04) and


                                              85
                              STIs, HIV and AIDS: 2005 - 2008

             trichomoniasis (HR, 0.55; 95% CI, 0.27-1.12) among treated women were less than
             those among control subjects, but the differences were not statistically
             significant. Periodic presumptive treatment reduced the incidence of BV and
             promoted colonization with normal vaginal flora. Vaginal health interventions
             have the potential to provide simple, female-controlled approaches for reducing
             the risk of HIV-1 acquisition. (author's)

Langauage:   English

Keywords:    KENYA | RESEARCH REPORT | CLINICAL TRIALS | WOMEN | SEX
             WORKERS | VAGINAL ABNORMALITIES | INFECTIONS | RISK
             FACTORS | HIV INFECTIONS | DRUGS | ADMINISTRATION AND
             DOSAGE | DEVELOPING COUNTRIES | AFRICA, EASTERN | AFRICA,
             SUB SAHARAN | AFRICA | CLINICAL RESEARCH | RESEARCH
             METHODOLOGY | DEMOGRAPHIC FACTORS | POPULATION | SEX
             BEHAVIOR | BEHAVIOR | DISEASES | BIOLOGY | VIRAL DISEASES |
             TREATMENT | MEDICAL PROCEDURES | MEDICINE | HEALTH
             SERVICES | DELIVERY OF HEALTH CARE | HEALTH


Document Number: 326470


Herpes simplex virus type 2 infection among young uncircumcised men
in Kisumu, Kenya.
Author:      Mehta SD; Moses S; Agot K; Agingu W; Parker C

Source:      Sexually Transmitted Infections.

Abstract:    The objectives were to identify factors associated with herpes simplex virus type
             2 (HSV-2) infection among men aged 18-24 in Kisumu, Kenya. Baseline data from
             a randomised trial of male circumcision were analysed. Participants were
             interviewed for tors were considered singly and in combination through logistic
             regression models. Asociodemographic and behavioural risks. The outcome was
             HSV-2 by antibody status. Risk facmong 2771 uncircumcised men, 766 (27.6%;
             95% confidence interval (CI) 26.0% to 29.3%) tested antibody positive for HSV-2.
             The median age at first sex was 16 years, and the median number of lifetime
             sexual partners was four. HSV-2 seroprevalence increased from 19% among 18-
             year-olds to 43% among 24-year-olds (p less than 0.001). In multivariable
             analysis, statistically significant risks for infection were increasing age (adjusted
             odds ratio (AOR)=1.22-2.58), being married or having a live-in female partner
             (AOR=1.80; 95% CI 1.28 to 2.53), preferring "dry" sex (AOR=1.39; 95% CI 1.14 to
             1.69), reported penile cuts or abrasions during sex (AOR=1.58; 95% CI 1.32 to
             1.91), increasing lifetime sex partners (multiple response categories; AORs
             ranging from 1.65 to 1.97), and non-student occupation (multiple response
             categories; AORs ranging from 1.44 to 1.93). Risk decreased with reported


                                              86
                             STIs, HIV and AIDS: 2005 - 2008

             condom used at last sex (AOR=0.82; 95% CI 0.68 to 0.99). Primary prevention
             efforts should be initiated at an early age. The same behavioural interventions
             used currently for HIV prevention-abstinence, reducing the number of sex
             partners and increasing condom use-should be effective for HSV-2 prevention.
             (author's)

Langauage:   English

Keywords:    KENYA | RESEARCH REPORT | INTERVIEWS | CLINICAL RESEARCH |
             CROSS SECTIONAL ANALYSIS | YOUTH | MEN | MALE
             CIRCUMCISION | HERPES GENITALIS | RISK FACTORS | DEVELOPING
             COUNTRIES | AFRICA, EASTERN | AFRICA, SUB SAHARAN | AFRICA |
             DATA COLLECTION | RESEARCH METHODOLOGY | AGE FACTORS |
             POPULATION CHARACTERISTICS | DEMOGRAPHIC FACTORS |
             POPULATION | MEDICAL PROCEDURES | MEDICINE | HEALTH
             SERVICES | DELIVERY OF HEALTH CARE | HEALTH | SEXUALLY
             TRANSMITTED DISEASES | REPRODUCTIVE TRACT INFEC IVE TIONS
             | INFECTIONS | DISEASES | BIOLOGY


Document Number: 323782


Sexual and demographic determinants for herpes simplex virus type 2
among fishermen along Lake Victoria, Kenya.
Author:      Ng'ayo MO; Bukusi E; Morrow RA; Rowhani-Rahbar A; Obare BA

Source:      Sexually Transmitted Infections

Abstract:    The objectives were to determine the prevalence and correlates of herpes simplex
             virus type 2 (HSV-2) seropositivity among fishermen along the shores of Lake
             Victoria in Kisumu district, Kenya. Sera from a random sample of 250 fishermen
             from 18 beaches were collected after a detailed sociodemographic interview.
             HSV-2 infection was tested by Kalon HSV-2 ELISA. The HSV-2 seroprevalence
             was 63.9%. In multivariate analysis, fishermen were more likely to be infected
             with HSV-2 if they were HIV positive (prevalence ratio (PR) 1.27; 95% CI 1.06 to
             1.52) compared with those testing HIV negative, were aged 18-20 (PR 0.49; 95%
             CI 0.24 to 0.99) and older than 40 (PR 1.66; 95% CI 1.30 to 2.14) years compared
             with those aged 21-25 years, perceived their last two sexual partners to have a
             sexually transmitted infection (STI; PR 1.27; 95% CI 1.06 to 1.52) compared with
             those who did not and were more likely to be circumcised (PR 1.49; 95% CI 1.19
             to 1.86). HSV-2 seroprevalence is high among this population and is associated
             with HIV serostatus, age, perception about partner's STI status and circumcision.
             (author's)

Langauage:   English


                                               87
                            STIs, HIV and AIDS: 2005 - 2008



Keywords:   KENYA | RESEARCH REPORT | SAMPLING STUDIES | MEN | ADULTS
            | HERPES GENITALIS | PREVALENCE | RISK FACTORS |
            DEMOGRAPHIC FACTORS | FISHING | DEVELOPING COUNTRIES |
            AFRICA, EASTERN | AFRICA, SUB SAHARAN | AFRICA | STUDIES |
            RESEARCH METHODOLOGY | POPULATION | AGE FACTORS |
            POPULATION CHARACTERISTICS | SEXUALLY TRANSMITTED
            DISEASES | REPRODUCTIVE TRACT INFECTIONS | INFECTIONS |
            DISEASES | MEASUREMENT | BIOLOGY | OCCUPATIONS | HUMAN
            RESOURCES | ECONOMIC FACTORS

Document Number: 325713


Role of governmental and non-governmental organizations in mitigation
of stigma and discrimination among HIV / AIDS persons in Kibera,
Kenya.
Author:     Odindo MA; Mwanthi MA

Source:     East African Journal of Public Health

Abstract:   This study assessed the role of governmental and non-governmental
            organizations in mitigation of stigma and discrimination among people infected
            and affected by HIV/AIDS in informal settlements of Kibera. This was a
            descriptive cross-sectional study and used a multi stage stratified sampling
            method. The study was conducted in Kibera, an informal settlement with a
            population of over one million people which makes it the largest slum not only
            in Kenya but in sub-Saharan Africa. The study targeted infected individuals,
            non-infected community members, managers of the organizations implementing
            HIV/AIDS programmes and service providers. In the process 1331 households
            were interviewed using qualitative and quantitative data collection instruments.
            Statistical Package for Social Sciences (SPSS) and Nudist 4 packages were used to
            analyze the quantitative and qualitative data respectively. More than 61% of the
            respondents had patients in their households. Fifty five percent (55%) of the
            households receivedassistance from governmental and non-governmental
            organizations in taking care of the sick. Services provided included awareness,
            outreach, counseling, testing, treatment, advocacy, home based care, assistance
            to the orphans and legal issues. About 90% of the respondents perceived health
            education, counseling services and formation of post counseling support groups
            to combat stigma and discrimination to be helpful. Stigma and discrimination
            affects the rights of People Living with HIV/AIDS (PLWHAs). Such
            stigmatization and discrimination goes beyond and affects those who care for the
            PLWHAs, and remains the biggest impediment in the fight against HIV/AIDS in
            Kibera. Governmental and non-governmental organizations continue to provide
            key services in the mitigation of stigma and discrimination in Kibera. However,



                                            88
                              STIs, HIV and AIDS: 2005 - 2008

             personal testimonies by PLWHAs showed that HIV positive persons still suffer
             from stigma and discrimination. Approximately 43% of the study population
             experienced stigma and discrimination. (author's)

Langauage:   English

Keywords:    KENYA | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS |
             SAMPLING STUDIES | INTERVIEWS | PERSONS LIVING WITH
             HIV/AIDS | GOVERNMENT | NONGOVERNMENTAL ORGANIZATIONS
             | STIGMA | SOCIAL DISCRIMINATION | DEVELOPING COUNTRIES |
             AFRICA, EASTERN | AFRICA, SUB SAHARAN | AFRICA | RESEARCH
             METHODOLOGY | STUDIES | DATA COLLECTION | HIV INFECTIONS
             | VIRAL DISEASES | DISEASES | POLITICAL FACTORS |
             SOCIOCULTURAL FACTORS | ORGANIZATIONS | SOCIAL PROBLEMS


Document Number: 327599


Acute HIV infection among Kenyan infants.
Author:      Richardson BA; Nduati R; Mbori-Ngacha D; Overbaugh J; John-Stewart GC

Source:      Clinical Infectious Diseases

Abstract:    Clinical signs and symptoms of acute human immunodeficiency virus (HIV)
             infection in infants are not well characterized. Serial clinical assessments and
             HIV PCR assays were conducted in a cohort of children born to HIV-seropositive
             mothers from birth to 2 years of age. Acute HIV infection visits were defined as
             those up to 3 months prior to and including the visit at which HIV DNA was first
             detected. Noninfection visits included all visits at which the child had test results
             negative for HIV, including the last visit at which a test result negative for HIV
             DNA was obtained in children who later acquired HIV infection. Differences in
             the prevalence of symptoms at acute infection versus noninfection visits were
             determined overall and were stratified by age at infection (< 2 months vs. >/= 2
             months). HIV RNA was measured serially in infected infants and was compared
             between infants with and infants without symptoms of acute HIV infection.
             There were 125 acute infection visits (among 56 infants) and 3491 noninfection
             visits (among 306 infants). Acute HIV infection was associated with rash (odds
             ratio [OR], 1.8; 95% confidence interval [CI], 1.1-2.8), failure to thrive (OR, 1.9;
             95% CI, 1.0-3.5), and lymphadenopathy (OR, 2.5; 95% CI, 1.4-4.8). Acute HIV
             infection was associated with lymphadenopathy (OR, 2.6; 95% CI, 1.3-5.0) in
             infants < 2 months of age and with pneumonia (OR, 3.2; 95% CI, 1.1-9.3) and
             dehydration (OR, 6.0; 95% CI, 1.9-18.5) in infants >/= 2 months of age. Infant
             peak viral load and mortality were not associated with symptoms of acute HIV
             infection. However, infants with symptoms had higher viral levels later in the
             course of infection than did those without symptoms (P = .05). Infants may


                                              89
                              STIs, HIV and AIDS: 2005 - 2008

             manifest symptoms early during the course of HIV infection, and symptoms of
             acute HIV infection may correlate with poor viral control. Rash, failure to thrive,
             lymphadenopathy, pneumonia, and dehydration may signify acute HIV
             infection in infants. (author's)
             Clinical signs and symptoms of acute human immunodeficiency virus (HIV)
             infection in infants are not well characterized. Serial clinical assessments and
             HIV PCR assays were conducted in a cohort of children born to HIV-seropositive
             mothers from birth to 2 years of age. Acute HIV infection visits were defined as
             those up to 3 months prior to and including the visit at which HIV DNA was first
             detected. Noninfection visits included all visits at which the child had test results
             negative for HIV, including the last visit at which a test result negative for HIV
             DNA was obtained in children who later acquired HIV infection. Differences in
             the prevalence of symptoms at acute infection versus noninfection visits were
             determined overall and were stratified by age at infection (< 2 months vs. >/= 2
             months). HIV RNA was measured serially in infected infants and was compared
             between infants with and infants without symptoms of acute HIV infection.
             There were 125 acute infection visits (among 56 infants) and 3491 noninfection
             visits (among 306 infants). Acute HIV infection was associated with rash (odds
             ratio [OR], 1.8; 95% confidence interval [CI], 1.1-2.8), failure to thrive (OR, 1.9;
             95% CI, 1.0-3.5), and lymphadenopathy (OR, 2.5; 95% CI, 1.4-4.8). Acute HIV
             infection was associated with lymphadenopathy (OR, 2.6; 95% CI, 1.3-5.0) in
             infants < 2 months of age and with pneumonia (OR, 3.2; 95% CI, 1.1-9.3) and
             dehydration (OR, 6.0; 95% CI, 1.9-18.5) in infants >/= 2 months of age. Infant
             peak viral load and mortality were not associated with symptoms of acute HIV
             infection. However, infants with symptoms had higher viral levels later in the
             course of infection than did those without symptoms (P = .05). Infants may
             manifest symptoms early during the course of HIV infection, and symptoms of
             acute HIV infection may correlate with poor viral control. Rash, failure to thrive,
             lymphadenopathy, pneumonia, and dehydration may signify acute HIV
             infection in infants. (author's)

Language:    English

Keywords:    KENYA | RESEARCH REPORT | COHORT ANALYSIS | PREGNANT
             WOMEN | INFANT | HIV INFECTIONS | PREVALENCE | LABORATORY
             PROCEDURES | MOTHER-TO-CHILD TRANSMISSION | AGE FACTORS
             | SIGNS AND SYMPTOMS | MORTALITY | DEVELOPING COUNTRIES |
             AFRICA, EASTERN | AFRICA, SUB SAHARAN | AFRICA | RESEARCH
             METHODOLOGY | POPULATION CHARACTERISTICS |
             DEMOGRAPHIC FACTORS | POPULATION | YOUTH | VIRAL DISEASES
             | DISEASES | MEASUREMENT | LABORATORY EXAMINATIONS AND
             DIAGNOSES | EXAMINATIONS AND DIAGNOSES | MEDICAL
             PROCEDURES | MEDICINE | HEALTH SERVICES | DELIVERY OF
             HEALTH CARE | HEALTH | TRANSMISSION | INFECTIONS |
             POPULATION DYNAMICS

Langauage:   English



                                              90
                             STIs, HIV and AIDS: 2005 - 2008



Document Number: 323115


Characteristics of psychosocial support seeking during HIV-related
treatment in western Kenya.
Author:      Shacham E; Reece M; Ong'or WO; Omollo O; Monahan PO; Ojwang C

Source:      AIDS Patient Care and STDs

Abstract:    While the characteristics of those who seek psychosocial support following an
             HIV diagnosis have been well documented in western countries where linkages
             between HIV-related treatment and psychosocial support programs are well
             established, little is known about those who become engaged with such services
             in countries of the world where comprehensive HIV-related care and prevention
             systems are continuing to develop. Data were collected from 397 individuals
             who had enrolled in HIV-related psychosocial support groups in western Kenya
             in November 2005. Demographic and HIV-related characteristics, as well as
             assessments of psychological distress, were collected from each participant and
             analyzed by gender in order to document the characteristics of those seeking
             psychosocial care in conjunction with their participation in an HIV-related
             treatment and prevention program. Those seeking psychosocial support were
             primarily female (72%), living with HIV for an average of 2.5 years, and
             unemployed (70%). Women were younger and more likely to be either widowed
             or never married; while men were more likely to have advanced HIV disease,
             including lower CD4 counts and an AIDS diagnosis. Across all participants, HIV
             serostatus disclosure was rarely reported to sex partners, family members, and
             friends. Symptoms of psychological distress were more prevalent among women
             on multiple measures, including depression, anxiety, paranoid ideation,
             interpersonal sensitivity, and somatization. An increased understanding of the
             characteristics of those likely to seek psychosocial support groups will help HIV
             program managers to develop protocols necessary for facilitating linkages to
             psychosocial support for those enrolled in HIV-related treatment programs.
             Patient engagement in psychosocial support may facilitate improvements in
             psychological function and support an individual's maintenance of HIV
             treatment and prevention behaviors. (author's)

Langauage:   English

Keywords:    KENYA | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS |
             QUESTIONNAIRES | PERSONS LIVING WITH HIV/AIDS | HIV
             INFECTIONS | PSYCHOSOCIAL FACTORS | STRESS | SIGNS AND
             SYMPTOMS | TREATMENT | CARE AND SUPPORT | AFRICA, EASTERN
             | AFRICA, SUB SAHARAN | AFRICA | DEVELOPING COUNTRIES |
             RESEARCH METHODOLOGY | VIRAL DISEASES | DISEASES |
             BEHAVIOR | PSYCHOLOGICAL FACTORS | MEDICAL PROCEDURES |


                                             91
                            STIs, HIV and AIDS: 2005 - 2008

            MEDICINE | HEALTH SERVICES | DELIVERY OF HEALTH CARE |
            HEALTH

Document Number: 328369


A prospective study of risk factors for bacterial vaginosis in HIV-1-
seronegative African women.

Author:     McClelland RS; Richardson BA; Graham SM; Masese LN; Gitau R

Source:     Sexually Transmitted Diseases. 2008 Jun;35(6):617-623.

Abstract:   Bacterial vaginosis (BV) is common and has been associated with increased HIV-
            1 susceptibility. The objective of this study was to identify risk factors for BV in
            African women at high risk for acquiring HIV-1. We conducted a prospective
            study among 151 HIV-1-seronegative Kenyan female sex workers. Nonpregnant
            women were eligible if they did not have symptoms of abnormal vaginal itching
            or discharge at the time of enrollment. At monthly follow-up, a vaginal
            examination and laboratory testing for genital tract infections were performed.
            Multivariate Andersen-Gill proportional hazards analysis was used to identify
            correlates of BV. Participants completed a median of 378 (interquartile range 350-
            412) days of follow-up. Compared with women reporting no vaginal washing,
            those who reported vaginal washing 1 to 14 [adjusted hazard ratio (aHR) 1.29,
            95% confidence interval (CI) 0.88-1.89], 15 to 28 (aHR 1.60, 95% CI 0.98 -2.61), and
            greater than 28 times/wk (aHR 2.39, 95% CI 1.35-4.23) were at increased risk of
            BV. Higher BV incidence was also associated with the use of cloth for
            intravaginal cleansing (aHR 1.48, 95% CI 1.06 -2.08) and with recent unprotected
            intercourse (aHR 1.75, 95% CI 1.47-2.08). Women using depot
            medroxyprogesterone acetate contraception were at lower risk for BV (aHR 0.59,
            95% CI 0.48-0.73). Vaginal washing and unprotected intercourse were associated
            with increased risk of BV. These findings could help to inform the development
            of novel vaginal health approaches for HIV-1 risk reduction in women. (author's)

Language:   English

Keywords:   KENYA | RESEARCH REPORT | PROSPECTIVE STUDIES | SEX
            WORKERS | VAGINOSIS | RISK FACTORS | LABORATORY
            EXAMINATIONS AND DIAGNOSES | SEX BEHAVIOR | HYGIENE |
            DEPO-PROVERA | DEVELOPING COUNTRIES | AFRICA, EASTERN |
            AFRICA, SUB SAHARAN | AFRICA | STUDIES | RESEARCH
            METHODOLOGY | BEHAVIOR | VAGINAL ABNORMALITIES |
            DISEASES | BIOLOGY | EXAMINATIONS AND DIAGNOSES | MEDICAL
            PROCEDURES | MEDICINE | HEALTH SERVICES | DELIVERY OF
            HEALTH CARE | HEALTH | PUBLIC HEALTH |
            MEDROXYPROGESTERONE ACETATE | CONTRACEPTIVE AGENTS,
            PROGESTIN | CONTRACEPTIVE AGENTS, FEMALE | CONTRACEPTIVE


                                             92
                             STIs, HIV and AIDS: 2005 - 2008

            AGENTS | CONTRACEPTION | FAMILY PLANNING


Document Number: 327423


HIV / AIDS and cultural practices in western Kenya: The impact of
sexual cleansing rituals on sexual behaviours.

Author:     Ayikukwei R; Ngare D; Sidle J; Ayuku D; Baliddawa J

Source:     Culture, Health and Sexuality. 2008 Aug;10(6):587-599.

Abstract:   This paper reports on an exploratory study examining the role of sexual
            cleansing rituals in the transmission of HIV among the Luo community in
            western Kenya. Data were collected using both i-ndepth interviews and focus
            group discussions. The study population consisted of 38 widows, 12 community
            elders and 44 cleansers. Data were collected on non-behavioural causes,
            behavioural causes and behavioural indicators associated with sexual rituals.
            Content analysis revealed five central themes: the effect of the ritual on sexual
            behaviours; factors contributing to the continued practice of the ritual, including
            a sub-theme on the commercialization of the ritual; the inseparable relationship
            between the sanctity of sex, prosperity and fertility of the land; and the effects of
            modernization on the ritual, including a sub-theme on the effects of mass media
            on HIV-prevention awareness campaigns. Causal factors of unchanging sexual
            behaviours are deeply rooted in traditional beliefs, which the community uphold
            strongly. These beliefs encourage men and women to have multiple sexual
            partners in a context where the use of condoms is rejected and little HIV testing
            is carried out. (author's)

Language:   English

Keywords:   KENYA | RESEARCH REPORT | PILOT PROJECTS | INTERVIEWS |
            FOCUS GROUPS | HIV TRANSMISSION | SEX BEHAVIOR | CULTURE |
            BELIEFS | ETHNIC GROUPS | TRADITIONAL HEALTH PRACTICES |
            AFRICA, EASTERN | AFRICA, SUB SAHARAN | AFRICA | DEVELOPING
            COUNTRIES | STUDIES | RESEARCH METHODOLOGY | DATA
            COLLECTION | HIV INFECTIONS | VIRAL DISEASES | DISEASES |
            BEHAVIOR | SOCIOCULTURAL FACTORS | CULTURAL BACKGROUND
            | POPULATION CHARACTERISTICS | DEMOGRAPHIC FACTORS |
            POPULATION


Document Number: 327818




                                             93
                            STIs, HIV and AIDS: 2005 - 2008


Kaposi’s sarcoma in patients with and without human
immunodeficiency virus infection, in a tertiary referral centre in Kenya.
Author:     Mwanda OW; Fu P; Collea R; Whalen C; Remick SC

Source:     Annals of Tropical Medicine and Parasitology

Abstract:   The clinical features of Kaposi’s sarcoma (KS), in patients with and without HIV
            infection, were investigated in a tertiary referral centre in Kenya between 1997
            and 1999. Although 186 cases were identified prospectively, the data analysis
            was restricted to the 91 (49%) cases who had pathological confirmation of
            Kaposi’s sarcoma and documented HIV serostatus. Among these 91 subjects
            (58% of whom were male), the age-group holding the largest number of KS cases
            was that of individuals aged 31–40 years; most of the paediatric cases were aged
            6–10 years. The ratio of HIV-seropositives to HIV-seronegatives was 8.5:1 for the
            adult cases and 0.9:1 for the paediatric. Of the signs and symptoms of Kaposi’s
            sarcoma seen at presentation, only peripheral lympadenopathy was found to be
            significantly associated with underlying HIV infection (P=0.05). The median
            survival was 104 days. It is apparent that, as the HIV epidemic advances in
            regions of the world with endemic KS, the clinical presentation and natural
            history of the endemic KS are blending with those of the epidemic or AIDS-
            associated disease, leading to a reduction in the mean age of the cases and a
            nearly identical incidence in men and women. In regions of the world where
            patients have ready access to such chemotherapy, the impact of treatment with
            highly active antiretroviral drugs on the incidence and natural history of KS has
            been dramatic. It will be important to monitor the clinico–pathological features
            of KS in the developing world, as more active antiretroviral regimens become
            available in clinical practice there. (author's)

Language:   English

Keywords:   KENYA | RESEARCH REPORT | CLINICAL RESEARCH | PROSPECTIVE
            STUDIES | HIV POSITIVE PERSONS | TARGET POPULATION | CANCER
            | REFERRAL AND CONSULTATION PROGRAM DESIGN | PROGRAMS |
            ORGANIZATION AND ADMINISTRATION | NEOPLASMS | PROGRAM
            ACTIVITIES | POPULATION CHARACTERISTICS | DEMOGRAPHIC
            FACTORS | POPULATION | MEASUREMENT | HIV

Document Number: 279454




                                            94
                            STIs, HIV and AIDS: 2005 - 2008


Men's condom use in higher-risk sex: Trends and determinants in five
Sub-Saharan countries.
Author:     Adair T

Source:     Calverton, Maryland, Macro International, MEASURE DHS, 2008 Apr.

Abstract:   This paper examines men's condom use at last higher-risk sex (i.e., nonmarital,
            noncohabiting partner) in five sub-Saharan countries: Burkina Faso, Cameroon,
            Kenya, Tanzania, and Zambia. The two most recent Demographic and Health
            Surveys (DHS) in each country are analyzed to show trends in various indicators.
            Condom use is an important way to prevent the transmission of HIV, the virus
            that causes AIDS. Encouragingly, use of condoms has increased substantially in
            Burkina Faso, Cameroon, and Tanzania, with smaller increases in Kenya and
            Zambia. At the same time, levels of higher-risk sex have declined in four of the
            five countries, although use of a condom at last higher-risk sex remains below 50
            percent in Kenya and Zambia. Multivariate analysis shows that higher education
            is a consistently strong, positive predictor of condom use at last higher-risk sex,
            whereas higher wealth status is not significant in most surveys. Knowledge that
            use of condoms can reduce the risk of HIV transmission is a consistently strong,
            positive predictor of condom use, but urban-rural residence and region are
            significant only in some surveys. Comparing the two most recent DHS surveys in
            each of the five countries, there are no clear patterns of change in the predictive
            strength of explanatory variables. However, there is evidence of widening gaps
            in condom use by level of education in Cameroon and by urban-rural residence
            in Kenya. One important policy finding that emerged from this study is that low
            wealth status is not a barrier to condom use in most countries, but lack of
            education is. (author's)

Language:   English

Keywords:   BURKINA FASO | CAMEROON | KENYA | TANZANIA | ZAMBIA |
            RESEARCH REPORT | DEMOGRAPHIC AND HEALTH SURVEYS |
            MULTIVARIATE ANALYSIS | MEN | CONDOM USE | RISK BEHAVIOR |
            EDUCATIONAL STATUS | DEVELOPING COUNTRIES | AFRICA,
            WESTERN | AFRICA, SUB SAHARAN | AFRICA | AFRICA, EASTERN |
            AFRICA, SOUTHERN | DEMOGRAPHIC SURVEYS | POPULATION
            DYNAMICS | DEMOGRAPHIC FACTORS | POPULATION | DATA
            ANALYSIS | RESEARCH METHODOLOGY | RISK REDUCTION
            BEHAVIOR | BEHAVIOR | SOCIOECONOMIC STATUS |
            SOCIOECONOMIC FACTORS | ECONOMIC FACTORS


Document Number: 326392




                                            95
                            STIs, HIV and AIDS: 2005 - 2008


Does cotrioxazole prophylaxis for the prevention of HIV-associated
opportunistic infections select for resistant pathogens in Kenyan adults?
Author:     Hamel MJ, Greene C, Chiller T, Ouma P, Polyak C, Otieno K, Williamson J,
            Shi YP, Feikin DR, Marston B, Brooks JT, Poe A, Zhou Z

Source:     Am J Trop Med Hyg. 2008 Sep;79(3):320-30.

Abstract:   We assessed the effect of daily cotrimoxazole, essential for HIV care, on
            development of antifolate-resistant Plasmodium falciparum, naso-pharyngeal
            Streptococcus pneumoniae (pneumococcus), and commensal Escherichia coli.
            HIV-positive subjects with CD4 cell count < 350 cells/muL (lower-CD4; N = 692)
            received cotrimoxazole; HIV-positive with CD4 cell count > or = 350 cells/muL
            (higher-CD4; N = 336) and HIV-negative subjects (N = 132) received
            multivitamins.
            Specimens were collected at baseline, 2 weeks, monthly, and at sick visits during
             6 months of follow-up to compare changes in resistance, with higher-CD4 as
            referent. P. falciparum parasitemia incidence density was 16 and 156/100
            person-years in lower-CD4 and higher-CD4, respectively (adjusted rate ratio
            [ARR] = 0.11; 95% confidence interval [CI] = 0.06-0.15; P < 0.001) and 97/100
            person-years in HIV-negative subjects (ARR = 0.62; 95% CI = 0.44-0.86; P = 005).
            Incidence density of triple and quintuple dihydrofol reductase/dihydropteroate-
            synthetase mutations was 90% reduced in lower-CD4 compared with referent.
            Overall, cotrimoxazole non-susceptibility was high among isolated
            pneumococcus (92%) and E. coli (76%) and increased significantly in lower-CD4
            subjects by Week 2 (P < 0.005). Daily cotrimoxazole prevented malaria and
            reduced incidence of antifolate-resistant P. falciparum but
            contributed to increased pneumococcus and commensal Escherichia coli
            resistance.

Language:   English

Keywords:   |AIDS-RELATED OPPORTUNISTIC INFECTIONS|PREVENTION &
            CONTROL|ADOLESCENT|ADULT|AGED|ANIMALS|ANTI-
            BACTERIAL AGENTS/PHARMACOLOGY|ANTI-INFECTIVE
            GENTS/ADMINISTRATION & DOSAGE THERAPEUTICUSE
            |ANTIMALARIALS/PHARMACOLOGY|COHORT STUDIES |DRUG
            RESISTANCE|ESCHERICHIA COLI/DRUG EFFECTS|FEMALE|HIV
            INFECTIONS|DRUG THERAPY|HUMANS|KENYA|MALARIA,
            ALCIPARUM/PARASITOLOGY/PREVENTION & CONTROL
            |MALE|MIDDLE AGED|PLASMODIUM FALCIPARUM/DRUG
            EFFECTS|PROSPECTIVE STUDIES|STREPTOCOCCUS
            PNEUMONIAE|DRUG EFFECTS|TRIMETHOPRIM-
            SULFAMETHOXAZOLE COMBINATION/ADMINISTRATION &
            DOSAGE| THERAPEUTIC




                                            96
                            STIs, HIV and AIDS: 2005 - 2008


HIV infection does not disproportionately affect the poorer in sub-
Saharan Africa.
Author:     Mishra V

Source:     AIDS. 2007 Nov;21 Suppl 7:S17-28.

Language:   English

Abstract:   Background:
            Wealthier populations do better than poorer ones on most measures of
            health status, including nutrition, morbidity and mortality, and healthcare
            utilization.

            Objectives:
            This study examines the association between household
            wealth status and HIV serostatus to identify what characteristics and behaviours
            are associated with HIV infection, and the role of confounding factors such as
            place of residence and other risk factors.

            Methods:
            Data are from eight national surveys in sub-Saharan Africa (Kenya, Ghana,
            Burkina Faso, Cameroon, Tanzania, Lesotho, Malawi, and Uganda) conducted
            during 2003-2005. Dried blood spot samples were collected and tested for HIV,
            following internationally accepted ethical standards and laboratory procedures.
            The association between household wealth (measured by an index based on
            household ownership of durable assets and other amenities) and HIV serostatus
            is examined using both descriptive and multivariate statistical methods.

            Results:
            In all eight countries, adults in the wealthiest quintiles have a higher prevalence
            of HIV than those in the poorer quintiles. Prevalence increases monotonically
            with wealth in most cases. Similarly for cohabiting couples, the likelihood that
            one or both partners is HIV infected increases with wealth. The positive
            association between wealth and HIV prevalence is only partly explained by an
            association of wealth with other underlying factors, such as place of residence
            and education, and by differences in sexual behaviour, such as multiple sex
            partners, condom use, and male circumcision.

            Conclusion:
            In sub-Saharan Africa, HIV prevalence does not exhibit the same
            pattern of association with poverty as most other diseases. HIV programmes
            should also focus on the wealthier segments of the population.

Language:   English




                                             97
                            STIs, HIV and AIDS: 2005 - 2008


The impact of onset controllability on stigmatization and supportive
 communication goals toward persons with HIV versus lung cancer: a
comparison between Kenyan and U.S. participants.
Author:     Miller AN, Fellows KL, Kizito MN

Source:     Health Commun. 2007;22(3):207-19.

Abstact:    This study examined the impact of controllability of onset (i.e., means of
            transmission), disease type (HIV and lung cancer), and culture (Kenya and U.S.)
            on stigmatizing attitudes and goals for supportive communication. Four
            hundred sixty-four Kenyan students and 526 American students, and 441
            Kenyan nonstudents and 591 American nonstudents were randomly assigned to
            1 of 12 hypothetical scenario conditions and asked to respond to questions
            regarding 3 different types of stigmatizing attitudes and 6 types of supportive
            communication goals with respect to the character in the scenario. Means of
            transmission had a strong effect on the blame component of stigma, but none on
            cognitive attitudes and social interaction components. Similarly, although an
            effect for means of transmission emerged on intention to provide "recognize own
            responsibility" and "see others' blame" types of support, no effect was evident for
            most other supportive interaction goals. Although effects for culture were small,
            Kenyan participants, student and nonstudent alike, were not as quick as
            American participants to adopt goals of communicating blame in any direction.
            Implications for measurement of stigma in future research are discussed.

Language:   English

Keywords:   |ADOLESCENT |ADULT |AGED |AGED, 80 AND OVER|ATTITUDE TO
            HEALTH| CROSS-CULTURAL COMPARISON| EDUCATIONAL STATUS
            |FEMALE |HIINFECTIONS|EPIDEMIOLOGY|ETIOLOGY|PSYCHOLOGY
            |HEALTH BEHAVIOR|HUMANS |INTERNAL-EXTERNAL
            CONTROL|KENYA|EPIDEMIOLOGY| LUNG
            NEOPLASMS/EPIDEMIOLOGY/ETIOLOGY|PSYCHOLOGY
            | MALE| MIDDLE AGED| PRECIPITATING FACTORS|PREJUDICE
            |QUESTIONNAIRES|SOCIAL SUPPORT |STEREOTYPING
            |STUDENTS|PSYCHOLOGY |UNITED STATES/EPIDEMIOLOGY|
            UNIVERSITIES


Education and nutritional status of orphans and children of HIV-infected
parents in Kenya.
Author:     Mishra V, Arnold F, Otieno F, Cross A, Hong R

Source:     AIDS Educ Prev. 2007 Oct;19(5):383-95.




                                            98
                            STIs, HIV and AIDS: 2005 - 2008

Abstract:   We examined whether orphaned and fostered children and children of HIV-
            infected parents are disadvantaged in schooling, nutrition, and health care. We
            analyzed data on 2,756 children aged 0-4 years and 4,172 children aged 6-14
            years included in the 2003 Kenya Demographic and Health Survey, with linked
            anonymous HIV testing, using multivariate logistic regression. Results indicate
            that orphans, fostered children, and children of HIV-infected parents are
            significantly less likely to attend school than non-orphaned/non-fostered
            children of HIV-negative parents. Children of HIV-infected parents are more
            likely to be underweight and wasted, and less likely to receive medical care for
            ARI and diarrhea. Children of HIV-negative single mothers are also
            disadvantaged on most indicators. The findings highlight the need to expand
            child welfare programs to include not only orphans but also fostered children,
            children of single mothers, and children of HIV-infected parents, who tend to be
            equally, if not more, disadvantaged.

Language:   English

Keywords:   |ADOLESCENT|ADULT|CHILDCHILD WELFARE/*STATISTICS &
            NUMERICAL DATA|CHILD OF IMPAIRED
            ARENTS/EDUCATION/*STATISTICS & NUMERICAL DATA
            |CHILD, ORPHANED/EDUCATION/*STATISTICS & NUMERICAL
            DATA|CHILD, PRESCHOOL|EDUCATIONAL STATUS|FAMILY
            CHARACTERISTICS|FEMALE|FOSTER HOME CARE
            |HIV INFECTIONS|HEALTH STATUS
            DISPARITIES|HUMANS|INFANT|INFANT, NEWBORN
            |KENYA/EPIDEMIOLOGY|LOGISTIC MODELS|MALE|MIDDLE
            AGED|MULTIVARIATE ANALYSIS|NUTRITIONAL
            STATUS|VULNERABLE POPULATIONS


Religious and cultural traits in HIV/AIDS epidemics in sub-Saharan
Africa.
Author:     Bakayev V,Velayati AA, Bahadori M, Tabatabaei SJ, Alaei A, Farahbood A,
            Masjedi MR

Source:     Arch Iran Med. 2007 Oct;10(4):486-97.

Abstract:   Background:
            The pandemic of HIV/AIDS in sub-Saharan Africa and the rise of epidemics in
            Asia to the previously unforeseen level are likely to have global social, economic,
            and political impacts. In this emergency, it is vital to reappraise the weight of
            powerful religious and cultural factors in spreading the disease. The role of Islam
            in shaping values, norms, and public policies in North African states is to be
            appreciated for the lowest HIV prevalence in their populations. Yet, the place of
            religion in prevention of the disease diffusion is not fully understood nor
            worldwide acknowledged by the primary decision makers.


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                            STIs, HIV and AIDS: 2005 - 2008

            Another topic, which has received little attention to date, despite the abundance
            of literature concerning the unfortunate Africa's anti-AIDS campaign, is an issue
            of colonial past.

            Methods:
            To better comprehend the share of both traits in
            diverse spread of HIV in sub-Saharan Africa, we studied the correlation between
            Muslim and Christian proportions in the state's population and HIV rate.

            Results:
            By this method, Muslim percentage came out as a potential predictor of HIV
            prevalence in a given state. In another approach, most subcontinental countries
            were clustered by colocalization and similarity in their leading religion,
            colonial past, and HIV seroprevalence starting from barely noticeable (0.6 - 1.2%,
            for Mauritania, Senegal, Somalia, and Niger) and low levels (1.9 - 4.8%, for Mali,
            Eritrea, Djibouti, Guinea, Guinea-Bissau, Burkina-Faso, and Chad) for Muslim
            populated past possessions of France and Italy, in the northern part of the
            subcontinent. Former territories of France, Belgium, Portugal, and the UK
            formed two other groups of the countries nearing the equator with Catholic
            prevailing (Democratic Republic of Congo, Republic of Congo, Rwanda, Gabon,
            and Burundi) or mixed populations comprising Christian, Muslim, and
            indigenous believers (Benin, Ghana, Uganda, Togo, Angola, Nigeria, Liberia,
            Kenya, Cameroon, Cote d'Ivoire, and Sierra-Leone), which covered the HIV
            prevalence range from 1.9% to 7%. Albeit being traced by origin to the central
            part of the continent, HIV has reached the highest rates in the South, particularly
            Malawi (14.2%), Zambia (16.5%), South Africa (21.5%), Zimbabwe (24.6%),
            Lesotho (28.9%), Botswana (37.3%), and Swaziland (38.8%)-all former British
            colonies with dominating Christian population.

            Conclusion:
            In the group ranking list, a distinct North to
            South oriented incline in HIV rates related to prevailing religion and previous
            colonial history of the country was found, endorsing the preventive role of the
             Islam against rising HIV and the increased vulnerability to menace in states with
            particular colonial record.

Language:   English

Keywords:   |ACQUIRED IMMUNODEFICIENCY SYNDROME| EPIDEMIOLOGY|
            ETHNOLOGY| VIROLOGY|ADOLESCENT|ADULT|AFRICA SOUTH OF
            THE SAHARA/EPIDEMIOLOGY|CULTURE|FEMALE |GEOGRAPHY
            |HIV/GENETICS|HUMANS|MALE|PREVALENCE|RELIGION
            |RISK FACTORS|SEXUAL BEHAVIOR|VIRAL LOAD




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                            STIs, HIV and AIDS: 2005 - 2008


High prevalence of HIV infection among rural tea plantation residents in
Kericho, Kenya.
Author:     Foglia G, Sateren WB, Renzullo PO, Bautista CT, Langat L

Source:     Epidemiol Infect. 2008 May;136(5):694-702. Epub 2007 Jun 29.

Abstract:   Human immunodeficiency virus type 1 (HIV-1) epidemiology among residents
            of a rural agricultural plantation in Kericho, Kenya was studied. HIV-1
            prevalence was 14.3%, and was higher among women (19.1%) than men (11.3%).
            Risk factors associated with HIV-1 for men were age (>or=25 years), marital
            history (one or more marriages), age difference from current spouse (>or=5
            years), Luo ethnicity, sexually transmitted infection (STI) symptoms in the past 6
            months, circumcision (protective), and sexual activity (>or=7 years). Among
            women, risk factors associated with HIV-1 were age (25-29 years, >or=35 years),
            marital history (one or more marriages), age difference from current spouse
            (>or=10 years), Luo ethnicity, STI symptoms in the past 6 months, and a STI
            history in the past 5years. Most participants (96%) expressed a willingness to
            participate in a future HIV vaccine study. These findings will facilitate targeted
            intervention and prevention measures for HIV-1 infection in Kericho.

Language:   English

Keywords:   |ADOLESCENT|ADULT|AGE FACTORS|ETHNIC GROUPS
            |FEMALE|HIV INFECTIONS |EPIDEMIOLOGY |VIROLOGY|HIV-1
            |ISOLATION & PURIFICATION|HUMANS |KENYA
            |EPIDEMIOLOGY|MALE|MIDDLE AGED|PREVALENCE
            |RISK FACTORS|RURAL POPULATION|SEX FACTORS


The protective effect of circumcision on HIV incidence in rural low-risk
men circumcised predominantly by traditional circumcisers in Kenya:
two-year follow-up of the Kericho HIV Cohort Study.
Author:     Shaffer DN, Bautista CT, Sateren WB, Sawe FK, Kiplangat SC, Miruka AO,
            Renzullo PO, Scott PT, Robb ML, Michael NL, Birx DL

Source:     J Acquir Immune Defic Syndr. 2007 Aug 1;45(4):371-9.

Abstract:   Background:
            Three randomized controlled trials (RCTs) have demonstrated that male
            circumcision prevents female-to-male HIV transmission in sub-Saharan Africa.
            Data from prospective cohort studies are helpful in considering generalizability of
            RCT results to populations with unique epidemiologic/cultural characteristics.




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                            STIs, HIV and AIDS: 2005 - 2008

            Methods:
            Prospective observational cohort sub-analysis. A total of 1378 men were
            evaluated after 2 years of follow-up. Baseline sociodemographic and
            behavioral/HIV risk characteristics were compared between 270 uncircumcised
            and 1108 circumcised men. HIV incidence rates (per 100 person-years) were
            calculated, and Cox proportional hazards regression analyses estimated hazard
            rate ratios (HRs).

            Results:
            Of the men included in this study, 80.4% were circumcised; 73.9% were
            circumcised by traditional circumcisers. Circumcision was associated with tribal
            affiliation, high school education, fewer marriages, and smaller age difference
            between spouses (P < 0.05). After 2 years of follow-up, there were 30 HIV
            incident cases (17 in circumcised and 13 in uncircumcised men). Two-year HIV
            incidence rates were 0.79 (95% confidence interval [CI]: 0.46 to 1.25) for
            circumcised men and 2.48 (95% CI: 1.33 to 4.21) for uncircumcised men
            corresponding to a HR = 0.31 (95% CI: 0.15 to 0.64). In one model controlling for
              sociodemographic factors, the HR increased and became non-significant (HR =
            0.55; 95% CI: 0.20 to 1.49). CONCLUSIONS: Circumcision by traditional
            circumcisers offers protection from HIV infection in adult men in rural Kenya.
            Data from well-designed prospective cohort studies in populations with unique
            cultural characteristics can supplement RCT data in recommending public health
            policy.

Language:   English

Keywords:   |ADOLESCENT| ADULT| CHILD|CIRCUMCISION, MALE/STATISTICS
            & NUMERICAL DATA| COHORT STUDIES| HIV INFECTIONS
            |EPIDEMIOLOGY/*PREVENTION & CONTROL/VIROLOGY|HIV-
            1|HUMANS|INCIDENCE|KENYA/EPIDEMIOLOGY| MALE |MEDICINE,
            AFRICAN TRADITIONAL|RISK FACTORS|RURAL POPULATION
            |SEXUAL BEHAVIOR


Antiretroviral durability and tolerability in HIV-infected adults living in
urban Kenya.
Author:     Hawkins C, Achenbach C, Fryda W, Ngare D, Murphy R

Source:     J Acquir Immune Defic Syndr. 2007 Jul 1;45(3):304-10.

Abstract:   Background:
            Insufficient data exist on the durability and tolerability of
            first-line antiretroviral therapy (ART) regimens provided by HIV treatment
            programs implemented in developing countries.




                                           102
                            STIs, HIV and AIDS: 2005 - 2008

            Methods:
            Longitudinal observation of clinical, immunologic, and treatment parameters of
            all HIV-infected adult patients initiated on ART was performed at Saint Mary's
            Mission Hospital in Nairobi, Kenya from September 2004 until August 2006.

            Results:
            A total of 1286 patients were analyzed (59.1% female). Initial ART regimens were
            primarily stavudine, lamivudine, and nevirapine (62.1%). Median ART duration
            was 350 days (11.6 months). Significant improvements in clinical and
            immunologic status were noted after 12 months of therapy. ART switches
            occurred in 701 (54.5%) patients. The cumulative incidence of ART switch at 12
            months was 78.4%. Concurrent ART-related toxicities (40.6%) and tuberculosis
            treatment interactions (28.1%) were the most frequent reasons for ART switch.
            Baseline AIDS symptoms (hazard rate [HR]=1.59, 95% confidence interval [CI]:
            1.28 to 1.98; P<0.01) and a CD4 count<or=100 cells/mm3 (HR=1.20, CI: 1.01 to
            1.43; P=0.04) were independent predictors of ART switch. ART-related clinical
            toxicity occurred in 341 (26.5%) patients. Peripheral neuropathy was reported
            most frequently (20.7%). A CD4 count<or=100 cells/mm3 was an independent
            predictor of clinical toxicity.

            Conclusions:
            Excellent clinical and immunologic responses to ART were observed in
            this urban Kenyan population; however, frequent switches in ART among
            medication classes because of toxicity or drug interactions may limit the
            durability of these responses.

Language:   English

Keywords:   |ADOLESCENT |ADULT |AGED|ANTI-RETROVIRAL AGENTS
            |ADVERSE EFFECTS |THERAPEUTIC USE|CD4 LYMPHOCYTE
            COUNT|DEVELOPING COUNTRIES|DRUG THERAPY, COMBINATION
            |EXANTHEMA|CHEMICALLY INDUCED|PREVENTION & CONTROL
            |FEMALE|GOVERNMENT PROGRAMS|TRENDS|HIV INFECTIONS
            |DRUG THERAPY|IMMUNOLOGY|PREVENTION & CONTROL
            |HUMANS |KENYA|EPIDEMIOLOGY|MALE |MIDDLE
            AGED|PATIENT COMPLIANCE|PERIPHERAL NERVOUS SYSTEM
            DISEASES|CHEMICALLY INDUCED|PREVENTION & CONTROL
            |PROBABILITY|SENTINEL SURVEILLANCE |TREATMENT OUTCOME
            |URBAN POPULATION




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                            STIs, HIV and AIDS: 2005 - 2008


Understanding the differences between contrasting HIV epidemics in
east and west Africa: results from a simulation model of the Four Cities
Study.
Author:     Orroth KK, Freeman EE, Bakker R, Buve A, Glynn JR, Boily MC, White RG,
            Habbema JD, Hayes RJ

Source:     Sex Transm Infect. 2007 Aug;83 Suppl 1:i5-16. Epub 2007 Apr 3.

Abstract:   Objective:
            To determine if the differences in risk behaviours, the proportions of
            males circumcised and prevalences of sexually transmitted infections (STIs)
            observed in two African cities with low prevalence of HIV (Cotonou, Benin, and
            Yaounde, Cameroon) and two cities with high prevalence (Kisumu, Kenya, and
            Ndola, Zambia) could explain the contrasting HIV epidemics in the four cities.

            Methods:
            An individual-based stochastic model, STDSIM, was fitted to the demographic,
            behavioural and epidemiological characteristics of the four urban study
            populations based on data from the Four Cities Study and other relevant sources.
            Model parameters pertaining to STI and HIV natural history and transmission
            were held constant across the four populations. The probabilities of HIV, syphilis
            and chancroid acquisition were assumed to be doubled among uncircumcised
            males. A priori plausible ranges for model inputs and outputs were defined and
            sexual behaviour characteristics, including those pertaining to commercial sex
            workers (CSWs) and their clients, which were allowed to vary across the sites,
            were identified based on comparisons of the empirical data from the four sites.
            The proportions of males circumcised in the model, 100% in Cotonou and
            Yaounde, 25%in Kisumu and 10% in Ndola, were similar to those observed. A
            sensitivity analysis was conducted to assess how changes in critical parameters
            may affect the model fit.

            Results:
            Population characteristics observed from the study that
            were replicated in the model included younger ages at sexual debut and
            marriage in east Africa compared with west Africa and higher numbers of casual
            partners in the past 12 months in Yaounde than in the other three sites. The
            patterns in prevalence of STIs in females in the general population and CSWs
            were well fitted. HIV prevalence by age and sex and time trends in prevalence in
            the model were consistent with study data with the highest simulated
            prevalences in Kisumu and Ndola, intermediate in Yaounde and lowest in
            Cotonou. The sensitivity analysis suggested that the effect of circumcision on the
            development of the HIV epidemics may have been mediated indirectly by its
            effect on ulcerative STI.




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                            STIs, HIV and AIDS: 2005 - 2008

            Conclusions:
            The contrasting HIV epidemics in east and west Africa could be
            replicated in our model by assuming that male circumcision reduced
            susceptibility to HIV, syphilis and chancroid. Varying rates of male circumcision
            may have played an important role in explaining the strikingly different HIV
            epidemics observed in different parts of sub-Saharan Africa.

Language:   English

Keywords:   |ADOLESCENT| ADULT|AFRICA, EASTERN |EPIDEMIOLOGY
            |AFRICA, WESTERN |EPIDEMIOLOGY|CIRCUMCISION, MALE
            |STATISTICS & NUMERICAL DATA|DISEASE OUTBREAKS
            |STATISTICS & NUMERICAL DATA|FEMALE|HIV INFECTIONS
            |EPIDEMIOLOGY|HUMANS|MALE|PREVALENCE|RISK
            FACTORS|RISK-TAKING|SENSITIVITY AND SPECIFICITY|SEXUAL
            BEHAVIOR|STATISTICS & NUMERICAL DATA|SEXUALLY
            TRANSMITTED DISEASES|EPIDEMIOLOGY|TRANSMISSION


The ABCs of HIV prevention in men: associations with HIV risk and
protective behaviors.
Author:     Steele MS, Bukusi E, Cohen CR, Shell-Duncan BA, Holmes KK

Source:     J Acquir Immune Defic Syndr. 2006 Dec 15;43(5):571-6.

Abstact:    Objective:
            To elucidate associations between beliefs in abstinence, fidelity, and condom use
            (the "ABCs" of preventing HIV and other sexually transmitted infections) and
            associated self-reported risk behaviors among Kenyan men.

            Methods:
            We assessed associations of beliefs in the ABCs with sociodemographic
            characteristics and sexual risk behaviors in a respondent-driven sample of 500
            men in Nairobi.

            Results:
            Younger age, single marital status, and higher education
            were associated with beliefs in abstinence and condom use as "best" prevention
            methods; and older age and marriage were associated with belief in fidelity.
            Many of these and other associations persisted in multivariate models. Men
            citing abstinence or fidelity belief less often reported sex with a female sex
            worker (FSW) ever or recent concurrent partnerships less often. Belief in fidelity
            was negatively associated with reported use of condoms ever. Belief in condom
            use to prevent HIV was most common among those having recent concurrent
            partnerships.



                                            105
                            STIs, HIV and AIDS: 2005 - 2008

            Conclusions:
            Beliefs in abstinence, fidelity ("being faithful"), or condom use
            were associated, in plausible directions, with life stages and other demographic
            factors and with corresponding risk and preventive behaviors. Context-specific
            and selective educational promotion of individual ABC components rather than
            comprehensive education from an early age in a wide repertoire of prevention
            strategies ignores the evolution of sexual behaviors and the relative utility of
            different approaches throughout the life course.

Language:   English

Keywords:   |ADOLESCENT |ADULT |AGING |CONDOMS|UTILIZATION |HIV
            NFECTIONS|PREVENTION & CONTROL|HEALTH BEHAVIOR|HEALTH
            KNOWLEDGE, ATTITUDES, PRACTICE|HUMANS|KENYA |MALE
            |MARITAL STATUS |MIDDLE AGED |RISK FACTORS |SAFE SEX


Epidemiology of HIV-1 infection in agricultural plantation residents in
Kericho, Kenya: preparation for vaccine feasibility studies.
Author:     Sateren WB, Foglia G, Renzullo PO, Elson L, Wasunna M, Bautista CT,
            Birx DL

Source:     J Acquir Immune Defic Syndr. 2006 Sep;43(1):102-6.

Abstract:   A cross-sectional study was performed to determine the prevalence and risk
            factors for HIV-1 infection among agricultural plantation residents in Kericho,
            Kenya. Volunteers were recruited, interviewed, and phlebotomized for HIV-1
            serologic testing. Sex-specific adjusted odds ratios were estimated using
            logistic regression. The overall HIV-1 prevalence was 9.9% (81/820), with
            prevalence in women more than twice that in men (17.4% vs 8.0%, P=0.001).
            Among men, elevated HIV-1 prevalence was seen with increasing age, peaking
            in those older than 30 years (10.3%), marriage (10.4%), Luo tribe affiliation
            (23.5%), employment (8.9%), travel (11.0%), and being uncircumcised (29.2%).
            Among women, elevated HIV-1 prevalence was seen in those with no formal
            education (36.8%) and those who received goods in exchange for sex (36.0%).
            More than 97% of volunteers expressed a willingness to participate in future
            HIV-1 studies requiring semiannual visits. HIV prevention efforts have been
            implemented, along with further research to characterize this population for
            future cohort feasibility studies and HIV-1 vaccine efficacy trials.

Language:   English

Keywords:   | ADOLESCENT|AGRICULTURE|STATISTICS & NUMERICAL DATA
            |CANCER VACCINES| CHILD, PRESCHOOL| CROSS-CULTURAL
            COMPARISON| FEMALE| HIV INFECTIONS |EPIDEMIOLOGY
            |IMMUNOLOGY| HUMANS| KENYA/EPIDEMIOLOGY


                                           106
                            STIs, HIV and AIDS: 2005 - 2008

            | MALE| PREVALENCE

HIV testing in national population-based surveys: experience from the
Demographic and Health Surveys.
Author:     Mishra V, Vaessen M, Boerma JT, Arnold F, Way A, Barrere B, Cross A, Hong R,
            Sangha J

Source:     Bull World Health Organ. 2006 Jul;84(7):537-45.

Abstract:   Objectives:
            To describe the methods used in the Demographic and Health Surveys
            (DHS) to collect nationally representative data on the prevalence of human
            immunodeficiency virus (HIV) and assess the value of such data to country HIV
            surveillance systems.

            Methods:
            During 2001-04, national samples of adult women
            and men in Burkina Faso, Cameroon, Dominican Republic, Ghana, Mali, Kenya,
            United Republic of Tanzania and Zambia were tested for HIV. Dried blood spot
            samples were collected for HIV testing, following internationally accepted ethical
            standards. The results for each country are presented by age, sex, and urban
            versus rural residence. To estimate the effects of non-response, HIV prevalence
            among non-responding males and females was predicted using multivariate
            statistical models for those who were tested, with a common set of predictor
            variables.

            Results:
            Rates of HIV testing varied from 70% among Kenyan men to 92%
            among women in Burkina Faso and Cameroon. Despite large differences in HIV
            prevalence between the surveys (1-16%), fairly consistent patterns of HIV
            infection were observed by age, sex and urban versus rural residence, with
            considerably higher rates in urban areas and in women, especially at younger
            ages. Analysis of non-response bias indicates that although predicted HIV
            prevalence tended to be higher in non-tested males and females than in those
            tested, the overall effects of non-response on the observed national estimates of
            HIV prevalence are insignificant.

            Conclusions:
            Population-based surveys can provide reliable, direct estimates of national and
            regional HIV seroprevalence among men and women irrespective of pregnancy
            status. Survey data greatly enhance surveillance systems and the accuracy of
            national estimates in generalized epidemics.

Language:   English




                                           107
                            STIs, HIV and AIDS: 2005 - 2008

Keywords:   | ADOLESCENT |ADULT|DEMOGRAPHY |DEVELOPING COUNTRIES
            |FEMALE|HIV INFECTIONS/*DIAGNOSIS|HEALTH SURVEYS
            |HUMANS |MALE|MASS SCREENING |MIDDLE AGED|POPULATION
            SURVEILLANCE


HIV-1 target cells in foreskins of African men with varying histories of
sexually transmitted infections.
Author:     Donoval BA, Landay AL, Moses S, Agot K, Agot K, Ndinya-Achola JO, Nyagaya
            EA, MacLean I, Bailey RC,

Source:     Am J Clin Pathol. 2006 Mar;125(3):386-91.

Abstract:   Numerous epidemiologic studies have found significant associations between
            lack of circumcision and HIV-1 acquisition in men. To our knowledge, this is the
            first study of human foreskin tissue that examines biologic mechanisms that
            increase susceptibility of uncircumcised African men to HIV-1. Foreskin
            specimens from 20 men with and 19 men with no history of sexually transmitted
            infections were examined for HIV-1 target cells. Most Langerhans cells were
            found in the epithelium; most CD4+ T cells and macrophages were in the
            submucosa. There were no differences in HIV-1 target cells between men with
            and those without history of sexually transmitted infections. However
            Langerhans cells and macrophages were more abundant in the group with a
            history of infection. The densities and positions of HIV-1 target cells in the
            foreskin tissue of these Kenyan men indicate that the inner mucosal surface of
            the human foreskin contains cells that make it highly susceptible to HIV
            infection.

Language:   English

Keywords:   |ADOLESCENT |ADULT |ANTIGENS, CD/METABOLISM |CD4-
            POSITIVE T-LYMPHOCYTES |CYTOLOGY |VIROLOGY
            |CIRCUMCISION, MALE |HIV-1 |PHYSIOLOGY|HUMANS |IMMUNE
            SYSTEM |IMMUNOLOGY |PATHOLOGY |VIROLOGY
            |IMMUNOHISTOCHEMISTRY |KENYA |LANGERHANS CELLS
            |CYTOLOGY |VIROLOGY |MACROPHAGES |CYTOLOGY |VIROLOGY
            |MALE |PENIS/CYTOLOGY |SEXUALLY TRANSMITTED DISEASES
            |COMPLICATIONS |SKIN |CYTOLOGY




                                           108
                             STIs, HIV and AIDS: 2005 - 2008


Evidence for population level declines in adult HIV prevalence in
Kenya.
Author:     Cheluget B, Baltazar G, Orege P, Ibrahim M, Marum LH, Stover J

Source:     Sex Transm Infect. 2006 Apr;82 Suppl 1:i21-6.

Abstract:   The HIV/AIDS epidemic in Kenya has been tracked through annual sentinel
            surveillance in antenatal clinics since 1990. The system started with 13 sites
            and now has over 35. Behaviours have been measured through national
            Demographic and Health Surveys in 1993, 1998, and 2003. The surveillance data
            indicate that prevalence has declined substantially starting in 1998 in five of the
            original 13 sites and starting in 2000 in another four sites. No decline is evident in
            the other five original sites although the 2004 estimate is the lowest recorded.
            Nationally, adult prevalence has declined from 10% in the late 1990s to under 7%
            today. Surveys indicate that both age at first sex and use of condoms are rising
            and that the percentage of adults with multiple partners is falling. It is clear
            that HIV prevalence is now declining in Kenya in a pattern similar to that seen
            in Uganda but seven or eight years later. Although the coverage of preventive
            interventions has expanded rapidly since 2000 this expansion was too late to
            account for the beginnings of the decline in prevalence. More work is needed to
            understand fully the causes of this decline, but it is encouraging to see Kenya
            join the small list of countries experiencing significant declines in HIV
            prevalence.

Language:   English

Keywords:   |ADOLESCENT |ADULT |FEMALE |HIV INFECTIONS EPIDEMIOLOGY
            |PSYCHOLOGY|HUMANS |KENYA|EPIDEMIOLOGY |MALE |MIDDLE
            AGED |PREVALENCE |SENTINEL SURVEILLANCE |SEXUAL
            BEHAVIOR|PSYCHOLOGY|STATISTICS & NUMERICAL DATA
            |SEXUALLY TRANSMITTED DISEASES|EPIDEMIOLOGY


Late marriage and the HIV epidemic in sub-Saharan Africa.
Author:     Bongaarts J,

Source:     Popul Stud (Camb). 2007 Mar;61(1):73-83.

Abstact:    The causes of large variation in the sizes of HIV epidemics among countries in
            sub-Saharan Africa are not well understood. Here we assess the potential roles of
            late age at marriage and a long period of premarital sexual activity as
            population risk factors, using ecological data from 33 sub-Saharan African
            countries and with individual-level data from Demographic and Health Surveys
            (DHS) in Kenya and Ghana in 2003. The ecological analysis finds a significant



                                             109
                            STIs, HIV and AIDS: 2005 - 2008

            positive correlation between HIV prevalence and median age at first marriage,
            and between HIV prevalence and interval between first sexual intercourse and
            first marriage. The individual-level analysis shows that HIV infection per year of
            exposure is higher before than after first marriage. These findings support the
            hypothesis of a link between a high average age at marriage and a long period of
            premarital intercourse during which partner changes are relatively common and
            facilitate the spread of HIV.

Language:   English

Keywords:   |ADOLESCENT |ADULT |AFRICA SOUTH OF THE SAHARA
            |EPIDEMIOLOGY |AGE FACTORS |CIRCUMCISION, MALE
            |STATISTICS & NUMERICAL DATA|DISEASE OUTBREAKS
            |STATISTICS & NUMERICAL DATA |FEMALE |HIV INFECTIONS
            |EPIDEMIOLOGY |HUMANS |MALE |MARRIAGE |STATISTICS &
            NUMERICAL DATA |MIDDLE AGED |SEXUAL BEHAVIOR


Declines in HIV prevalence can be associated with changing sexual
behaviour in Uganda, urban Kenya, Zimbabwe, and urban Haiti.
Author:     Hallett TB, Aberle-Grasse J, Bello G, Boulos LM, Cayemittes MP, Cheluget B,
            Cheluget B, Cheluget B, Chipeta J ,Dorrington R, Dube S, Ekra AK, Garcia-Calleja
            JM, Garnett GP, Greby S, Gregson S, Grove JT, Hader S, Hanson J, Hladik W,
            Ismail S, Kassim S, Kirungi W, Kouassi L, Mahomva A, Marum L, Maurice C,
            Nolan M, Rehle T, Walker N

Source:     Sex Transm Infect. 2006 Apr;82 Suppl 1:i1-8.

Abstact:    Objective:
            To determine whether observed changes in HIV prevalence in countries with
            generalised HIV epidemics are associated with changes in sexual risk
            behaviour.

            Methods:
            A mathematical model was developed to explore the relation
            between prevalence recorded at antenatal clinics (ANCs) and the pattern of
            incidence of infection throughout the population. To create a null model a range
            of assumptions about sexual behaviour, natural history of infection, and
            sampling biases in ANC populations were explored to determine which factors
            maximised declines in prevalence in the absence of behaviour change. Modelled
            prevalence, where possible based on locally collected behavioural data, was
            compared with the observed prevalence data in urban Haiti, urban Kenya, urban
            Cote d'Ivoire, Malawi, Zimbabwe, Rwanda, Uganda, and urban Ethiopia.




                                           110
                            STIs, HIV and AIDS: 2005 - 2008

            Results:
            Recent downturns in prevalence observed in urban Kenya, Zimbabwe, and
            urban Haiti, like Uganda before them, could only be replicated in the model
            through reductions in risk associated with changes in behaviour. In contrast,
            prevalence trends in urban Cote d'Ivoire, Malawi, urban Ethiopia, and Rwanda
            show no signs of changed sexual behaviour. CONCLUSIONS: Changes in
            patterns of HIV prevalence in urban Kenya, Zimbabwe, and urban Haiti are
            quite recent and caution is required because of doubts over the accuracy and
            representativeness of these estimates. Nonetheless, the observed changes are
            consistent with behaviour change and not the natural course of the HIV
            epidemic.

Language:   English

Keywords:   |ADOLESCENT |ADULT |DISEASE OUTBREAKS/*STATISTICS &
            NUMERICAL DATA |FEMALE |HIV INFECTIONS |EPIDEMIOLOGY
            |PSYCHOLOGY |HAITI |EPIDEMIOLOGY |HETEROSEXUALITY
            |HUMANS |KENYA |EPIDEMIOLOGY |MALE |PREVALENCE
            |RISK REDUCTION BEHAVIOR|SEX DISTRIBUTION |SEXUAL
            BEHAVIOR |PSYCHOLOGY |STATISTICS & NUMERICAL DATA
            |UGANDA |EPIDEMIOLOGY |URBAN HEALTH |ZIMBABWE
            |EPIDEMIOLOGY


Gene sequence variation among HIV-1-infected African children.
Author:     Chakraborty R, Reinis M, Rostron T, Philpott S, Dong T, D'Agostino A, Musoke
            R, Silva E, Stumpf M, Weiser B, Burger H, Rowland-Jones SL

Source:     HIV Med. 2006 Mar;7(2):75-84.

Abstract:   Background:
            There are few data on African children infected with nonclade B HIV-1
            in endemic settings, which limits generalizations about pathogenesis and
            progression. Genotypic and phenotypic variations in host immunogenetics and
            HIV-1 negative factor (nef) accessory protein may influence disease progression
            and have frequently been characterized in subjects infected with clade B HIV-1.

            Methods:
            In this descriptive study, we report nef gene sequence variation and
            host genetic polymorphisms in 32 Kenyan children, including 12 slow
            progressors.

            Results:
            Phylogenetic analysis identified HIV-1 clades A, C and D and a




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                            STIs, HIV and AIDS: 2005 - 2008

            recombinant A/D subtype. Grossly defective nef genes or significant changes
            from relevant clade reference sequences were not identified in children with
            delayed disease progression.

            Conclusions:
            nef sequence variations may not be common in perinatally infected African
            children. Further studies are warranted in HIV-1-infected subjects in settings
            where infection is endemic.

Language:   English

Keywords:   | ADOLESCENT| AMINO ACID SEQUENCE |CD4 LYMPHOCYTE COUNT
            |CHILD |CHILD, PRESCHOOL |DISEASE PROGRESSION |FEMALE
             |GENES, MHC CLASS I |GENES, NEF/*GENETICS |HIV
            INFECTIONS/GENETICS/IMMUNOLOGY/*VIROLOGY |HIV LONG-
            TERM SURVIVORS |HIV-1/CLASSIFICATION/*GENETICS
            |HUMANS |INFANT |MALE |MOLECULAR SEQUENCE DATA
            |PHYLOGENY |POLYMORPHISM, GENETIC |SEQUENCE ALIGNMENT
            |SEQUENCE ANALYSIS, DNA/METHODS |VIRAL LOAD


Cost, affordability and cost-effectiveness of strategies to control
tuberculosis in countries with high HIV prevalence.
Author:     Currie CS, Floyd K, Williams BG, Dye C

Source:     BMC Public Health. 2005 Dec 12;5:130.

Abstract:   Background:
            The HIV epidemic has caused a dramatic increase in tuberculosis (TB) in East
            and southern Africa. Several strategies have the potential to reduce the burden of
            TB in high HIV prevalence settings, and cost and cost-effectiveness analyses can
            help to prioritize them when budget constraints exist. However, published cost
            and cost-effectiveness studies are limited.

            Methods:
            Our objective was to compare the cost, affordability and cost-effectiveness of
            seven strategies for reducing the burden of TB in countries with high HIV
            prevalence. A compartmental difference equation model of TB and HIV and
            recent cost data were used to assess the costs (year 2003 USD prices) and effects
            (TB cases averted, deaths averted, DALYs gained) of these strategies in Kenya
            during the period 2004-2023.

            Results:
            The three lowest cost and most cost-effective strategies were
            improving TB cure rates, improving TB case detection rates, and improving both
            together. The incremental cost of combined improvements to case detection and


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                            STIs, HIV and AIDS: 2005 - 2008

            cure was below USD 15 million per year (7.5% of year 2000 government health
            expenditure); the mean cost per DALY gained of these three strategies ranged
            from USD 18 to USD 34. Antiretroviral therapy (ART) had the highest
            incremental costs, which by 2007 could be as large as total government health
            expenditures in year 2000. ART could also gain more DALYs than the other
            strategies, at a cost per DALY gained of around USD 260 to USD 530. Both the
            costs and effects of treatment for latent tuberculosis infection (TLTI) for HIV+
            individuals were low; the cost per DALY gained ranged from about USD 85 to
            USD 370. Averting one HIV infection for less than USD 250 would be as cost-
            effective as improving TB case detection and cure rates to WHO target levels.

            Conclusion:
            To reduce the burden of TB in high HIV prevalence settings, the immediate goal
            should be to increase TB case detection rates and, to the extent possible, improve
            TB cure rates, preferably in combination. Realising the full potential of ART will
            require substantial new funding and strengthening of health system capacity so
            that increased funding can be used effectively.

Language:   English

Keywords:   |AIDS-RELATED OPPORTUNISTIC INFECTIONS |ECONOMICS
            |EPIDEMIOLOGY |PREVENTION & CONTROL|ADOLESCENT
            |ADULT |ANTIRETROVIRAL THERAPY, HIGHLY ACTIVE
            |UTILIZATION |ANTITUBERCULAR AGENTS |THERAPEUTIC USE
            |COST OF ILLNESS |COST-BENEFIT ANALYSIS |DIRECTLY OBSERVED
            THERAPY |FEMALE |HEALTH CARE COSTS | STATISTICS &
            NUMERICAL DATA |HEALTH SERVICES ACCESSIBILITY
            |HUMANS |KENYA |EPIDEMIOLOGY |MIDDLE AGED |MODELS,
            ECONOMETRIC |PREVALENCE |QUALITY-ADJUSTED LIFE YEARS
            |TUBERCULOSIS |ECONOMICS |EPIDEMIOLOGY |PREVENTION &
            CONTROL


The role for government health centers in provision of same-day
voluntary HIV counseling and testing in Kenya.
Author:     Arthur GR, Ngatia G, Rachier C, Mutemi R, Odhiambo J, Gilks CF

Source:     J Acquir Immune Defic Syndr. 2005 Nov 1;40(3):329-35

Abstract:   Objective:
            To explore the role of primary health centers in provision of voluntary
            counseling and testing (VCT) in Kenya.

            Design and setting:
            Prospective service evaluation at 3 (1 urban and 2 rural) government health
            centers. SUBJECTS: Consecutive adult clients.


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                             STIs, HIV and AIDS: 2005 - 2008

            Main outcome measures:
            Uptake of services, user characteristics, quality of service.

            Results:
            Counseling services received 2315 new clients over 26 months. The last quarter
            averaged 101 clients per clinic. More than 80% of clients lived locally. Overall
            93% opted to test, 91% receiving results, 82% on the same day. Most clients tested
            HIV negative (81%). Youth and men were well represented. Few couples (10%)
            attended. Seventeen percent of women were pregnant. Self-referral was common
            and illness was an uncommon reason for testing (<20%). Thirty-one percent of
            clients were referred from VCT to other health center services. Counseling was
            perceived as high quality by users and providers. Validation of the test algorithm
            showed a sensitivity of 98.0% and specificity of 98.7%.

            Conclusion:
            Government health centers in Kenya can be appropriate providers of VCT. This
            pilot helped initiate a new strategy of health center-based VCT in Kenya and this
            has facilitated rapid expansion and more equitable provision for Kenyans.

Language:   English

Keywords:   |AGE FACTORS |COMMUNITY HEALTH CENTERS |STATISTICS &
            NUMERICAL DATA |COUNSELING |STATISTICS & NUMERICAL DATA
            |FAMILY CHARACTERISTICS |FEMALE |GOVERNMENT AGENCIES
            |STATISTICS & NUMERICAL DATA |HIV ANTIBODIES |BLOOD
            |HIV INFECTIONS |DIAGNOSIS |EPIDEMIOLOGY |PREVENTION &
            CONTROL |HIV SERONEGATIVITY |HUMANS |KENYA
            |EPIDEMIOLOGY |MALE |PREGNANT WOMEN |PRIMARY HEALTH
            CARE |STATISTICS & NUMERICAL DATA|QUALITY OF HEALTH CARE
            |SELF CARE |SENSITIVITY AND SPECIFICITY |SEROEPIDEMIOLOGIC
            STUDIES


Piloting post-exposure prophylaxis in Kenya raises specific concerns for
the management of childhood rape.
Author:     Speight CG, Klufio A, Kilonzo SN, Mbugua C, Kuria E, Bunn JE, Taegtmeyer M

Source:     Trans R Soc Trop Med Hyg. 2006 Jan;100(1):14-8. Epub 2005 Oct 12.

Abstract:   Thika District, Kenya, is the site of an operational research study on the
            provision of comprehensive post-rape care, including the free provision of HIV
            post-exposure prophylaxis (PEP). It is a typical rural Kenyan district in terms
            of resources and patient throughput. The high rate of children attending for
            post-rape services was unexpected and had significant programming
            implications. An age-disaggregated analysis of existing quantitative data from
            the first 8 months of service provision was conducted. Ninety-four case records


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                            STIs, HIV and AIDS: 2005 - 2008

            were reviewed, of whom 48 (51%) were in the age range 1.5-17 years inclusive.
            All three cases of male rape were in children. Children were more likely to know
            their assailant than adults and were more likely to be HIV-negative at baseline.
            The majority (86%) of children presented in time for PEP, with adherence and
            completion rates similar to adults but lower rates of 6-week follow-up. The use
            of weight bands to determine drug dosages greatly simplified the appropriate
            and early administration of paediatric PEP. The high rates of childhood rape and
            demand for post-rape services were an enormous challenge for service providers
            and policy-makers.

Language:   English

Keywords:   |ADOLESCENT |ADULT |ANTI-HIV AGENTS |ADMINISTRATION &
            DOSAGE |BODY WEIGHT |CHILD|CHILD ABUSE, SEXUAL |CHILD,
            PRESCHOOL |FEASIBILITY STUDIES |FEMALE |HIV INFECTIONS
            |PREVENTION & CONTROL |HUMANS |INFANT
            |KENYA |LAMIVUDINE |ADMINISTRATION & DOSAGE
            |MALE |PILOT PROJECTS |PRACTICE GUIDELINES AS TOPIC
            |RAPE| RISK FACTORS| RURAL HEALTH|SEXUALLY TRANSMITTED
            DISEASES/PREVENTION & CONTROL|ZIDOVUDINE
            |ADMINISTRATION & DOSAGE


Adult male circumcision: results of a standardized procedure in Kisumu
District, Kenya.
Author:     Krieger JN, Bailey RC, Opeya J, Ayieko B, Opiyo F, Agot K, Parker C, Ndinya-
            Achola JO, Magoha GA, Moses S

Source:     BJU Int. 2005 Nov;96(7):1109-13.

Abstract:   Objective:
            To develop a standard procedure for male circumcision in a resource-poor
            medical setting and prospectively evaluate the outcome in a randomized,
            controlled trial with the incidence of human immunodeficiency virus
            (HIV) as the main outcome, as studies suggest that circumcision is associated
            with a lower incidence of HIV and other sexually transmitted infections in
            high-risk populations.

            Subjects and methods:
            Healthy, uncircumcised, HIV-seronegative men aged 18-24 years from Kisumu
            District, Kenya, were offered participation in a clinical trial using a standard
            circumcision procedure based on "usual" medical procedures in Western Kenya.
            The follow-up included visits at 3, 8 and 30 days after circumcision, with
            additional visits if necessary.
            Healing, satisfaction and resumption of activities were assessed at these visits
            and 3 months from randomization.


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                            STIs, HIV and AIDS: 2005 - 2008

            Results:
            Overall, 17 (3.5%) of the 479 circumcisions were associated with adverse events
            judged definitely, probably or possibly related to the procedure. The most
            common adverse events were wound infections (1.3%), bleeding (0.8%), and
            delayed wound healing or suture line disruption (0.8%). After 30 days, 99% of
            participants reported being very satisfied with the procedure; approximately
            23% reported having had sex and 15% reported that their partners had expressed
            an opinion, all of whom were very satisfied with the outcome. About 96% of the
            men resumed normal general activities within the first week after the procedure.

            Conclusion:
            Safe and acceptable adult male circumcision services can be delivered in
            developing countries should male circumcision ultimately be advocated as a
            public-health measure.

Language:   English

Keywords:   | ADOLESCENT |ADULT |CIRCUMCISION, MALE |METHODS
            |DEVELOPING COUNTRIES |FOLLOW-UP STUDIES |HIV INFECTIONS
            |PREVENTION & CONTROL |HUMANS |INCIDENCE |KENYA
            |MALE |PATIENT SATISFACTION |PROSPECTIVE STUDIES
            |SEXUALLY TRANSMITTED DISEASES | PREVENTION & CONTROL
            |SURGICAL WOUND INFECTION |TREATMENT OUTCOME


HIV type 1 subtypes in circulation in northern Kenya.
Author:     Khamadi SA, Ochieng W, Lihana RW, Kinyua J, Muriuki J, Mwangi J, Lwembe
            R, Kiptoo M, Osman S, Lagat N, Pelle R, Muigai A, Carter JY, Oishi I, Ichimura
            H, Mwaniki DL, Okoth FA, Mpoke S, Songok EM

Source:     AIDS Res Hum Retroviruses. 2005 Sep;21(9):810-4.

Abstract:   The genetic subtypes of HIV-1 circulating in northern Kenya have not been
            characterized. Here we report the partial sequencing and analysis of samples
            collected in the years 2003 and 2004 from 72 HIV-1-positive patients in northern
            Kenya, which borders Ethiopia, Somalia, and Sudan. From the analysis of partial
            env sequences, it was determined that 50% were subtype A, 39% subtype C, and
            11% subtype D. This shows that in the northern border region of Kenya subtypes
            A and C are the dominant HIV-1 subtypes in circulation. Ethiopia is dominated
            mainly by HIV-1 subtype C, which incidentally is the dominant subtype in the
            town of Moyale, which borders Ethiopia. These results show that cross-border
            movements play an important role in the circulation of subtypes in Northern
            Kenya.

Language:   English




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                            STIs, HIV and AIDS: 2005 - 2008

Keywords:    |ADOLESCENT |ADULT |CHILD |CHILD, PRESCHOOL |GENES, ENV
            |GENETICS |HIV ENVELOPE PROTEIN GP41 |GENETICS |HIV
            INFECTIONS |EPIDEMIOLOGY |HIV-1 | GENETICS |HUMANS
            |KENYA/EPIDEMIOLOGY |MALE |MIDDLE AGED |MOLECULAR
            SEQUENCE DATA |PHYLOGENY |SPECIES SPECIFICITY


The relationship between expressed HIV/AIDS-related stigma and
beliefs and knowledge about care and support of people living with
AIDS in families caring for HIV-infected children in Kenya.
Author:     Hamra M, Ross MW, Karuri K, Orrs M, D'Agostino A

Source:     Trop Doct. 2005 Jul;35(3):159-60.

Abstract:   At the end of 2001, AIDS-related deaths had left an estimated 900,000 living
            orphans in Kenya (UNAIDS/WHO Epidemiology fact sheet, Kenya report, 2004).
            Many of those orphans are also HIV+. In Eastern Kenya, the Lea Toto Kangemi
            Outreach Program provides support to families caring for HIV+ children, many
            of whom are orphaned or soon to be orphaned. A major challenge for these
            families is the stigma attached to the family. In 2003, the Kangemi Program
            conducted a household survey of client families. We examined markers of
            expressed stigma and the association between expressed stigma and other
            demographic and belief/knowledge domains. The focus of the present study was
            the specific belief/knowledge domain surrounding care/support of HIV+
            persons. Our goal was to explore this domain in the Kangemi families and to
            examine its relationship to expressed stigma. We created an AIDS-related stigma
            scale from selected items in the household survey and cross-tabulated stigma
            scores with care/support knowledge items. We found significant associations
            between less expressed stigma and greater care/support knowledge. Our results
            have implications for interventions that reduce expressed stigma and/or
            improve quality of care.

Language:   English

Keywords:   |ADOLESCENT |ADULT |CAREGIVERS/*PSYCHOLOGY |CHILD
            |CHILD, PRESCHOOL|FAMILY |FEMALE |HIV INFECTIONS
            |PSYCHOLOGY|HEALTH KNOWLEDGE, ATTITUDES, PRACTICE
            |HUMANS|INFANT |KENYA |MALE |MIDDLE AGED|PREJUDICE
            |STEREOTYPING |ABORTION, INDUCED/*LEGISLATION &
            JURISPRUDENCE/STATISTICS & NUMERICAL DATA
            |ADOLESCENT |ADULT |FEMALE |HUMANS |KENYA/EPIDEMIOLOGY
            |MATERNAL MORTALITY|POSTOPERATIVE COMPLICATIONS
            |PREGNANCY




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                            STIs, HIV and AIDS: 2005 - 2008


Audio computer-assisted self-interviewing (ACASI) may avert socially
desirable responses about infant feeding in the context of HIV.

Author:     Waruru AK, Nduati R, Tylleskar T

Source:     BMC Med Inform Decis Mak. 2005 Aug 2;5:24.

Abstract:   Background:
            Understanding infant feeding practices in the context of HIV and factors that put
            mothers at risk of HIV infection is an important step towards prevention of
            mother to child transmission of HIV (PMTCT). Face-to-face (FTF) interviewing
            may not be a suitable way of ascertaining this information because respondents
            may report what is socially desirable. Audio computer-assisted self-interviewing
            (ACASI) is thought to increase privacy, reporting of sensitive issues and to
            eliminate socially desirable responses. We compared ACASI with FTF
            interviewing and explored its feasibility, usability, and acceptability in a
            PMTCT program in Kenya.

            Methods:
            A graphic user interface (GUI) was developed using Macromedia Authorware
            and questions and instructions recorded in local languages Kikuyu and
            Kiswahili. Eighty mothers enrolled in the PMTCT program were interviewed
            with each of the interviewing mode (ACASI and FTF) and responses obtained in
            FTF interviews and ACASI compared using McNemar's chi2 for paired
            proportions. A paired Student's t-test was used to compare means of age,
            marital-time and parity when measuring interview mode effect and two-sample
            Student's t-test to compare means for samples stratified by education level -
            determined during the exit interview. A Chi-Square (chi2test) was used to
            compare ability to use ACASI by education level. RESULTS: Mean ages for
            intended time for breastfeeding as reported by ACASI were 11 months by ACASI
            and 19 months by FTF interviewing (p < 0.001). Introduction of complementary
            foods at <or=3 months was reported more frequently by respondents in ACASI
            compared to FTF interviews for 7 of 13 complementary food items commonly
            utilized in the study area (p < 0.05). More respondents reported use of
            unsuitable utensils for infant feeding in ACASI than in FTF interviewing (p =
            0.001). In other sensitive questions, 7% more respondents reported unstable
            relationships with ACASI than when interviewed FTF (p = 0.039). Regardless of
            education level, respondents used ACASI similarly and majority (65%) preferred
            it to FTF interviewing mainly due to enhanced usability and privacy. Most
            respondents (79%) preferred ACASI to FTF for future interviewing.

            Conclusion:
            ACASI seems to improve quality of information by increasing response to
            sensitive questions, decreasing socially desirable responses, and by preventing
            null responses and was suitable for collecting data in a setting where formal
            education is low.



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                            STIs, HIV and AIDS: 2005 - 2008



Language:   English

Keywords:   |ADOLESCENT |ADULT |COMPUTER SYSTEMS/*UTILIZATION
            |CONFIDENTIALITY |DISEASE TRANSMISSION, VERTICAL
            |PREVENTION & CONTROL |FEMALE |HIV INFECTIONS
            |PREVENTION & CONTROL |TRANSMISSION |HEALTH CARE
            SURVEYS |METHODS |HUMANS |INFANT |INFANT FOOD
            |INFANT NUTRITION PHYSIOLOGY |INTERVIEWS AS TOPIC
            |METHODS |KENYA |MOTHERS/*PSYCHOLOGY/STATISTICS &
            NUMERICAL DATA |PREGNANCY |QUESTIONNAIRES |SOCIAL
            DESIRABILITY |SOFTWARE|USER-COMPUTER INTERFACE


Communication for HIV/AIDS prevention in Kenya: social-cultural
considerations.
Author:     Muturi N

Source:     J Health Commun. 2005 Jan-Feb;10(1):77-98.

Abstract:   The acquired immune deficiency syndrome (AIDS) epidemic is spreading fast in
            Africa in spite of the various efforts and resources put in place to prevent it.
            In Kenya, reproductive health programs have used the mass media and other
            communication interventions to inform and educate the public about the disease
            and to promote behavior change and healthy sexual practices. This effort has led
            to a discrepancy between awareness and behavioral change among people of
            reproductive age. In this article I examine the discrepancy in Kenya from a
            communications perspective addressing social cultural and related factors
            contributing to the lack of change in behavior and sexual practices. I draw on
            the theoretical framework of Grunig's model of excellence in communication, the
            importance of understanding and relationship building between programs and
            their stakeholders. Data were gathered qualitatively using focus groups and in-
            depth interviews among men and women in rural Kenya. Key findings indicate
            that although awareness of sexually transmitted diseases (STDs) including
            human immunodeficiency virus (HIV)/AIDS is high in Kenya, a majority of the
            population, particularly those in the rural communities, lack understanding of
            the communicated messages. They also lack the knowledge of other ways of
            transmitting HIV particularly among those not sexually involved. Cultural
            beliefs, values, norms, and myths have played a role in the rapidly increasing
            epidemic in the rural communities and yet HIV/AIDS communication programs
            have not addressed these factors adequately. I conclude that successful behavior
            change communication must include strategies that focus on increasing
            understanding of the communicated messages and understanding of the
            audience through application of appropriate methodologies. Building a
            relationship with the audience or stakeholders through dialogues and two-way
            symmetrical communication contributes


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                            STIs, HIV and AIDS: 2005 - 2008

            toward this understanding and the maintenance of the newly adopted behaviors
            and practices.

Language:   English

Keywords:   |ADOLESCENT |ADULT|ATTITUDE TO HEALTH| COMMUNICATION
            CULTURE |FEMALE |FOCUS GROUPS |HIV INFECTIONS PREVENTION
            & CONTROL |PSYCHOLOGY |TRANSMISSION |HEALTH EDUCATION
            |METHODS |HUMANS |KENYA |MALE |MASS MEDIA |MIDDLE
            AGED |RURAL POPULATION |SEXUAL BEHAVIOR |PSYCHOLOGY


No HIV stage is dominant in driving the HIV epidemic in sub-Saharan
Africa.
Author:     Abu-Raddad LJ, Longini IM Jr

Source:     AIDS. 2008 May 31;22(9):1055-61.

Abstract:   Objective:
            To estimate the role of each of the HIV progression stages in fueling
            HIV transmission in sub-Saharan Africa by using the recent measurements of
            HIV transmission probability per coital per HIV stage in the Rakai study.

            Methods:
            A mathematical model, parameterized by empirical data from the Rakai, Masaka,
            and Four-City studies, was used to estimate the proportion of infections due to
            each of the HIV stages in two representative epidemics in sub-Saharan Africa.
            The first setting represents a hyperendemic HIV epidemic (Kisumu, Kenya)
            whereas the second setting represents a generalized but not hyperendemic HIV
            epidemic (Yaounde, Cameroon).

            Results:
            We estimate that 17, 51, and 32% of HIV transmissions in Kisumu were due to
            index cases in their acute, latent, and late stages, respectively. In Yaounde, the
            fractions were 25, 44, and 31%. We found that the relative contribution of each
            stage varied with the epidemic evolution with the acute stage prevailing early on
            when the infection is concentrated in the high-risk groups with the late stage
            playing a major role as the epidemic matured and stabilized. The latent stage
            contribution remained largely stable throughout the epidemic and contributed
            about half of all transmissions.

            Conclusion:
            No HIV stage dominated the epidemical though the latent stage provided the
            largest contribution. The role of each stage depends on the phase of the epidemic
            and on the prevailing levels of sexual risk behavior in the populations in which



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                            STIs, HIV and AIDS: 2005 - 2008

            HIV is spreading. These findings may influence the design and implementation
            of different HIV interventions.

Language:   English

Keywords:    |CAMEROON/EPIDEMIOLOGY |CIRCUMCISION, MALE/STATISTICS &
            NUMERICAL DATA |DISEASE OUTBREAKS/*STATISTICS &
            NUMERICAL DATA |DISEASE PROGRESSION |FEMALE |HIV
            INFECTIONS/*EPIDEMIOLOGY/TRANSMISSION |HUMANS
            |KENYA/EPIDEMIOLOGY |MALE|MODELS, STATISTICAL
            | PROSTITUTION/STATISTICS & NUMERICAL DATA| RISK FACTORS
            | RISK-TAKING |SEXUAL BEHAVIOR/STATISTICS & NUMERICAL
            DATA |SEXUAL PARTNERS


Selection for human immunodeficiency virus type 1 envelope
glycosylation variants with shorter V1-V2 loop sequences occurs during
transmission of certain genetic subtypes and may impact viral RNA
levels.
Author:     Chohan B, Lang D, Sagar M, Korber B, Lavreys L, Richardson B, Overbaugh J

Source:     J Virol. 2005 May;79(10):6528-31.

Abstract:   Designing an effective human immunodeficiency virus type 1 (HIV-1) vaccine
            will rely on understanding which variants, from among the myriad of circulating
            HIV-1 strains, are most commonly transmitted and determining whether such
            variants have an Achilles heel. Here we show that heterosexually acquired
            subtype A HIV-1 envelopes have signature sequences that include shorter V1-V2
            loop sequences and fewer predicted N-linked glycosylation sites relative to the
            overall population of circulating variants. In contrast, recently transmitted
            subtype B variants did not, and this was true for cases where the major risk
            factor was homosexual contact, as well as for cases where it was heterosexual
            contact. This suggests that selection during HIV-1 transmission may vary
            depending on the infecting subtype. There was evidence from 23 subtype A-
            infected women for whom there was longitudinal data that those who were
            infected with viruses with fewer potential N-linked glycosylation sites in V1-V2
            had lower viral set point levels. Thus, our study also suggests that the extent of
            glycosylation in the infecting virus could impact disease progression.

Language:   English.

Keywords:   | DISEASE PROGRESSION| DISEASE TRANSMISSION, HORIZONTAL
            |FEMALE |GLYCOSYLATION |HIV ENVELOPE PROTEIN GP120
            |GENETICS |HIV NFECTIONS |DIAGNOSIS |TRANSMISSION
            |VIROLOGY |HIV-1 |GENETICS |HETEROSEXUALITY |HUMANS



                                            121
                            STIs, HIV and AIDS: 2005 - 2008

            |KENYA |MALE |MOLECULAR SEQUENCE DATA |PEPTIDE
            FRAGMENTS |GENETICS |VARIATION (GENETICS) |VIRAL ENVELOPE
            PROTEINS/*GENETICS |VIRAL LOAD


Characteristics of psychosocial support seeking during HIV-related
treatment in western Kenya.
Author:     Shacham E, Reece M, Ong'or WO, Omollo O, Monahan PO, Ojwang C

Source:     AIDS Patient Care STDS. 2008 Jul;22(7):595-601.

Abstract:   While the characteristics of those who seek psychosocial support following an
            HIV diagnosis have been well documented in western countries where linkages
            between HIV-related treatment and psychosocial support programs are well
            established, little is known about those who become engaged with such services
            in countries of the world where comprehensive HIV-related care and prevention
            systems are continuing to develop. Data were collected from 397 individuals
            who had enrolled in HIV-related psychosocial support groups in western Kenya
            in November 2005.
            Demographic and HIV-related characteristics, as well as assessments of
            psychological distress, were collected from each participant and analyzed by
            gender in order to document the characteristics of those seeking psychosocial
            care in conjunction with their participation in an HIV-related treatment and
            prevention program. Those seeking psychosocial support were primarily female
            (72%), living with HIV for an average of 2.5 years, and unemployed (70%).
            Women were younger and more likely to be either widowed or never married;
            while men were more likely to have advanced HIV disease, including lower CD4
            counts and an AIDS diagnosis. Across all participants, HIV serostatus disclosure
            was rarely reported to sex partners, family members, and friends. Symptoms of
            psychological distress were more prevalent among women on multiple
            measures, including depression, anxiety, paranoid ideation, interpersonal
            sensitivity, and somatization. An increased understanding of the characteristics
            of those likely to seek psychosocial support groups will help HIV program
            managers to develop protocols necessary for facilitating linkages to psychosocial
            support for those enrolled in HIV-related treatment programs. Patient
            engagement in psychosocial support may facilitate improvements in
            psychological function and support an individual's maintenance of HIV
            treatment and prevention behaviors.

Language:   English

Keywords:   |ADOLESCENT| ADULT |ANTI-HIV AGENTS/THERAPEUTIC USE
            |COMMUNITY MENTAL HEALTH SERVICES/UTILIZATION
            |CROSS-SECTIONAL STUDIES |FEMALE |HIV INFECTIONS/*DRUG
            THERAPY/EPIDEMIOLOGY/*PSYCHOLOGY/VIROLOGY |HUMANS



                                           122
                            STIs, HIV and AIDS: 2005 - 2008

            |KENYA|MALE|MIDDLE AGED|PREVALENCE|
            QUESTIONNAIRES|SOCIAL SUPPORT |STRESS,
            PSYCHOLOGICAL/EPIDEMIOLOGY/PHYSIOPATHOLOGY


No HIV stage is dominant in driving the HIV epidemic in sub-Saharan
Africa.
Author:     Abu-Raddad, L. J. and Longini, I. M.

Source:     Jr. AIDS. 2008 May 31; 22(9):1055-61.

Abstract:   Objective:
            To estimate the role of each of the HIV progression stages in fueling HIV
            transmission in sub-Saharan Africa by using the recent measurements of HIV
            transmission probability per coital per HIV stage in the Rakai study.

            Methods:
            A mathematical model, parameterized by empirical data from the Rakai,
            Masaka, and Four-City studies, was used to estimate the proportion of infections
            due to each of the HIV stages in two representative epidemics in sub-Saharan
            Africa. The first setting represents a hyperendemic HIV epidemic (Kisumu,
            Kenya) whereas the second setting represents a generalized but not
            hyperendemic HIV epidemic (Yaounde, Cameroon).

            Results:
            We estimate that 17, 51, and 32% of HIV transmissions in Kisumu were due to
            index cases in their acute, latent, and late stages, respectively. In Yaounde, the
            fractions were 25, 44, and 31%. We found that the relative contribution of each
            stage varied with the epidemic evolution with the acute stage prevailing early on
            when the infection is concentrated in the high-risk groups with the late stage
            playing a major role as the epidemic matured and stabilized. The latent stage
            contribution remained largely stable throughout the epidemic and contributed
            about half of all transmissions.

            Conclusion:
            No HIV stage dominated the epidemical though the latent stage provided the
            largest contribution. The role of each stage depends on the phase of the epidemic
            and on the prevailing levels of sexual risk behavior in the populations in which
            HIV is spreading. These findings may influence the design and implementation
            of different HIV interventions




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Genital herpes has played a more important role than any other sexually
transmitted infection in driving HIV prevalence in Africa.
Author:     Abu-Raddad, L. J.; Magaret, A. S.; Celum, C.; Wald, A.; Longini, I. M. Jr; Self, S.
            G., and Corey, L

Source:     PLoS ONE. 2008; 3(5):e2230.

Abstract:   Background:
            Extensive evidence from observational studies suggests a role for genital herpes
            in the HIV epidemic. A number of herpes vaccines are under development and
            several trials of the efficacy of HSV-2 treatment with acyclovir in reducing HIV
            acquisition, transmission, and disease progression have just reported their results
            or will report their results in the next year. The potential impact of these
            interventions requires a quantitative assessment of the magnitude of the synergy
            between HIV and HSV-2 at the population level.

            Methods and findings:
            A deterministic compartmental model of HIV and HSV-2 dynamics and
            interactions was constructed. The nature of the epidemiologic synergy was
            explored qualitatively and quantitatively and compared to other sexually
            transmitted infections (STIs). The results suggest a more substantial role for
            HSV-2 in fueling HIV spread in sub-Saharan Africa than other STIs. We estimate
            that in settings of high HSV-2 prevalence, such as Kisumu, Kenya, more than a
            quarter of incident HIV infections may have been attributed directly to HSV-2.
            HSV-2 has also contributed considerably to the onward transmission of HIV by
            increasing the pool of HIV positive persons in the population and may explain
            one-third of the differential HIV prevalence among the cities of the Four City
            study. Conversely, we estimate that HIV had only a small net impact on HSV-2
            prevalence.

            Conclusions:
            HSV-2 role as a biological cofactor in HIV acquisition and transmission may have
            contributed substantially to HIV particularly by facilitating HIV spread among
            the low-risk population with stable long-term sexual partnerships. This finding
            suggests that prevention of HSV-2 infection through a prophylactic vaccine may
            be an effective intervention both in nascent epidemics with high HIV incidence
            in the high risk groups, and in established epidemics where a large portion of
            HIV transmission occurs in stable partnerships.




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Paediatric HIV and neurodevelopment Saharan Africa: a systematic
review. in sub-Saharan Africa: a systematic review.
Author:     Abubakar, A.; Van Baar, A.; Van de Vijver, F. J.; Holding, P., and Newton, C. R.

Source:     Trop Med Int Health. 2008 Jul; 13(7):880-7.

Abstract:   Objective:
            To determine the degree of motor, cognitive, language and social-emotional
            impairment related to HIV infection in children living in sub-Saharan Africa
            (SSA).

            Methods:
            Literature searches using MEDLINE and PsycINFO. Additionally, the reference
            lists of previous reviews were checked to ensure that all eligible studies were
            identified. Cohen's d, a measure of effect size, was computed to estimate the
            level of impairment.

            Results:
            Six reports met the inclusion criteria. In infancy a consistent delay in motor
            development was observed with a median value of Cohen's d = 0.97 at 18
            months, indicating a severe degree of impairment. Mental development showed
            a moderate delay at 18 months, with a median value d = 0.67. Language delay
            did not appear until 24 months of age, d = 0.91. Less clear findings occurred in
            older subjects.

            Conclusion:
            Although HIV has been shown to affect all domains of child functioning, motor
            development is the most apparent in terms of severity, early onset, and
            persistence across age groups. However, motor development has been the most
            widely assessed domain while language development has been less vigorously
            evaluated in SSA, hence an accurate quantitative estimate of the effect cannot yet
            be made.


Dual infection with HIV and malaria fuels the spread of both diseases in
sub-Saharan Africa.
Author:     Abu-Raddad, L. J.; Patnaik, P., and Kublin, J. G.

Source:     Science. 2006 Dec 8; 314(5805):1603-6.

Abstract:   Mounting evidence has revealed pathological interactions between HIV and
            malaria in dually infected patients, but the public health implications of the
            interplay have remained unclear. A transient almost one-log elevation in HIV
            viral load occurs during febrile malaria episodes; in addition, susceptibility to



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            malaria is enhanced in HIV-infected patients. A mathematical model applied to a
            setting in Kenya with an adult population of roughly 200,000 estimated that,
            since 1980, the disease interaction may have been responsible for 8,500 excess
            HIV infections and 980,000 excess malaria episodes. Co-infection might also have
            facilitated the geographic expansion of malaria in areas where HIV prevalence is
            high. Hence, transient and repeated increases in HIV viral load resulting from
            recurrent co-infection with malaria may be an important factor in promoting the
            spread of HIV in sub-Saharan Africa.


Male circumcision in Siaya and Bondo Districts, Kenya: prospective
cohort study to assess behavioral disinhibition following circumcision.
Author:     Agot, K. E.; Kiarie, J. N.; Nguyen, H. Q.; Odhiambo, J. O.; Onyango, T. M., and
            Weiss, N. S.

Source:     J Acquir Immune Defic Syndr. 2007 Jan 1; 44(1):66-70.

Abstract:   Background:
            Evidence for efficacy of male circumcision as an HIV prevention measure is
            increasing, but there is serious concern that men who are circumcised may
            subsequently adopt more risky sexual behaviors.

            Methods:
            Using a prospective cohort study, we compared sexual behaviors of 324 recently
            circumcised and 324 uncircumcised men at 1, 3, 6, 9, and 12 months after
            circumcision/study enrollment. The main outcome indicators were incidence of
            sexual behaviors known to place men at increased risk of acquiring HIV,
            namely, having sex with partners other than their wife/wives for married men
            or other than "regular" girlfriends for unmarried men.

            Results:
            During the first month following circumcision, men were 63% and 61% less
            likely to report having 0 to 0.5 and >0.5 risky sex acts/week, respectively, than
            men who remained uncircumcised. This difference disappeared during the
            remainder of follow-up, with no excess of reported risky sex acts among
            circumcised men. Similar results were observed for risky unprotected sex acts,
            number of risky sex partners, and condom use.

            Discussion:
            During the first year post-circumcision, men did not engage in more risky sexual
            behaviors than uncircumcised men, suggesting that any protective effect of male
            circumcision on HIV acquisition is unlikely to be offset by an adverse behavioral
            impact.




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HLA and T in cross-reactive immune responses to HIV-1 subtype A,
CRF01_AE and CRF02_AG cell elements vaccine sequence in Ivorian
blood donors. Vaccine.
Author:     Aidoo, M.; Sawadogo, S.; Bile, E. C.; Yang, C.; Nkengasong, J. N., and McNicholl,
            J. M.

Abstract:   Comprehensive understanding of the determinants of cross-subtype immune
            responses in HIV infection is critical to developing efficacious HIV vaccines
            against multiple viral subtypes. Because HIV-1 subtype A or recombinants
            comprising subtype A are prevalent in Africa and parts of Asia where HIV is
            spreading, we assessed the determinants of cross-subtype immune responses in
            HIV-infected blood donors from Cote d'Ivoire to peptides from a candidate
            CRF02_AG vaccine sequence, a subtype A sequence from western Kenya and a
            CRF01_AE sequence from Thailand. We present evidence that immune
            recognition of multiple viral subtypes is maintained by recognition of multiple
            epitopes. Our data suggest that complete escape of HIV from immune
            recognition is uncommon. Evaluation of these frequently generated cross-
            reactive responses should be included in immunogenicity trials of HIV vaccines.


Independent associations of insulin resistance with high whole-body
intermuscular and low leg subcutaneous adipose tissue distribution in
obese HIV- infected women.
Author:     J. B.; Kenya, S.; He, Q.; Wainwright, M.; Berk, E. S.; Heshka, S.; Kotler, D. P., and
            Engelson, E. S.

Source:     Am J Clin Nutr. 2007 Jul; 86(1):100-6.

Abstract:   Background:
            Obesity and insulin resistance are growing problems in HIV-positive (HIV+)
            women receiving highly active antiretroviral therapy (HAART).

            Objective:
            The objective was to determine the contribution of adipose tissue (AT)
            enlargement and distribution to the presence of insulin resistance in obese HIV+
            women.

            Design:
            Whole-body intermuscular AT (IMAT), visceral AT (VAT), subcutaneous AT
            (SAT), and SAT distribution (leg versus upper body) were measured by whole-
            body magnetic resonance imaging. Insulin sensitivity (S(I)) was measured with
            an intravenous glucose tolerance test in obese HIV+ women recruited because of
            their desire to lose weight (n=17) and in obese healthy controls (n=32).



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            Results:
            The HIV+ women had relatively less whole-body SAT and more VAT and IMAT
            than did the controls (P<0.05 for all). A significant interaction by HIV status was
            observed for the relation of total SAT with S(I) (P<0.001 for the regression's slope
            interactions after adjustment for age, height, and weight). However, relations of
            IMAT, VAT, and SAT distribution (leg SAT as a percentage of total SAT; leg
            SAT%) with S(I) did not differ significantly between groups. For both groups
            combined, the best model predicting a low S(I) included significant contributions
            by both high IMAT and low leg SAT%, independent of age, height, and weight,
            and no interaction between groups was observed (overall r(2)=0.44, P=0.0003).

            Conclusion:
            In obese HIV+ women, high whole-body IMAT and low leg SAT% distribution
            are independently associated with insulin resistance.


Characterization of CD8 T-cell responses in HIV-1-exposed seronegative
commercial sex workers from Nairobi, Kenya.
Author:     Alimonti, J. B.; Kimani, J.; Matu, L.; Wachihi, C.; Kaul, R.; Plummer, F. A., and
            Fowke, K. R.

Source:     Immunol Cell Biol. 2006 Oct; 84(5):482-5.

Abstract:   CD8+ T-lymphocyte responses are crucial to the control of HIV-1; therefore,
            studying the CD8+ immune response in a naturally resistant population could
            provide valuable insights into an effective anti-HIV response in healthy
            uninfected individuals. Approximately 5-10% of the women in the Pumwani
            Commercial Sex Worker cohort in Nairobi, Kenya, have been highly exposed to
            HIV-1 yet remain HIV-IgG-seronegative and HIV-PCR negative (HIV(ES)). As
            IFN-gamma production correlates to cytotoxic function, the CD8+ T-lymphocyte
            IFN-gamma response to HIV p24 peptides was compared in HIV(ES) and HIV-
            infected (HIV+) individuals. Almost 40% of the HIV(ES) had a CD8+ IFN-
            gamma+ response that was five times lower in magnitude than that of the HIV+
            group. The breadth of the response in HIV(ES) was very narrow and focused
            primarily on one peptide that is similar to the protective KK10 peptide. In the
            HIV+ group, low peripheral CD4+ counts negatively influenced the number of
            CD8+ cells producing IFN-gamma, which may undermine the ability to control
            HIV. Overall, many of the HIV(ES) women possess a HIV-1 p24-specific CD8+
            IFN-gamma response, providing evidence to the specificity needed for an
            effective HIV vaccine




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CD4+ T cell responses in HIV-exposed seronegative women are
qualitatively distinct from those in HIV-infected women.
Author:     Alimonti, J. B.; Koesters, S. A.; Kimani, J.; Matu, L.; Wachihi, C.; Plummer, F. A.,
            and Fowke, K. R.

Source:     J Infect Dis. 2005 Jan 1; 191(1):20-4.

Abstract:   The immune response of human immunodeficiency virus (HIV)-exposed
            seronegative (ESN) women may be qualitatively different from that in those
            infected with HIV (HIV(+)). In a cohort of female commercial sex workers in
            Nairobi, Kenya, we found significantly lower (P< or =.01) levels of CD4(+)-
            specific immune activation and apoptosis in the ESN women compared with
            those in the HIV(+) women. Compared with the HIV(+) women, a lower
            proportion of the ESN women showed p24 peptide pool responses by the short-
            term, CD4(+)-specific, interferon (IFN)- gamma intracellular cytokine staining
            assay, whereas the proportion showing responses by the long-term, CD8(+)-
            depleted T cell proliferation assay was similar. Interestingly, the ESN responders
            had a 4.5-fold stronger proliferation response (P=.002) than the HIV(+) group.
            These data suggest that, compared with those in HIV(+) women, CD4(+) T cells
            in ESN women have a much greater ability to proliferate in response to p24
            peptides.


Widowhood in the era of HIV/AIDS: a case study of Siaya District,
Kenya.
Author:     Ambasa-Shisanya, C. R.

Source:     SAHARA J. 2007 Aug; 4(2):606-15.

Abstract:   Luo women are believed to acquire contagious cultural impurity after the death
            of their husbands that is perceived as dangerous to other people. To neutralise
            this impure state, a sexual cleansing rite is observed. In the indigenous setting,
            the ritual was observed by a brother-in-law or cousin of the deceased husband
            through a guardianship institution. However, with the emergence of HIV/AIDS,
            many educated brothers-in-law refrain from the practice and instead hire
            professional cleansers as substitutes. If the deceased spouses were HIV positive,
            the ritual places professional cleansers at risk of infection. Thereafter, they could
            act as a bridge for HIV/AIDS transmission to other widows and to the general
            population. This paper provides insights into reasons for continuity of
            widowhood rites in Siaya District. Twelve focus group discussions and 20 in-
            depth interviews were conducted.The cultural violence against Luo widows
            could spread HIV/AIDS, but Christianity and condoms act as coping
            mechanisms.




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Evidence for expression of endogenous retroviral sequences on primate
reproductive tissues and detection of cross-reactive ERVS antigens in the
baboon ovary: a review.
Author:     Arimi, M. M.; Nyachieo, A.; Langat, D. K.; Abdi, A. M., and Mwenda, J. M..

Source:     East Afr Med J. 2006 Feb; 83(2):106-12.

Abstract:   Objective:
            To review recent research findings on the specific expression of endogenous
            retroviral sequences (ERVS) in reproductive tissues and their possible
            physiological roles. ERVS have been implicated in several biological events such
            as induction of resistance to exogenous retrovirus invasion, involvement in
            placental trophoblast formation, sperm maturation and differentiation; and
            stimulation of local immunosuppression to protect the foetus from
            immunological attack.

            Data sources:
            Critical review of relevant articles and abstracts cited in international and local
            journals, literature searches on Medline and Medchem up to 2005.

            Data synthesis:
            Retroviruses have been implicated in the induction of tumour and
            immunological disorders. Over the years, endogenous retroviruses (ERVs) and
            retroviral elements have been detected in the genome of many vertebrate species,
            including primates. The evidence for the presence of retroviruses in the primate
            tissues such as the placenta, ovary, breast, testis and epididymis has been
            documented using electron microscopic studies. Retrovirus-like particles were
            found budding from the basal membrane of syncytiotrophoblasts, as well as in
            tumour cell lines in embryonic carcinoma or teratocarcinomas. Apart from their
            pathological effects, recent evidence suggests that these ERVs may play useful
            roles in normal physiological events.

            Results:
            Recent studies indicate the expression of endogenous retroviruses in the testis,
            epididymis, placenta and breast. However, limited data exist on the detection of
            ERVs in the ovary. Overall, the precise functions for ERVs in these tissues are not
            well understood. In the testis and epididymis, speculative functions may include
            among others spermatogenesis and/or sperm maturation (differentiation)
            whereas in placenta they are possibly associated with trophoblast fusion and
            locally induced immunosuppression to protect the foetus from immunological
            attack. Experiments in our laboratory have indicated restricted expression of
            retroviral antigens including baboon endogenous retroviral proteins (BERV),
            ERV-3, HIV-1 gp41 and HERV-K env in the baboon ovary.




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            Conclusion:
            ERVs are specifically expressed in different mammalian reproductive tissues and
            may have unique physiological roles.


Behaviour change in clients of health centre-based voluntary HIV
counselling and testing services in Kenya.
Author:     Arthur, G.; Nduba, V.; Forsythe, S.; Mutemi, R.; Odhiambo, J., and Gilks, C..

Source:     Sex Transm Infect. 2007 Dec; 83(7):541-6.

Abstract:   Objective:
            To explore behaviour change, baseline risk behaviour, perception of risk, HIV
            disclosure and life events in health centre-based voluntary counselling and
            testing (VCT) clients.

            Design and setting:
            Single-arm prospective cohort with before-after design at three (one urban and
            two rural) government health centres in Kenya; study duration 2 years, 1999-
            2001.

            Subjects:      Consecutive eligible adult clients.

            Main outcome measures:
            Numbers of sexual partners, partner type, condom use, reported symptoms of
            sexually transmitted infection, HIV disclosure and life events.

            Results:
            High rates of enrollment and follow-up provided a demographically
            representative sample of 401 clients with mean time to follow-up of 7.5 months.
            Baseline indicators showed that clients were at higher risk than the general
            population, but reported a poor perception of risk. Clients with multiple partners
            showed a significant reduction of sexual partners at follow-up (16% to 6%;
            p<0.001), and numbers reporting symptoms of sexually transmitted infection
            decreased significantly also (from 40% to 15%; p<0.001). Condom use improved
            from a low baseline. Low rates of disclosure (55%) were reported by HIV-
            positive clients. Overall, no changes in rates of life events were seen.

            Conclusion:
            This study suggests that significant prevention gains can be recorded in clients
            receiving health centre-based VCT services in Africa. Prevention issues should be
            considered when refining counselling and testing policies for expanding
            treatment programmes.




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Potential impact of infant feeding recommendations on mortality and
HIV-infection in children born to HIV-infected mothers in Africa: a
simulation.
Author:     Atashili, J.; Kalilani, L.; Seksaria, V., and Sickbert-Bennett, E. E.

Source:     BMC Infect Dis. 2008; 8:66.

Abstract:   Background:
            Although breast-feeding accounts for 15-20% of mother-to-child transmission
            (MTCT) of HIV, it is not prohibited in some developing countries because of the
            higher mortality associated with not breast-feeding. We assessed the potential
            impact, on HIV infection and infant mortality, of a recommendation for shorter
            durations of exclusive breast-feeding (EBF) and poor compliance to these
            recommendations.

            Methods:
            We developed a deterministic mathematical model using primarily parameters
            from published studies conducted in Uganda or Kenya and took into account
            non-compliance resulting in mixed-feeding practices. Outcomes included the
            number of children HIV-infected and/or dead (cumulative mortality) at 2 years
            following each of 6 scenarios of infant-feeding recommendations in children born
            to HIV-infected women: Exclusive replacement-feeding (ERF) with 100%
            compliance, EBF for 6 months with 100% compliance, EBF for 4 months with
            100% compliance, ERF with 70% compliance, EBF for 6 months with 85%
            compliance, EBF for 4 months with 85% compliance.

            Results:
            In the base model, reducing the duration of EBF from 6 to 4 months reduced HIV
            infection by 11.8% while increasing mortality by 0.4%. Mixed-feeding in 15% of
            the infants increased HIV infection and mortality respectively by 2.1% and 0.5%
            when EBF for 6 months was recommended; and by 1.7% and 0.3% when EBF for
            4 months was recommended. In sensitivity analysis, recommending EBF resulted
            in the least cumulative mortality when the a) mortality in replacement-fed
            infants was greater than 50 per 1000 person-years, b) rate of infection in
            exclusively breast-fed infants was less than 2 per 1000 breast-fed infants per
            week, c) rate of progression from HIV to AIDS was less than 15 per 1000 infected
            infants per week, or d) mortality due to HIV/AIDS was less than 200 per 1000
            infants with HIV/AIDS per year.

            Conclusion:
            Recommending shorter durations of breast-feeding in infants born to HIV-
            infected women in these settings may substantially reduce infant HIV infection
            but not mortality. When EBF for shorter durations is recommended, lower
            mortality could be achieved by a simultaneous reduction in the rate of




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            progression from HIV to AIDS and or HIV/AIDS mortality, achievable by the
            use of HAART in infants.


Hormonal contraceptive use, herpes simplex virus infection, and risk of
HIV-1 acquisition among Kenyan women.
Author:     Baeten, J. M.; Benki, S.; Chohan, V.; Lavreys, L.; McClelland, R. S.; Mandaliya, K.;
            Ndinya-Achola, J. O.; Jaoko, W., and Overbaugh, J. Kenyan women.

Source :    AIDS. 2007 Aug 20; 21(13):1771-7.

Abstract:   Background:
            Studies of the effect of hormonal contraceptive use on the risk of HIV-1
            acquisition have generated conflicting results. A recent study from Uganda and
            Zimbabwe found that women using hormonal contraception were at increased
            risk for HIV-1 if they were seronegative for herpes simplex virus type 2 (HSV-2),
            but not if they were HSV-2 seropositive.

            Objective:
            To explore the effect of HSV-2 infection on the relationship between hormonal
            contraception and HIV-1 in a high-risk population. Hormonal contraception has
            previously been associated with increased HIV-1 risk in this population.

            Methods:
            Data were from a prospective cohort study of 1206 HIV-1 seronegative sex
            workers from Mombasa, Kenya who were followed monthly. Multivariate Cox
            proportional hazards analyses were used to adjust for demographic and
            behavioral measures and incident sexually transmitted diseases.

            Results:
            Two hundred and thirty-three women acquired HIV-1 (8.7/100 person-years).
            HSV-2 prevalence (81%) and incidence (25.4/100 person-years) were high. In
            multivariate analysis, including adjustment for HSV-2, HIV-1 acquisition was
            associated with use of oral contraceptive pills [adjusted hazard ratio (HR), 1.46;
            95% confidence interval (CI), 1.00-2.13] and depot medroxyprogesterone acetate
            (adjusted HR, 1.73; 95% CI, 1.28-2.34). The effect of contraception on HIV-1
            susceptibility did not differ significantly between HSV-2 seronegative versus
            seropositive women. HSV-2 infection was associated with elevated HIV-1 risk
            (adjusted HR, 3.58; 95% CI, 1.64-7.82).

            Conclusions:
            In this group of high-risk African women, hormonal contraception and HSV-2
            infection were both associated with increased risk for HIV-1 acquisition. HIV-1
            risk associated with hormonal contraceptive use was not related to HSV-2
            serostatus



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HIV-1 subtype D infection is associated with faster disease progression
than subtype A in spite of similar plasma HIV-1 loads.
Author:     Baeten, J. M.; Chohan, B.; Lavreys, L.; Chohan, V.; McClelland, R. S.; Certain, L.;
            Mandaliya, K.; Jaoko, W., and Overbaugh, J.

Source :    J Infect Dis. 2007 Apr 15; 195(8):1177-80.

Abstract:   We investigated the effect of human immunodeficiency virus type 1 (HIV-1)
            subtype on disease progression among 145 Kenyan women followed from the
            time of HIV-1 acquisition. Compared with those infected with subtype A,
            women infected with subtype D had higher mortality (hazard ratio, 2.3 [95%
            confidence interval, 1.0-5.6]) and a faster rate of CD4 cell count decline (P=.003).
            The mortality risk persisted after adjustment for plasma HIV-1 load. There were
            no differences in plasma viral load by HIV-1 subtype during follow-up. HIV-1
            subtype D infection is associated with a >2-fold higher risk of death than subtype
            A infection, in spite of similar plasma HIV-1 loads.


Female-to-male infectivity of HIV-1 among circumcised and
uncircumcised Kenyan men.
Author:     Baeten, J. M.; Richardson, B. A.; Lavreys, L.; Rakwar, J. P.; Mandaliya, K.; Bwayo,
            J. J., and Kreiss, J. K.

Source :    J Infect Dis. 2005 Feb 15; 191(4):546-53.

Abstract:   Background:
            A lack of male circumcision has been associated with increased risk of human
            immunodeficiency virus type 1 (HIV-1) acquisition in a number of studies, but
            questions remain as to whether confounding by behavioral practices explains
            these results. The objective of the present study was to model per-sex act
            probabilities of female-to-male HIV-1 transmission (i.e., infectivity) for
            circumcised and uncircumcised men, by use of detailed accounts of sexual
            behavior in a population with multiple partnerships.

            Methods:
            Data were collected as part of a prospective cohort study of HIV-1 acquisition
            among 745 Kenyan truck drivers. Sexual behavior with wives, casual partners,
            and prostitutes was recorded at quarterly follow-up visits. Published HIV-1
            seroprevalence estimates among Kenyan women were used to model HIV-1 per-
            sex act transmission probabilities.

            Results:
            The overall probability of HIV-1 acquisition per sex act was 0.0063 (95%
            confidence interval, 0.0035-0.0091). Female-to-male infectivity was significantly


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            higher for uncircumcised men than for circumcised men (0.0128 vs. 0.0051;
            P=.04). The effect of circumcision was robust in subgroup analyses and across a
            wide range of HIV-1 prevalence estimates for sex partners.

            Conclusions:
            After accounting for sexual behavior, we found that uncircumcised men were at
            a >2-fold increased risk of acquiring HIV-1 per sex act, compared with
            circumcised men. Moreover, female-to-male infectivity of HIV-1 in the context of
            multiple partnerships may be considerably higher than that estimated from
            studies of HIV-1-serodiscordant couples. These results may explain the rapid
            spread of the HIV-1 epidemic in settings, found throughout much of Africa, in
            which multiple partnerships and a lack of male circumcision are common.


Polymorphisms in IRF-1 associated with resistance to HIV-1 infection in
highly exposed uninfected Kenyan sex workers.
Author:     Ball, T. B.; Ji, H.; Kimani, J.; McLaren, P.; Marlin, C.; Hill, A. V., and Plummer, F.
            A.

Source :    AIDS. 2007 May 31; 21(9):1091-101.

Abstract:   Objective:
            To determine the correlation between polymorphisms in the IL-4 gene cluster
            and resistance to HIV-1 infection.

            Design:
            A cross-sectional genetic analysis of polymorphisms within the IL-4 gene cluster
            was conducted in a well-described female sex worker cohort from Nairobi,
            Kenya, known to exhibit differential susceptibility to HIV-1 infection.

            Methods:
            Microsatellite genotyping was used to screen six microsatellite markers in the IL-
            4 gene cluster for associations with HIV-1 resistance. Further analysis of the
            interferon regulatory factor 1 (IRF-1) gene was conducted by genomic
            sequencing. Associations between IRF-1 gene polymorphisms and the HIV-1
            resistance phenotype were determined using the chi-square test and Kaplan-
            Meier survival analysis. The functional consequence of IRF-1 polymorphism was
            conducted by quantitative Western blot.

            Results:
            Three polymorphisms in IRF-1, located at 619, the microsatellite region and 6516
            of the gene, showed associations with resistance to HIV-1 infection. The 619A,
            179 at IRF-1 microsatellite and 6516G alleles were associated with the HIV-1-
            resistant phenotype and a reduced likelihood of seroconversion. Peripheral
            blood mononuclear cells from patients with protective IRF-1 genotypes



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            exhibited significantly lower basal IRF-1 expression and reduced responsiveness
            to exogenous IFN-gamma stimulation.

            Conclusion:
            Polymorphisms in the IRF-1 gene are associated with resistance to infection by
            HIV-1 and a lowered level of IRF-1 protein expression. This study adds IRF-1, a
            transcriptional immunoregulatory gene, to the list of genetic correlates of altered
            susceptibility to HIV-1. This is the first report suggesting that a viral
            transcriptional regulator might contribute to resistance to HIV-1. Further
            functional analysis on the role of IRF-1 polymorphisms and HIV-1 resistance is
            underway.


Cost effectiveness and delivery study for future HIV vaccines.
Author:     Barth-Jones, D. C.; Cheng, H.; Kang, L. Y.; Kenya, P. R.; Odera, D.; Mosqueira, N.
            R.; Mendoza, W.; Portela, M. C.; Brito, C.; Tangcharoensathien, V.; Akaleephan,
            C.; Supantamart, S.; Patcharanarumol, W.; de Macedo Brigido, L. F.; Fonseca, M.
            G.; Sanchez, M.

Source :    AIDS. 2005 Sep 2; 19(13):w1-6. .; Chang, M. L.; Osmanov, S.; Avrett, S.; Esparza,
            J., and Griffiths, U.

Abstract:   Research teams from five countries, Brazil, China, Kenya, Peru and Thailand,
            have initiated a policy-maker survey on vaccine delivery, cost studies for future
            HIV vaccination programmes, and associated simulation modeling exercises
            analysing the relative cost-effectiveness of potential HIV vaccination strategies.
            The survey assesses challenges and opportunities for future country-level HIV
            vaccination strategies, providing data on the vaccine characteristics (e.g. vaccine
            efficacies for susceptibility, infectiousness and disease progression) and
            vaccination programme strategies to be considered in the cost-effectiveness
            modeling analyses. The study will provide decision-makers with modeling data
            on vaccination policy considerations that will assist in developing country-level
            capacities for future HIV vaccine policy adoption and effective delivery systems,
            and will help delineate the long-term financial requirements for sustainable HIV
            vaccination programmes. The WHO-UNAIDS HIV Vaccine Initiative and the
            collaborating researchers welcome comments or questions from policy makers,
            health professionals and other stakeholders in the public and private sectors
            about this effort to help advance policy and capacity related to future potential
            HIV vaccines.




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HIV/AIDS and cultural practices in western Kenya: the impact of sexual
cleansing rituals on sexual behaviours.
Author:     R.; Ngare, D.; Sidle, J.; Ayuku, D.; Baliddawa, J., and Greene, J.

Source :    Cult Health Sex. 2008 Aug; 10(6):587-99.

Abstract:   This paper reports on an exploratory study examining the role of sexual
            cleansing rituals in the transmission of HIV among the Luo community in
            western Kenya. Data were collected using both in-depth interviews and focus
            group discussions. The study population consisted of 38 widows, 12 community
            elders and 44 cleansers. Data were collected on non-behavioural causes,
            behavioural causes and behavioural indicators associated with sexual rituals.
            Content analysis revealed five central themes: the effect of the ritual on sexual
            behaviours; factors contributing to the continued practice of the ritual, including
            a sub-theme on the commercialization of the ritual; the inseparable relationship
            between the sanctity of sex, prosperity and fertility of the land; and the effects of
            modernization on the ritual, including a sub-theme on the effects of mass media
            on HIV-prevention awareness campaigns. Causal factors of unchanging sexual
            behaviours are deeply rooted in traditional beliefs, which the community uphold
            strongly. These beliefs encourage men and women to have multiple sexual
            partners in a context where the use of condoms is rejected and little HIV testing
            is carried out.


Quantification of genital human immunodeficiency virus type 1 (HIV-1)
DNA in specimens from women with low plasma HIV-1 RNA levels
typical of HIV-1 nontransmitters.
Author:     Benki, S.; McClelland, R. S.; Emery, S.; Baeten, J. M.; Richardson, B. A.; Lavreys,
            L.; Mandaliya, K., and Overbaugh, J.

Source :    J Clin Microbiol. 2006 Dec; 44(12):4357-62.

Abstract:   Studies of human immunodeficiency virus type 1 (HIV-1) transmission suggest
            that genital HIV-1 RNA and DNA may both be determinants of HIV-1
            infectivity. Despite its potential role in HIV-1 transmission, there are limited
            quantitative data on genital HIV-1 DNA. Here we validated an in-house real-
            time PCR method for quantification of HIV-1 DNA in genital specimens. In
            reactions with 100 genomes to 1 genome isolated from a cell line containing one
            HIV-1 provirus/cell, this real-time PCR assay is linear and agrees closely with a
            commercially available real-time PCR assay specific for a cellular housekeeping
            gene. In mock genital samples spiked with low numbers of HIV-1-infected cells
            such that the expected HIV-1 DNA copy number/reaction was 100, 10, or 5, the
            average copy number/reaction was 80.2 (standard deviation [SD], 28.3), 9.1 (SD,
            5.4), or 3.1 (SD, 2.1), respectively. We used this method to examine genital HIV-1


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            DNA levels in specimens from women whose low plasma HIV-1 RNA levels are
            typical of HIV-1 nontransmitters. The median HIV-1 DNA copy number in
            endocervical secretions from these women (1.8 HIV-1 DNA copies/10,000 cells)
            was lower than that for women with higher plasma HIV-1 RNA levels (16.6 HIV-
            1 DNA copies/10,000 cells) (P=0.04), as was the median HIV-1 DNA copy
            number in vaginal secretions (undetectable versus 1.0 HIV-1 DNA copies/10,000
            cells). These data suggest that women with low plasma HIV-1 RNA and thus a
            predicted low risk of HIV-1 transmission have low levels of genital HIV-1 cell-
            associated virus. The assay described here can be utilized in future efforts to
            examine the role of cell-associated HIV-1 in transmission.


Infant feeding practices among HIV infected women receiving
prevention of mother-to-child transmission services at Kitale District
Hospital, Kenya.
Source :    East Afr Med J. 2008 Apr; 85(4):156-61.

Abstract:   Objectives:
            To determine the types and modes of infant feeding practices among the HIV
            infected mothers on prevention of mother-to-child transmission (PMTCT) and
            attending MCH-FP clinic at Kitale District Hospital, Kenya.

            Design: Descriptive cross-sectional study.

            Setting:
            Kitale District Hospital in Western Kenya within the maternal and child health
            and family planning (MCH-FP) and comprehensive care clinics.

            Subjects:
            A total of 146 respondents who had delivered 150 babies were recruited for this
            study.

            Results:
            Thirty five percent (52/150) of the babies were exclusively breastfed while 50%
            (75/150) were not breastfed at all and 14% (21/150) of the babies received mixed
            feeding. The length of exclusive breastfeeding ranged from 1-6 months with most
            (53%) women exclusively breastfeeding for two to three months. Only 13% of the
            women exclusively breastfed for five to six months. There was a strong
            relationship between mode of infant feeding and spouse's awareness of HIV
            status. Mothers who had disclosed their HIV status to their spouses were more
            likely not to breastfeed than mothers who had not disclosed their status (p <
            0.05%). The choice of infant feeding method was also influenced by the socio-
            economic status of the mothers and nevirapine uptake. The level of education
            did not influence the mode of infant feeding.




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            Conclusion:
            Infant feeding decisions were mainly influenced by the male partner's
            involvement and the socio economic status of the mother. Half of the
            respondents did not breastfeed at all. The duration of exclusive breastfeeding
            rarely reached six months. To encourage women to adhere to good infant feeding
            practices, involvement of their partners, family members as well as the
            community for support should be encouraged.


HIV-1 subtype A envelope variants from early in infection have variable
sensitivity to neutralization and to inhibitors of viral entry.
Author:     Blish, C. A.; Nedellec, R.; Mandaliya, K.; Mosier, D. E., and Overbaugh, J.

Source :    AIDS. 2007 Mar 30; 21(6):693-702.

Abstract:   Background:
            An effective HIV-1 vaccine or microbicide must block the transmitted virus
            variants that initially establish a new infection; consequently, it is critical that
            such viruses be isolated and characterized.

            Objective:
            To evaluate HIV-1 envelope variants from early in infection from individuals
            infected heterosexually with subtype A HIV-1 for their sensitivity to antibody-
            mediated neutralization and to inhibitors of viral entry.

            Methods:
            Full-length subtype A HIV-1 envelope clones from 28-75 days postinfection were
            used to generate pseudoviruses for infection studies. The susceptibility of these
            pseudoviruses to neutralization by autologous and heterologous plasma and by
            monoclonal antibodies was examined. The sensitivity of these pseudoviruses to
            PSC-RANTES and TAK-779, inhibitors of CCR5, and to soluble CD4 (sCD4) was
            also evaluated. RESULTS: Pseudoviruses with subtype A HIV-1 envelopes from
            early in infection demonstrated a broad range of neutralization sensitivities to
            both autologous and heterologous plasma. However, neutralization by the
            monoclonal antibodies b12, 2G12, 4E10 and 2F5 was generally poor; notably,
            none of the 14 early virus variants were neutralized by 2G12 and only one was
            neutralized by b12. Viruses bearing these early CCR5-using envelopes were
            generally sensitive to the CCR5 inhibitors PSC-RANTES and TAK-779, but they
            demonstrated more variable sensitivity to sCD4.

            Conclusions:
            These subtype A HIV-1 variants, representing the viruses that must be blocked
            by antibody-based prevention strategies, vary in their susceptibility to
            neutralization. A subset of these HIV-1 variants from early in infection will be
            useful for screening candidate vaccines and microbicides.



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Enhancing exposure of HIV-1 neutralization epitopes through mutations
in gp41.
Author:     Blish, C. A.; Nguyen, M. A., and Overbaugh, J. Enhancing exposure of HIV-1
            neutralization epitopes through mutations in gp41

Source :    PLoS Med. 2008 Jan 3; 5(1):e9.

Abstract:   Background:
            The generation of broadly neutralizing antibodies is a priority in the design of
            vaccines against HIV-1. Unfortunately, most antibodies to HIV-1 are narrow in
            their specificity, and a basic understanding of how to develop antibodies with
            broad neutralizing activity is needed. Designing methods to target antibodies to
            conserved HIV-1 epitopes may allow for the generation of broadly neutralizing
            antibodies and aid the global fight against AIDS by providing new approaches to
            block HIV-1 infection. Using a naturally occurring HIV-1 Envelope (Env) variant
            as a template, we sought to identify features of Env that would enhance exposure
            of conserved HIV-1 epitopes.

            Methods and findings:
            Within a cohort study of high-risk women in Mombasa, Kenya, we previously
            identified a subtype A HIV-1 Env variant in one participant that was unusually
            sensitive to neutralization. Using site-directed mutagenesis, the unusual
            neutralization sensitivity of this variant was mapped to two amino acid
            mutations within conserved sites in the transmembrane subunit (gp41) of the
            HIV-1 Env protein. These two mutations, when introduced into a neutralization-
            resistant variant from the same participant, resulted in 3- to >360-fold enhanced
            neutralization by monoclonal antibodies specific for conserved regions of both
            gp41 and the Env surface subunit, gp120, >780-fold enhanced neutralization by
            soluble CD4, and >35-fold enhanced neutralization by the antibodies found
            within a pool of plasmas from unrelated individuals. Enhanced neutralization
            sensitivity was not explained by differences in Env infectivity, Env concentration,
            Env shedding, or apparent differences in fusion kinetics. Furthermore,
            introduction of these mutations into unrelated viral Env sequences, including
            those from both another subtype A variant and a subtype B variant, resulted in
            enhanced neutralization susceptibility to gp41- and gp120-specific antibodies,
            and to plasma antibodies. This enhanced neutralization sensitivity exceeded
            1,000-fold in several cases.

            Conclusions:
            Two amino acid mutations within gp41 were identified that expose multiple
            discontinuous neutralization epitopes on diverse HIV-1 Env proteins. These
            exposed epitopes were shielded on the unmodified viral Env proteins, and
            several of the exposed epitopes encompass desired target regions for protective
            antibodies. Env proteins containing these modifications could act as a scaffold



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            for presentation of such conserved domains, and may aid in developing methods
            to target


Late marriage and the HIV epidemic in sub-Saharan Africa.
Source :    Popul Stud (Camb). 2007 Mar; 61(1):73-83.

Abstract:   The causes of large variation in the sizes of HIV epidemics among countries in
            sub-Saharan Africa are not well understood. Here we assess the potential roles of
            late age at marriage and a long period of premarital sexual activity as population
            risk factors, using ecological data from 33 sub-Saharan African countries and
            with individual-level data from Demographic and Health Surveys (DHS) in
            Kenya and Ghana in 2003. The ecological analysis finds a significant positive
            correlation between HIV prevalence and median age at first marriage, and
            between HIV prevalence and interval between first sexual intercourse and first
            marriage. The individual-level analysis shows that HIV infection per year of
            exposure is higher before than after first marriage. These findings support the
            hypothesis of a link between a high average age at marriage and a long period of
            premarital intercourse during which partner changes are relatively common and
            facilitate the spread of HIV.


Tuberculosis after HAART initiation in HIV-positive patients from five
countries with a high tuberculosis burden. Tuberculosis after HAART
initiation in HIV-positive patients from five countries with a high
tuberculosis burden.
Author:     Bonnet, M. M.; Pinoges, L. L.; Varaine, F. F.; Oberhauser, B. B.; O'Brien, D. D.;
            Kebede, Y. Y.; Hewison, C. C.; Zachariah, R. R., and Ferradini, L. L.

Source :    AIDS. 2006 Jun 12; 20(9):1275-9.

Abstract:   Background:
            HAART reduces tuberculosis (TB) incidence in people living with HIV/AIDS but
            those starting HAART may develop active TB or subclinical TB may become
            apparent in the immune reconstitution inflammatory syndrome.

            Objective:
            To measure the incidence rate of notified TB in people receiving HAART in five
            HIV programmes occurring in low-resource countries with a high TB/HIV
            burden.




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                            STIs, HIV and AIDS: 2005 - 2008

            Methods:
            A retrospective review in five Medecins Sans Frontieres programmes (Cambodia,
            Thailand, Kenya, Malawi and Cameroon) allowed incidence rates of notified TB
            to be calculated based on follow-up time after HAART initiation.

            Result:
            Among 3151 patients analysed, 90% had a CD4 cell count of < 200 cells/mul.
            Median follow-up time ranged from 3.7 months in Thailand or Kenya to 11.1
            months in Cambodia. Incidence rates were 7.6, 10.4, 17.6, 14.3 and 4.8/100
            person-years for pulmonary TB and 12.7, 4.3, 6.9, 2.1 and 0/100 person-years for
            extra-pulmonary TB in the programmes in Cambodia, Thailand, Kenya, Malawi
            and Cameroon, respectively. Overall, 62.3% of pulmonary TB and 54.9% of extra-
            pulmonary TB were diagnosed within 3 months after HAART initiation.

            Conclusion:
            High incidence rates of notified TB under HAART in programmes held in poor-
            resource countries were observed; these were likely to include both undiagnosed
            prevalent TB at HAART initiation and subclinical TB developing during the
            immune reconstitution inflammatory syndrome. This raises operational issues
            concerning TB diagnosis and treatment of TB/HIV-coinfected patients and
            prompts for urgent TB and HIV care integration.


Longitudinal comparison of chemokines in breastmilk early postpartum
among HIV-1-infected and uninfected Kenyan women.
Author:     Bosire, R.; Guthrie, B. L.; Lohman-Payne, B.; Mabuka, J.; Majiwa, M.; Wariua, G.;
            Mbori-Ngacha, D.; Richardson, B.; John-Stewart, G., and Farquhar, C

Source :    Breastfeed Med. 2007 Sep; 2(3):129-38.

Abstract:   Breastmilk chemokines have been associated with increased HIV-1 RNA levels in
            breastmilk and altered risk of mother-to-child HIV-1 transmission. To
            characterize CC and CXC chemokines in breastmilk postpartum, we collected
            breastmilk specimens at regular intervals for 6 months after delivery from
            women with and without HIV-1 infection and used commercial ELISA kits to
            measure breastmilk concentrations of MIP-1alpha, MIP-1beta, RANTES, and
            SDF-1alpha. Among 54 HIV-1-infected and 26 uninfected women, mean
            chemokine levels were compared cross-sectionally and longitudinally at days 5
            and 10, and months 1 and 3 postpartum. For both HIV-1-infected and uninfected
            women, breastmilk chemokine levels were highest at day 5 for MIP-1alpha, MIP-
            1beta, and SDF-1alpha, and subsequently decreased. RANTES levels remained
            constant over the follow-up period among HIV-1-uninfected women, and
            increased moderately among HIV-1-infected women. For MIP-1beta and
            RANTES, breastmilk levels were significantly higher among HIV-1-infected
            women compared to uninfected women early postpartum. In addition, HIV-1-
            infected women transmitting HIV-1 to their infant had consistently higher


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            breastmilk RANTES levels than those who did not transmit, with the greatest
            difference observed at 1 month (2.68 vs. 2.21 log10 pg/mL, respectively; p =
            0.007). In summary, all four chemokines were most elevated within the first
            month postpartum, a period of high transmission risk via breastmilk. MIP-1beta
            and RANTES levels in breastmilk were higher among HIV-1-infected women
            than among uninfected women, and breastmilk RANTES was positively
            associated with vertical transmission in this study, consistent with results from
            our earlier cohort.


Effect of CCR2 chemokine receptor polymorphism on HIV type 1
mother-to-child transmission and child survival in Western Kenya. AIDS
Res Hum Retroviruses.

Author:     Brouwer, K. C.; Yang, C.; Parekh, S.; Mirel, L. B.; Shi, Y. P.; Otieno, J.; Lal, A. A.,
            and Lal, R. B.

Source :    AIDS Res Hum Retroviruses. 2005 May; 21(5):358-62.

Abstract:   The effect of CCR2 polymorphism on HIV-1 mother-to-child transmission and
            disease progression has not been explored in depth within Africa. As the CCR2-
            64I variant of this putative HIV coreceptor has been associated with slower
            progression to AIDS in adults, the current study was undertaken to examine the
            relationship between CCR2 polymorphism and HIV-1 perinatal transmission and
            child survival in western Kenya. CCR2 genotype was determined for 445 HIV-
            seropositive mothers and their infants. The CCR2-64I allele frequency of both
            mothers and children did not differ by HIV-1 transmission status, regardless of
            maternal viral load, viral subtype, immune status, or placental malaria status.
            For infants who acquired HIV perinatally (n = 78), there was no association
            between CCR2 genotype and viral load upon infection or survival rate over the
            2-year follow-up. Our results do not indicate an effect of CCR2-64I on perinatal
            HIV transmission and survival in Kenyan children.



Identification of differentially expressed proteins in the cervical mucosa
of HIV-1-resistant sex workers.
Author:     Burgener, A.; Boutilier, J.; Wachihi, C.; Kimani, J.; Carpenter, M.; Westmacott, G.;
            Cheng, K.; Ball, T. B., and Plummer, F.

Source :    J Proteome Res. 2008 Oct; 7(10):4446-54.

Abstract:   Novel tools are necessary to understand mechanisms of altered susceptibility to
            HIV-1 infection in women of the Pumwani Sex Worker cohort, Kenya. In this
            cohort, more than 140 of the 2000 participants have been characterized to be



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            relatively resistant to HIV-1 infection. Given that sexual transmission of HIV-1
            occurs through mucosal surfaces such as that in the cervicovaginal environment,
            our hypothesis is that innate immune factors in the genital tract may play a role
            in HIV-1 infection resistance. Understanding this mechanism may help develop
            microbicides and/or vaccines against HIV-1. A quantitative proteomics
            technique (2D-DIGE: two-dimensional difference in-gel electrophoresis) was
            used to examine cervical mucosa of HIV-1 resistant women ( n = 10) for
            biomarkers of HIV-1 resistance. Over 15 proteins were found to be differentially
            expressed between HIV-1-resistant women and control groups ( n = 29), some
            which show a greater than 8-fold change. HIV-1-resistant women overexpressed
            several antiproteases, including those from the serpin B family, and also cystatin
            A, a known anti-HIV-1 factor. Immunoblotting for a selection of the identified
            proteins confirmed the DIGE volume differences. Validation of these results on a
            larger sample of individuals will provide further evidence these biomarkers are
            associated with HIV-1 resistance and could help aid in the development of
            effective microbicides against HIV-1.


Correlation of CD4 counts and CD4/CD8 ratio with HIV-infection
associated oral manifestations.
Author:     Butt, F. M.; Vaghela, V. P., and Chindia, M. L. Correlation of CD4 counts and
            CD4/CD8 ratio with HIV-infection associated oral manifestations.

Source :    East Afr Med J. 2007 Aug; 84(8):383-8.

Abstract:   Background:
            The relationship between oral lesions arising from HIV infection and CD4/CD8
            cell ratios is of relevance in clinical assessment of immune suppression.

            Objective:
            To correlate the prevalence of oral manifestations arising from HIV infection and
            the levels of CD4/CD8 cell ratios.

            Design: A cross-sectional study.

            Setting: Kenyatta National Hospital, Nairobi, Kenya.

            Subjects:
            Two hundred and seven HIV-infected patients in medical wards were recruited
            in the study.

            Results:
            Seventy eight (37.7%) were male and 129 (62.3%) female, with an age range of 18-
            73 years (mean=34.81 years). Oral manifestations encountered with highest
            prevalence in the oral cavity included: hyperplastic candidosis (labial mucosa)
            15%, erythematous candidosis (gingival) 5%, angular cheilitis 32.4%, herpes


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                            STIs, HIV and AIDS: 2005 - 2008

            simplex (corner of the mouth) 0.5%, persistent oral ulceration (labial mucosa)
            0.5%, Parotid enlargement 2% and Kaposis sarcoma (hard/soft palate) 2.9%.

            Conclusion:
            The prevalence of oral manifestations was higher with low CD4 count <200
            cell/mm3 and mean CD4/CD8<0.39(95%CI 0.32-0.48).


Integrating nutrition security with treatment of people living with HIV:
lessons from Kenya.
Author:     Byron, E.; Gillespie, S., and Nangami, M

Source :    Food Nutr Bull. 2008 Jun; 29(2):87-97.

Abstract:   Background:
            The increased caloric requirements of HIV-positive individuals, undesirable side
            effects of treatment that may be worsened by malnutrition (but alleviated by
            nutritional support), and associated declines in adherence and possible increased
            drug resistance are all justifications for developing better interventions to
            strengthen the nutrition security of individuals receiving antiretroviral
            treatment.

            Objective:
            To highlight key benefits and challenges relating to interventions aimed at
            strengthening the nutrition security of people living with HIV who are receiving
            antiretroviral treatment.

            Methods:
            Qualitative research was undertaken on a short-term nutrition intervention
            linked to the provision of free antiretroviral treatment for people living with HIV
            in western Kenya in late 2005 and early 2006.

            Results:
            Patients enrolled in the food program while on treatment regimens self-reported
            greater adherence to their medication, fewer side effects, and a greater ability to
            satisfy increased appetite. Most clients self-reported weight gain, recovery of
            physical strength, and the resumption of labor activities while enrolled in dual
            (food supplementation and treatment) programs. Such improvements were seen
            to catalyze increased support from family and community.

            Conclusions:
            These findings provide further empirical support to calls for a more holistic and
            comprehensive response to the coexistence of AIDS epidemics with chronic
            nutrition insecurity. Future work is needed to clarify ways of bridging the gap
            between short-term nutritional support to individuals and longer-term
            livelihood security programming for communities affected by AIDS. Such


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            interdisciplinary research will need to be matched by intersectoral action on the
            part of the agriculture and health sectors in such environments.


Lessons learned in the conduct, validation, and interpretation of national
population based HIV surveys.
Author:     Calleja, J. M.; Marum, L. H.; Carcamo, C. P.; Kaetano, L.; Muttunga, J., and Way,
            A.

Source :    AIDS. 2005 May; 19 Suppl 2:S9-S17.

Abstract:   In the past few years several countries have conducted national population-
            based HIV surveys. Survey methods, levels of participation bias from absence or
            refusal and lessons learned conducting such surveys are compared in four
            national population surveys: Mali, Kenya, Peru and Zambia. In Mali, Zambia,
            and Kenya, HIV testing of adult women and men was included in the national-
            level demographic and health surveys carried out regularly in these countries,
            whereas in Peru the national HIV survey targeted young people in 24 cities with
            populations over 50 000.The household response rate was above 90% in all
            countries, but some individuals were absent for interviews. HIV testing rates
            were between 70 and 79% of those eligible, with higher test rates for women.
            Three critical questions in this type of survey need to be answered: who did the
            surveys miss; how much it matters that they were missed; and what can be done
            to increase the participation of respondents so the coverage rates are adequate.
            The level of representativeness of the populations tested was adequate in each
            survey to provide a reliable national estimate of HIV prevalence that
            complements other methods of HIV surveillance. Different lessons were learned
            from each survey.These population-based HIV seroprevalence surveys
            demonstrate that reliable and useful results can be obtained, although they
            require careful planning and increased financial and human resource investment
            to maximize responses at the household and individual level, which are key
            elements to validate survey results.This review was initiated through an
            international meeting on 'New strategies for HIV/AIDS Surveillance in
            Resource-constrained Countries' held in Addis Ababa on 26-30 January 2004 to
            share and develop recommendations to guide future surveys.


National scale-up of HIV testing and provision of HIV care to
tuberculosis patients in Kenya.
Author:     Chakaya, J. M.; Mansoer, J. R.; Scano, F.; Wambua, N.; L'Herminez, R.;
            Odhiambo, J.; Mohamed, I.; Kangangi, J.; Ombeka, V.; Akeche, G.; Adala, S.;
            Gitau, S.; Maina, J.; Kibias, S.; Langat, B.; Abdille, N.; Wako, I.; Kimuu, P., and
            Sitienei, J.




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                            STIs, HIV and AIDS: 2005 - 2008

Source :    Int J Tuberc Lung Dis. 2008 Apr; 12(4):424-9.

Abstract:   Setting:
            Kenya, one of the 22 tuberculosis (TB) high-burden countries, whose TB burden
            is fuelled by the human immunodeficiency virus (HIV).

            Objective:
            To monitor and evaluate the implementation of HIV testing and provision of
            HIV care to TB patients in Kenya through the establishment of a routine TB-HIV
            integrated surveillance system.

            Design:
            A descriptive report of the status of implementation of HIV testing and provision
            of HIV interventions to TB patients one year after the introduction of the revised
            TB case recording and reporting system.

            Results:
            From July 2005 to June 2006, 88% of 112835 TB patients were reported to the
            National Leprosy and TB Control Programme, 98773 (87.9%) of whom were
            reported using a revised recording and reporting system that included TB-HIV
            indicators. HIV testing of TB patients increased from 31.5% at the beginning of
            this period to 59% at the end. Of the 46428 patients tested for HIV, 25558 (55%)
            were found to be HIV-positive, 85% of whom were provided with cotrimoxazole
            preventive treatment and 28% with antiretroviral treatment.

            Conclusion:
            A country-wide integrated TB-HIV surveillance system in TB patients can be
            implemented and provides essential data to monitor and evaluate TB-HIV
            related interventions.


Correlates of delayed disease progression in HIV-1-infected Kenyan
children. Correlates of delayed disease progression in HIV-1-infected
Kenyan children.
Author:     Author: Chakraborty, R.; Morel, A. S.; Sutton, J. K.; Appay, V.; Ripley, R. M.;
            Dong, T.; Rostron, T.; Ogola, S.; Palakudy, T.; Musoke, R.; D'Agostino, A.; Ritter,
            M., and Rowland-Jones, S. L.

Source :    J Immunol. 2005 Jun 15; 174(12):8191-9.

Abstract:   Without treatment most HIV-1-infected children in Africa die before their third
            birthday (>89%) and long-term nonprogressors are rare. The mechanisms
            underlying nonprogression in HIV-1-infected children are not well understood.
            In the present study, we examined potential correlates of delayed HIV disease
            progression in 51 HIV-1-infected African children. Children were assigned to



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            progression subgroups based on clinical characterization. HIV-1-specific
            immune responses were studied using a combination of ELISPOT assays,
            tetramer staining, and FACS analysis to characterize the magnitude, specificity,
            and functional phenotype of HIV-1-specific CD8(+) and CD4(+) T cells. Host
            genetic factors were examined by genotyping with sequence-specific primers.
            HIV-1 nef gene sequences from infecting isolates from the children were
            examined for potential attenuating deletions. Thymic output was measured by T
            cell rearrangement excision circle assays. HIV-1-specific CD8(+) T cell responses
            were detected in all progression groups. The most striking attribute of long-term
            survivor nonprogressors was the detection of HIV-1-specific CD4(+) Th
            responses in this group at a magnitude substantially greater than previously
            observed in adult long-term nonprogressors. Although long-term survivor
            nonprogressors had a significantly higher percentage of CD45RA(+)CD4(+) T
            cells, nonprogression was not associated with higher thymic output. No
            protective genotypes for known coreceptor polymorphisms or large sequence
            deletions in the nef gene associated with delayed disease progression were
            identified. In the absence of host genotypes and attenuating mutations in HIV-1
            nef, long-term surviving children generated strong CD4(+) T cell responses to
            HIV-1. As HIV-1-specific helper cells support anti-HIV-1 effector responses in
            active disease, their presence may be important in delaying disease progression.


nef gene sequence variation among HIV-1-infected African children nef
gene sequence variation among HIV-1-infected African children.
Author:     Chakraborty, R.; Reinis, M.; Rostron, T.; Philpott, S.; Dong, T.; D'Agostino, A.;
            Musoke, R.; Silva, E.; Stumpf, M.; Weiser, B.; Burger, H., and Rowland-Jones, S.
            L. nef gene sequence variation among HIV-1-infected African children.

Source :    HIV Med. 2006 Mar; 7(2):75-84.

Abstract:   Background:
            There are few data on African children infected with nonclade B HIV-1 in
            endemic settings, which limits generalizations about pathogenesis and
            progression. Genotypic and phenotypic variations in host immunogenetics and
            HIV-1 negative factor (nef) accessory protein may influence disease progression
            and have frequently been characterized in subjects infected with clade B HIV-1.

            Methods:
            In this descriptive study, we report nef gene sequence variation and host genetic
            polymorphisms in 32 Kenyan children, including 12 slow progressors.

            Results:
            Phylogenetic analysis identified HIV-1 clades A, C and D and a recombinant
            A/D subtype. Grossly defective nef genes or significant changes from relevant
            clade reference sequences were not identified in children with delayed disease
            progression.


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            Conclusions:
            nef sequence variations may not be common in perinatally infected African
            children. Further studies are warranted in HIV-1-infected subjects in settings
            where infection is endemic.


HIV testing and counselling for women attending child health clinics: an
opportunity for entry to prevent mother-to-child transmission and HIV
treatment.
Author:     Author: Chersich, M. F.; Luchters, S. M.; Othigo, M. J.; Yard, E.; Mandaliya, K.,
            and Temmerman, M.

Source :    Int J STD AIDS. 2008 Jan; 19(1):42-6.

Abstract:   This study assessed the potential for HIV testing at child health clinics to increase
            knowledge of HIV status, and entry to infant feeding counselling and HIV
            treatment. At a provincial hospital in Mombasa, Kenya, HIV testing and
            counselling were offered to women bringing their child for immunization or
            acute care services. Most women said HIV testing should be offered in these
            clinics (472/493, 95.7%), with many citing the benefits of regular testing and
            entry to prevent mother-to-child transmission. Of 500 women, 416 (83.4%)
            received test results, 97.6% on the same day. After 50 participants, point-of-care
            testing replaced laboratory-based rapid testing. Uptake increased 2.6 times with
            point-of-care testing (95% confidence interval = 1.4-5.1; P = 0.003). Of 124 women
            who had not accessed HIV testing during pregnancy, 98 tested in the study
            (79.0%). Measured by uptake and attitudes, HIV testing in child health clinics is
            acceptable. This could optimize entry into HIV treatment, infant feeding
            counselling and family planning services.


Optimizing paediatric HIV care in Kenya: challenges in early infant
diagnosis. Bull World Health Organ.
Author:     Cherutich, P.; Inwani, I.; Nduati, R., and Mbori-Ngacha, D.

Source :    Bull World Health Organ. 2008 Feb; 86(2):155-60.

Abstract:   Problem:
            In 2003, the goal of the Kenyan Ministry of Health was to avail antiretroviral
            treatment (ART) to 50% of the estimated 250 000 eligible individuals by the end
            of 2005. By July 2005, 45 000 adults and more than 2000 children were on
            treatment. A study was conducted to determine the barriers to identification of
            HIV-infected children.



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            Approach:
            Existing government policies were reviewed and the ART register of the Kenya
            National AIDS Control Programme was used to identify facilities providing
            ART. This paper reports the findings around diagnosis and staging of HIV
            infection in children.

            Local setting:
            At the time of the study, 58 health facilities were providing ART to children.
            Only one institution had achieved universal HIV testing in the antenatal clinics.
            Six facilities systematically followed up HIV-exposed children. HIV antibody
            testing was not readily available to the children. Although four research centres
            were capable of carrying out diagnostic HIV polymerase chain reaction (PCR),
            the services were restricted to research purposes. Other constraints were
            inadequate physical infrastructure, inadequate systems for quality control in the
            laboratories and shortage of staff.

            Lessons learnt:
            The policy framework to support identification of HIV-infected children had
            been established, albeit with narrow focus on sick children. The assessment
            identified the weaknesses in the structures for systematic diagnosis of HIV
            through laboratory or clinical-based algorithms. The researchers concluded that
            health staff training and implementation of a systematic standard approach to
            identification of HIV-infected children is urgently required


Selection for human immunodeficiency virus type 1 envelope
glycosylation variants with shorter V1-V2 loop sequences occurs during
transmission of certain genetic subtypes and may impact viral RNA
levelsSelection for human immunodeficiency virus type 1 envelope
glycosylation variants with shorter V1-V2 loop sequences occurs during
transmission of certain genetic subtypes and may impact viral RNA
levels.
Author:     Chohan, B.; Lang, D.; Sagar, M.; Korber, B.; Lavreys, L.; Richardson, B., and
            Overbaugh, J

Source :    Virol. 2005 May; 79(10):6528-31.

Abstract:   Designing an effective human immunodeficiency virus type 1 (HIV-1) vaccine
            will rely on understanding which variants, from among the myriad of circulating
            HIV-1 strains, are most commonly transmitted and determining whether such
            variants have an Achilles heel. Here we show that heterosexually acquired
            subtype A HIV-1 envelopes have signature sequences that include shorter V1-V2
            loop sequences and fewer predicted N-linked glycosylation sites relative to the
            overall population of circulating variants. In contrast, recently transmitted



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            subtype B variants did not, and this was true for cases where the major risk
            factor was homosexual contact, as well as for cases where it was heterosexual
            contact. This suggests that selection during HIV-1 transmission may vary
            depending on the infecting subtype. There was evidence from 23 subtype A-
            infected women for whom there was longitudinal data that those who were
            infected with viruses with fewer potential N-linked glycosylation sites in V1-V2
            had lower viral set point levels. Thus, our study also suggests that the extent of
            glycosylation in the infecting virus could impact disease progression.


Infant feeding in the time of HIV: rapid assessment of infant feeding
policy and programmes in four African countries scaling up prevention
of mother to child transmission programmes.
Author:     Chopra, M. and Rollins, N.

Source :    Arch Dis Child. 2008 Apr; 93(4):288-91.

Abstract:   Objective:
            To assess the infant feeding components of prevention of mother to child HIV
            transmission (PMTCT) programmes.

            Methods:
            Assessments were performed across Botswana, Kenya, Malawi and Uganda. 29
            districts offering PMTCT were selected by stratified random sampling with rural
            and urban strata. All health facilities in the selected PMTCT district were
            assessed. The facility level manager and the senior nurse in charge of maternal
            care were interviewed. 334 randomly selected health workers involved in the
            PMTCT programme completed self-administered questionnaires. 640 PMTCT
            counselling observations were carried out and 34 focus groups were conducted
            amongst men and women.

            Results:
            Most health workers (234/334, 70%) were unable to correctly estimate the
            transmission risks of breastfeeding irrespective of exposure to PMTCT training.
            Infant feeding options were mentioned in 307 of 640 (48%) observations of
            PMTCT counselling sessions, and in only 35 (5.5%) were infant feeding issues
            discussed in any depth; of these 19 (54.3%) were rated as poor. Several health
            workers also reported receiving free samples of infant formula in contravention
            of the International Code on Breastmilk Substitutes. National HIV managers
            stated they were unsure about infant feeding policy in the context of HIV.
            Finally, there was an almost universal belief that an HIV positive mother who
            breastfeeds her child will always infect the child and intentional avoidance of
            breastfeeding by the mother indicates that she is HIV positive.




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            Conclusion:
            These findings underline the need to implement and support systematic infant
            feeding policies and programme responses in the context of HIV programmes


Independent effects of nevirapine prophylaxis and HIV-1 RNA
suppression in breast milk on early perinatal HIV-1 transmission.
Author:     Chung, M. H.; Kiarie, J. N.; Richardson, B. A.; Lehman, D. A.; Overbaugh, J.;
            Njiri, F., and John-Stewart, G. C.

Source :    Defic Syndr. 2007 Dec 1; 46(4):472-8.

Abstract:   Background:
            The mechanism of action of single-dose nevirapine on reducing mother-to-child
            transmission of HIV-1 may involve reduction of maternal HIV-1 or prophylaxis
            of infants.

            Methods:
            In a study that randomized pregnant mothers to HIVNET 012 nevirapine versus
            short-course antenatal zidovudine, we compared breast milk HIV-1 RNA viral
            shedding and administration of single-dose nevirapine between mothers who
            transmitted HIV-1 to their infants at 6 weeks postpartum and those who did not.

            Results:
            In multivariate analyses, maximum breast milk HIV-1 RNA levels (hazard ratio
            [HR] = 2.50, 95% confidence interval [CI]: 1.25 to 4.99; P = 0.01) and nevirapine
            use (HR = 0.12, 95% CI: 0.02 to 0.97; P = 0.05) were each independently associated
            with perinatal transmission at 6 weeks postpartum. Mothers who transmitted
            HIV-1 to their infants had significantly higher HIV-1 RNA levels in their breast
            milk between the second day and sixth week postpartum. Among mothers with
            maximum breast milk virus levels less than a median of 3.5 log(10) copies/mL,
            the administration of nevirapine further decreased HIV-1 transmission risk from
            22.2% to 0.0% (P = 0.04).

            Conclusions:
            Peripartum administration of single-dose nevirapine to mother and infant
            decreases early perinatal HIV-1 transmission by means of breast milk HIV-1
            RNA suppression and, independently, by providing the infant with exposure
            prophylaxis.




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Mandatory neonatal male circumcision in Sub-Saharan Africa: medical
and ethical analysis.
Author:     Clark, P. A.; Eisenman, J., and Szapor, S.

Source :    Med Sci Monit. 2007 Dec; 13(12):RA205-13.

Abstract:   The majority of those infected with HIV in sub-Saharan Africa do not have access
            to antiretroviral therapy, which is known to prolong the lives of HIV-positive
            persons in industrialized countries. Although the availability of antiretroviral
            therapy for those infected with HIV has increased worldwide, the infection rate
            out surpasses those started on such treatment. Without an AIDS vaccine or
            curative treatment, and given the difficulty in getting persons at risk to adopt
            healthy sexual behaviors, alternative approaches to decrease the spread of HIV
            infection are urgently needed. Three recent randomized controlled trials
            undertaken in Kisumu, Kenya, Raki District, Uganda and Orange Farm, South
            Africa have confirmed that male circumcision reduces the risk of heterosexually
            acquired HIV infection in men by approximately 51% to 60%. These three studies
            provide a solid evidence-base for future health policy. The procedure for
            adolescents and adults is expensive compared to abstinence, condoms or other
            methods; and the surgery is not without serious risks if performed by traditional
            healers using unsterilized blades as often happens in rural Africa. However,
            neonatally, the procedure is relatively inexpensive and the risks diminish
            considerably. Mandating neonatal male circumcision is an effective therapy that
            has minimal risks, is cost efficient and will save human lives. To deny
            individuals access to this effective therapy is to deny them the dignity and
            respect all persons deserve. Neonatal male circumcision is medically necessary
            and ethically imperative.


Immunoepidemiologic profile of Chlamydia trachomatis infection:
importance of heat-shock protein 60 and interferon- gamma.
Author:     Cohen, C. R.; Koochesfahani, K. M.; Meier, A. S.; Shen, C.; Karunakaran, K.;
            Ondondo, B.; Kinyari, T.; Mugo, N. R.; Nguti, R., and Brunham, R. C.

Source :    J Infect Dis. 2005 Aug 15; 192(4):591-9.

Abstract:   Epidemiological, animal, and in vitro investigations suggest that Chlamydia
            trachomatis infection engenders acquired immunity, the basis for which is
            incompletely defined, especially in humans. In a prospective cohort study of
            women at high risk for C. trachomatis infection, we found that, at baseline and
            after adjustment for age and other potential confounding variables, production
            of interferon- gamma by peripheral-blood mononuclear cells (PBMCs)
            stimulated with chlamydia heat-shock protein 60 strongly correlated with
            protection against incident C. trachomatis infection. This investigation supports a


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            direct role for C. trachomatis-specific immune responses in altering the risk of
            infection and suggests immune correlates of protection that are potentially useful
            in vaccine development.


AIDS-affected children face systemic discrimination in accessing
education.
Author:     Cohen, J. Southern Africa:

Source :    HIV AIDS Policy Law Rev. 2005 Dec; 10(3):24-5.

Abstract:   In June 2005, Human Rights Watch (HRW) conducted an investigation in Kenya,
            South Africa and Uganda to document AIDS-affected children's experiences of
            inequality and neglect in the school system. HRW found, consistent with
            previous research, that the sickness of one or both parents due to HIV/AIDS led
            many children withdraw from school to perform household labour or offset lost
            family income. Parental death often led to abandonment, discrimination within
            extended and foster families, and emotional trauma that interfered with school
            performance.



Market incentives, human lives, and AIDS vaccines.
Author:     Craddock, S. Market incentives, human lives, and AIDS vaccines.

Source :    Soc Sci Med. 2007 Mar; 64(5):1042-56.

Abstract:   For many, an AIDS vaccine holds the promise of intervening in a widespread
            epidemic because it is not predicated on changing economic structures and social
            contexts underlying vulnerability to HIV for millions of individuals. Yet 20 years
            into the AIDS epidemic, there is still no vaccine. Based on interviews of AIDS
            vaccine researchers, watchdog organizations, and ethics groups from the United
            States, South Africa, and Kenya conducted between August and December of
            2003, this paper explores possible answers to the question of why there is no
            vaccine, looking in particular at contradictions between a biomedical research
            industry increasingly driven by market incentives and a disease that primarily
            affects individuals living in low-income countries with little vaccine purchasing
            power. Producing a vaccine that could be effective in low-income regions
            requires new kinds of initiatives that can coordinate research nationally and
            globally, and circumvent current regulatory mechanisms that dictate against the
            development and dissemination of low-profit medical technologies. Until such
            initiatives are supported, however, vaccine research will continue at a
            devastatingly slow pace at the cost of millions of lives annually.




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Cost, affordability and cost-effectiveness of strategies to control
tuberculosis in countries with high HIV prevalence.
Author:     Currie, C. S.; Floyd, K.; Williams, B. G., and Dye, C

Source :    BMC Public Health. 2005; 5:130.

Abstract:   Background:
            The HIV epidemic has caused a dramatic increase in tuberculosis (TB) in East
            and southern Africa. Several strategies have the potential to reduce the burden
            of TB in high HIV prevalence settings, and cost and cost-effectiveness analyses
            can help to prioritize them when budget constraints exist. However, published
            cost and cost-effectiveness studies are limited.

            Methods:
            Our objective was to compare the cost, affordability and cost-effectiveness of
            seven strategies for reducing the burden of TB in countries with high HIV
            prevalence. A compartmental difference equation model of TB and HIV and
            recent cost data were used to assess the costs (year 2003 USD prices) and effects
            (TB cases averted, deaths averted, DALYs gained) of these strategies in Kenya
            during the period 2004-2023.

            Results:
            The three lowest cost and most cost-effective strategies were improving TB cure
            rates, improving TB case detection rates, and improving both together. The
            incremental cost of combined improvements to case detection and cure was
            below USD 15 million per year (7.5% of year 2000 government health
            expenditure); the mean cost per DALY gained of these three strategies ranged
            from USD 18 to USD 34. Antiretroviral therapy (ART) had the highest
            incremental costs, which by 2007 could be as large as total government health
            expenditures in year 2000. ART could also gain more DALYs than the other
            strategies, at a cost per DALY gained of around USD 260 to USD 530. Both the
            costs and effects of treatment for latent tuberculosis infection (TLTI) for HIV+
            individuals were low; the cost per DALY gained ranged from about USD 85 to
            USD 370. Averting one HIV infection for less than USD 250 would be as cost-
            effective as improving TB case detection and cure rates to WHO target levels.

            Conclusion:
            To reduce the burden of TB in high HIV prevalence settings, the immediate goal
            should be to increase TB case detection rates and, to the extent possible, improve
            TB cure rates, preferably in combination. Realising the full potential of ART will
            require substantial new funding and strengthening of health system capacity so
            that increased funding can be used effectively.




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Microcredit for people affected by HIV and AIDS: insights from Kenya.
Author:     Datta, D. and Njuguna, J.

Source :    SAHARA J. 2008 Jul; 5(2):94-1

Abstract:   Consequences of HIV and AIDS are exponential in Kenya, touching not only the
            health of those infected, but also depleting socioeconomic resources of entire
            families. Access to financial services is one of the important ways to protect and
            build economic resources. Unfortunately, the norm of financial viability
            discourages microfinance institutions from targeting people severely impacted
            by HIV and AIDS. Thus, HIV and AIDS service NGOs have been increasingly
            getting involved in microcredit activity in recent years for economic
            empowerment of their clients. Despite limited human resources and funding in
            the area of microcredit activity, these NGOs have demonstrated that nearly 50%
            of their microcredit beneficiaries invested money in income-generating activities,
            resulting in enhancement to their livelihood security. In the short term these
            NGOs need to improve their current practices. However, this does not mean
            launching microfinance initiatives within their AIDS-focused programmes, as
            financial services are best provided by specialised institutions. Longer-term
            cooperation between microfinance institutions and other AIDS service
            organisations and donors is necessary to master appropriate and rapid responses
            in areas experiencing severe impacts of HIV and AIDS.


Do unsafe tetanus toxoid injections play a significant role in the
transmission of HIV/AIDS? Evidence from seven African countries.
Author:     de Walque, D.

Source :    Sex Transm Infect. 2008 Apr; 84(2):122-5.

Abstract:   Objectives:
            Although sexual transmission is generally considered to be the main factor
            driving the HIV/AIDS epidemic in Africa, recent studies have claimed that
            iatrogenic transmission should be considered as an important source of HIV
            infection. In particular, receipt of tetanus toxoid injections during pregnancy has
            been reported to be associated with HIV infection in Kenya. The objective of this
            paper is to assess the robustness of this association among women in nationally
            representative HIV surveys in seven African countries.

            Methods:
            The association between prophylactic tetanus toxoid injections during pregnancy
            and HIV infection was analysed, using individual-level data from women who
            gave birth in the past five years. These data are from the nationally
            representative Demographic and Health Surveys, which included HIV testing in



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            seven African countries: Burkina Faso 2003 (N = 2424), Cameroon 2004 (N =
            2600), Ethiopia 2005 (N = 2886), Ghana 2003 (N = 2560), Kenya 2003 (N = 1617),
            Lesotho 2004 (N = 1278) and Senegal 2005 (N = 2126).

            Results:
            Once the odds ratios (OR) were adjusted for five-year age groups and for ethnic,
            urban and regional indicators, the association between prophylactic tetanus
            toxoid injections during pregnancy and HIV infection was never statistically
            significant in any of the seven countries. Only in Cameroon was there an
            association between previous tetanus toxoid injection and HIV positivity but it
            became weaker (OR 1.53, 95% CI 0.91 to 2.57) once urban location and ethnic
            group were adjusted for.

            Conclusions:
            Although the risk of HIV infection through unsafe injections and healthcare
            should not be ignored and should be reduced, it does not seem that there is, at
            present and in the seven countries studied, strong evidence supporting the claim
            that unsafe tetanus toxoid injections are a major factor driving the HIV epidemic.


Quality and quantity of antenatal HIV counselling in a PMTCT
programme in Mombasa, Kenya.
Author:     Delva, W.; Mutunga, L.; Quaghebeur, A., and Temmerman, M.

Source :    AIDS Care. 2006 Apr; 18(3):189-93.

Abstract:   A recent report from a PMTCT implementation study in Mombasa, Kenya,
            points at an important gap between the efficacy in clinical trial circumstances
            and the effectiveness of PMTCT programmes when implemented in real life.
            Hence, the quality and quantity of antenatal HIV counselling in a routine setting
            were appraised. The counsellors' social and communicative skills, duration and
            topics covered during pre- and post-test counselling sessions were assessed by
            means of the VCT assessment tools published by UNAIDS. A total of 14 group
            educational sessions, 66 pre-test counselling sessions and 50 post-test counselling
            sessions were observed and assessed. In general, the frequency and duration of
            the counselling was low. Crucial topics such as window period and partner
            involvement and follow-up support were covered haphazardly. The counsellor's
            social and communicative skills were given high marks, yet information was
            rarely repeated or summarized. The limited time dedicated to women receiving
            antenatal VCT contrasts with the heavy and comprehensive load of health
            information and advice they are supposed to receive. Ample pre- and post-test
            counselling including follow-up should be pursued for optimal effectiveness of
            PMTCT. We propose a number of health system interventions preceded and
            guided by ongoing audit.




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The role of sexually transmitted infections in male circumcision
effectiveness against HIV--insights from clinical trial simulation.
Author:     Desai, K.; Boily, M. C.; Garnett, G. P.; Masse, B. R.; Moses, S., and Bailey, R. C.

Source :    Emerg Themes Epidemiol. 2006; 3:19.

Abstract:   Background:
            A landmark randomised trial of male circumcision (MC) in Orange Farm, South
            Africa recently showed a large and significant reduction in risk of HIV infection,
            reporting MC effectiveness of 61% (95% CI: 34%-77%). Additionally, two further
            randomised trials of MC in Kisumu, Kenya and Rakai, Uganda were recently
            stopped early to report 53% and 48% effectiveness, respectively. Since MC may
            protect against both HIV and certain sexually transmitted infections (STI), which
            are themselves cofactors of HIV infection, an important question is the extent to
            which this estimated effectiveness against HIV is mediated by the protective
            effect of circumcision against STI. The answer lies in the trial data if the
            appropriate statistical analyses can be identified to estimate the separate
            efficacies against HIV and STI, which combine to determine overall effectiveness.

            Objectives and methods:
            Focusing on the MC trial in Kisumu, we used a stochastic prevention trial
            simulator (1) to determine whether statistical analyses can validly estimate
            efficacy, (2) to determine whether MC efficacy against STI alone can produce
            large effectiveness against HIV and (3) to estimate the fraction of all HIV
            infections prevented that are attributable to efficacy against STI when both
            efficacies combine. RESULTS: Valid estimation of separate efficacies against HIV
            and STI as well as MC effectiveness is feasible with available STI and HIV trial
            data, under Kisumu trial conditions. Under our parameter assumptions, high
            overall effectiveness of MC against HIV was observed only with a high MC
            efficacy against HIV and was not possible on the basis of MC efficacy against STI
            alone. The fraction of all HIV infections prevented which were attributable to MC
            efficacy against STI was small, except when efficacy of MC specifically against
            HIV was very low. In the three MC trials which reported between 48% and 61%
            effectiveness (combining STI and HIV efficacies), the fraction of HIV infections
            prevented in circumcised males which were attributable to STI was unlikely to be
            more than 10% to 20%.

            Conclusion:
            Estimation of efficacy, attributable fraction and effectiveness leads to improved
            understanding of trial results, gives trial results greater external validity and is
            essential to determine the broader public health impact of circumcision to men
            and women.




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Urban-rural differences in the socioeconomic deprivation--sexual
behavior link in Kenya.
Author:     Dodoo, F. N.; Zulu, E. M., and Ezeh, A. C.

Source :    Soc Sci Med. 2007 Mar; 64(5):1019-31.

Abstract:   We compare the impact of socioeconomic deprivation on risky sexual outcomes
            in rural and urban Kenya. Quantitative data are drawn from the Demographic &
            Health Surveys (DHS) and qualitative data from the Sexual Networking and
            Associated Reproductive and Social Health Concerns study. Using two separate
            indicators of deprivation we show that, although poverty is significantly
            associated with the examined sexual outcomes in all settings, the urban poor are
            significantly more likely than their rural counterparts to have an early sexual
            debut and a greater incidence of multiple sexual partnerships. The disadvantage
            of the urban poor is accentuated for married women; those in Nairobi's slums
            are at least three times as likely to have multiple sexual partners as their rural
            counterparts. The implications of these findings are discussed.


Health workforce issues and the Global Fund to fight AIDS,
Tuberculosis and Malaria: an analytical review.
Author:     rager, S.; Gedik, G., and Dal Poz, M. R.

Source :    um Resour Health. 2006; 4:23.

Abstract:   Recent studies have shown evidence of a direct and positive causal link between
            the number of health workers and health outcomes. Several studies have
            identified an adequate health workforce as one of the key ingredients to
            achieving improved health outcomes. Global health initiatives are faced with
            human resources issues as a major, system-wide constraint. This article explores
            how the Global Fund addresses the challenges of a health workforce bottleneck
            to the successful implementation of priority disease programmes. Possibilities for
            investment in human resources in the Global Fund's policy documents and
            guidelines are reviewed. This is followed by an in-depth study of 35 Global Fund
            proposals from five African countries: Ethiopia, Ghana, Kenya, Malawi and
            Tanzania. The discussion presents specific human resources interventions that
            can be found in proposals. Finally, the comments on human resources
            interventions in the Global Fund's Technical Review Panel and the budget
            allocation for human resources for health were examined. Policy documents and
            guidelines of the Global Fund foster taking account of human resources
            constraints in recipient countries and interventions to address them. However,
            the review of actual proposals clearly shows that countries do not often take
            advantage of their opportunities and focus mainly on short-term, in-service
            training in their human resources components. The comments of the Technical


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            Review Panel on proposed health system-strengthening interventions reveal a
            struggle between the Global Fund's goal to fight the three targeted diseases, on
            the one hand, and the need to strengthen health systems as a prerequisite for
            success, on the other. In realizing the opportunities the Global Fund provides for
            human resources interventions, countries should go beyond short-term
            objectives and link their activities to a long-term development of their human
            resources for health.


Herpes simplex virus type 2 and risk of intrapartum human
immunodeficiency virus transmission.
Author:     rake, A. L.; John-Stewart, G. C.; Wald, A.; Mbori-Ngacha, D. A.; Bosire, R.;
            Wamalwa, D. C.; Lohman-Payne, B. L.; Ashley-Morrow, R.; Corey, L., and
            Farquhar, C.

Source :    Obstet Gynecol. 2007 Feb; 109(2 Pt 1):403-9.

Abstract:   Objective:
            To determine whether herpes simplex virus type 2 (HSV-2) infection was
            associated with risk of intrapartum human immunodeficiency virus type 1 (HIV-
            1) transmission and to define correlates of HSV-2 infection among HIV-1-
            seropositive pregnant women.

            Methods:
            We performed a nested case control study within a perinatal cohort in Nairobi,
            Kenya. Herpes simplex virus type 2 serostatus and the presence of genital ulcers
            were ascertained at 32 weeks of gestation. Maternal cervical and plasma HIV-1
            RNA and cervical HSV DNA were measured at delivery.

            Results:
            One hundred fifty-two (87%) of 175 HIV-1-infected mothers were HSV-2-
            seropositive. Among the 152 HSV-2-seropositive women, nine (6%) had genital
            ulcers at 32 weeks of gestation, and 13 (9%) were shedding HSV in cervical
            secretions. Genital ulcers were associated with increased plasma HIV-1 RNA
            levels (P=.02) and an increased risk of intrapartum HIV-1 transmission (16% of
            transmitters versus 3% of nontransmitters had ulcers; P = .003), an association
            which was maintained in multivariable analysis adjusting for plasma HIV-1
            RNA levels (P=.04). We found a borderline association for higher plasma HIV-1
            RNA among women shedding HSV (P=.07) and no association between cervical
            HSV shedding and either cervical HIV-1 RNA levels or intrapartum HIV-1
            transmission (P=.4 and P=.5, [corrected] respectively).

            Conclusion:
            Herpes simplex virus type 2 is the leading cause of genital ulcers among women
            in sub-Saharan Africa and was highly prevalent in this cohort of pregnant
            women receiving prophylactic zidovudine. After adjusting for plasma HIV-1


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            RNA levels, genital ulcers were associated with increased risk of intrapartum
            HIV-1 transmission. These data suggest that management of HSV-2 during
            pregnancy may enhance mother-to-child HIV-1 prevention efforts. LEVEL OF
            EVIDENCE: II.


Severe gynecomastia in an African boy with perinatally acquired human
immunodeficiency virus infection receiving highly active antiretroviral
therapy.
Author:     Author: Dzwonek, A.; Clapson, M.; Withey, S.; Bates, A., and Novelli, V.

Source :    Pediatr Infect Dis J. 2006 Feb; 25(2):183-4.

Abstract:   Highly active antiretroviral therapy (HAART) slows the progression of human
            immunodeficiency virus (HIV) disease and lowers mortality and morbidity in
            children. Coincident with these advances, an increasing number of side effects
            are being reported. We describe an adolescent boy with perinatally acquired HIV
            infection who developed significant bilateral breast enlargement as a result of
            HAART. He required bilateral mastectomies. Pediatricians need to be aware of
            less common side effects of HAART.


Responding to the HIV pandemic: the power of an academic medical
partnership.
Author:     Einterz, R. M.; Kimaiyo, S.; Mengech, H. N.; Khwa-Otsyula, B. O.; Esamai, F.;
            Quigley, F., and Mamlin, J. J.

Source :    Acad Med. 2007 Aug; 82(8):812-8.

Abstract:   Partnerships between academic medical center (AMCs) in North America and
            the developing world are uniquely capable of fulfilling the tripartite needs of
            care, training, and research required to address health care crises in the
            developing world. Moreover, the institutional resources and credibility of AMCs
            can provide the foundation to build systems of care with long-term
            sustainability, even in resource-poor settings. The authors describe a partnership
            between Indiana University School of Medicine and Moi University and Moi
            Teaching and Referral Hospital in Kenya that demonstrates the power of an
            academic medical partnership in its response to the HIV/AIDS pandemic in
            sub-Saharan Africa. Through the Academic Model for the Prevention and
            Treatment of HIV/AIDS, the partnership currently treats over 40,000 HIV-
            positive patients at 19 urban and rural sites in western Kenya, now enrolls nearly
            2,000 new HIV positive patients every month, feeds up to 30,000 people weekly,
            enables economic security, fosters HIV prevention, tests more than 25,000
            pregnant women annually for HIV, engages communities, and is developing a


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            robust electronic information system.The partnership evolved from a program of
            limited size and a focus on general internal medicine into one of the largest and
            most comprehensive HIV/AIDS-control systems in sub-Saharan Africa. The
            partnership's rapid increase in scale, combined with the comprehensive and
            long-term approach to the region's health care needs, provides a twinning model
            that can and should be replicated to address the shameful fact that millions are
            dying of preventable and treatable diseases in the developing world.


The STARK study: a cross-sectional study of adherence to short-term
drug regiments in urban Kenya.
Author:     Ellis, A. E.; Gogel, R. P.; Roman, B. R.; Watson, J. B.; Indyk, D., and Rosenberg, G.

Source :    Soc Work Health Care. 2006; 42(3-4):237-50.

Abstract:   The purpose of the STARK study (Short-Term Adherence Research in Kenya)
            was to identify factors that predict adherence to short-term drug regimens in
            Nairobi, Kenya. The participants (N = 357) in the study were recruited from the
            RAFIKI Foundation Clinic, a free primary healthcare clinic in Kibera, Nairobi's
            largest slum. Quantitative surveys were administered to all the participants
            regarding their adherence patterns and to a subgroup of mothers (N = 233)
            regarding their adherence in giving medicine to their children. 40 participated in
            four focus groups. 52% of participants reported taking all of their prescribed
            medication and 47% took it until they felt better. Over 65% of mothers reported
            giving all prescribed medication to their children. The most frequently cited
            barriers to adherence included lack of food and clean water, stress, and financial
            problems. By identifying obstacles to adherence and strategies to overcome
            them, this study showed that a community- based clinic with committed
            healthcare workers in Kenya can empower an economically disadvantaged
            population to be adherent.

Orphans and schooling in Africa: a longitudinal analysis. Demography.
Author:     Evans, D. K. and Miguel, E.

Source :    Demography. 2007 Feb; 44(1):35-57.

Abstract:   AIDS deaths could have a major impact on economic development by affecting
            the human capital accumulation of the next generation. We estimate the impact
            of parent death on primary school participation using an unusual five-year panel
            data set of over 20,000 Kenyan children. There is a substantial decrease in school
            participation following a parent death and a smaller drop before the death
            (presumably due to pre-death morbidity). Estimated impacts are smaller in
            specifications without individual fixed effects, suggesting that estimates based
            on cross-sectional data are biased toward zero. Effects are largest for children



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            whose mothers died and, in a novel finding, for those with low baseline
            academic performance.


Pediatric HIV type 1 vaccine trial acceptability among mothers in Kenya.
Author:     Author: Farquhar, C.; John-Stewart, G. C.; John, F. N.; Kabura, M. N., and Kiarie,
            J. N.

Source :    AIDS Res Hum Retroviruses. 2006 Jun; 22(6):491-5.

Abstract:   Vaccination of infants against human immunodeficiency virus type 1 (HIV-1)
            may prevent mother-to-child HIV-1 transmission. Successful trials and
            immunization efforts will depend on the willingness of individuals to participate
            in pediatric vaccine research and acceptance of infant HIV-1 vaccines. In a cross-
            sectional study, pregnant women presenting to a Nairobi antenatal clinic for
            routine care were interviewed regarding their attitudes toward participation in
            research studies and HIV-1 vaccine acceptability for their infants. Among 805
            women, 782 (97%) reported they would vaccinate their infant against HIV-1 and
            729 (91%) reported willingness to enroll their infant in a research study.
            However, only 644 (80%) would enroll their infants if HIV- 1 testing was
            required every 3 months and 513 (64%) would agree to HIV-1 vaccine trial
            participation. Reasons for not wanting to enroll in a pediatric HIV-1 vaccine trial
            included concerns about side effects (75%), partner objection (34%), and fear of
            discrimination (10%), HIV-1 acquisition (8%), or false-positive HIV-1 results
            (5%). The strongest correlate of pediatric vaccine trial participation was maternal
            willingness to be a vaccine trial participant herself; in univariate and multivariate
            models this was associated with a 17-fold increased likelihood of participation
            (HR 17.1; 95% CI 11.7-25; p < 0.001). We conclude from these results that
            immunizing infants against HIV-1 and participation in pediatric vaccine trials
            are generally acceptable to women at high risk for HIV-1 infection. It will be
            important to address barriers identified in this study and to include male
            partners when mobilizing communities for pediatric HIV-1 vaccine trials and
            immunization programs.


Salivary human immunodeficiency virus (HIV)-1-specific
immunoglobulin A in HIV-1-exposed infants in Kenya.
Author:     Farquhar, C.; VanCott, T.; Bosire, R.; Bermudez, C.; Mbori-Ngacha, D.; Lohman-
            Payne, B.; Nduati, R.; Otieno, P., and John-Stewart, G

Source:     Clin Exp Immunol. 2008 Jul; 153(1):37-43.

Abstract:   Humoral immunity, and specifically immunoglobulin A (IgA) that is directed
            against human immunodeficiency virus (HIV)-1, may contribute to protection



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            against HIV-1 acquisition at mucosal surfaces. HIV-1-specific IgA has been
            detected in genital tract secretions of HIV-1-uninfected commercial sex workers
            with HIV-1 exposure, and may be produced in parotid saliva by infants exposed
            orally to HIV-1 during delivery and breastfeeding. To explore this hypothesis,
            we collected saliva from 145 infants aged < or = 6 months enrolled in a perinatal
            HIV-1 transmission study in Nairobi and from 55 control infants without HIV-1
            exposure who were born to HIV-1-seronegative mothers. Among the 145 infants,
            115 (79%) remained uninfected during the 12-month study period and 30 (21%)
            became HIV-1-infected during follow-up. Nine (8%) of the 115 HIV-1-exposed,
            uninfected infants had detectable levels of HIV-1 gp160-specific IgA compared
            with four (13%) of 30 infected infants and none of 55 control infants (P = 0.47 and
            P = 0.03 respectively). Among the nine HIV-1-exposed, uninfected infants with
            positive assays, median age was 1 month and none acquired HIV-1 during
            follow-up. We conclude that HIV-1-specific salivary IgA responses may be
            generated by very young infants exposed perinatally to maternal HIV-1. Mucosal
            responses would be an appropriate target for paediatric vaccines against breast
            milk HIV-1 transmission.


Mapping transactional sex on the Northern Corridor highway in Kenya.
Health Place.
Author:     Ferguson, A. G. and Morris, C. N.

Source :    2007 Jun; 13(2):504-19.

Abstract:   Even in generalized HIV/AIDS epidemics, vulnerable populations such as sex
            workers and truckers require special attention in programming. Combining a
            number of elicitation methods, centred on Geographical Information Systems
            (GIS) mapping, the Kenyan section of the Northern Corridor highway was
            studied to characterize the 'hot spots' where transactional sex is concentrated and
            to provide estimates of numbers of truckers and sex workers and the volumes of
            transactional sex taking place on the highway. An average of 2400 trucks park
            overnight at the 39 hot spots identified. These spots have an estimated sex
            worker population of 5600 women. Analysis of 403 sex worker diaries shows an
            average of 13.6 different clients and 54.2 sex acts in a month. Condom use is 69%
            in liaisons with regular clients and 90% with casual clients. The use of GIS is
            demonstrated at regional and local scales. The 'bridge population' of clients of
            sex workers, containing a wide rage of occupations, supports the concept of
            programming for 'vulnerable places' as well as vulnerable groups


Using diaries to measure parameters of transactional sex: an example
from the Trans-Africa highway in Kenya.
Author:     Ferguson, A. G.; Morris, C. N., and Kariuki, C. W.


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Source :    Cult Health Sex. 2006 Mar-2006 Apr 30; 8(2):175-85.

Abstract:   Conventional methods of elicitation have severe limitations where sensitive
            information is being sought, resulting from both self-disclosure and recall bias.
            The use of diaries largely circumvents both of these problems. Four hundred and
            three female sex workers based on a section of the Trans-Africa Highway in
            Kenya completed standard diaries for consecutive 28-day periods. Variables
            measured included numbers and types of different clients, condom use,
            occupation of client, movement patterns and days of menses. Mean numbers of
            sexual partners, liaisons and sex acts and inter-relationships between the
            variables measured are analysed. The study affirms the value of diaries as an
            elicitation method for studying transactional sex in a resource-poor setting.
            Usable diaries were received from 70% of those who had agreed to participate in
            the study. The diaries yield detailed quantitative data that describe the
            characteristics and dynamics of transactional sex on a major highway in Africa
            and provide information that may be used to estimate HIV transmission rates.


The gradient in sub-Saharan Africa: socioeconomic status and
HIV/AIDS.
Author:     Fortson, J. G.

Source :    Demography. 2008 May; 45(2):303-22.

Abstract:   Using data from the Demographic and Health Surveys (DHS) for Burkina Faso
            (2003), Cameroon (2004), Ghana (2003), Kenya (2003), and Tanzania (2003), I
            investigate the cross-sectional relationship between HIV status and
            socioeconomic status. I find evidence of a robust positive education gradient in
            HIV infection, showing that, up to very high levels of education, better-educated
            respondents are more likely to be HIV-positive. Adults with six years of
            schooling are as much as three percentage points more likely to be infected with
            HIV than adults with no schooling. This gradient is not an artifact of age, sector
            of residence, or region of residence. With controls for sex, age, sector of
            residence, and region of residence, adults with six years of schooling are as
            much as 50% more likely to be infected with HIV than those with no schooling.
            Education is positively related to certain risk factors for HIV including the
            likelihood of having premarital sex. Estimates of the wealth gradient in HIV, by
            contrast, vary substantially across countries and are sensitive to the choice of
            measure of wealth.




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Proportion of new HIV infections attributable to herpes simplex 2
increases over time: simulations of the changing role of sexually
transmitted infections in sub-Saharan African HIV epidemics.
Author:     Freeman, E. E.; Orroth, K. K.; White, R. G.; Glynn, J. R.; Bakker, R.; Boily, M. C.;
            Habbema, D.; Buve, A., and Hayes, R.

Source :    Sex Transm Infect. 2007 Aug; 83 Suppl 1:i17-24.

Abstract:   Objective:
            To understand the changing impact of herpes simplex 2 (HSV-2) and other
            sexually transmitted infections (STIs) on HIV incidence over time in four sub-
            Saharan African cities, using simulation models.

            Methods:
            An individual-based stochastic model was fitted to demographic, behavioural
            and epidemiological data from cross-sectional population-based surveys in four
            African cities (Kisumu, Kenya; Ndola, Zambia; Yaounde, Cameroon; and
            Cotonou, Benin) in 1997. To estimate the proportion of new HIV infections
            attributable to HSV-2 and other STIs over time, HIV incidence in the fitted model
            was compared with that in model scenarios in which the cofactor effect of the
            STIs on HIV susceptibility and infectivity were removed 5, 10, 15, 20 and 25 years
            into the simulated HIV epidemics.

            Results:
            The proportion of incident HIV attributable to HSV-2 infection (the model
            estimated population attributable fraction (PAF(M))) increased with maturity of
            the HIV epidemic. In the different cities, the PAF(M) was 8-31% 5 years into the
            epidemic, but rose to 35-48% 15 years after the introduction of HIV. In contrast,
            the proportion of incident HIV attributable to chancroid decreased over time
            with strongest effects five years after HIV introduction, falling to no effect 15
            years after. Sensitivity analyses showed that, in the model, recurrent HSV-2
            ulcers had more of an impact on HIV incidence than did primary HSV-2 ulcers,
            and that the effect of HSV-2 on HIV infectivity may be more important for HIV
            spread than the effect on HIV susceptibility, assuming that HSV-2 has similar
            cofactor effects on HIV susceptibility and infectivity. The overall impact of other
            curable STIs on HIV spread (syphilis, gonorrhoea and chlamydia) remained
            relatively constant over time.

            Conclusions:
            Although HSV-2 appears to have a limited impact on HIV incidence in the early
            stages of sub-Saharan African HIV epidemics when the epidemic is concentrated
            in core groups, it has an increasingly large impact as the epidemic progresses. In
            generalised HIV epidemics where control programmes for curable STIs are
            already in place, interventions against HSV-2 may have a key role in HIV
            prevention.



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Factors associated with self-reported unprotected anal sex among male
sex workers in Mombasa, Kenya.
Author:     Geibel, S.; Luchters, S.; King'Ola, N.; Esu-Williams, E.; Rinyiru, A., and Tun, W.

Source :    Sex Transm Dis. 2008 Aug; 35(8):746-52.

Abstract:   Objectives:
            To identify social and behavioral characteristics associated with sexual risk
            behaviors among male sex workers who sell sex to men in Mombasa, Kenya.

            Methods:
            Using time-location sampling, 425 men who had recently sold, and were
            currently willing to sell sex to men were invited to participate in a cross-sectional
            survey. A structured questionnaire was administered using handheld computers.
            Factors associated with self-reported unprotected anal sex with male clients in
            the past 30 days were identified and subjected to multivariate analysis.

            Results:
            Thirty-five percent of respondents did not know HIV can be transmitted via anal
            sex, which was a significant predictor of unprotected anal sex [adjusted odds
            ratio (AOR) 1.92; 95% confidence interval (95% CI), 1.16-3.16]. Other associated
            factors included drinking alcohol 3 or more days per week (AOR, 1.63; 95% CI,
            1.05-2.54), self-report of burning urination within the past 12 months (AOR, 2.07;
            95% CI, 1.14-3.76), and having never been counseled or tested for HIV (AOR,
            1.66; 95% CI, 1.07-2.57). Only 21.2% of respondents correctly knew that a water-
            based lubricant should be used with latex condoms.

            Conclusions:
            Male sex workers who sell sex to men in Mombasa are in acute need of targeted
            prevention information on anal HIV and STI transmission, consistent condom
            use, and correct lubrication use with latex condoms. HIV programs in Africa
            need to consider and develop specific prevention strategies to reach this
            vulnerable population.


'Are you on the market?': a capture-recapture enumeration of men who
sell sex to men in and around Mombasa, Kenya.
Author:     Geibel, S.; van der Elst, E. M.; King'ola, N.; Luchters, S.; Davies, A.; Getambu, E.
            M.; Peshu, N.; Graham, S. M.; McClelland, R. S., and Sanders, E. J.

Source :    AIDS. 2007 Jun 19; 21(10):1349-54.




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Abstract:   Background:
            Men who have sex with men (MSM) are highly vulnerable to HIV infection, but
            this population can be particularly difficult to reach in sub-Saharan Africa. We
            aimed to estimate the number of MSM who sell sex in and around Mombasa,
            Kenya, in order to plan HIV prevention research.

            Methods:
            We identified 77 potential MSM contact locations, including public streets and
            parks, brothels, bars and nightclubs, in and around Mombasa and trained 37
            MSM peer leader enumerators to extend a recruitment leaflet to MSM who were
            identified as 'on the market', that is, a man who admitted to selling sex to men.
            We captured men on two consecutive Saturdays, 1 week apart. A record was
            kept of when, where and by whom the invitation was extended and received,
            and of refusals. The total estimate of MSM who sell sex was derived from
            capture-recapture calculation.

            Results:
            Capture 1 included 284 men (following removal of 15 duplicates); 89 men
            refused to participate. Capture 2 included 484 men (following removal of 35
            duplicates); 75 men refused to participate. Of the 484 men in capture 2, 186 were
            recaptures from capture 1, resulting in a total estimate of 739 (95% confidence
            interval, 690-798) MSM who sell sex in the study area.

            Conclusions:
            We estimated that 739 MSM sell sex in and around Mombasa. Of these, 484 were
            contacted through trained peer enumerators in a single day. MSM who sell sex in
            and around Mombasa represent a sizeable population who urgently need to be
            targeted by HIV prevention strategies.


Acceptability of human immunodeficiency virus testing in patients with
invasive cervical cancer in Kenya.
Author:     Gichangi, P.; Estambale, B.; Bwayo, J.; Rogo, K.; Ojwang, S.; Njuguna, E., and
            Temmerman, M.

Source :    Int J Gynecol Cancer. 2006 Mar-2006 Apr 30; 16(2):681-5.

Abstract:   Invasive cervical cancer (ICC) is common in areas where human
            immunodeficiency virus (HIV) is also prevalent. Currently, HIV seroprevalence
            as well as acceptability of HIV testing in ICC patients in Kenya is unknown. The
            objective of this study was to determine the acceptability of HIV testing among
            patients with ICC. Women with histologically verified ICC at Kenyatta National
            Hospital participated in the study. A structured questionnaire was administered
            to patients who gave informed consent. HIV pre- and posttesting counseling was
            done. Blood was tested for HIV using enzyme-linked immunosorbent assay.
            Overall, 11% of ICC patients were HIV seropositive. The acceptance rate of HIV


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            testing was 99%; yet, 5% of the patients did not want to know their HIV results.
            Patients less than 35 years old were two times more likely to refuse the result of
            the HIV test (odds ratio [OR] 2.2). Patients who did not want to know their HIV
            results were three times more likely to be HIV seropositive (OR 3.1). Eighty four
            percent of the patients were unaware of their HIV seropositive status. The HIV-1
            seroprevalence in ICC patients was comparable to the overall seroprevalence in
            Kenya. ICC patients were interested in HIV testing following pretest counseling.
            Offering routine HIV testing is recommended in ICC patients.


Predictors of mortality in HIV-1 exposed uninfected post-neonatal
infants at the Kenyatta National Hospital, Nairobi.
Author:     Gichuhi, C.; Obimbo, E.; Mbori-Ngacha, D.; Mwatha, A.; Otieno, P.; Farquhar, C.;
            Wariua, G.; Wamalwa, D.; Bosire, R., and John-Stewart,

Source:     G. East Afr Med J. 2005 Sep; 82(9):447-51.

Abstract:   Objectives:
            To identify potential predictors of mortality, to determine mortality rate and to
            identify prevalent causes of death in a cohort of HIV-1 exposed uninfected
            infants.

            Design:        Prospective cohort study.

            Setting:       Kenyatta National Hospital, Nairobi, Kenya.

            Subjects:
            Three hundred and fifty one HIV-1 exposed uninfected post-neonatal infants
            who survived to one year of age.

            Results:
            Sixteen infants died (post-neonatal mortality rate of 47/1000 live births), 14 (88%)
            before six months of age. The most frequently identified medical conditions at
            death included bronchopneumonia, diarrhoea and failure to thrive. In
            multivariate analysis, prematurity (RR=10.5, 95%CI 3.8-29.1, p<0.001), teenage
            motherhood (RR=3.6, Cl 1.0-13.2, p=0.05) and symptomatic maternal HIV-1
            disease (RR=2.7, CI 0.9-7.7, p=0.06) were associated with infant mortality.

            Conclusion:
            Prematurity, teenage motherhood and symptomatic HIV-1 maternal disease
            were important predictors for post-neonatal mortality in this cohort of HIV-1
            exposed uninfected infants. These factors should be considered in monitoring
            and follow up in prevention of mother-to-child HIV-1 transmission (PMTCT)
            programs.




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Total lymphocyte count as a surrogate marker for CD4+ t cell count in
initiating antiretroviral therapy at Kenyatta National Hospital, Nairobi.

Author:     Gitura, B.; Joshi, M. D.; Lule, G. N., and Anzala, O

Source :    East Afr Med J. 2007 Oct; 84(10):466-72.

Abstract:   Objective:
            To evaluate the utility of Total Lymphocyte Count (TLC) as a surrogate marker
            for CD4 + T cell count in antiretroviral (ARV) treatment initiation in a Kenyan
            population of HIV seropositive patients at Kenyatta National Hospital.

            Design:        Cross-sectional descriptive study.

            Setting:
            Kenyatta National Hospital, HIV treatment and follow-up outpatient facility;
            Comprehensive Care Centre, Nairobi, Kenya.

            Subjects:
            Two hundred and twenty five HIV Elisa positive, ARV naive patients visiting the
            Comprehensive Care Centre between January 2006 to March 2006.

            Results:
            A significant linear correlation was found between TLC and CD4 cell count for
            the whole group with a Spearman rank correlation of 0.761 (p < 0.01); and was
            also independently observed in the four WHO clinical stages. The classification
            utility of TLC 1200 cells/mm3 cut-off was suboptimal; sensitivity 37% specificity
            of 99% and the NPV of 56%. The receiver operator characteristics (ROC) curve
            generated an optimal TLC cut-off of 1900 cells/mm3 cut-off to be of greatest
            utility with a sensitivity of 81.1%, specificity of 90.3%, PPV of 90.8% and NPV of
            80.2%. This implies that a TLC cut-off of 1900 cells/mm3 correctly classify eight
            out of ten HIV positive patients as having a CD4 < 200 cells/mm3 and only
            misclassify two such patients. Serial CD4 testing can then be performed on the
            minority of patients who despite a TLC > or = 1900 cells/mm3 are, on basis of
            clinical data, suspect of more advanced disease warranting ARV therapy. This
            would reduce the number of patients tested for and focus the application of CD4
            testing and thus reduce attendant cost in care provision in CD4 resource poor
            settings.

            Conclusion:
            Our data showed a good positive correlation between TLC and CD4 cell count,
            however the WHO recommended TLC cuto-ff of 1200/mm3 was found to be of
            low sensitivity in classifying patients as having a CD4 counts < 200 cells/mm3.
            This would result in underestimation of advanced stage of disease and to
            withholding ARVs treatment to persons who need treatment. We recommend a
            TLC cut-off of 1900 cells/mm3 for our population to classify patients as either



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            above or below the CD4 count cut-off of 200 cells/mm3 as an indicator of when
            to start antiretroviral therapy.


Short term estimates of adult HIV incidence by mode of transmission:
Kenya and Thailand as examples.
Author:     Gouws, E.; White, P. J.; Stover, J., and Brown, T.

Source :    Sex Transm Infect. 2006 Jun; 82 Suppl 3:iii51-55.

Abstract:   Objective:
            Patterns of transmission of HIV are different among different regions of the
            world and change over time within regions. In order to adapt prevention
            strategies to changing patterns of risk, we need to understand the behaviours
            that put people at risk of infection and how new infections are distributed among
            risk groups.

            Methods:
            A model is described to calculate the expected incidence of HIV infections in the
            adult population by mode of exposure using the current distribution of prevalent
            infections and the patterns of risk within different populations. For illustration
            the model is applied to Thailand and Kenya.

            Results:
            New infections in Kenya were mainly transmitted through heterosexual contact
            (90%), while a small but significant number were related to injecting drug use
            (4.8%) and men who have sex with men (4.5%). In Thailand, the epidemic has
            spread over time to the sexual partners of vulnerable groups and in 2005 the
            majority of new infections occurred among the low risk heterosexual population
            (43%). Men having sex with men accounted for 21% and sex work (including sex
            workers, clients, and partners of clients) for 18% of new infections. Medical
            interventions did not contribute significantly to new infections in either Kenya
            or Thailand.

            Conclusions:
            The model provides a simple tool to inform the planning of effective,
            appropriately targeted, country specific intervention programmes. However,
            better surveillance systems are needed in countries to obtain more reliable
            biological and behavioural data in order to improve the estimates of incidence by
            risk group.




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Higher pre-infection vitamin E levels are associated with higher
mortality in HIV-1-infected Kenyan women: a prospective study.
Author:     Graham, S. M.; Baeten, J. M.; Richardson, B. A.; Bankson, D. D.; Lavreys, L.;
            Ndinya-Achola, J. O.; Mandaliya, K.; Overbaugh, J., and McClelland, R. S.

Source:     BMC Infect Dis. 2007; 7:63.

Abstract:   Background:
            Low vitamin E levels are often found in HIV-1 infection, and studies have
            suggested that higher levels may decrease the risk of disease progression.
            However, vitamin E supplementation has also been reported to increase CCR5
            expression, which could increase HIV-1 replication. We hypothesized that
            vitamin E levels at HIV-1 acquisition may influence disease progression.

            Methods:
            Vitamin E status was measured in stored samples from the last pre-infection visit
            for 67 Kenyan women with reliably estimated dates of HIV-1 acquisition.
            Regression analyses were used to estimate associations between pre-infection
            vitamin E and plasma viral load, time to CD4 count <200 cells/muL, and
            mortality.

            Results:
            After controlling for potential confounding factors, each 1 mg/L increase in pre-
            infection vitamin E was associated with 0.08 log10 copies/mL (95% CI -0.01 to
            +0.17) higher set point viral load and 1.58-fold higher risk of mortality (95% CI
            1.15-2.16). The association between higher pre-infection vitamin E and mortality
            persisted after adjustment for set point viral load (HR 1.55, 95% CI 1.13-2.13).

            Conclusion:
            Higher pre-infection vitamin E levels were associated with increased mortality.
            Further research is needed to elucidate the role vitamin E plays in HIV-1
            pathogenesis.


A decrease in albumin in early HIV type 1 infection predicts subsequent
disease progression.
Author:     Graham, S. M.; Baeten, J. M.; Richardson, B. A.; Wener, M. H.; Lavreys, L.;
            Mandaliya, K.; Ndinya-Achola, J. O.; Overbaugh, J., and McClelland, R. S.

Source:     AIDS Res Hum Retroviruses. 2007 Oct; 23(10):1197-200.

Abstract:   We investigated the association between albumin levels and HIV-1 disease
            progression among 78 Kenyan women followed from before infection through a
            median of 70 months. With HIV-1 acquisition, median albumin decreased from



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            38.5 g/liter to 36.8 g/liter (p = 0.07) and the prevalence of hypoalbuminemia
            increased from 16% to 32% (p = 0.02). Each 1 g/liter decrease in albumin with
            HIV-1 acquisition was associated with a 13% increase (p = 0.01) in the risk of
            progressing to a CD4 count <200 cells/mul, after adjustment for set point plasma
            viral load. A decrease in albumin of over 10% was associated with a 3.5-fold
            increase in the risk of progressing to a CD4 count <200 cells/mul (95% CI 1.4-9.0,
            p = 0.008). Trends for an increased risk of mortality were also seen. A greater
            decrease in albumin levels accompanying HIV-1 acquisition may be a marker for
            changes in early infection associated with more rapid disease progression.


Screening for genital and anorectal sexually transmitted infections in
HIV prevention trials in Africa.
Author:     Grijsen, M. L.; Graham, S. M.; Mwangome, M.; Githua, P.; Mutimba, S.;
            Wamuyu, L.; Okuku, H.; Price, M. A.; McClelland, R. S.; Smith, A. D., and
            Sanders, E. J.

Source:     Sex Transm Infect. 2008 Oct; 84(5):364-70.

Abstract:   Objectives:
            To demonstrate the value of routine, basic sexually transmitted infection (STI)
            screening at enrolment into an HIV-1 vaccine feasibility cohort study and to
            highlight the importance of soliciting a history of receptive anal intercourse
            (RAI) in adults identified as "high risk".

            Methods:
            Routine STI screening was offered to adults at high risk of HIV-1 upon
            enrolment into a cohort study in preparation for HIV-1 vaccine trials. Risk
            behaviours and STI prevalence were summarised and the value of microscopy
            assessed. Associations between prevalent HIV-1 infection and RAI or prevalent
            STI were evaluated with multiple logistic regression.

            Results:
            Participants had a high burden of untreated STI. Symptom-directed management
            would have missed 67% of urethritis cases in men and 59% of cervicitis cases in
            women. RAI was reported by 36% of male and 18% of female participants. RAI
            was strongly associated with HIV-1 in men (adjusted odds ratio (aOR) 3.8; 95%
            CI 2.0 to 6.9) and independently associated with syphilis in women (aOR 12.9;
            95% CI 3.4 to 48.7).

            Conclusions:
            High-risk adults recruited for HIV-1 prevention trials carry a high STI burden.
            Symptom-directed treatment may miss many cases and simple laboratory-based
            screening can be done with little cost. Risk assessment should include questions
            about anal intercourse and whether condoms were used. STI screening,



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            including specific assessment for anorectal disease, should be offered in African
            research settings recruiting participants at high risk of HIV-1 acquisition.


Declines in HIV prevalence can be associated with changing sexual
behaviour in Uganda, urban Kenya, Zimbabwe, and urban Haiti.
Author:     Hallett, T. B.; Aberle-Grasse, J.; Bello, G.; Boulos, L. M.; Cayemittes, M. P.;
            Cheluget, B.; Chipeta, J.; Dorrington, R.; Dube, S.; Ekra, A. K.; Garcia-Calleja, J.
            M.; Garnett, G. P.; Greby, S.; Gregson, S.; Grove, J. T.; Hader, S.; Hanson, J.;
            Hladik, W.; Ismail, S.; Kassim, S.; Kirungi, W.; Kouassi, L.; Mahomva, A.;
            Marum, L.; Maurice, C.; Nolan, M.; Rehle, T.; Stover, J., and Walker, N.

Source:     Sex Transm Infect. 2006 Apr; 82 Suppl 1:i1-8.

Abstract:   Objective:
            To determine whether observed changes in HIV prevalence in countries with
            generalised HIV epidemics are associated with changes in sexual risk behaviour.

            Methods:
            A mathematical model was developed to explore the relation between
            prevalence recorded at antenatal clinics (ANCs) and the pattern of incidence of
            infection throughout the population. To create a null model a range of
            assumptions about sexual behaviour, natural history of infection, and sampling
            biases in ANC populations were explored to determine which factors maximised
            declines in prevalence in the absence of behaviour change. Modelled prevalence,
            where possible based on locally collected behavioural data, was compared with
            the observed prevalence data in urban Haiti, urban Kenya, urban Cote d'Ivoire,
            Malawi, Zimbabwe, Rwanda, Uganda, and urban Ethiopia.

            Results:
            Recent downturns in prevalence observed in urban Kenya, Zimbabwe, and
            urban Haiti, like Uganda before them, could only be replicated in the model
            through reductions in risk associated with changes in behaviour. In contrast,
            prevalence trends in urban Cote d'Ivoire, Malawi, urban Ethiopia, and Rwanda
            show no signs of changed sexual behaviour.

            Conclusions:
            Changes in patterns of HIV prevalence in urban Kenya, Zimbabwe, and urban
            Haiti are quite recent and caution is required because of doubts over the
            accuracy and representativeness of these estimates. Nonetheless, the observed
            changes are consistent with behaviour change and not the natural course of the
            HIV epidemic.




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Does cotrimoxazole prophylaxis for the prevention of HIV-associated
opportunistic infections select for resistant pathogens in Kenyan adults?
Author:     Hamel, M. J.; Greene, C.; Chiller, T.; Ouma, P.; Polyak, C.; Otieno, K.;
            Williamson, J.; Shi, Y. P.; Feikin, D. R.; Marston, B.; Brooks, J. T.; Poe, A.; Zhou,
            Z.; Ochieng, B.; Mintz, E., and Slutsker, L.

Source:     Am J Trop Med Hyg. 2008 Sep; 79(3):320-30.

Abstract:   We assessed the effect of daily cotrimoxazole, essential for HIV care, on
            development of antifolate-resistant Plasmodium falciparum, naso-pharyngeal
            Streptococcus pneumoniae (pneumococcus), and commensal Escherichia coli.
            HIV-positive subjects with CD4 cell count < 350 cells/muL (lower-CD4; N = 692)
            received cotrimoxazole; HIV-positive with CD4 cell count > or = 350 cells/muL
            (higher-CD4; N = 336) and HIV-negative subjects (N = 132) received
            multivitamins. Specimens were collected at baseline, 2 weeks, monthly, and at
            sick visits during 6 months of follow-up to compare changes in resistance, with
            higher-CD4 as referent. P. falciparum parasitemia incidence density was 16 and
            156/100 person-years in lower-CD4 and higher-CD4, respectively (adjusted rate
            ratio [ARR] = 0.11; 95% confidence interval [CI] = 0.06-0.15; P < 0.001) and 97/100
            person-years in HIV-negative subjects (ARR = 0.62; 95% CI = 0.44-0.86; P = 005).
            Incidence density of triple and quintuple dihydrofolate-
            reductase/dihydropteroate-synthetase mutations was 90% reduced in lower-
            CD4 compared with referent. Overall, cotrimoxazole non-susceptibility was high
            among isolated pneumococcus (92%) and E. coli (76%) and increased
            significantly in lower-CD4 subjects by Week 2 (P < 0.005). Daily cotrimoxazole
            prevented malaria and reduced incidence of antifolate-resistant P. falciparum but
            contributed to increased pneumococcus and commensal Escherichia coli
            resistance


Potential for abuse in the VCT counselling room: service provider's
perceptions in Kenya.
Author:     Hamilton, C.; Okoko, D.; Tolhurst, R.; Kilonzo, N.; Theobald, S., and Taegtmeyer,
            M

Source:     Health Policy Plan. 2008 Nov; 23(6):390-6.

Abstract:   The rapid scale-up of HIV counselling and testing programmes in Kenya has led
            to quality concerns, including the potential for abuse within the private,
            confidential setting of client-initiated voluntary counselling and testing (VCT). A
            qualitative study was conducted in three provinces of Kenya, involving 26 VCT
            service providers and 13 key informants. First and second hand accounts of
            emotional, physical and sexual abuse emerged in all three study sites in spite of
            measures to mitigate such occurrences. Whilst uncommon, abuse was perceived


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            by service providers to be serious and sufficiently widespread to raise significant
            concerns. Abuse occurred client to counsellor, from counsellor to client and from
            counsellor to counsellor. In all cases the person suffering the abuse was female.
            While the potential for abuse was demonstrated in VCT sites, we argue that
            experiences of abuse are not confined to VCT and are largely shaped by gender
            and power relations within the Kenyan cultural context. The international
            impetus for scale-up of HIV services provides an urgent rationale for the need to
            address and highlight these difficult issues at multiple levels. International
            guidelines, policy and methods need adapting in recognition of the potential for
            abuse. Systems for investigating and deregistering counsellors have been
            developed in Kenya but require formalizing. Institutions providing VCT should
            consider unlocked doors, semi-opaque windows and the use of 'mystery clients'
            as a quality assurance measure.


The relationship between expressed HIV/AIDS-related stigma and
beliefs and knowledge about care and support of people living with
AIDS in families caring for HIV-infected children in Kenya.
Author:     Hamra, M.; Ross, M. W.; Karuri, K.; Orrs, M., and D'Agostino, A.

Source:     AIDS Care. 2005 Oct; 17(7):911-22.

Abstract:   At the end of 2001, AIDS-related deaths had left an estimated 900,000 living
            orphans in Kenya (UNAIDS/WHO Epidemiology fact sheet, Kenya report, 2004).
            Many of those orphans are also HIV+. In Eastern Kenya, the Lea Toto Kangemi
            Outreach Program provides support to families caring for HIV+ children, many
            of whom are orphaned or soon to be orphaned. A major challenge for these
            families is the stigma attached to the family. In 2003, the Kangemi Program
            conducted a household survey of client families. We examined markers of
            expressed stigma and the association between expressed stigma and other
            demographic and belief/knowledge domains. The focus of the present study was
            the specific belief/knowledge domain surrounding care/support of HIV+
            persons. Our goal was to explore this domain in the Kangemi families and to
            examine its relationship to expressed stigma. We created an AIDS-related stigma
            scale from selected items in the household survey and cross-tabulated stigma
            scores with care/support knowledge items. We found significant associations
            between less expressed stigma and greater care/support knowledge. Our results
            have implications for interventions that reduce expressed stigma and/or
            improve quality of care.




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HIV, hepatitis B and hepatitis C coinfection in Kenya.
Author:     Harania, R. S.; Karuru, J.; Nelson, M., and Stebbing, J.

Source:     AIDS. 2008 Jun 19; 22(10):1221-2.

Abstract:   There are few data regarding hepatitis and HIV coinfection in Africa. In 378 HIV
            seropositive individuals in Nairobi, 23 (6%) were hepatitis B virus (HBV) and
            HIV coinfected, four (1%) were hepatitis C virus (HCV) and HIV coinfected and
            one patient was infected with all three viruses. Coinfected individuals were more
            likely to be men and older; a lack of HBV vaccination was a risk factor for
            HIV/HBV coinfection (P = 0.001) and tenofovir containing regimens appeared
            most effective at reducing HBV viral load.


Human leukocyte antigen-DQ alleles and haplotypes and their
associations with resistance and susceptibility to HIV-1 infection.
Author:     Hardie, R. A.; Luo, M.; Bruneau, B.; Knight, E.; Nagelkerke, N. J.; Kimani, J.;
            Wachihi, C.; Ngugi, E. N., and Plummer, F. A.

Source:     AIDS. 2008 Apr 23; 22(7):807-16.

Abstract:   Objectives:
            To determine the association of DQ antigens with resistance and susceptibility to
            HIV-1.

            Design:
            Despite repeated exposure to HIV-1, a subset of women in the Pumwani Sex
            Worker cohort established in Nairobi, Kenya in 1985 have remained HIV-1
            negative for at least 3 years and are classified as resistant. Differential
            susceptibility to HIV-1 infection is associated with HIV-1 specific CD4 and CD8
            T cell responses. As human leukocyte antigen-DQ antigens present viral peptides
            to CD4 cells, we genotyped human leukocyte antigen -DQ alleles for 978 women
            enrolled in the cohort and performed cross-sectional and longitudinal analyses to
            identify associations of human leukocyte antigen -DQ with
            resistance/susceptibility to HIV-1.

            Methods:
            QA1 and DQB1 were genotyped using taxonomy-based sequence analysis. SPSS
            13.0 was used to determine associations of DQ alleles/haplotypes with HIV-1
            resistance, susceptibility, and seroconversion rates.

            Results:
            Several DQB1 alleles and DQ haplotypes were associated with resistance to HIV-
            1 infection. These included DQB1*050301 (P = 0.055, Odds Ratio = 12.77, 95%



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                             STIs, HIV and AIDS: 2005 - 2008

            Confidence Interval = 1.44-112), DQB1*0603 and DQB1*0609 (P = 0.037, Odds
            Ratio = 3.25, 95% Confidence Interval = 1.12-9.47), and DQA1*010201-DQB1*0603
            (P = 0.044, Odds Ratio = 17.33, 95% Confidence Interval = 1.79-168). Conversely,
            DQB1*0602 (P = 0.048, Odds Ratio = 0.68, 95% Confidence Interval = 0.44-1.05)
            and DQA1*010201-DQB1*0602 (P = 0.039, Odds Ratio = 0.64, 95% Confidence
            Interval = 0.41-1.03) were overrepresented in the HIV-1 infected population.
            DQA1*0504-DQB1*0201, DQA1*010201-DQB1*0201, DQA1*0402-DQB1*0402 and
            DQA1*0402-DQB1*030101 genotypes were only found in HIV-1 positive subjects
            (Odds Ratio = 0.30-0.31, 95% Confidence Interval = 0.03-3.70), and these women
            seroconverted rapidly. The associations of these DQ alleles and haplotypes with
            resistance and susceptibility to HIV-1 were independent of the previously
            reported human leukocyte antigen-DRB*01, human leukocyte antigen A2/6802,
            and human leukocyte antigen-A*2301.

            Conclusion:
            The associations of DQ alleles and haplotypes with resistance and susceptibility
            to HIV-1 emphasize the importance of human leukocyte antigen-DQ and CD4 in
            anti-HIV-1 immunity.


Antiretroviral durability and tolerability in HIV-infected adults living in
urban Kenya.
Author:     Hawkins, C.; Achenbach, C.; Fryda, W.; Ngare, D., and Murphy, R.

Source:     J Acquir Immune Defic Syndr. 2007 Jul 1; 45(3):304-10.

Abstract:   Background:
            Insufficient data exist on the durability and tolerability of first-line antiretroviral
            therapy (ART) regimens provided by HIV treatment programs implemented in
            developing countries.

            Methods:
            Longitudinal observation of clinical, immunologic, and treatment parameters of
            all HIV-infected adult patients initiated on ART was performed at Saint Mary's
            Mission Hospital in Nairobi, Kenya from September 2004 until August 2006.

            Results:
            A total of 1286 patients were analyzed (59.1% female). Initial ART regimens were
            primarily stavudine, lamivudine, and nevirapine (62.1%). Median ART duration
            was 350 days (11.6 months). Significant improvements in clinical and
            immunologic status were noted after 12 months of therapy. ART switches
            occurred in 701 (54.5%) patients. The cumulative incidence of ART switch at 12
            months was 78.4%. Concurrent ART-related toxicities (40.6%) and tuberculosis
            treatment interactions (28.1%) were the most frequent reasons for ART switch.
            Baseline AIDS symptoms (hazard rate [HR]=1.59, 95% confidence interval [CI]:
            1.28 to 1.98; P<0.01) and a CD4 count<or=100 cells/mm3 (HR=1.20, CI: 1.01 to


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            1.43; P=0.04) were independent predictors of ART switch. ART-related clinical
            toxicity occurred in 341 (26.5%) patients. Peripheral neuropathy was reported
            most frequently (20.7%). A CD4 count<or=100 cells/mm3 was an independent
            predictor of clinical toxicity.

            Conclusions:
            Excellent clinical and immunologic responses to ART were observed in this
            urban Kenyan population; however, frequent switches in ART among
            medication classes because of toxicity or drug interactions may limit the
            durability of these responses.


HIV-neutralizing immunoglobulin A and HIV-specific proliferation are
independently associated with reduced HIV acquisition in Kenyan sex
workers.
Author:     Hirbod, T.; Kaul, R.; Reichard, C.; Kimani, J.; Ngugi, E.; Bwayo, J. J.; Nagelkerke,
            N.; Hasselrot, K.; Li, B.; Moses, S.; MacDonald, K. S., and Broliden, K.

Source:     AIDS. 2008 Mar 30; 22(6):727-35.

Abstract:   Objectives:
            HIV-neutralizing immunoglobulin A (IgA) and HIV-specific cellular immunity
            have been described in highly exposed, persistently seronegative (HEPS)
            individuals, but well controlled studies have not been performed. We performed
            a prospective, nested case-control study to examine the association of genital
            IgA and systemic cellular immune responses with subsequent HIV acquisition in
            high-risk Kenyan female sex workers (FSWs).

            Design and methods:
            A randomized trial of monthly antibiotic prophylaxis to prevent sexually
            transmitted disease/HIV infection was performed from 1998 to 2002 in HIV-
            uninfected Kenyan FSWs. After the completion of trial, FSWs who had acquired
            HIV (cases) were matched 1: 4 with persistently uninfected controls based on
            study arm, duration of HIV-seronegative follow-up, and time of cohort
            enrolment. Blinded investigators assayed the ability at enrolment of genital IgA
            to neutralize primary HIV isolates as well as systemic HIV-specific cellular
            IFNgamma-modified enzyme-linked immunospot and proliferative responses.

            Results:
            The study cohort comprised 113 FSWs: 24 cases who acquired HIV and 89
            matched controls. Genital HIV-neutralizing IgA was associated with reduced
            HIV acquisition (P = 0.003), as was HIV-specific proliferation (P = 0.002), and
            these associations were additive. HIV-specific IFNgamma production did not
            differ between case and control groups. In multivariable analysis, HIV-
            neutralizing IgA and HIV-specific proliferation each remained independently



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            associated with lack of HIV acquisition. Genital herpes (HSV2) was associated
            with increased HIV risk and with reduced detection of HIV-neutralizing IgA.

            Conclusion:
            Genital HIV-neutralizing IgA and systemic HIV-specific proliferative responses,
            assayed by blinded investigators, were prospectively associated with HIV
            nonacquisition. The induction of these immune responses may be an important
            goal for HIV vaccines.


Prevention of mother-to-child transmission and voluntary counseling
and testing programme data: what is their utility for HIV surveillance?
Author:     Hladik, W.; Masupu, K.; Roels, T.; Plipat, T.; Kaharuza, F.; Bunnell, R.; Seguy, N.,
            and Marum, L. H.

Source:     AIDS. 2005 May; 19 Suppl 2:S19-24.

Abstract:   Objective:
            Antenatal clinic (ANC)-based surveillance through unlinked anonymous testing
            (UAT) for HIV without informed consent provides solid long-term trend data in
            resource-constrained countries with generalized epidemics. The rapid expansion
            of the prevention of mother-to-child transmission (PMTCT) and voluntary
            counseling and testing (VCT) programmes prompts the question regarding their
            utility for HIV surveillance and their potential to replace UAT-based ANC
            surveillance.

            Methods:
            Four presentations on the use of PMTCT or VCT data for HIV surveillance were
            presented at a recent international conference. The main findings are presented
            in this paper, and the operational and epidemiological aspects of using PMTCT
            or VCT data for surveillance are considered.

            Results:
            VCT data in Uganda confirm the falling trend in HIV prevalence observed in
            ANC surveillance. Thailand, a country with nationwide PMTCT coverage and a
            very high acceptance of HIV testing, has replaced UAT data in favor of PMTCT
            data for surveillance. Studies from Botswana and Kenya showed that PMTCT-
            based HIV prevalences was similar, but the quality and availability of the
            PMTCT data varied.

            Conclusion:
            The strength of UAT lies in the absence of selection bias and the availability of
            individual data. Conversely, the quantity of VCT and PMTCT programme
            testing data often exceed those in UAT, but may be subject to bias due to self-
            selection or test refusal. When using VCT or PMTCT data for surveillance,



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            investigators must consider these caveats, as well as their varying data quality,
            accessibility, and availability of individual records

AMPATH: living proof that no one has to die from HIV.
Author:     Inui, T. S.; Nyandiko, W. M.; Kimaiyo, S. N.; Frankel, R. M.; Muriuki, T.; Mamlin,
            J. J.; Einterz, R. M., and Sidle, J. E.

Source:     J Gen Intern Med. 2007 Dec; 22(12):1745-50.

Abstract:   Background and objective:
            The HIV/AIDS epidemic in sub-Saharan Africa is decimating populations,
            deteriorating economies, deepening poverty, and destabilizing traditional social
            orders. The advent of the U.S. President's Emergency Plan for AIDS Relief
            (PEPFAR) made significant supplemental resources available to sub-Saharan
            national programs for the prevention and treatment of HIV/AIDS, but few
            programs have demonstrated the capacity to use these resources to increase
            rapidly in size. In this context, AMPATH, a collaboration of Indiana University
            School of Medicine, the Moi University School of Medicine, and the Moi
            Teaching and Referral Hospital in Eldoret, Kenya, is a stunning exception. This
            report summarizes findings from an assessment of AMPATH staff perceptions of
            how and why this has happened.

            Participants and approach:
            Semistructured, in-depth, individual interviews of 26 AMPATH workers were
            conducted and recorded. Field notes from these interviews were generated by
            independent reviewers and subjected to close-reading qualitative analysis for
            themes.

            Results:
            The themes identified were as follows: creating effectively, connecting with
            others, making a difference, serving those in great need, providing
            comprehensive care to restore healthy lives, and growing as a person and a
            professional.

            Conclusion:
            Inspired personnel are among the critical assets of an effective program. Among
            the reasons for success of this HIV/AIDS program are a set of work values and
            motivations that would be helpful in any setting, but perhaps nowhere more
            critical than in the grueling work of making a complex program work
            spectacularly well in the challenging setting of a resource-poor country.
            Sometimes, even in the face of long odds, the human spirit prevails.




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Elevated T cell counts and RANTES expression in the genital mucosa of
HIV-1-resistant Kenyan commercial sex workers.
Author:     Iqbal, S. M.; Ball, T. B.; Kimani, J.; Kiama, P.; Thottingal, P.; Embree, J. E.; Fowke,
            K. R., and Plummer, F. A.

Source:     J Infect Dis. 2005 Sep 1; 192(5):728-38.

Abstract:   The initial site of exposure to human immunodeficiency virus (HIV)-1 during
            heterosexual transmission occurs in the genital tract. Although the majority of
            immunological studies have focused on the immune response to HIV-1 at the
            systemic level, our understanding of tissue-specific immunity is deficient. The
            goal of the present study was to characterize T cell populations found in the
            cervix of women shown to be resistant to infection by HIV-1. Levels of both
            systemic and cervical mucosal lymphocytes were compared between HIV-1-
            resistant, HIV-1-uninfected, and HIV-1-infected commercial sex workers (CSWs)
            as well as HIV-1-uninfected non-CSW control subjects at low risk for exposure.
            The HIV-1-resistant CSWs had increased cervical CD4+ and CD8+ T cell counts,
            compared with the HIV-1-uninfected CSWs; importantly, these increases were
            not reflected in the systemic lymphocyte compartment. There was a 2-fold
            increase in CD4+ T cell counts in the HIV-1-resistant CSWs, compared with both
            the HIV-1-infected and the HIV-1-uninfected CSWs. Expression of the HIV-1
            coreceptors CCR5 and CXCR4 was also determined, and cytokine and beta
            chemokine levels in the genital mucosa were assessed. The HIV-1-resistant CSWs
            had a 10-fold increase in RANTES expression, compared with the HIV-1-
            uninfected CSWs. This is the first study to show elevated levels of beta
            chemokines and CD4+ T cells in the genital tracts of women who are exposed to
            HIV-1 and yet are uninfected.


HIV voluntary counselling and testing in Nakuru, Kenya: findings from
a community survey.
Author:     Irungu, T. K.; Varkey, P.; Cha, S., and Patterson, J. M.

Source:     HIV Med. 2008 Feb; 9(2):111-7.

Abstract:   Objectives:
            HIV voluntary counselling and testing (VCT) is important for prevention,
            detection and treatment of HIV infection. A study was conducted to determine
            the extent of utilization of VCT, and to study the attitudes and preferences of the
            community regarding VCT.

            Methods:
            A total of 301 adults, aged 18-49 years, residing in Nakuru, Kenya were
            randomly selected using a two-stage sampling process. A self-administered


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            questionnaire delivered during home visits was used to collect data over a 4-
            week period.

            Results:
            The majority of study participants (184 of 287; 64.1%) had never been tested for
            HIV; 77 (26.8%) had received VCT, and 26 (9.1%) had received HIV testing
            without counselling. A total of 219 (78.2%) of the 280 responding participants
            expressed readiness to have VCT. The majority of participants (216 of 296; 73%)
            preferred VCT, while 46 (15.5%) preferred testing without counselling. The
            majority (227; 76.7%) preferred couple testing and dedicated clinics and private
            doctors' offices as testing facilities. The choice of a nearby facility was ranked
            above the provision of anonymity by most participants (162 of 298; 54.4%; vice
            versa for 136 of 298; 45.6%).

            Conclusions:
            With HIV/AIDS continuing to be a major public health concern in Kenya, the
            issues surrounding acceptance and use of VCT need to be addressed. Enhancing
            community awareness of the benefits of early HIV diagnosis, providing couple-
            based VCT as an integral part of VCT and increasing access to VCT testing sites
            may enhance utilization of VCT.


Safety and immunogenicity of recombinant low-dosage HIV-1 A vaccine
candidates vectored by plasmid pTHr DNA or modified vaccinia virus
Ankara (MVA) in humans in East Africa.
Author:     Jaoko, W.; Nakwagala, F. N.; Anzala, O.; Manyonyi, G. O.; Birungi, J.; Nanvubya,
            A.; Bashir, F.; Bhatt, K.; Ogutu, H.; Wakasiaka, S.; Matu, L.; Waruingi, W.; Odada,
            J.; Oyaro, M.; Indangasi, J.; Ndinya-Achola, J.; Konde, C.; Mugisha, E.; Fast, P.;
            Schmidt, C.; Gilmour, J.; Tarragona, T.; Smith, C.; Barin, B.; Dally, L.; Johnson, B.;
            Muluubya, A.; Nielsen, L.; Hayes, P.; Boaz, M.; Hughes, P.; Hanke, T.;
            McMichael, A.; Bwayo, J., and Kaleebu, P.

Source:     Vaccine. 2008 May 23; 26(22):2788-95.

Abstract:   The safety and immunogenicity of plasmid pTHr DNA, modified vaccinia virus
            Ankara (MVA) human immunodeficiency virus type 1 (HIV-1) vaccine
            candidates were evaluated in four Phase I clinical trials in Kenya and Uganda.
            Both vaccines, expressing HIV-1 subtype A gag p24/p17 and a string of CD8 T-
            cell epitopes (HIVA), were generally safe and well-tolerated. At the dosage levels
            and intervals tested, the percentage of vaccine recipients with HIV-1-specific cell-
            mediated immune responses, assessed by a validated ex vivo interferon gamma
            (IFN-gamma) ELISPOT assay and Cytokine Flow Cytometry (CFC), did not
            significantly differ from placebo recipients. These trials demonstrated the
            feasibility of conducting high-quality Phase 1 trials in Africa.




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Cost effectiveness of couple counselling to enhance infant HIV-1
prevention.
Author:     John, F. N.; Farquhar, C.; Kiarie, J. N.; Kabura, M. N., and John-Stewart, G. C.

Source:     Int J STD AIDS. 2008 Jun; 19(6):406-9.

Abstract:   Data collected in the years 2001--2003 from an antenatal clinic in Nairobi, Kenya,
            were used to assess the benefit of couple counselling and test it as a way of
            increasing the uptake of interventions in the prevention of mother-to-child
            transmission of HIV-1. Among 2833 women enrolled, 311 (11%) received couple
            pretest counselling and 2100 (74%) accepted HIV-1 testing. Among those tested
            314 (15%) were HIV-1 seropositive. We incorporated these and other data from
            the cohort study into a spreadsheet-based model and costs associated with
            couple counselling were compared with individual counselling in a theoretical
            cohort of 10,000 women. Voluntary couple counselling and testing (VCT),
            although more expensive, averted a greater number of infant infections when
            compared with individual VCT. Cost per disability-adjusted life year was similar
            to that of individual VCT. Sensitivity analyses found that couple VCT was more
            cost-effective in scenarios with increased uptake of couple counselling and
            higher HIV-1 prevalence.


Risk factors for HIV infection in a national adult population: evidence
from the 2003 Kenya Demographic and Health Survey.
Author:     Johnson, K. and Way, A.

Source:     J Acquir Immune Defic Syndr. 2006 Aug 15; 42(5):627-36.

Abstract:   Objective:
            To study demographic, social, behavioral, and biological variables as risk factors
            for HIV infection among men and women in Kenya.

            Methods:
            Data from the cross-sectional, population-based 2003 Kenya Demographic and
            Health Survey were used. During the course of survey fieldwork, 3,273 women
            aged 15 to 49 years and 2,941 men aged 15 to 54 years gave consent to have a few
            drops of blood taken for anonymous testing. HIV serostatus data for men and
            women were analyzed for their relationships to key characteristics using
            bivariate and multivariate techniques to determine factors associated with being
            HIV-positive.

            Results:
            National HIV prevalence in Kenya was found to be 6.7%. In the analysis of the
            study sample, uncircumcised men were 4 times more likely to be HIV-positive


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            than those who were not. Compared with nonpolygynously married women,
            widowed women (odds ratio [OR] = 10.9), divorced women (OR = 2.3), and
            women who were 1 of 3 or more wives (OR = 3.4) were all at higher risk for
            being HIV-positive. Both men and women from Nyanza province were at a
            significantly higher risk for infection with HIV (OR = 2.9 and 2.3, respectively)
            than were the men and women from Nairobi. Men aged 35 to 44 years had the
            highest risk of being HIV-positive, whereas the ages of highest risk for women
            were 25 to 29 years. Increased wealth was positively related to risk for HIV: the
            wealthiest women were 2.6 times more likely than the poorest women to be
            HIV-positive. A key finding was that both men and women who considered
            themselves to be at low risk for contracting HIV were, in fact, the most likely to
            be HIV-positive.

            Conclusions:
            This analysis demonstrates that HIV is a multidimensional epidemic, with
            demographic, residential, social, biological, and behavioral factors all exerting
            influence on individual probability of becoming infected with HIV. Although all
            of these factors contribute to the risk profile for a given individual, the results
            suggest that differences in biological factors such as circumcision and sexually
            transmitted infections may be more important in assessing risk for HIV than
            differences in sexual behavior.


The impact of maternal HIV status on infant feeding patterns in Nakuru,
Kenya.
Author:     Kamau-Mbuthia, E.; Elmadfa, I., and Mwonya, R.

Source:     J Hum Lact. 2008 Feb; 24(1):34-41.

Abstract:   The aim of the study was to assess the impact of maternal HIV status on infant
            feeding patterns. Two hundred eighty mothers (205 HIV uninfected, 75 infected)
            and their infants were recruited from the Provincial General Hospital, Nakuru,
            Kenya, from delivery and were followed for 14 weeks. From the feeding
            patterns, HIV-infected mothers were more likely to exclusively breastfeed in
            week 1 than HIV-uninfected mothers (71.7% vs 56.3%, P = .001), but there were
            no differences by week 14 (9.8% vs 4.8% P = .212). Mixed feeding increased for
            both groups from weeks 1 to 14. In multivariate logistic regression analysis,
            maternal age (younger mothers, P < .05) was associated with exclusive
            breastfeeding in the 6th week and infant birth weight (> mean birth weight, P <
            .05) in the 10th week. The results indicate a need to reassess adherence to infant
            feeding recommendations irrespective of maternal HIV status and also the infant
            feeding counseling process in the hospital. J Hum Lact . 24(1):34-41.




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Anti-HIV-1 activities in extracts from some medicinal plants as assessed
in an in vitro biochemical HIV-1 reverse transcriptase assay.
Author:     Kanyara, J. N. and Njagi, E. N.

Source:     Phytother Res. 2005 Apr; 19(4):287-90.

Abstract:   An in vitro HIV-1 reverse transcriptase (RT) assay was used for screening of anti-
            HIV activity of extracts obtained from some Kenyan medicinal plants. The assay
            utilises [3H]-methyl thymidine triphosphate (dTTP) as the enzyme substrate and
            polyadenylic acid.oligodeoxythymidylic acid [poly(rA).p(dT)(12-18)] as the
            template-primer dimmer. This assay was optimised and standardised with
            respect to the various experimental parameters in a microtiter plate
            methodology. The assay was then applied to test for potential antiviral activities
            of several Kenyan medicinal plant extracts and the concentrations producing
            50% inhibition (IC50) of the HIV-1 RT were determined. This assay is described
            in this report and results obtained with some of the extracts are presented.


Knowledge, attitude and practice towards HIV/AIDS in a rural Kenyan
community.
Author:     Karama, M.; Yamamoto, T.; Shimada, M.; Orago, S. S., and Moji, K.

Source:     J Biosoc Sci. 2006 Jul; 38(4):481-90.

Abstract:   The aim of this research was to explore people's knowledge, attitude, behaviour
            and practice towards HIV/AIDS and sexual activity in rural Kenya, where HIV
            is widespread. The study community was located in south-eastern Kenya, 50 km
            north of Mombassa, and had an estimated population of 1500. Subjects aged
            between 16 and 49 were recruited using a stratified cluster-sampling method and
            they completed self-administered questionnaires.Almost all respondents knew
            the word 'IV' Around 50% knew of a person living with HIV. About 80% gave
            'death' or 'fear' as words representing their image of AIDS. With regard to sexual
            activity, the distribution of answers to the question 'how many partners have you
            ever had in your life' was bimodal in males but had only one peak in females,
            indicating that some men have a large number of sexual partners in their
            lifetime. First sexual intercourse was at around 12-13 years for both sexes, but
            female teenagers were more sexually experienced than their male counterparts.




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Risk factors for treatment denial and loss to follow-up in an
antiretroviral treatment cohort in Kenya.
Author:     Karcher, H.; Omondi, A.; Odera, J.; Kunz, A., and Harms, G.

Source:     Trop Med Int Health. 2007 May; 12(5):687-94.

Abstract:   Objectives:
            To evaluate risk factors for treatment denial and loss to follow-up in an
            antiretroviral treatment (ART) cohort in a rural African setting in western Kenya.

            Method:
            Sociodemographic and clinical data of patients enrolled in an ART cohort were
            collected within 18 months of an observational longitudinal study and analysed
            by logistic and Cox regression models.

            Results:
            Of 159 patients with treatment indication 35 (22%) never started ART. Pregnancy
            [adjusted odds ratio (AOR) 3.60, 95% confidence interval (CI) 1.10-11.8; P = 0.035]
            and lower level of education (AOR 3.80, 95% CI 1.14-12.7; P = 0.03) were
            independently associated with treatment denial. The incidence of total loss of
            patients under therapy was 43.2 per 100 person years (pys) (mortality rate 19.2
            per 100 pys plus drop out rate 24 per 100 pys). Older age [adjusted hazard ratio
            (AHR) 1.06, 95% CI 1.01-1.12; P = 0.04], AIDS before starting treatment (AHR
            5.83, 95% CI 1.15-29.5; P = 0.03) and incomplete adherence to treatment (AHR
            1.05, 95% CI 1.03-1.07; P < 0.001) were independent risk factors for death.
            Incomplete adherence also independently predicted drop out because of other
            reasons (AHR 1.06, 95% CI 1.04-1.09; P < 0.001).

            Conclusion:
            Pregnancy and lower level of education, higher age, advanced AIDS stage and
            impaired compliance to ART were identified as risk factors for treatment denial
            and death, respectively. Adequate counselling strategies for patients with these
            characteristics could help to improve adherence and outcome of treatment
            programmes in resource-limited settings.


Prevalence of HCV and HCV/HIV co-infection among in-patients at the
Kenyatta National Hospital.
Author:     Karuru, J. W.; Lule, G. N.; Joshi, M., and Anzala, O.

Source:     East Afr Med J. 2005 Apr; 82(4):170-2.




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Abstract:   Objective:
            To determine the prevalence of HCV and HCV/HIV co-infection among medical
            in-patients at the Kenyatta National Hospital. DESIGN: Prospective cross-
            sectional descriptive study.

            Setting:
            Kenyatta National Hospital, a tertiary referral and teaching hospital, in-patient
            department

            Subjects:
            HIV/AIDS and HIV negative in-patients at KNH medical wards. RESULTS:
            Among 458 HIV/AIDS medical in-patients, the prevalence of HCV was 3.7%
            while in the 518 HIV negative patients, it was 4.4%. The prevalence of co-
            infection with HCV and HIV was 3.7%. The incidence of risk factors in persons
            with HCV and/or HIV infection(s) was low.

            Conclusion:
            This study found the prevalence of HCV infection among medical in-patients to
            be similar in HIV positive and HIV negative group of patients. The co-infection
            rates were low, as were the risk factors for transmission of these infections.


Prevalent herpes simplex virus type 2 infection is associated with altered
vaginal flora and an increased susceptibility to multiple sexually
transmitted infections.
Author:     Kaul, R.; Nagelkerke, N. J.; Kimani, J.; Ngugi, E.; Bwayo, J. J.; Macdonald, K. S.;
            Rebbaprgada, A.; Fonck, K.; Temmerman, M.; Ronald, A. R., and Moses, S.

Source:     J Infect Dis. 2007 Dec 1; 196(11):1692-7.

Abstract:   Background:
            Prevalent herpes simplex virus type 2 (HSV-2) infection increases human
            immunodeficiency virus acquisition. We hypothesized that HSV-2 infection
            might also predispose individuals to acquire other common sexually transmitted
            infections (STIs).

            Methods:
            We studied the association between prevalent HSV-2 infection and STI incidence
            in a prospective, randomized trial of periodic STI therapy among Kenyan female
            sex workers. Participants were screened monthly for infection with Neisseria
            gonorrhoeae and Chlamydia trachomatis, and at least every 6 months for
            bacterial vaginosis (BV) and infection with Treponema pallidum, Trichomonas
            vaginalis, and/or HSV-2.




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                             STIs, HIV and AIDS: 2005 - 2008

            Results:
            Increased prevalence of HSV-2 infection and increased prevalence of BV were
            each associated with the other; the direction of causality could not be
            determined. After stratifying for sexual risk-taking, BV status, and antibiotic use,
            prevalent HSV-2 infection remained associated with an increased incidence of
            infection with N. gonorrhoeae (incidence rate ratio [IRR], 4.3 [95% confidence
            interval {CI}, 1.5-12.2]), T. vaginalis (IRR, 2.3 [95% CI, 1.3-4.2]), and syphilis (IRR,
            4.7 [95% CI, 1.1-19.9]). BV was associated with increased rates of infection with C.
            trachomatis (IRR, 2.1 [95% CI, 1.1-3.8]) and T. vaginalis (IRR, 8.0 [95% CI, 3.2-
            19.8]).

            Conclusion:
            Increased prevalences of HSV-2 infection and BV were associated with each
            other and also associated with enhanced susceptibility to an overlapping
            spectrum of other STIs. Demonstration of causality will require clinical trials that
            suppress HSV-2 infection, BV, or both.


Drug evaluation: DNA/MVA prime-boost HIV vaccine.
Author:     Kent, S.; De Rose, R., and Rollman, E.

Source:     Curr Opin Investig Drugs. 2007 Feb; 8(2):159-67.

Abstract:   Oxford University and Nairobi University are jointly developing a
            HIVA.DNA/modified vaccinia Ankara (MVA) prime-boost vaccine for the
            potential prevention of infection with HIV subtype A. The vaccination strategy
            consists of priming with a DNA vaccine made from HIV-1 clade A gag p24/p17
            consensus sequence (pTHr.HIVA) then boosting with a MVA virus expressing
            HIVA (MVA.HIVA). Phase II clinical trials of the vaccine are underway in Kenya
            and the UK.


Rapid Identification of Infants for Antiretroviral Therapy in a Resource
Poor Setting: The Kenya Experience.
Author:     Khamadi, S.; Okoth, V.; Lihana, R.; Nabwera, J.; Hungu, J.; Okoth, F.; Lubano, K.,
            and Mwau, M.

Source:     J Trop Pediatr. 2008 May 29.

Abstract:   In Kenya, HIV diagnosis is not routinely carried out in infants, and yet rapid
            diagnosis could improve access to lifesaving interventions. A cheap and readily
            accessible service can resolve this problem, if feasible. In this pilot study the
            feasibility and costs of provision of an infant HIV diagnosis service in Kenya are
            evaluated. Dried blood spots (DBS) were collected from infants exposed to HIV,



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                             STIs, HIV and AIDS: 2005 - 2008

            sent to a central testing laboratory and tested using the Roche Amplicor v. 1.5
            DNA PCR kit. The results were then dispatched to health facilities within a week.
            A total of 15.4% of the samples tested HIV+ despite the widespread access to
            prevention of mother to child transmission (PMTCT) programs in Kenya. The
            cost per test at 21.50 USD is prohibitive and will limit access to diagnosis. It
            remains to be seen whether the increase in testing will immediately lead to an
            increase in access to antiretroviral therapy (ART) services for infants.



HIV type 1 subtypes in circulation in northern Kenya.
Author:     Khamadi, S. A.; Ochieng, W.; Lihana, R. W.; Kinyua, J.; Muriuki, J.; Mwangi, J.;
            Lwembe, R.; Kiptoo, M.; Osman, S.; Lagat, N.; Pelle, R.; Muigai, A.; Carter, J. Y.;
            Oishi, I.; Ichimura, H.; Mwaniki, D. L.; Okoth, F. A.; Mpoke, S., and Songok, E.
            M.

Source:     AIDS Res Hum Retroviruses. 2005 Sep; 21(9):810-4.

Abstract:   The genetic subtypes of HIV-1 circulating in northern Kenya have not been
            characterized. Here we report the partial sequencing and analysis of samples
            collected in the years 2003 and 2004 from 72 HIV-1-positive patients in northern
            Kenya, which borders Ethiopia50% were subtype A, 39% subtype C, and 11%
            subtype D. This shows that in the northern border region of Kenya subtypes A
            and C are the dominant HIV-1 subtypes in circulation. Ethiopia is dominated
            mainly by HIV-1 subtype C, which incidentally is the dominant subtype in the
            town of Moyale, which borders Ethiopia. These results show that cross-border
            movements play an important role in the circulation of subtypes in Northern
            Kenya., Somalia, and Sudan. From the analysis of partial env sequences, it was
            determined that


Genetic analysis of HIV-1 subtypes in Nairobi, Kenya.
Author:     Khoja, S.; Ojwang, P.; Khan, S.; Okinda, N.; Harania, R., and Ali, S.

Source:     PLoS ONE. 2008; 3(9):e3191.

Abstract:   Background:
            Genetic analysis of a viral infection helps in following its spread in a given
            population, in tracking the routes of infection and, where applicable, in vaccine
            design. Additionally, sequence analysis of the viral genome provides
            information about patterns of genetic divergence that may have occurred during
            viral evolution.




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                             STIs, HIV and AIDS: 2005 - 2008

            Objective:
            In this study we have analyzed the subtypes of Human Immunodeficiency Virus
            -1 (HIV-1) circulating in a diverse sample population of Nairobi, Kenya.

            Methodology:
            69 blood samples were collected from a diverse subject population attending the
            Aga Khan University Hospital in Nairobi, Kenya. Total DNA was extracted from
            peripheral blood mononuclear cells (PBMCs), and used in a Polymerase Chain
            Reaction (PCR) to amplify the HIV gag gene. The PCR amplimers were partially
            sequenced, and alignment and phylogenetic analysis of these sequences was
            performed using the Los Alamos HIV Database.

            Results:
            Blood samples from 69 HIV-1 infected subjects from varying ethnic backgrounds
            were analyzed. Sequence alignment and phylogenetic analysis showed 39
            isolates to be subtype A, 13 subtype D, 7 subtype C, 3 subtype AD and
            CRF01_AE, 2 subtype G and 1 subtype AC and 1 AG. Deeper phylogenetic
            analysis revealed HIV subtype A sequences to be highly divergent as compared
            to subtypes D and C.

            Conclusion:
            Our analysis indicates that HIV-1 subtypes in the Nairobi province of Kenya are
            dominated by a genetically diverse clade A. Additionally, the prevalence of
            highly divergent, complex subtypes, intersubtypes, and the recombinant forms
            indicates viral mixing in Kenyan population, possibly as a result of dual
            infections.


Reference ranges for the clinical laboratory derived from a rural
population in Kericho, Kenya.
Author:     Kibaya, R. S.; Bautista, C. T.; Sawe, F. K.; Shaffer, D. N.; Sateren, W. B.; Scott, P.
            T.; Michael, N. L.; Robb, M. L.; Birx, D. L., and de Souza, M. S.

Source:     PLoS ONE. 2008; 3(10):e3327.

Abstract:   The conduct of Phase I/II HIV vaccine trials internationally necessitates the
            development of region-specific clinical reference ranges for trial enrollment and
            participant monitoring. A population based cohort of adults in Kericho, Kenya, a
            potential vaccine trial site, allowed development of clinical laboratory reference
            ranges. Lymphocyte immunophenotyping was performed on 1293 HIV
            seronegative study participants. Hematology and clinical chemistry were
            performed on up to 1541 cohort enrollees. The ratio of males to females was 1.9:1.
            Means, medians and 95% reference ranges were calculated and compared with
            those from other nations. The median CD4+ T cell count for the group was 810
            cells/microl. There were significant gender differences for both red and white
            blood cell parameters. Kenyan subjects had lower median hemoglobin


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                             STIs, HIV and AIDS: 2005 - 2008

            concentrations (9.5 g/dL; range 6.7-11.1) and neutrophil counts (1850
            cells/microl; range 914-4715) compared to North Americans. Kenyan clinical
            chemistry reference ranges were comparable to those from the USA, with the
            exception of the upper limits for bilirubin and blood urea nitrogen, which were
            2.3-fold higher and 1.5-fold lower, respectively. This study is the first to assess
            clinical reference ranges for a highland community in Kenya and highlights the
            need to define clinical laboratory ranges from the national community not only
            for clinical research but also care and treatment.


Adverse Events in HIV-Infected Persons Receiving Antiretroviral Drug
Regimens in a Large Urban Slum in Nairobi, Kenya, 2003-2005.

Author:     Kim, A. A.; Wanjiku, L.; Macharia, D. K.; Wangai, M.; Isavwa, A.; Abdi, H.;
            Marston, B. J.; Ilako, F.; Kjaer, M.; Chebet, K.; De Cock, K. M., and Weidle, P. J.

Source:     J Int Assoc Physicians AIDS Care (Chic Ill). 2007 Sep; 6(3):206-9.

Abstract:   Objective:
            This article describes toxicities to antiretroviral therapy (ART) among HIV-
            infected patients receiving care at a clinic in a large urban slum in Nairobi,
            Kenya.

            Methods:
            Patients were treated with nonnucleoside reverse transcriptase inhibitor-based
            ART and followed at scheduled intervals. Frequencies and cumulative
            probabilities of toxicities were calculated.

            Results:
            Among 283 patients starting ART, any and severe clinical toxicity were recorded
            as 65% and 6%, respectively. Cumulative probabilities for remaining free of any
            and severe clinical toxicities at 6, 12, and 18 months, were 0.47, 0.26, and 0.17,
            respectively and 0.98, 0.95, and 0.89, respectively. The probability of remaining
            free from elevated and grade 3 or 4 serum aminotransferase (AST) at 6, 12, and
            18 months were 0.62, 0.42, and 0.21, respectively, and 0.99 at 6, 12, and 18
            months.

            Conclusions:
            ART toxicities were frequent, but severe toxicities were less common. In
            resource-limited settings, ART toxicity should not represent a barrier to care.




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IL-7Ralpha expression on CD4+ T lymphocytes decreases with HIV
disease progression and inversely correlates with immune activation.
Author:     Koesters, S. A.; Alimonti, J. B.; Wachihi, C.; Matu, L.; Anzala, O.; Kimani, J.;
            Embree, J. E.; Plummer, F. A., and Fowke, K. R.

Source:     Eur J Immunol. 2006 Feb; 36(2):336-44.

Abstract:   Many factors can influence the rate of HIV disease progression, including those
            that maintain T cell homeostasis. One key homeostatic regulator is the IL-7
            receptor (IL-7R). Previous studies have shown IL-7R expression levels decrease
            in HIV infection, but effects on memory subtypes, CD4(+) T cells, and cell
            function have not been explored. The present study examined the expression of
            the IL-7Ralpha chain on naive and memory T lymphocyte subsets of both HIV-
            positive and HIV-negative individuals from Nairobi, Kenya to assess the role of
            IL-7Ralpha in HIV disease. Expression of IL-7Ralpha was significantly reduced
            in all CD4(+) and CD8(+) T cell subsets in HIV-positive individuals. This
            reduction was further enhanced in those with advanced HIV progression.
            Expression of IL-7Ralpha was inversely correlated to immune activation, and
            apoptosis, and was positively correlated with CD4 count in both bivariate and
            multivariate analysis. Expression of IL-7Ralpha did not correlate with HIV viral
            loads, indicating the elevated immune activation seen in HIV-infected
            individuals may be impacting expression of IL-7Ralpha, independent of viral
            loads. Signaling via the IL-7R is essential for T cell homeostasis and maintenance
            of T cell memory. Reduction of this receptor may contribute to the homeostatic
            disruption seen in HIV.


Social networks and HIV/AIDs risk perceptions.
Author:     Kohler, H. P.; Behrman, J. R., and Watkins, S. C.

Source:     Demography. 2007 Feb; 44(1):1-33.

Abstract:   Understanding the determinants of individuals' perceptions of their risk of
            becoming infected with HIV and their perceptions of acceptable strategies of
            prevention is an essential step toward curtailing the spread of this disease. We
            focus in this article on learning and decision-making about AIDS in the context of
            high uncertainty about the disease and appropriate behavioral responses. We
            argue that social interactions are important for both. Using longitudinal survey
            data from rural Kenya and Malawi, we test this hypothesis. We investigate
            whether social interactions--and especially the extent to which social network
            partners perceive themselves to be at risk--exert causal influences on
            respondents' risk perceptions and on one approach to prevention, spousal
            communication about the threat of AIDS to the couple and their children. The
            study explicitly allows for the possibility that important characteristics, such as



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            unobserved preferences or community characteristics, determine not only the
            outcomes of interest but also the size and composition of networks. The most
            important empirical result is that social networks have significant and substantial
            effects on risk perceptions and the adoption of new behaviors even after we
            control for unobserved factors.



Etiology and resistance patterns of respiratory isolates in Kenyan adults
with AIDS from slum population.
Author:     Krcmery, V.; Benca, J.; Liskova, A.; Mitterpachova, E.; Kolenova, A.; Sladeckova,
            V.; Horvathova, D., and Kiwou, M.

Source:     Neuro Endocrinol Lett. 2007 Nov; 28 Suppl 3:37-9.

Abstract:   We investigated regularly swabs of adults dispenzarised at Mary Immaculate
            Clinic of Trnava University in Nairobi providing free health care for about 50 000
            population of Mukuru Slums. 20 patients who were treated for AIDS by our
            clinic (those who started HAART before Free National AIDS Cooperation
            Programme - NASCOP) were assessed after 1, 2 and 3 years (18 of 20 completed
            the survey, other 2 loss of follow up, probably died. Exposure to other molecules
            can select resistant mutants. Previous exposure to TMP/SMX was similar in
            both groups and therefore was not responsible for the difference between
            resistance patterns.


Adult male circumcision: results of a standardized procedure in Kisumu
District, Kenya.
Author:     Krieger, J. N.; Bailey, R. C.; Opeya, J.; Ayieko, B.; Opiyo, F.; Agot, K.; Parker, C.;
            Ndinya-Achola, J. O.; Magoha, G. A., and Moses, S.

Source:     BJU Int. 2005 Nov; 96(7):1109-13.

Abstract:   Objective:
            To develop a standard procedure for male circumcision in a resource-poor
            medical setting and prospectively evaluate the outcome in a randomized,
            controlled trial with the incidence of human immunodeficiency virus (HIV) as
            the main outcome, as studies suggest that circumcision is associated with a lower
            incidence of HIV and other sexually transmitted infections in high-risk
            populations.

            Subjects and methods:
            Healthy, uncircumcised, HIV-seronegative men aged 18-24 years from Kisumu
            District, Kenya, were offered participation in a clinical trial using a standard
            circumcision procedure based on "usual" medical procedures in Western Kenya.


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            The follow-up included visits at 3, 8 and 30 days after circumcision, with
            additional visits if necessary. Healing, satisfaction and resumption of activities
            were assessed at these visits and 3 months from randomization.

            Results:
            Overall, 17 (3.5%) of the 479 circumcisions were associated with adverse events
            judged definitely, probably or possibly related to the procedure. The most
            common adverse events were wound infections (1.3%), bleeding (0.8%), and
            delayed wound healing or suture line disruption (0.8%). After 30 days, 99% of
            participants reported being very satisfied with the procedure; approximately
            23% reported having had sex and 15% reported that their partners had expressed
            an opinion, all of whom were very satisfied with the outcome. About 96% of the
            men resumed normal general activities within the first week after the procedure.

            Conclusion:
            Safe and acceptable adult male circumcision services can be delivered in
            developing countries should male circumcision ultimately be advocated as a
            public-health measure.


Associations of human leukocyte antigen DRB with resistance or
susceptibility to HIV-1 infection in the Pumwani Sex Worker Cohort.
Author:     Lacap, P. A.; Huntington, J. D.; Luo, M.; Nagelkerke, N. J.; Bielawny, T.; Kimani,
            J.; Wachihi, C.; Ngugi, E. N., and Plummer, F. A.

Source:     AIDS. 2008 May 31; 22(9):1029-38.

Abstract:   Objective:
            A group of commercial sex workers in the Pumwani Sex Worker Cohort,
            established in 1985 in Nairobi, Kenya, remain HIV-1 uninfected despite heavy
            exposure to HIV-1 through active sex work. Previous studies showed that this
            resistance is associated with a strong CD4+ T-cell response, which suggested that
            human leukocyte antigen class II antigens are important in
            resistance/susceptibility to HIV-1 infection. DRB1 is the most polymorphic locus
            among class II genes and forms haplotypes with DRB3, DRB4 and DRB5. The
            aim of this study is to investigate the role of DRB alleles/haplotypes on
            resistance/susceptibility to HIV-1 infection.

            Design:
            In total, 1090 women enrolled in the Pumwani cohort were genotyped for DRB1,
            DRB3, DRB4 and DRB5 using a high-resolution sequence-based method.
            Allele/haplotype frequencies were compared between HIV-positive women and
            women who have remained HIV negative for more than 3 years despite frequent
            exposure.




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            Methods:
            Human leukocyte antigen DRB genes were amplified, sequenced and genotyped
            using a two-step sequence-based method. Allele/haplotype frequencies were
            determined using PyPop32-0.6.0. Statistical analysis was conducted using SPSS
            11.0 for Windows.

            Results:
            Three DRB1 alleles were associated with resistance: DRB1*010101 (P = 0.016; odd
            ratio (OR): 2.55; 95% confidence interval (CI): 1.16-5.61), DRB1*010201 (P = 0.019;
            OR: 1.86; 95% CI: 1.10-3.15), and DRB1*1102 (P = 0.025; OR: 1.72; 95% CI: 1.07-
            2.78). DRB1*030201 (P = 0.038; OR: 0.48; 95% CI: 0.23-0.98), DRB1*070101 (P =
            0.035; OR: 0.54; 95% CI: 0.30-0.97), DRB1*1503 (P = 0.0004; OR: 0.34; 95% CI: 0.19-
            0.64), and DRB5*010101 (P = 0.001; OR: 0.37; 95% CI: 0.20-0.67) were associated
            with susceptibility. The haplotype DRB1*1102-DRB3*020201 was associated with
            HIV-1 resistance (P = 0.041; OR: 1.68; 95% CI: 1.02-2.78), whereas the haplotypes
            DRB1*070101-DRB4*01010101 (P = 0.041; OR: 0.52; 95% CI: 0.28-0.98) and
            DRB1*1503-DRB5*01010101 (P = 0.0002; OR: 0.30; 95% CI: 0.15-0.58) were
            associated with susceptibility. These associations with resistance/susceptibility
            to HIV-1 were independent of previously reported alleles HLA-DRB1*01 and
            HLA-A*2301.

            Conclusion:
            Our findings indicate that human leukocyte antigen DRB-specific CD4+ T-cell
            responses are an important factor in resistance/susceptibility to HIV-1 infection.


Human immunodeficiency virus (HIV) type 1 proviral hypermutation
correlates with CD4 count in HIV-infected women from Kenya.
Author:     Land, A. M.; Ball, T. B.; Luo, M.; Pilon, R.; Sandstrom, P.; Embree, J. E.; Wachihi,
            C.; Kimani, J., and Plummer, F. A.

Source:     J Virol. 2008 Aug; 82(16):8172-82.

Abstract:   APOBEC3G is an important innate immune molecule that causes human
            immunodeficiency virus type 1 (HIV-1) hypermutation, which can result in
            detrimental viral genome mutations. The Vif protein of wild-type HIV-1
            counteracts APOBEC3G activity by targeting it for degradation and inhibiting its
            incorporation into viral particles. Additional APOBEC cytidine deaminases have
            been identified, such as APOBEC3F, which has a similar mode of action but
            different sequence specificity. A relationship between APOBEC3F/G and HIV
            disease progression has been proposed. During HIV-1 sequence analysis of the
            vpu/env region of 240 HIV-infected subjects from Nairobi, Kenya, 13 drastically
            hypermutated proviral sequences were identified. Sequences derived from
            plasma virus, however, lacked hypermutation, as did proviral vif. When
            correlates of disease progression were examined, subjects with hypermutated
            provirus were found to have significantly higher CD4 counts than the other


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            subjects. Furthermore, hypermutation as estimated by elevated adenine content
            positively correlated with CD4 count for all 240 study subjects. The sequence
            context of the observed hypermutation was statistically associated with
            APOBEC3F/G activity. In contrast to previous studies, this study demonstrates
            that higher CD4 counts correlate with increased hypermutation in the absence of
            obvious mutations in the APOBEC inhibiting Vif protein. This strongly suggests
            that host factors, such as APOBEC3F/G, are playing a protective role in these
            patients, modulating viral hypermutation and host disease progression. These
            findings support the potential of targeting APOBEC3F/G for therapeutic
            purposes.


Full-length HIV type 1 proviral sequencing of 10 highly exposed women
from Nairobi, Kenya reveals a high proportion of intersubtype
recombinants.

Author:     Land, A. M.; Ball, T. B.; Luo, M.; Rutherford, J.; Sarna, C.; Wachihi, C.; Kimani, J.,
            and Plummer, F. A.

Source:     AIDS Res Hum Retroviruses. 2008 Jun; 24(6):865-72.

Abstract:   Phylogenetic analysis has revealed that the current HIV/AIDS pandemic consists
            of a multitude of different viral clades and recombinant viruses. The
            predominant circulating HIV-1 clade in Kenya is A1; however, Kenya borders
            countries where different subtypes are prominent, making Kenya a likely
            location for recombination. Previous studies have reported significant differences
            in the proportions of sequences in Kenya that are intersubtype recombinants.
            Studies that performed sequence-based typing on multiple HIV-1 genomic
            regions or full-length sequences found higher rates of recombination than those
            that examined a single gene or gene fragment. In this study, we describe full-
            length HIV-1 proviral sequence-based genotyping after limited peripheral blood
            mononuclear cell (PBMC) coculture. Ten subjects from a highly exposed cohort
            located in Nairobi, Kenya were examined. Pairwise comparison found minimal
            difference between sequences generated directly from patient PBMC DNA
            compared to sequences from cocultured PBMC DNA. Of the 10 full-length HIV-1
            sequences examined, five were nonrecombinant clade A1, while the other five
            were unique intersubtype recombinants. Although this frequency of
            recombination is higher than previously described in Kenya, this finding is in
            agreement with previous full-length sequence data. Interestingly, although all
            the nonrecombinant sequences were clade A1, not all the recombinant sequences
            contained a clade A1 sequence.




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Effects of antiretroviral therapy on work performance: preliminary
results from a cohort study of Kenyan agricultural workers.
Author:     Larson, B. A.; Fox, M. P.; Rosen, S.; Bii, M.; Sigei, C.; Shaffer, D.; Sawe, F.;
            Wasunna, M., and Simon, J. L.

Source:     AIDS. 2008 Jan 30; 22(3):421-5.

Abstract:   Objective:
            This paper estimates the impact of antiretroviral therapy (ART) on days
            harvesting tea per month for tea-estate workers in Kenya. Such information is
            needed to assess the potential economic benefits of providing treatment to
            working adults.

            Methods:
            Data for this analysis come from company payroll records for 59 HIV-infected
            workers and a comparison group of all workers assigned to the same work teams
            (reference group, n = 1992) for a period covering 2 years before and 1 year after
            initiating ART. Mean difference tests were used to obtain overall trends in days
            harvesting tea by month. A difference in difference approach was used to
            estimate the impact of HIV/AIDS on days working in the pre-ART period.
            Information on likely trends in the absence of the therapy was used to estimate
            the positive impacts on days harvesting tea over the initial 12 months on ART.

            Results:
            No significant difference existed in days plucking tea each month until the ninth
            month before initiating ART, when workers worked -2.79 fewer days than
            references (15% less). This difference grew to 5.09 fewer days (27% less) in the
            final month before initiating ART. After 12 months on ART, we conservatively
            estimate that workers worked at least twice as many days in the month than they
            would have in the absence of ART.

            Conclusions:
            Treatment had a large, positive impact on the ability of workers to undertake
            their primary work activity, harvesting tea, in the first year on ART.


Higher set point plasma viral load and more-severe acute HIV type 1
(HIV-1) illness predict mortality among high-risk HIV-1-infected African
women.
Author:     Lavreys, L.; Baeten, J. M.; Chohan, V.; McClelland, R. S.; Hassan, W. M.;
            Richardson, B. A.; Mandaliya, K.; Ndinya-Achola, J. O., and Overbaugh, J.

Source:     Clin Infect Dis. 2006 May 1; 42(9):1333-9.



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Abstract:   Background:
            There is limited information on the natural history of human immunodeficiency
            virus type 1 (HIV-1) infection in Africa, especially from individuals with well-
            defined dates of infection. We used data from a prospective cohort study of
            female sex workers in Mombasa, Kenya, who were followed up monthly from
            before the date of HIV-1 infection.

            Methods:
            Antiretroviral-naive women who had a well-defined date of HIV-1 infection
            were included in this analysis. The effects of set point plasma viral load
            (measured 4-24 months after infection), early CD4+ cell count, and symptoms of
            acute HIV-1 infection on mortality were assessed using Cox proportional
            hazards analysis.

            Results:
            Among 218 women, the median duration of follow-up after HIV-1 infection was
            4.6 years. Forty women died, and at 8.7 years (the time of the last death), the
            cumulative survival rate was 51% by Kaplan-Meier analysis. Higher set point
            viral load, lower early CD4+ cell count, and more-symptomatic acute HIV-1
            illness each predicted death. In multivariate analysis, set point viral load (hazard
            ratio [HR], 2.28 per 1 log10 copies/mL increase; P=.001) and acute HIV-1 illness
            (HR, 1.14 per each additional symptom; P=.05) were independently associated
            with higher mortality.

            Conclusion:
            Among this group of African women, the survival rate was similar to that for
            HIV-1-infected individuals in industrialized nations before the introduction of
            combination antiretroviral therapy. Higher set point viral load and more-severe
            acute HIV-1 illness predicted faster progression to death. Early identification of
            individuals at risk for rapid disease progression may allow closer clinical
            monitoring, including timely initiation of antiretroviral treatment.


Commercial sex and HIV transmission in mature epidemics: a study of
five African countries.
Author:     Leclerc, P. M. and Garenne, M.

Source:     Int J STD AIDS. 2008 Oct; 19(10):660-4.

Abstract:   The study compares the association between using the services of commercial
            sex workers and male HIV seroprevalence in five African countries: Ghana,
            Kenya, Lesotho, Malawi and Rwanda. The HIV seroprevalence among men who
            'ever paid for sex' was compared with controls who 'never paid for sex'. Results
            were based on 12,929 eligible men, aged 15-59 years, interviewed in
            Demographic and Health Surveys. The odds ratio of HIV seroprevalence
            associated with ever paying for sex was 1.89 (95% confidence interval = 1.57-


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            2.28), with only minor differences by country. The results were stable in
            multivariate analysis after controlling for available potential cofactors (data on
            non-sexual routes of transmission were not available). Given the relatively small
            proportion of men involved, the risk attributable to 'ever paying for sex'
            remained low: 7.1% in univariate analysis and 4.4% after adjustment, and it
            varied among countries (range 1.3-9.4%). These results match previous
            observations that commercial sex seems to play a minor role in the spread of HIV
            in mature epidemics.


Toll-like receptor expression and responsiveness are increased in
viraemic HIV-1 infection.
Author:     Lester, R. T.; Yao, X. D.; Ball, T. B.; McKinnon, L. R.; Kaul, R.; Wachihi, C.; Jaoko,
            W.; Plummer, F. A., and Rosenthal, K. L.

Source:     AIDS. 2008 Mar 30; 22(6):685-94.

Abstract:   Objectives:
            Toll-like receptors (TLR) are important in pathogen recognition and may play a
            role in HIV disease. We evaluated the effect of chronic untreated and treated
            HIV-1 infection on systemic TLR expression and TLR signalling. METHODS:
            Two hundred HIV-infected and uninfected women from a Kenya cohort
            participated in the studies. TLR1 to TLR10 messenger RNA expression was
            determined by quantitative reverse transcriptase polymerase chain reaction in
            peripheral blood mononuclear cells (PBMC). TLR ligand responsiveness was
            determined in or using ex-vivo PBMC by cytokine production in culture
            supernatants.

            Results:
            Chronic, untreated HIV-1 infection was significantly associated with increased
            mRNA expression of TLR6, TLR7, and TLR8 and when analysis was limited to
            those with advanced disease (CD4 cell count < 200 cells/ml) TLR2, TLR3, and
            TLR4 were additionally elevated. TLR expression correlated with the plasma
            HIV-RNA load, which was significant for TLR6 and TLR7. In vitro HIV single-
            stranded RNA alone could enhance TLR mRNA expression. PBMC of HIV-
            infected subjects also demonstrated profoundly increased proinflammatory
            responsiveness to TLR ligands, suggesting sensitization of TLR signalling in
            HIV. Finally, viral suppression by HAART was associated with a normalization
            of TLR levels.

            Conclusion:
            Together, these data indicate that chronic viraemic HIV-1 is associated with
            increased TLR expression and responsiveness, which may perpetuate innate
            immune dysfunction and activation that underlies HIV pathogenesis, and thus
            reveal potential new targets for therapy



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HIV type 1 subtypes among STI patients in Nairobi: a genotypic study
based on partial pol gene sequencing.
Author:     Lihana, R. W.; Khamadi, S. A.; Kiptoo, M. K.; Kinyua, J. G.; Lagat, N.; Magoma,
            G. N.; Mwau, M. M.; Makokha, E. P.; Onyango, V.; Osman, S.; Okoth, F. A., and
            Songok, E. M.

Source:     IDS Res Hum Retroviruses. 2006 Nov; 22(11):1172-7.

Abstract:   Circulating strains of human immunodeficiency virus (HIV) exhibit an
            extraordinary degree of genetic diversity and have been classified on the basis of
            relationships into distinct lineages called groups, types, subtypes, and
            subsubtypes. Sexually transmitted infections (STIs) are known to be a risk factor
            for HIV infection. To establish HIV-1 subtype diversity among STI patients in
            Nairobi, 140 samples were collected and partial pol gene sequencing done. From
            the analysis it was established that subtype A1 was the major subtype (64%)
            followed by D (17%), C (9%), G (1%), and recombinants AD (4%), AC (3%),
            CRF02()AG (1%), and CRF16()A2D (1%). These results suggest that the HIV-1
            epidemic may be evolving toward more virulent and complex subtypes through
            transmission of complex recombinants due to viral mixing. Any use of ARVs
            may therefore require initial testing for de novo resistance before commencement
            of treatment and/or management.



Longitudinal assessment of human immunodeficiency virus type 1 (HIV-
1)-specific gamma interferon responses during the first year of life in
HIV-1-infected infants.
Author:     Lohman, B. L.; Slyker, J. A.; Richardson, B. A.; Farquhar, C.; Mabuka, J. M.;
            Crudder, C.; Dong, T.; Obimbo, E.; Mbori-Ngacha, D.; Overbaugh, J.; Rowland-
            Jones, S., and John-Stewart, G.

Source:     J Virol. 2005 Jul; 79(13):8121-30.

Abstract:   Human immunodeficiency virus type 1 (HIV-1) infection results in different
            patterns of viral replication in pediatric compared to adult populations. The role
            of early HIV-1-specific responses in viral control has not been well defined,
            because most studies of HIV-1-infected infants have been retrospective or cross-
            sectional. We evaluated the association between HIV-1-specific gamma
            interferon (IFN-gamma) release from the cells of infants of 1 to 3 months of age
            and peak viral loads and mortality in the first year of life among 61 Kenyan HIV-
            1-infected infants. At 1 month, responses were detected in 7/12 (58%) and 6/21
            (29%) of infants infected in utero and peripartum, respectively (P = 0.09), and in
            approximately 50% of infants thereafter. Peaks of HIV-specific spot-forming
            units (SFU) increased significantly with age in all infants, from 251/10(6)


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            peripheral blood mononuclear cells (PBMC) at 1 month of age to 501/10(6)
            PBMC at 12 months of age (P = 0.03), although when limited to infants who
            survived to 1 year, the increase in peak HIV-specific SFU was no longer
            significant (P = 0.18). Over the first year of life, infants with IFN-gamma
            responses at 1 month had peak plasma viral loads, rates of decline of viral load,
            and mortality risk similar to those of infants who lacked responses at 1 month.
            The strength and breadth of IFN-gamma responses at 1 month were not
            significantly associated with viral containment or mortality. These results
            suggest that, in contrast to HIV-1-infected adults, in whom strong cytotoxic T
            lymphocyte responses in primary infection are associated with reductions in
            viremia, HIV-1-infected neonates generate HIV-1-specific CD8+-T-cell responses
            early in life that are not clearly associated with improved clinical outcomes.


Impact of five years of peer-mediated interventions on sexual behavior
and sexually transmitted infections among female sex workers in
Mombasa, Kenya.
Author:     Luchters, S.; Chersich, M. F.; Rinyiru, A.; Barasa, M. S.; King'ola, N.; Mandaliya,
            K.; Bosire, W.; Wambugu, S.; Mwarogo, P., and Temmerman, M.

Source:     BMC Public Health. 2008; 8:143.

Abstract:   Background:
            Since 2000, peer-mediated interventions among female sex workers (FSW) in
            Mombasa Kenya have promoted behavioural change through improving
            knowledge, attitudes and awareness of HIV serostatus, and aimed to prevent
            HIV and other sexually transmitted infection (STI) by facilitating early STI
            treatment. Impact of these interventions was evaluated among those who
            attended peer education and at the FSW population level.

            Methods:
            A pre-intervention survey in 2000, recruited 503 FSW using snowball sampling.
            Thereafter, peer educators provided STI/HIV education, condoms, and
            facilitated HIV testing, treatment and care services. In 2005, data were collected
            using identical survey methods, allowing comparison with historical controls,
            and between FSW who had or had not received peer interventions.

            Results:
            Over five years, sex work became predominately a full-time activity, with
            increased mean sexual partners (2.8 versus 4.9/week; P < 0.001). Consistent
            condom use with clients increased from 28.8% (145/503) to 70.4% (356/506; P <
            0.001) as well as the likelihood of refusing clients who were unwilling to use
            condoms (OR = 4.9, 95%CI = 3.7-6.6). In 2005, FSW who received peer
            interventions (28.7%, 145/506), had more consistent condom use with clients
            compared with unexposed FSW (86.2% versus 64.0%; AOR = 3.6, 95%CI = 2.1-



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            6.1). These differences were larger among FSW with greater peer-intervention
            exposure. HIV prevalence was 25% (17/69) in FSW attending > or = 4 peer-
            education sessions, compared with 34% (25/73) in those attending 1-3 sessions (P
            = 0.21). Overall HIV prevalence was 30.6 (151/493) in 2000 and 33.3% (166/498)
            in 2005 (P = 0.36).

            Conclusion:
            Peer-mediated interventions were associated with an increase in protected sex.
            Though peer-mediated interventions remain important, higher coverage is
            needed and more efficacious interventions to reduce overall vulnerability and
            risk.


Safer sexual behaviors after 12 months of antiretroviral treatment in
Mombasa, Kenya: a prospective cohort.
Author:     Luchters, S.; Sarna, A.; Geibel, S.; Chersich, M. F.; Munyao, P.; Kaai, S.;
            Mandaliya, K. N.; Shikely, K. S.; Rutenberg, N., and Temmerman, M.

Source:     AIDS Patient Care STDS. 2008 Jul; 22(7):587-94.

Abstract:   Roll-out of antiretroviral treatment (ART) raises concerns about the potential for
            unprotected sex if sexual activity increases with well-being, resulting in
            continued HIV spread. Beliefs about reduced risk for HIV transmission with
            ART may also influence behavior. From September 2003 to November 2004, 234
            adults enrolled in a trial assessing the efficacy of modified directly observed
            therapy in improving adherence to ART. Unsafe sexual behavior (unprotected
            sex with an HIV-negative or unknown status partner) before starting ART and 12
            months thereafter was compared. Participants were a mean 37.2 years (standard
            deviation [SD] = 7.9 years) and 64% (149/234) were female. Nearly half
            (107/225) were sexually active in the 12 months prior to ART, the majority
            (96/107) reporting one sexual partner. Unsafe sex was reported by half of those
            sexually active in the 12 months before ART (54/107), while after 12 months
            ART, this reduced to 28% (30/107). Unsafe sex was associated with
            nondisclosure of HIV status to partner; recent HIV diagnosis; not being married
            or cohabiting; stigma; depression and body mass index <18.5 kg/m(2). ART
            beliefs, adherence, and viral suppression were not associated with unsafe sex.
            After adjusting for gender and stigma, unsafe sex was 0.59 times less likely after
            12 months ART than before initiation (95% confidence interval [CI] = 0.37-0.94; p
            = 0.026). In conclusion, although risky sexual behaviors had decreased, a
            considerable portion do not practice safe sex. Beliefs about ART's effect on
            transmission, viral load, and adherence appear not to influence sexual behavior
            but require long-term surveillance. Positive prevention interventions for those
            receiving ART must reinforce safer sex practices and partner disclosure




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Challenges of a pandemic: HIV/AIDS-related problems affecting Kenyan
widows.
Author:     Luginaah, I.; Elkins, D.; Maticka-Tyndale, E.; Landry, T., and Mathui, M.

Source:     Soc Sci Med. 2005 Mar; 60(6):1219-28.

Abstract:   The paper reports the findings of a qualitative study using focus group
            discussions and in-depth interviews about the challenges faced by widows as
            they confront the direct and indirect impacts of HIV/AIDS in Nyanza, Kenya.
            Two focus groups were conducted with widows from two community-based
            organizations. This was followed by in-depth interviews with four members and
            two leaders from each of the community-based organizations. The contents were
            analysed using grounded theory. The findings reveal several challenges
            encountered by widows in their struggles with the direct and indirect impacts of
            HIV/AIDS. Widows who know or do not know their HIV status are conscious
            about the possibility of contracting or transmitting the virus. Wife inheritance (a
            Luo custom), emerged as an outstanding issue for the widows in the context of
            HIV/AIDS transmission. The widows employ various strategies to resist being
            inherited. Widows in the current epidemic navigate issues of sexuality in various
            ways, such as insisting their partners use condoms or permanently abstaining
            from sexual intercourse.


Confronting the 'sugar daddy' stereotype: age and economic asymmetries
and risky sexual behavior in urban Kenya.
Author:     Luke, N.

Source:     Int Fam Plan Perspect. 2005 Mar; 31(1):6-14.

Abstract:   Context:
            "Sugar daddy" relationships, which are characterized by large age and economic
            asymmetries between partners, are believed to be a major factor in the spread of
            HIV in Sub-Saharan Africa. Information is needed about sugar daddy
            partnerships-and about age and economic asymmetries more generally-to
            determine how common they are and whether they are related to unsafe sexual
            behavior.

            Methods:
            The sample comprised 1,052 men aged 21-45 who were surveyed in Kisumu,
            Kenya, in 2001. Data on these men and their 1,614 recent non-marital
            partnerships were analyzed to calculate the prevalence of sugar daddies and
            sugar daddy relationships, as well as a range of age and economic disparities
            within non-marital partnerships. Logistic regression models were constructed to




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            assess relationships between condom use at last sexual intercourse and various
            measures of age and economic asymmetry.

            Results:
            The mean age difference between non-marital sexual partners was 5.5 years, and
            47% of men's female partners were adolescents. Fourteen percent of
            partnerships involved an age difference of at least 10 years, and 23% involved
            more than the mean amount of male-to-female material assistance. Men who
            reported at least one partnership with both these characteristics were defined as
            sugar daddies and made up 5% of the sample; sugar daddy relationships
            accounted for 4% of partnerships. Sugar daddy partnerships and the largest age
            and economic asymmetries we constructed were associated with decreased odds
            of condom use.

            Conclusions:
            Although sugar daddy relationships are not as pervasive as generally assumed,
            age and economic asymmetries in non-marital partnerships are relatively
            common. All these types of asymmetries are associated with nonuse of condoms.
            Increasing women's power within asymmetric sexual relationships could
            improve their ability to negotiate safer sexual behaviors, such as condom use.


Anti-retroviral drug resistance-associated mutations among non-subtype
B HIV-1-infected Kenyan children with treatment failure.

Author:     Lwembe, R.; Ochieng, W.; Panikulam, A.; Mongoina, C. O.; Palakudy, T.;
            Koizumi, Y.; Kageyama, S.; Yamamoto, N.; Shioda, T.; Musoke, R.; Owens, M.;
            Songok, E. M.; Okoth, F. A., and Ichimura, H.

Source:     J Med Virol. 2007 Jul; 79(7):865-72.

Abstract:   Recently increased availability of anti-retroviral therapy (ART) has mitigated
            HIV-1/AIDS prognoses especially in resource poor settings. The emergence of
            ART resistance-associated mutations from non-suppressive ART has been
            implicated as a major cause of ART failure. Reverse transcriptase inhibitor (RTI)-
            resistance mutations among 12 non-subtype B HIV-1-infected children with
            treatment failure were evaluated by genotypically analyzing HIV-1 strains
            isolated from plasma obtained between 2001 and 2004. A region of pol-RT gene
            was amplified and at least five clones per sample were analyzed. Phylogenetic
            analysis revealed HIV-1 subtype A1 (n = 7), subtype C (n = 1), subtype D (n = 3),
            and CRF02_AG (n = 1). Before treatment, 4 of 12 (33.3%) children had primary
            RTI-resistance mutations, K103N (n = 3, ages 5-7 years) and Y181C (n = 1, age 1
            year). In one child, K103N was found as a minor population (1/5 clones) before
            treatment and became major (7/7 clones) 8 months after RTI treatment. In 7 of 12
            children, M184V appeared with one thymidine-analogue-associated mutation
            (TAM) as the first mutation, while the remaining 5 children had only TAMs



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                             STIs, HIV and AIDS: 2005 - 2008

            appearing either individually (n = 2), or as TAMs 1 (M41L, L210W, and T215Y)
            and 2 (D67N, K70R, and K219Q/E/R) appearing together (n = 3). These results
            suggest that "vertically transmitted" primary RTI-resistance mutations, K103N
            and Y181C, can persist over the years even in the absence of drug pressure and
            impact RTI treatment negatively, and that appearing patterns of RTI-resistance
            mutations among non-subtype B HIV-1-infected children could possibly be
            different from those reported in subtype B-infected children.


Prevalence of dyslipidemia and dysglycaemia in HIV infected patients.
Author:     Manuthu, E. M.; Joshi, M. D.; Lule, G. N., and Karari, E.

Source:     East Afr Med J. 2008 Jan; 85(1):10-7.

Abstract:   Background:
            Highly active antiretroviral therapy (HAART) has dramatically reduced AIDS
            morbidity and mortality, however long-term metabolic consequences including
            dysglycaemia and dyslipidemia have raised concern regarding accelerated
            cardiovascular disease risk.

            Objective:
            To determine the period prevalence of dyslipidemia and dysglycaemia in HIV-
            infected patients. DESIGN: Cross-sectional comparative group study.

            Setting:
            Kenyatta National Hospital, a tertiary HIV dedicated out-patient facility.

            Subjects:      Consecutive HIV- positive adult patients.

            Main outcome measures:
            Dyslipidemia: presence of raised total or LDL cholesterol or low HDL
            cholesterol, or raised triglycerides. Dysglycaemia: presence of impaired fasting
            glucose or impaired glucose tolerance, or diabetes mellitus. Results: Between
            January and April 2006, out of 342 screened patients, 295 were recruited and
            58% were females. One hundred and thirty four (45%) were on HAART, 82% of
            whom were on stavudine, lamivudine and either nevirapine or efavirenz.
            Overall prevalence of dyslipidemiawas 63.1% and dysglycaemia was 20.7%.
            High total cholesterol occurred in 39.2% of HAART and 10.0% HAART naive
            patients (p<0.0001, OR 5.18, CI 3.11-10.86), whereas high LDL cholesterol
            occurred in 40.8% and in 11.2% respectively (p<0.0001, OR 5.43, CI 2.973-9.917).
            HDL levels were low in 14.6% and 51.3% among HAART and HAART naive
            patients, respectively, (p<0.0001, OR 0.16, CI 0.091-0.29) while high triglycerides
            occurred in 25.6% and 22.5% respectively (p=0.541 OR 1.184 CI 0.688-2.037).
            Among patients on HAART compared to HAART naive patients, diabetes was
            found in 1.5% against 1.2% (p=0.85), impaired fasting in 2.2% against 0.6%



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            (p=0.30) and impaired glucose tolerance in 16.4% against 21.1% (p=0.22),
            respectively.

            Conclusions:
            HIV- infected patients demonstrated a high prevalence of dyslipidemia. HAART
            use was associated with high levels of total, and LDL cholesterol and high
            triglyceride levels, an established athrogenic lipid profile. However, HAART was
            not associated with low HDL cholesterol and had no significant effect on
            dysglycaemia.


A program to provide antiretroviral therapy to residents of an urban
slum in nairobi, kenya.
Author:     Marston, B. J.; Macharia, D. K.; Nga'nga, L.; Wangai, M.; Ilako, F.; Muhenje, O.;
            Kjaer, M.; Isavwa, A.; Kim, A.; Chebet, K.; Decock, K. M., and Weidle, P. J.

Source:     J Int Assoc Physicians AIDS Care (Chic Ill). 2007 Jun; 6(2):106-12.

Abstract:   Objective:
            To evaluate retention in care and response to therapy for patients enrolled in an
            antiretroviral treatment program in a severely resource-constrained setting.

            Methods:
            We evaluated patients enrolled between February 26, 2003, and February 28,
            2005, in a community clinic in Kibera, an informal settlement, in Nairobi, Kenya.
            Midlevel providers offered simplified, standardized antiretroviral therapy (ART)
            regimens and monitored patients clinically and with basic laboratory tests.
            Clinical, immunologic, and virologic indicators were used to assess response to
            ART; adherence was determined by 3-day recall. A total of 283 patients (70%
            women; median baseline CD4 count, 157 cells/ mm(3); viral load, 5.16 log
            copies/mL) initiated ART and were followed for a median of 7.1 months (n =
            2384 patient-months).

            Results:
            At 1 year, the median CD4 count change was +124.5 cells/mm(3) (n = 74;
            interquartile range, 42 to 180), and 71 (74%) of 96 patients had viral load <400
            copies/mL. The proportion of patients reporting 100% adherence over the 3 days
            before monthly clinic visits was 94% to 100%. As of February 28, 2005, a total of
            239 patients (84%) remained in care, 22 (8%) were lost to follow-up, 12 (4%) were
            known to have died, 5 (2%) had stopped ART, 3 (1%) moved from the area, and
            2 (< 1% ) transferred care.

            Conclusions:
            Response to ART in this slum population was comparable to that seen in
            industrialized settings. With government commitment, donor support, and



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            community involvement, it is feasible to implement successful ART programs in
            extremely challenging social and environmental conditions.

Using mass media campaigns to promote voluntary counseling and HIV-
testing services in Kenya.
Author:     Marum, E.; Morgan, G.; Hightower, A.; Ngare, C., and Taegtmeyer, M.

Source:     AIDS. 2008 Oct 1; 22(15):2019-24.

Abstract:   Background:
            Kenya, a country with high HIV prevalence, has seen a rapid scale-up of
            voluntary counseling and HIV-testing (VCT) services from three sites in 2000 to
            585 by June 2005. From 2002 onwards, services were promoted by a four-phase
            professionally designed mass media campaign.

            Objective:
            To assess the impact of a mass media campaign on VCT services. DESIGN:
            Observational data from client records.

            Methods:
            VCT client data from 131 voluntary counseling and testing sites were included.
            Descriptive statistics and Poisson regression were used to assess the impact of
            campaign phases.

            Results:
             Client records (381,160) from 131 sites were analyzed. A linear increase in new
            sites and an exponential increase in client utilization were observed. Regression
            analysis revealed that the first phase of the campaign increased attendance by
            28.5% (95% confidence interval = 15.9, 42.5%) and the fourth by 42.5% (95%
            confidence interval = 28.4, 64.1%). These two phases, which directly mentioned
            HIV, had more impact on utilization than the second and third phases, which did
            not have a significant effect.

            Conclusion:
            The Kenyan experience suggests that a professional, intensive mass media
            campaign is likely to contribute to increases in utilization of testing. Expansion of
            programs for counseling and HIV testing in developing countries is likely to be
            facilitated by mass media promotion of these services.




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Acceptability of male circumcision and predictors of circumcision
preference among men and women in Nyanza Province, Kenya.
Author:     Mattson, C. L.; Bailey, R. C.; Muga, R.; Poulussen, R., and Onyango, T.

Source:     AIDS Care. 2005 Feb; 17(2):182-94.

Abstract:   Numerous epidemiologic studies report significant associations between lack of
            male circumcision and HIV-1 infection, leading some to suggest that male
            circumcision be added to the limited armamentarium of HIV prevention
            strategies in areas where HIV prevalence is high and the mode of transmission is
            primarily heterosexual. This cross-sectional survey of 107 men and 110 women in
            Nyanza Province, Kenya, assesses the attitudes, beliefs, and predictors of
            circumcision preference among men and women in a traditionally non-
            circumcising region. Sixty per cent (n=64) of uncircumcised men and 69% (n=68)
            of women who had uncircumcised regular partners reported that they would
            prefer to be circumcised or their partners to be circumcised. Men's circumcision
            preference was associated with the belief that it is easier for uncircumcised men
            to get penile cancer, sexually transmitted diseases, and HIV/AIDS, and that
            circumcised men have more feeling in their penises, enjoy sex more, and confer
            more pleasure to their partners. Women with nine or more years of school were
            more likely to prefer circumcised partners. Men who preferred to remain
            uncircumcised were concerned about the pain and cost of the procedure, and
            pain was a significant deterrent for women to agree to circumcision for their
            sons. If clinical trials prove circumcision to be efficacious in reducing risk of HIV
            infection, it is likely that the procedure will be sought by a significant proportion
            of the population, especially if it is affordable and minimally painful.



Risk compensation is not associated with male circumcision in Kisumu,
Kenya: a multi-faceted assessment of men enrolled in a randomized
controlled trial.
Author:     Mattson, C. L.; Campbell, R. T.; Bailey, R. C.; Agot, K.; Ndinya-Achola, J. O., and
            Moses, S.

Source:     PLoS ONE. 2008; 3(6):e2443.

Abstract:   Background:
            Three randomized controlled trials (RCTs) have confirmed that male
            circumcision (MC) significantly reduces acquisition of HIV-1 infection among
            men. The objective of this study was to perform a comprehensive, prospective
            evaluation of risk compensation, comparing circumcised versus uncircumcised
            controls in a sample of RCT participants.




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                            STIs, HIV and AIDS: 2005 - 2008

            Methods and findings:
            Between March 2004 and September 2005, we systematically recruited men
            enrolled in a RCT of MC in Kenya. Detailed sexual histories were taken using a
            modified Timeline Followback approach at baseline, 6, and 12 months.
            Participants provided permission to obtain circumcision status and laboratory
            results from the RCT. We evaluated circumcised and uncircumcised men's
            sexual behavior using an 18-item risk propensity score and acquisition of
            incident infections of gonorrhea, chlamydia, and trichomoniasis. Of 1780 eligible
            RCT participants, 1319 enrolled (response rate = 74%). At the baseline RCT visit,
            men who enrolled in the sub-study reported the same sexual behaviors as men
            who did not. We found a significant reduction in sexual risk behavior among
            both circumcised and uncircumcised men from baseline to 6 (p<0.01) and 12 (p =
            0.05) months post-enrollment. Longitudinal analyses indicated no statistically
            significant differences between sexual risk propensity scores or in incident
            infections of gonorrhea, chlamydia, and trichomoniasis between circumcised and
            uncircumcised men. These results are based on the most comprehensive analysis
            of risk compensation yet done.

            Conclusion:
            In the context of a RCT, circumcision did not result in increased HIV risk
            behavior. Continued monitoring and evaluation of risk compensation associated
            with circumcision is needed as evidence supporting its' efficacy is disseminated
            and MC is widely promoted for HIV prevention.


Scaling Sexual Behavior or "Sexual Risk Propensity" Among Men at Risk
for HIV in Kisumu, Kenya.
Author:     Mattson, C. L.; Campbell, R. T.; Karabatsos, G.; Agot, K.; Ndinya-Achola, J. O.;
            Moses, S., and Bailey, R. C.

Source:     AIDS Behav. 2008 Jul 24.

Abstract:   We present a scale to measure sexual risk behavior or "sexual risk propensity" to
            evaluate risk compensation among men engaged in a randomized clinical trial of
            male circumcision. This statistical approach can be used to represent each
            respondent's level of sexual risk behavior as the sum of his responses on multiple
            dichotomous and rating scale (i.e. ordinal) items. This summary "score" can be
            used to summarize information on many sexual behaviors or to evaluate changes
            in sexual behavior with respect to an intervention. Our 18 item scale
            demonstrated very good reliability (Cronbach's alpha of 0.87) and produced a
            logical, unidimensional continuum to represent sexual risk behavior. We found
            no evidence of differential item function at different time points (except for
            reporting a concurrent partners when comparing 6 and 12 month follow-up
            visits) or with respect to the language with which the instrument was
            administered. Further, we established criterion validity by demonstrating a



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            statistically significant association between the risk scale and the acquisition of
            incident sexually transmitted infections (STIs) at the 6 month follow-up and HIV
            at the 12 month follow-up visits. This method has broad applicability to evaluate
            sexual risk behavior in the context of other HIV and STI prevention interventions
            (e.g. microbicide or vaccine trials), or in response to treatment provision (e.g.,
            anti-retroviral therapy


A comparison of genital HIV-1 shedding and sexual risk behavior among
Kenyan women based on eligibility for initiation of HAART according
to WHO guidelines.
Author:     McClelland, R. S.; Baeten, J. M.; Richardson, B. A.; Lavreys, L.; Emery, S.;
            Mandaliya, K.; Ndinya-Achola, J. O., and Overbaugh, J.

Source:     J Acquir Immune Defic Syndr. 2006 Apr 15; 41(5):611-5.

Abstract:   Background:
            Guidelines for initiating antiretrovirals are based on markers of advanced
            disease and are not directly linked to markers of HIV-1 transmission such as viral
            shedding.

            Methods:
            We evaluated genital HIV-1 shedding and risk behavior among 650
            antiretroviral-naive women stratified by WHO criteria for initiating
            antiretrovirals based on CD4 count and symptoms.

            Results:
            Genital HIV-1 concentrations increased in stepwise fashion with declining CD4
            counts and the presence of symptoms. Compared with the reference group
            (asymptomatic with CD4 >350 cells/microL), those with advanced
            immunosuppression (CD4 <200 cells/microL) had significantly higher cervical
            HIV-1 RNA concentrations (2.4 log10 copies/swab vs. 3.8 log10 copies/swab, P <
            0.001). However, women with CD4 counts <200 cells/microL were also less
            likely than the reference group to report intercourse during the past week (58%
            vs. 26%, P < 0.001).

            Conclusions:
            Antiretroviral guidelines focusing on individuals with the most advanced
            immunosuppression will target those with the highest genital HIV-1
            concentrations. However, individuals with less advanced immunosuppression
            also have high levels of genital HIV-1 and may be more sexually active. The
            effect of increased antiretroviral availability on the spread of HIV-1 might be
            enhanced by extending treatment, in addition to other risk reduction services, to
            those with less advanced disease.




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                            STIs, HIV and AIDS: 2005 - 2008


HIV-1 acquisition and disease progression are associated with decreased
high-risk sexual behaviour among Kenyan female sex workers.
Author:     McClelland, R. S.; Hassan, W. M.; Lavreys, L.; Richardson, B. A.; Mandaliya, K.;
            Ndinya-Achola, J.; Jaoko, W.; Kurth, A. E., and Baeten, J. M.

Source:     AIDS. 2006 Oct 3; 20(15):1969-73.

Abstract:   Background:
            Changes in sexual risk behaviour may occur following HIV-1 infection.

            Objective:
            To test the hypothesis that HIV-1 seroconversion and disease progression are
            associated with changes in risk behaviours, using data from a cohort of Kenyan
            female sex workers (FSWs).

            Methods:
            HIV-1-seronegative FSWs were enrolled in a prospective cohort study of risk
            factors for HIV-1 acquisition. At monthly visits, standardized interviews were
            conducted to assess sexual risk behaviour and HIV-1 serologic testing was
            performed. Seroconverters were invited to continue with follow-up. Between
            1993 and 2004 (when antiretroviral therapy was introduced in the cohort), 265
            women seroconverted for HIV-1 (incidence 7.7/100 person-years) and were
            included in this analysis.

            Results:
            Unprotected intercourse was reported at 546/2037 (27%) pre-seroconversion
            visits versus 557/3732 (15%) post-seroconversion visits (P < 0.001). These
            findings remained significant after adjustment for potential confounding factors
            [adjusted odds ratio (AOR) 0.69; 95% confidence interval (CI), 0.55-0.86].
            Compared with HIV-1-seronegative women, there was a progressive stepwise
            decrease in unprotected intercourse among HIV-1-seropositive women with CD4
            cell counts > or = 500 (AOR, 0.93; 95% CI, 0.62-1.39), 200-499 (AOR, 0.58; 95% CI,
            0.41-0.82) and < 200 cells/microl (AOR, 0.45; 95% CI, 0.25-0.82). Decreases in
            unprotected intercourse reflected increases in both abstinence and 100% condom
            use. Women also reported fewer partners and fewer episodes of intercourse after
            HIV-1 seroconversion.

            Conclusions:
            HIV-1 seroconversion and disease progression were associated with decreases in
            sexual risk behaviour among Kenyan FSWs.




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                            STIs, HIV and AIDS: 2005 - 2008


Vaginal washing and increased risk of HIV-1 acquisition among African
women: a 10-year prospective study.
Author:     McClelland, R. S.; Lavreys, L.; Hassan, W. M.; Mandaliya, K.; Ndinya-Achola, J.
            O., and Baeten, J. M.

Source:     AIDS. 2006 Jan 9; 20(2):269-73.

Abstract:   Background:
            No prospective study has examined the risk of HIV-1 acquisition associated with
            vaginal washing, although intravaginal practices have been identified as
            potentially important contributors to HIV-1 susceptibility.

            Objective:
            To evaluate the contribution of vaginal washing to incident HIV-1 infection.

            Design:        Prospective cohort study.

            Methods:
            Data were derived from a 10-year study of risk factors for HIV-1 acquisition
            among 1270 Kenyan female sex workers. Intravaginal practices were ascertained
            at study enrollment. At monthly follow-up visits, women completed a
            standardized interview and specimens were collected for diagnosis of HIV-1 and
            genital tract infections.

            Results:
            Compared with women who did not perform vaginal washing, there was an
            increased risk for acquiring HIV-1 among women who used water [adjusted
            hazard ratio (HR), 2.64; 95% confidence interval (CI), 1.00-6.97] or soap (adjusted
            HR 3.84; 95% CI, 1.51-9.77) to clean inside the vagina, after adjustment for
            demographic factors, sexual behavior, and sexually transmitted infections.
            Furthermore, women who performed vaginal washing with soap or other
            substances were at higher risk for HIV-1 compared with those who used water
            alone (adjusted HR, 1.47; 95% CI, 1.02-2.13).

            Conclusions:
            In populations where vaginal washing is common, this practice may be an
            important factor promoting the spread of HIV-1. Intervention strategies aimed at
            modifying intravaginal practices should be evaluated as a possible female-
            controlled HIV-1 prevention strategy.




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                             STIs, HIV and AIDS: 2005 - 2008


Contribution of HIV-1 infection to acquisition of sexually transmitted
disease: a 10-year prospective study.
Author:     McClelland, R. S.; Lavreys, L.; Katingima, C.; Overbaugh, J.; Chohan, V.;
            Mandaliya, K.; Ndinya-Achola, J., and Baeten, J. M.

Source:     J Infect Dis. 2005 Feb 1; 191(3):333-8.

Abstract:   Background:
            Sexually transmitted diseases (STDs) enhance human immunodeficiency virus
            (HIV)-1 susceptibility, but few studies have examined the reciprocal effect of
            HIV-1 on STD acquisition.

            Methods:
            Data from a prospective cohort study conducted among female sex workers in
            Mombasa, Kenya between 1993 and 2003 were used to determine the effect of
            HIV-1 infection on STD susceptibility. The cohort included 1215 HIV-1-
            seronegative women who underwent monthly HIV-1 and STD screening, of
            whom 238 experienced seroconversion to HIV-1 during follow-up. Andersen-Gill
            proportional-hazards models were used to compare the incidence rates for
            genital-tract infections (syphilis, genital ulcer disease [GUD], Neisseria
            gonorrhoeae infection, Chlamydia trachomatis infection, Trichomonas vaginalis
            infection, vulvovaginal candidiasis, and bacterial vaginosis) in HIV-1-
            seropositive versus HIV-1-seronegative women, after controlling for sexual
            behavior and other potential confounding factors.

            Results:
            HIV-1 infection was associated with a significantly higher incidence of GUD
            (hazard ratio [HR], 2.8; 95% confidence interval [CI], 2.0-3.9), gonorrhea (HR, 1.6;
            95% CI, 1.1-2.2), and vulvovaginal candidiasis (HR, 1.5; 95% CI, 1.3-1.8). The risks
            of GUD and vulvovaginal candidiasis increased with progressive levels of
            immunosuppression.

            Conclusions:
            The increased incidence of genital-tract infections among HIV-1-seropositive
            women could promote the spread of both HIV-1 and other STDs, particularly in
            areas where these conditions are highly prevalent.


A prospective study of risk factors for bacterial vaginosis in HIV-1-
seronegative African women.
Author:     McClelland, R. S.; Richardson, B. A.; Graham, S. M.; Masese, L. N.; Gitau, R.;
            Lavreys, L.; Mandaliya, K.; Jaoko, W.; Baeten, J. M., and Ndinya-Achola, J. O.

Source:     Sex Transm Dis. 2008 Jun; 35(6):617-23.



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                            STIs, HIV and AIDS: 2005 - 2008

Abstract:   Background:
            Bacterial vaginosis (BV) is common and has been associated with increased HIV-
            1 susceptibility. The objective of this study was to identify risk factors for BV in
            African women at high risk for acquiring HIV-1.

            Methods:
            We conducted a prospective study among 151 HIV-1-seronegative Kenyan
            female sex workers. Nonpregnant women were eligible if they did not have
            symptoms of abnormal vaginal itching or discharge at the time of enrollment. At
            monthly follow-up, a vaginal examination and laboratory testing for genital tract
            infections were performed. Multivariate Andersen-Gill proportional hazards
            analysis was used to identify correlates of BV.

            Results:
            Participants completed a median of 378 (interquartile range 350-412) days of
            follow-up. Compared with women reporting no vaginal washing, those who
            reported vaginal washing 1 to 14 [adjusted hazard ratio (aHR) 1.29, 95%
            confidence interval (CI) 0.88-1.89], 15 to 28 (aHR 1.60, 95% CI 0.98-2.61), and >28
            times/wk (aHR 2.39, 95% CI 1.35-4.23) were at increased risk of BV. Higher BV
            incidence was also associated with the use of cloth for intravaginal cleansing
            (aHR 1.48, 95% CI 1.06-2.08) and with recent unprotected intercourse (aHR 1.75,
            95% CI 1.47-2.08). Women using depot medroxyprogesterone acetate
            contraception were at lower risk for BV (aHR 0.59, 95% CI 0.48-0.73).

            Conclusions:
            Vaginal washing and unprotected intercourse were associated with increased
            risk of BV. These findings could help to inform the development of novel vaginal
            health approaches for HIV-1 risk reduction in women.


Improvement of vaginal health for Kenyan women at risk for acquisition
of human immunodeficiency virus type 1: results of a randomized trial.
Author:     McClelland, R. S.; Richardson, B. A.; Hassan, W. M.; Chohan, V.; Lavreys, L.;
            Mandaliya, K.; Kiarie, J.; Jaoko, W.; Ndinya-Achola, J. O.; Baeten, J. M.; Kurth, A.
            E., and Holmes, K. K.

Source:     J Infect Dis. 2008 May 15; 197(10):1361-8.

Abstract:   Background:
            Vaginal infections are common and have been associated with increased risk for
            acquisition of human immunodeficiency virus type 1 (HIV-1).

            Methods:
            We conducted a randomized trial of directly observed oral treatment
            administered monthly to reduce vaginal infections among Kenyan women at risk
            for HIV-1 acquisition. A trial intervention of 2 g of metronidazole plus 150 mg of


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                             STIs, HIV and AIDS: 2005 - 2008

            fluconazole was compared with metronidazole placebo plus fluconazole placebo.
            The primary end points were bacterial vaginosis (BV), vaginal candidiasis,
            trichomoniasis vaginalis (hereafter, "trichomoniasis"), and colonization with
            Lactobacillus organisms.

            Results:
            Of 310 HIV-1-seronegative female sex workers enrolled (155 per arm), 303 were
            included in the primary end points analysis. A median of 12 follow-up visits per
            subject were recorded in both study arms (P = .8). Compared with control
            subjects, women receiving the intervention had fewer episodes of BV (hazard
            ratio [HR], 0.55; 95% confidence interval [CI], 0.49-0.63) and more frequent
            vaginal colonization with any Lactobacillus species (HR, 1.47; 95% CI, 1.19-1.80)
            and H(2)O(2)-producing Lactobacillus species (HR, 1.63; 95% CI, 1.16-2.27). The
            incidences of vaginal candidiasis (HR, 0.84; 95% CI, 0.67-1.04) and trichomoniasis
            (HR, 0.55; 95% CI, 0.27-1.12) among treated women were less than those among
            control subjects, but the differences were not statistically significant.

            Conclusions:
            Periodic presumptive treatment reduced the incidence of BV and promoted
            colonization with normal vaginal flora. Vaginal health interventions have the
            potential to provide simple, female-controlled approaches for reducing the risk
            of HIV-1 acquisition.


Infection with Trichomonas vaginalis increases the risk of HIV-1
acquisition.
Author:     McClelland, R. S.; Sangare, L.; Hassan, W. M.; Lavreys, L.; Mandaliya, K.; Kiarie,
            J.; Ndinya-Achola, J.; Jaoko, W., and Baeten, J. M.

Source:     J Infect Dis. 2007 Mar 1; 195(5):698-702.

Abstract:   We conducted a prospective study among women in Mombasa, Kenya, to
            determine whether Trichomonas vaginalis infection was associated with an
            increased risk of human immunodeficiency virus type 1 (HIV-1) infection. At
            monthly follow-up visits, laboratory screening for HIV-1 and genital tract
            infections was conducted. Among 1335 HIV-1-seronegative women monitored
            for a median of 566 days, there were 806 incident T. vaginalis infections (23.6/100
            person-years), and 265 women seroconverted to HIV-1 (7.7/100 person-years).
            Trichomoniasis was associated with a 1.52-fold (95% confidence interval, 1.04-
            2.24-fold) increased risk of HIV-1 acquisition after adjustment for potential
            confounding factors. Treatment and prevention of T. vaginalis infection could
            reduce HIV-1 risk in women.




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                             STIs, HIV and AIDS: 2005 - 2008


Implication of Ariaal sexual mixing on gonorrhea.
Author:     McCluskey, C. C.; Roth, E., and van den Driessche, P.

Source:     Am J Hum Biol. 2005 May-2005 Jun 30; 17(3):293-301.

Abstract:    Recent research on sexual mixing in populations of sub-Saharan Africa raises the
            question as to whether STDs can persist in these populations without the
            presence of a core group. A mathematical model is constructed for the spread of
            gonorrhea among the Ariaal population of Northern Kenya. A formula for the
            basic reproduction number R(0) (the expected number of secondary infections
            caused by a single new infective introduced into a susceptible population) is
            determined for this population in the absence of a core group. Survey data taken
            in 2003 on sexual behavior from the Ariaal population are used in the model
            which is formulated for their age-set system including four subpopulations:
            single and married, female and male. Parameters derived from the data, and
            other information from sub-Saharan Africa are used to estimate R(0). Results
            indicate that, even with the elevating effect of the age-set system, the disease
            should die out since R(0) < 1. Thus, the persistence of gonorrhea in the
            population must be due to factors not included in the model, for example, a core
            group of commercial sex workers or concurrent partnerships.


Cross-clade CD8(+) T-cell responses with a preference for the
predominant circulating clade.
Author:     McKinnon, L. R.; Ball, T. B.; Kimani, J.; Wachihi, C.; Matu, L.; Luo, M.; Embree, J.;
            Fowke, K. R., and Plummer, F. A.

Source:     J Acquir Immune Defic Syndr. 2005 Nov 1; 40(3):245-9.

Abstract:   Human immunodeficiency virus (HIV) genetic diversity is a major impediment
            to the design of a successful vaccine. Even if an HIV vaccine is proven effective, it
            remains to be seen whether this protection will extend to inter-clade, intra-clade,
            and recombinant strains. We used recombinant vaccinia-based interferon gamma
            (IFN) Elispot assays to test the inter-clade crossreactivity of clades A, B, C, and D
            HIV Env in two cohorts of HIV-infected Kenyans. Despite the tremendous
            diversity in this HIV protein, a substantial proportion of multi-clade responses
            were observed. Although these multi-clade responses correlated well with each
            other in regression analyses, clade A responses were seen at a higher frequency
            and at greater relative magnitudes in a proportion of these patients, when
            compared to the other three clades. Epitope mapping indicates CD8(+) T cell
            recognition of conserved regions of Env, accounting for the high degree of cross-
            reactivity but not the clade A preference. A better understanding of cross-clade
            CD8(+) T cell responses to HIV may help to predict whether a successful vaccine
            could be used to stop geographically and genetically distinct HIV epidemics.



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                            STIs, HIV and AIDS: 2005 - 2008



Epitope cross-reactivity frequently differs between central and effector
memory HIV-specific CD8+ T cells.
Author:     McKinnon, L. R.; Ball, T. B.; Wachihi, C.; McLaren, P. J.; Waruk, J. L.; Mao, X.;
            Ramdahin, S.; Anzala, A. O.; Kamene, J.; Luo, M.; Fowke, K. R., and Plummer, F.
            A.

Source:     J Immunol. 2007 Mar 15; 178(6):3750-6.

Abstract:   HIV diversity may limit the breadth of vaccine coverage due to epitope sequence
            differences between strains. Although amino acid substitutions within CD8(+) T
            cell HIV epitopes can result in complete or partial abrogation of responses, this
            has primarily been demonstrated in effector CD8(+) T cells. In an HIV-infected
            Kenyan cohort, we demonstrate that the cross-reactivity of HIV epitope variants
            differs dramatically between overnight IFN-gamma and longer-term
            proliferation assays. For most epitopes, particular variants (not the index
            peptide) were preferred in proliferation in the absence of corresponding
            overnight IFN-gamma responses and in the absence of the variant in the HIV
            quasispecies. Most proliferating CD8(+) T cells were polyfunctional via cytokine
            analyses. A trend to positive correlation was observed between proliferation (but
            not IFN-gamma) and CD4 counts. We present findings relevant to the
            assessment of HIV vaccine candidates and toward a better understanding of how
            viral diversity is tolerated by central and effector memory CD8(+) T cells.


Association of hygiene, socioeconomic status, and circumcision with
reduced risk of HIV infection among Kenyan men.
Author:     Meier, A. S.; Bukusi, E. A.; Cohen, C. R., and Holmes, K. K.

Source:     J Acquir Immune Defic Syndr. 2006 Sep; 43(1):117-8.

Abstract:   Among Kenyan men recruited as sex partners of women with genital symptoms,
            22 of 150 were HIV seropositive. Because male HIV infection and male hygiene
            were unexpectedly found to be associated with each other, we examined the
            relationship of 5 hygiene variables with HIV infection in the men in a principal
            components analysis, controlling for socioeconomic status and other potential
            confounders. By multivariate analyses, HIV infection in men was not only
            independently associated with previous illness (odds ratio [OR], 5.1; 95%
            confidence interval [CI], 1.4-19.1) and inversely associated with being
            circumcised (OR, 0.12; 95% CI, 0.02-0.91), but also independently associated with
            a combined measure of hygiene (OR, 0.41; 95% CI, 0.19-0.90).312




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The impact of onset controllability on stigmatization and supportive
communication goals toward persons with HIV versus lung cancer: a
comparison between Kenyan and U.S. participants.
Author:     Miller, A. N.; Fellows, K. L., and Kizito, M. N.

Source:     Health Commun. 2007; 22(3):207-19.

Abstract:   This study examined the impact of controllability of onset (i.e., means of
            transmission), disease type (HIV and lung cancer), and culture (Kenya and U.S.)
            on stigmatizing attitudes and goals for supportive communication. Four
            hundred sixty-four Kenyan students and 526 American students, and 441
            Kenyan nonstudents and 591 American nonstudents were randomly assigned to
            1 of 12 hypothetical scenario conditions and asked to respond to questions
            regarding 3 different types of stigmatizing attitudes and 6 types of supportive
            communication goals with respect to the character in the scenario. Means of
            transmission had a strong effect on the blame component of stigma, but none on
            cognitive attitudes and social interaction components. Similarly, although an
            effect for means of transmission emerged on intention to provide "recognize own
            responsibility" and "see others' blame" types of support, no effect was evident for
            most other supportive interaction goals. Although effects for culture were small,
            Kenyan participants, student and nonstudent alike, were not as quick as
            American participants to adopt goals of communicating blame in any direction.
            Implications for measurement of stigma in future research are discussed.


Motivations and methods for self-disclosure of HIV seropositivity in
Nairobi, Kenya.
Author:     Miller, A. N. and Rubin, D. L.

Source:     AIDS Behav. 2007 Sep; 11(5):687-97.

Abstract:   This study employed structured interviews with 307 people living with HIV
            (PLHIVs) in Nairobi, Kenya to investigate their serostatus disclosure with respect
            to four types of relationships in their lives: partners, friends, family members,
            and religious leaders/clergy. Regarding motivations for disclosure, it was found
            that a sense of duty and seeking material support motivated disclosure to family
            and partners, fear of loss of confidentiality inhibited disclosure to friends, and
            the need for advice encouraged disclosure to religious leaders. The method of
            disclosure most frequently mentioned was direct, with males less likely than
            females to use direct methods when disclosing to spouses or partners.
            Intermediated disclosure was common in partner/spouse relationships with
            around one-third of partners preferring to disclose through a third party.



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                            STIs, HIV and AIDS: 2005 - 2008

            Methods used to disclose as well as reasons for doing so varied by relationship
            type


HIV infection does not disproportionately affect the poorer in sub-
Saharan Africa.
Author:     Mishra, V.; Assche, S. B.; Greener, R.; Vaessen, M.; Hong, R.; Ghys, P. D.; Boerma,
            J. T.; Van Assche, A.; Khan, S., and Rutstein, S.

Source:     AIDS. 2007 Nov; 21 Suppl 7:S17-28.

Abstract:   Background:
            Wealthier populations do better than poorer ones on most measures of health
            status, including nutrition, morbidity and mortality, and healthcare utilization.

            Objectives:
            This study examines the association between household wealth status and HIV
            serostatus to identify what characteristics and behaviours are associated with
            HIV infection, and the role of confounding factors such as place of residence and
            other risk factors.

            Methods:
            Data are from eight national surveys in sub-Saharan Africa (Kenya, Ghana,
            Burkina Faso, Cameroon, Tanzania, Lesotho, Malawi, and Uganda) conducted
            during 2003-2005. Dried blood spot samples were collected and tested for HIV,
            following internationally accepted ethical standards and laboratory procedures.
            The association between household wealth (measured by an index based on
            household ownership of durable assets and other amenities) and HIV serostatus
            is examined using both descriptive and multivariate statistical methods.

            Results:
            In all eight countries, adults in the wealthiest quintiles have a higher prevalence
            of HIV than those in the poorer quintiles. Prevalence increases monotonically
            with wealth in most cases. Similarly for cohabiting couples, the likelihood that
            one or both partners is HIV infected increases with wealth. The positive
            association between wealth and HIV prevalence is only partly explained by an
            association of wealth with other underlying factors, such as place of residence
            and education, and by differences in sexual behaviour, such as multiple sex
            partners, condom use, and male circumcision.

            Conclusion:
            In sub-Saharan Africa, HIV prevalence does not exhibit the same pattern of
            association with poverty as most other diseases. HIV programmes should also
            focus on the wealthier segments of the population.




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Comparison of HIV prevalence estimates from antenatal care
surveillance and population-based surveys in sub-Saharan Africa.
Author:     Montana, L. S.; Mishra, V., and Hong, R.

Source:     Sex Transm Infect. 2008 Aug; 84 Suppl 1:i78-i84.

Abstract:   Objective:
            To compare HIV seroprevalence estimates obtained from antenatal care (ANC)
            sentinel surveillance surveys in Ethiopia, Kenya, Malawi, Tanzania and Uganda
            with those from population-based demographic and health surveys (DHS) and
            AIDS indicator surveys (AIS).

            Methods:
            Geographical information system methods were used to map ANC surveillance
            sites and DHS/AIS survey clusters within a 15-km radius of the ANC sites.
            National DHS/AIS HIV prevalence estimates for women and men were
            compared with national prevalence estimates from ANC surveillance. DHS/AIS
            HIV prevalence estimates for women and men residing within 15 km of ANC
            sites were compared with those from ANC surveillance. For women, these
            comparisons were also stratified by current pregnancy status, experience of
            recent childbirth and receiving ANC for the last birth.

            Results:
            In four of the five countries, national DHS/AIS estimates of HIV prevalence were
            lower than the ANC surveillance estimates. Comparing women and men in the
            catchment areas of the ANC sites, the DHS/AIS estimates were similar to ANC
            surveillance estimates. DHS/AIS estimates for men residing in the catchment
            areas of ANC sites were much lower than ANC surveillance estimates for
            women in all cases. ANC estimates were higher for younger women than
            DHS/AIS estimates for women in ANC catchment areas, but lower at older ages.
            In all cases, urban prevalence was higher than rural prevalence but there were no
            consistent patterns by education.

            Conclusions:
            ANC surveillance surveys tend to overestimate HIV prevalence compared to
            prevalence among women in the general population in DHS/AIS surveys.
            However, the ANC and DHS/AIS estimates are similar when restricted to
            women and men, or to women only, residing in catchment areas of ANC sites.
            Patterns by age and urban/rural residence suggest possible bias in the ANC
            estimates.




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Estimation of the sexual transmission of HIV in Kenya and Uganda on
the trans-Africa highway: the continuing role for prevention in high risk
groups.
Author:     Morris, C. N. and Ferguson, A. G.

Source:     Sex Transm Infect. 2006 Oct; 82(5):368-71.

Abstract:   Objective:
            To explore the effect of transactional sex on the trans-Africa highway from
            Mombasa-Kampala in contributing to the HIV epidemic and the impact that an
            effective prevention intervention could have.

            Methods:
            Variables for input into a simple model of HIV prevention, AVERT, were derived
            from a study of hot spots of transactional sex on the trans-Africa highway.
            Diaries were completed by a sample of sex workers at selected sites of
            transactional sex for a period of 28 consecutive days. Key information elicited
            included numbers, types and occupations of clients, numbers of liaisons, sexual
            acts in each liaison, and condom use. 857 diaries were distributed and 578
            received and usable in 30 sites. A sexual patterning matrix was completed by 202
            truckers at the Malaba border point as part of a health seeking behaviour survey.
            Two methods were employed to estimate female sex worker (FSW) numbers on
            the highway. FSW focus group discussions (FGDs) at 15 sites were carried out
            and included questioning on the number of sex workers at the site. As most
            transactional sex on the highway is centred on bars and lodgings, a patron
            census and survey of 1007 bars and lodgings was carried out which included
            questions on the presence and proportions of FSWs among the clientele.

            Results:
            There are an estimated 8000 FSWs on the trans-Africa highway from Mombasa to
            Kampala. Annual numbers of different sexual partners per FSW were 129,
            annual numbers of sexual acts per FSW were 634, percentage of sexual acts
            protected by condom use was 77.7%. Using these input data an estimated 3200-
            4148 new HIV infections occur on this portion of the trans-Africa highway in 1
            year. Having a 90% condom use programme in place could prevent almost two
            thirds of these infections and cumulative incidence would decline from 1.29% to
            0.42%.

            Conclusions:
            In generalised epidemics there has been a debate as to the place of targeted
            interventions. In the current east African epidemic we show that a targeted
            intervention could have significant impact in averting HIV infections related to
            the trans-Africa highway.




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Sexual and treatment-seeking behaviour for sexually transmitted
infection in long-distance transport workers of East Africa.
Source:     Sex Transm Infect. 2007 Jun; 83(3):242-5.

Abstract:   Objective:
            To investigate the sexual and treatment-seeking behaviour for sexually
            transmitted infection (STI) in long-distance transport workers of East Africa.

            Methods:
            A health-seeking behaviour survey was carried out at four sites on the Mombasa-
            Kampala trans-Africa highway (n = 381). The questionnaires probed details of
            STI knowledge, symptoms and care-seeking behaviour. In one site at the Kenya-
            Uganda border, a sexual patterning matrix was used (n = 202) to measure sexual
            behaviour in truck drivers and their assistants over the 12-month period before
            the interview.

            Results:
            Over half of the sexual acts of long-distance transport workers over 12 months
            were with female sex workers, with an annual average of 2.8 sexual partners.
            Condom use was reported at 70% for liaisons with casual partners. 15% of
            truckers had had a self-reported STI and one-third exhibited high-risk sexual
            behaviour in the previous year. Of those with an STI, 85% had symptoms when
            on the road and 77.2% sought treatment within 1 week of onset of symptoms.
            94% of drivers and 56% of assistants sought treatment for STI in a private health
            facility or pharmacy. The cost of private facilities and pharmacies was not
            significantly higher than in the public sector. Waiting times were three times
            longer in the public sector. Only 28.9% of patients completed their medication
            courses as prescribed.

            Conclusions:
            Truck drivers and their assistants in East Africa have high rates of reported STIs
            and many continue to exhibit high-risk sexual behaviour. The transport workers
            studied here favoured private health facilities because of convenience and
            shorter waiting times.


Sexual Behavior of Female Sex Workers and Access to Condoms in
Kenya and Uganda on the trans-Africa Highway.
Author:     Morris, C. N.; Morris, S. R., and Ferguson, A. G.

Source:     AIDS Behav. 2008 Jul 30.

Abstract:   Female sex workers and their clients remain a high risk core group for HIV in
            Africa. We measured sexual behavior of a snowball sample of female sex



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                            STIs, HIV and AIDS: 2005 - 2008

            workers (FSW) along the Trans Africa highway from Mombasa, Kenya to
            Kampala, Uganda and surveyed the availability of male condoms at 1,007 bars
            and lodgings in Kenya along the highway trucking stops where transactional sex
            occurs. There were 578 FSW one month sex diaries analyzed, 403 from Kenya
            and 175 from Uganda. Kenyan FSW had a median of 45 sexual acts per 28 days
            compared to 39 sex acts per 28 days by Ugandan FSW (P < 0.05). Condom use by
            FSW for all sexual liaisons was 79% in Kenya compared to 74% in Uganda. In
            multivariate analysis, adjusting for repeated measures, Kenyan FSW were more
            likely to use a condom by an adjusted odds ratio of 2.54 (95% confidence interval
            1.89-3.41) compared to Ugandan FSW. Condom use with regular clients was
            50.8% in Uganda compared with 68.7% in Kenya (P < 0.01). The number of sex
            workers reporting 100% condom use was 26.8% in Kenya and 18.9% in Uganda
            (P < 0.01). Bars and lodges in Kenya compared to Uganda were more likely to:
            have condom dispensers, 25% versus 1%, respectively (P < 0.01); distribute or sell
            condoms, 73.9% versus 47.6% (P < 0.01); and have more weekly condom
            distribution, 4.92 versus 1.27 condoms per seating capacity (P < 0.01). Our data
            indicate that in both countries condom use for FSW is suboptimal, particularly
            with regular partners, and greater condom use by Trans African highway FSW in
            Kenya compared to Uganda may be related to availability. Targeted
            interventions are warranted for FSW and truck drivers to prevent transmission in
            this important core group.


Assessment of utilisation of PMTCT services at Nyanza Provincial
Hospital, Kenya.
Author:     Moth, I. A.; Ayayo, A. B., and Kaseje, D. O.

Source:     SAHARA J. 2005 Jul; 2(2):244-50.

Abstract:   The main objective of the study was to assess the utilisation of prevention of
            mother-to-child transmission (PMTCT) services among mothers registered for
            services at Nyanza Provincial Hospital in Kenya. A crosssectional exploratory
            study was conducted, using both quantitative and qualitative approaches to
            collect primary and secondary data.The study population was 133 clients
            registered for PMTCT services. The study revealed that 52.4% of clients received
            PMTCT information at the health facility without prior knowledge about
            intervention, 96% waited for more than 90 minutes, and 89% took less than 10
            minutes for post-test counselling. Knowledge of MTCT and PMTCT was
            inadequate even after counselling, as participants could not recall the
            information divulged during counselling. In addition, 80% of clients did not
            present for follow-up counselling irrespective of HIV status, and 95%, did not
            disclose positive HIV status to spouses/relatives for fear of stigma,
            discrimination and violence. Inadequate counselling services delivered to clients
            affected service utilisation, in that significant dropout occurred at the stages of
            HIV result (31.5%), enrollment (53.6%), and delivery (80.7%). Reasons for



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                            STIs, HIV and AIDS: 2005 - 2008

            dropout included fear of positive HIV result, chronic illness, stigma and
            discrimination, unsupportive spouse and inability to pay for the services


Promoting female condoms in HIV voluntary counselling and testing
centres in Kenya.
Author:     Mung'ala, L.; Kilonzo, N.; Angala, P.; Theobald, S., and Taegtmeyer, M.

Source:     Reprod Health Matters. 2006 Nov; 14(28):99-103.

Abstract:   Promotion of male condoms and voluntary counselling and testing for HIV
            (VCT) have been cornerstones of Kenya's fight against the HIV epidemic. This
            paper argues that there is an urgent need to promote the female condom in
            Kenya through VCT centres, which are rapidly being scaled-up across the
            country and are reaching increasingly large numbers of people. Training of
            counsellors using a vaginal demonstration model is needed, as well an adequate
            supply of free female condoms. In a study in five VCT centres, however,
            counsellors reported that most people they counselled believed female condoms
            were "not as good" as male condoms. In fact, many clients had little or no
            knowledge or experience of female condoms. Counsellors' knowledge too was
            largely based on hearsay; most felt constrained by lack of experience and had
            many doubts about female condoms, which need addressing. Additional areas
            that require attention in training include how to re-use female condoms and the
            value of female condoms for contraception. VCT counsellors in Kenya already
            promote male condoms as a routine part of risk reduction counselling alongside
            HIV testing. This cadre, trained in client-centred approaches, has the potential to
            champion female condoms as well, to better support the right to a healthy and
            safe sex life.


Communication for HIV/AIDS prevention in Kenya: social-cultural
considerations.
Author:     Muturi, N.

Source:     J Health Commun. 2005 Jan-2005 Feb 28; 10(1):77-98.

Abstract:   The acquired immune deficiency syndrome (AIDS) epidemic is spreading fast in
            Africa in spite of the various efforts and resources put in place to prevent it. In
            Kenya, reproductive health programs have used the mass media and other
            communication interventions to inform and educate the public about the disease
            and to promote behavior change and healthy sexual practices. This effort has led
            to a discrepancy between awareness and behavioral change among people of
            reproductive age. In this article I examine the discrepancy in Kenya from a
            communications perspective addressing social cultural and related factors


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            contributing to the lack of change in behavior and sexual practices. I draw on the
            theoretical framework of Grunig's model of excellence in communication, the
            importance of understanding and relationship building between programs and
            their stakeholders. Data were gathered qualitatively using focus groups and in-
            depth interviews among men and women in rural Kenya. Key findings indicate
            that although awareness of sexually transmitted diseases (STDs) including
            human immunodeficiency virus (HIV)/AIDS is high in Kenya, a majority of the
            population, particularly those in the rural communities, lack understanding of
            the communicated messages. They also lack the knowledge of other ways of
            transmitting HIV particularly among those not sexually involved. Cultural
            beliefs, values, norms, and myths have played a role in the rapidly increasing
            epidemic in the rural communities and yet HIV/AIDS communication programs
            have not addressed these factors adequately. I conclude that successful behavior
            change communication must include strategies that focus on increasing
            understanding of the communicated messages and understanding of the
            audience through application of appropriate methodologies. Building a
            relationship with the audience or stakeholders through dialogues and two-way
            symmetrical communication contributes toward this understanding and the
            maintenance of the newly adopted behaviors and practices.


Validation of a new clinical scoring system for acute bronchitis.
Author:     Mwachari, C.; Nduba, V.; Nguti, R.; Park, D. R.; Sanguli, L., and Cohen, C. R.

Source:     Int J Tuberc Lung Dis. 2007 Nov; 11(11):1253-9.

Abstract:   Introduction:
            Although several clinical prediction rules exist for lower respiratory tract
            infection (LRTI), few are for acute bronchitis (acute bronchitis) and most have
            not been validated in high human immunodeficiency virus (HIV) prevalence
            settings.

            Methods:
            An Acute Bronchitis Severity Score (ABSS) was developed and validated during
            a randomized trial of antibiotic treatment for acute bronchitis. Ambulatory
            adults with productive cough of < or =2 weeks at out-patient respiratory disease
            clinics in Nairobi, Kenya, were recruited and assessed for clinical response to
            therapy. The ABSS quantitative ratings of LRTI-associated symptoms, physical
            signs and sputum Gram stain purulence were assessed using standard
            psychometric tests.

            Results:
            The ABSS was evaluated among 649 cases of acute bronchitis; 129 (20%) were
            HIV-seropositive. The ABSS had small floor and ceiling effects (1.8/0.2) and
            demonstrated high internal consistency (alpha-coefficient of 0.66) and internal
            validity, with a mean inter item total correlation of > or =0.25. Effect sizes from


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                             STIs, HIV and AIDS: 2005 - 2008

            baseline to subsequent follow-up visits were large (>0.5). Wheezing and chest
            pain were associated with higher ABSS values, whereas irrelevant clinical
            variables were not.

            Conclusion:
            The ABSS demonstrated good responsiveness, high internal consistency, good
            correlation with common respiratory signs and symptoms and high
            discriminatory validity among patients with acute bronchitis in a high HIV-
            seroprevalence setting.


Modelling the public health impact of male circumcision for HIV
prevention in high prevalence areas in Africa.
Author:     Nagelkerke, N. J.; Moses, S.; de Vlas, S. J., and Bailey, R. C.

Source:     BMC Infect Dis. 2007; 7:16.

Abstract:   Background:
            Recent clinical trials in Africa, in combination with several observational
            epidemiological studies, have provided evidence that male circumcision can
            reduce HIV female-to-male transmission risk by 60% or more. However, the
            public health impact of large-scale male circumcision programs for HIV
            prevention is unclear.

            Methods:
            Two mathematical models were examined to explore this issue: a random mixing
            model and a compartmental model that distinguishes risk groups associated
            with sex work. In the compartmental model, two scenarios were developed, one
            calculating HIV transmission and prevalence in a context similar to the country
            of Botswana, and one similar to Nyanza Province, in western Kenya.

            Results:
            In both models, male circumcision programs resulted in large and sustained
            declines in HIV prevalence over time among both men and women. Men
            benefited somewhat more than women, but prevalence among women was also
            reduced substantially. With 80% male circumcision uptake, the reductions in
            prevalence ranged from 45% to 67% in the two "countries", and with 50% uptake,
            from 25% to 41%. It would take over a decade for the intervention to reach its full
            effect.

            Conclusion:
            Large-scale uptake of male circumcision services in African countries with high
            HIV prevalence, and where male circumcision is not now routinely practised,
            could lead to substantial reductions in HIV transmission and prevalence over
            time among both men and women.



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                             STIs, HIV and AIDS: 2005 - 2008


Factors leading to self-disclosure of a positive HIV diagnosis in Nairobi,
Kenya: people living with HIV/AIDS in the Sub-Sahara.

Author:     Neville Miller, A. and Rubin, D. L.

Source:     Qual Health Res. 2007 May; 17(5):586-98.

Abstract:   Understanding why, how, and to whom people living with HIV/AIDS disclose
            their diagnosis to others is a critical issue for HIV prevention and care efforts, but
            previous investigations of those issues in sub-Saharan Africa have been limited
            to one or two questions included in quantitative studies of social support or
            stigma. Instruments and findings on serostatus disclosure based on U.S.
            populations are likely to be at best only partially relevant because of Africa's
            primarily heterosexual transmission vectors and highly communalistic social
            structures. This qualitative analysis of two male and two female focus groups
            comprised of persons living with HIV/AIDS (PLWHAs) in Nairobi, Kenya,
            revealed several HIVstatus disclosure patterns that appear distinctive to Africa.
            These include (a) intermediaries as vehicles for disclosure to family, (b)
            indirectness as a communication strategy, and (c) church pastors as common
            targets for disclosure.



Sustained changes in sexual behavior by female sex workers after
completion of a randomized HIV prevention trial.
Author:     Ngugi, E. N.; Chakkalackal, M.; Sharma, A.; Bukusi, E.; Njoroge, B.; Kimani, J.;
            MacDonald, K. S.; Bwayo, J. J.; Cohen, C. R.; Moses, S., and Kaul, R.

Source:     J Acquir Immune Defic Syndr. 2007 Aug 15; 45(5):588-94.

Abstract:   Introduction:
            Behavioral interventions in female sex workers (FSWs) are associated with
            changes in sexual behavior and reduced rates of sexually transmitted infections
            (STIs) and HIV We examined the sustainability of such interventions.

            Methods:
            HIV-uninfected Kenyan FSWs were enrolled in a clinical trial that provided free
            male condoms, community and clinic-based counseling, and STI management.
            After trial completion, scaled-back community-based resources remained in
            place. More than a year later, women were invited to complete a follow-up
            behavioral questionnaire and to undergo STI/HIV counseling and testing.
            Individual changes in sexual behavior were assessed by paired analysis.

            Results:
            One hundred seventy-two women participated in the resurvey 1.2 years after
            trial termination. Client numbers had risen (paired t test, P < 0.001), but condom


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            use had also increased (P < 0.001); both remained substantially lower than at
            enrollment. Regular partners accounted for a greater proportion of unprotected
            FSW sexual encounters (35% vs. 10%; P < 0.001). Only 9 (5.2%) of 172 women had
            a conventional STI, and the follow-up HIV incidence of 1.6 per 100 person-years
            (PYs) was similar to that during the trial period (3.7 per 100 PYs). Incident STIs
            and HIV were associated with the frequency of unprotected sex and younger
            age.

            Conclusions:
            Less intensive community-based risk reduction services after clinical trial
            termination may support ongoing reductions in STIs and HIV among high-risk
            FSWs.


Ethical dilemmas of social science research on AIDS and orphanhood in
Western Kenya.
Author:     Nyambedha, E. O.

Source:     Soc Sci Med. 2008 Sep; 67(5):771-9.

Abstract:   This paper is based on the experiences drawn from a long-term social science
            research programme on the impact of the AIDS pandemic on orphanhood in
            western Kenya. It discusses the ethical dilemma of maintaining a delicate balance
            between research ethics, the expectations of the study population and
            negotiating the community's vested interests in a health related research project
            in a low-income society. I argue that informed consent and the intended benefits
            of the study to the participants continue to be major challenges facing the
            justification of social research with people affected by or living with AIDS in low-
            income societies. The paper underscores the importance of community feedback
            sessions as a way of enhancing chances of acceptability of research efforts and
            obtaining informed consent. It further shows how community feedback sessions
            contribute to local knowledge of the problem being studied, creating
            opportunities for advocacy. This discussion adds to the existing ethical debate on
            the wider contexts within which research on vulnerable people affected by AIDS
            is conducted by arguing that research practice is inseparable from
            epistemological concerns of knowledge production. I suggest that ethnographers
            should enhance efforts to innovatively design action research projects to serve
            the twin purposes of data collection and deal with ethical challenges that are
            experienced when doing long-term research on vulnerable groups.




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Sexual and demographic determinants for herpes simplex virus type 2
among fishermen along Lake Victoria, Kenya.
Author:     O Ng'ayo, M.; Bukusi, E.; A Morrow, R.; Rowhani-Rahbar, A.; A Obare, B.;
            Friedrich, D., and Holmes, K. K.

Source:     Sex Transm Infect. 2008 Apr; 84(2):140-2.

Abstract:   Objectives:
            To determine the prevalence and correlates of herpes simplex virus type 2 (HSV-
            2) seropositivity among fishermen along the shores of Lake Victoria in Kisumu
            district, Kenya.

            Methods:
            Sera from a random sample of 250 fishermen from 18 beaches were collected
            after a detailed sociodemographic interview. HSV-2 infection was tested by
            Kalon HSV-2 ELISA.

            Results:
            The HSV-2 seroprevalence was 63.9%. In multivariate analysis, fishermen were
            more likely to be infected with HSV-2 if they were HIV positive (prevalence ratio
            (PR) 1.27; 95% CI 1.06 to 1.52) compared with those testing HIV negative, were
            aged 18-20 (PR 0.49; 95% CI 0.24 to 0.99) and older than 40 (PR 1.66; 95% CI 1.30
            to 2.14) years compared with those aged 21-25 years, perceived their last two
            sexual partners to have a sexually transmitted infection (STI; PR 1.27; 95% CI 1.06
            to 1.52) compared with those who did not and were more likely to be
            circumcised (PR 1.49; 95% CI 1.19 to 1.86).

            Conclusions:
            HSV-2 seroprevalence is high among this population and is associated with HIV
            serostatus, age, perception about partner's STI status and circumcision.


Viral load, CD4+ T-lymphocyte counts and antibody titres in HIV-1
infected untreated children in Kenya; implication for immunodeficiency
and AIDS progression.
Author:     Ochieng, W.; Ogoyi, D.; Mulaa, F. J.; Ogola, S.; Musoke, R., and Otsyula, M. G.

Source:     Afr Health Sci. 2006 Mar; 6(1):3-13.

Abstract:   Background:
            There are limited reports on HIV-1 RNA load, CD4+ T-lymphocytes and
            antibody responses in relation to disease progression in HIV-1 infected untreated
            children in Africa.



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                             STIs, HIV and AIDS: 2005 - 2008

            Methods:
            To describe the relationships between these parameters, we conducted a
            longitudinal cohort study involving 51 perinatally HIV-1 infected children aged
            between 1 and 13 years. HIV status was determined by ELISA and confirmed by
            western blot and PCR. Antibodies were quantified by limiting dilution ELISA,
            plasma HIV-1 RNA load by RT-PCR and CD4+ T-lymphocytes by FACSCount.

            Results:
            Asymptomatic and symptomatic disease had, respectively, a rise in median
            HIV-1 RNA load from 1,195 to 132,543 and from 42,962 to 1,109,281 copies/ml in
            children below 6 years. The increase in viral load was 10-fold higher for
            asymptomatic compared to other categories and 2-fold faster for children less
            than 6 years than those above. Similarly, symptomatic children below 6 years
            had initial median CD4+ T-lymphocyte counts of 647 (22%) cells/muL, declining
            to 378 (20%) while those above 6 years had initial values of below 335 (15%) but
            which increased to 428 (17%). Median viral load correlated significantly with
            median CD4+ T-lymphocyte percentage in children above 6 years (p=0.026) but
            not below.

            Conclusions:
            Viral load is lower in older than younger children and correlates significantly
            with percentage CD4+ T-lymphocytes. Survival by HIV-1 infected children
            requires a competent immune response early in infection to counter the rapidly
            replicating virus. Interventions aimed at boosting the naive immune system may
            prolong survival in these children.


Tuberculosis and oral Candida species surveillance in HIV infected
individuals in Northern Kenya, and the implications on tuberculin skin
test screening for DOPT-P.
Author:     Ochieng, W.; Wanzala, P.; Bii, C.; Oishi, I.; Ichimura, H.; Lihana, R.; Mpoke, S.;
            Mwaniki, D., and Okoth, F. A.

Source:     East Afr Med J. 2005 Dec; 82(12):609-13.

Abstract:   Objective:
            To determine the pattern of opportunistic infections such as TB and Candida
            species in HIV infected patients in Northern Kenya.

            Design:
            Cross-sectional study. SETTING: Five health facilities in Moyale (n=224),
            Mandera (n=121) and Turkana Kakuma; (n=83), Lopiding; (n=94) districts during
            different periods in 2003. SUBJECTS: Five hundred and fifty two patients.




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                            STIs, HIV and AIDS: 2005 - 2008

            Results:
            In total 94 (18%) patients were found to be HIV positive (Moyale=42,
            Mandera=13, Turkana; Kakuma=8, Lopiding=31). Only 65 of 94 HIV positive
            patients provided saliva samples. Of these, 11 (17%) were TB smear positive and
            19 (29.2%) were colonized by oral Candida species. The Candida isolates were as
            follows; Co-infection of Candida species and TB (n=4), C. albicans only (n=12), C.
            tropicalis only (n=1), C. albicans and C. glabarata (n=1) and C. albicans, C.
            glabarata and C. tropicalis. co-infection (n=1).

            Conclusion:
            The findings provides an important insight into the differences in mucosal
            susceptibility to bacteria (TB) infection and fungal (Candida species) colonization
            during HIV immunosuppression, based on collected blood, sputum and saliva
            specimens. Further studies are needed to elucidate the comparative transmission
            dynamics and pathogenetic mechanisms of these opportunistic infections-in
            different regions of Kenya. Such studies would improve the efficiency of directly
            observed preventive therapy programme (DOPT-P) whose implementation
            involves screening by tuberculin skin testing.


Provider-initiated HIV testing and counselling for TB patients and
suspects in Nairobi, Kenya.
Author:     Odhiambo, J.; Kizito, W.; Njoroge, A.; Wambua, N.; Nganga, L.; Mburu, M.;
            Mansoer, J.; Marum, L.; Phillips, E.; Chakaya, J., and De Cock, K. M.

Source:     Int J Tuberc Lung Dis. 2008 Mar; 12(3 Suppl 1):63-8.

Abstract:   Setting:
            Integrated tuberculosis (TB) and human immunodeficiency virus (HIV) services
            in a resource-constrained setting.

            Objective:
            Pilot provider-initiated HIV testing and counselling (PITC) for TB patients and
            suspects. DESIGN: Through partnerships, resources were mobilised to establish
            and support services. After community sensitisation and staff training, PITC was
            introduced to TB patients and then to TB suspects from December 2003 to
            December 2005.

            Results:
            Of 5457 TB suspects who received PITC, 89% underwent HIV testing. Although
            not statistically significant, TB suspects with TB disease had an HIV prevalence
            of 61% compared to 63% for those without. Of the 614 suspects who declined
            HIV testing, 402 (65%) had TB disease. Of 2283 patients referred for
            cotrimoxazole prophylaxis, 1951 (86%) were enrolled, and of 1727 patients
            assessed for antiretroviral treatment (ART), 1618 (94%) were eligible and 1441
            (83%) started treatment.


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            Conclusions:
            PITC represents a paradigm shift and is feasible and acceptable to TB patients
            and TB suspects. Clear directives are nevertheless required to change practice.
            When offered to TB suspects, PITC identifies large numbers of persons requiring
            HIV care. Community sensitisation, staff training, multitasking and access to
            HIV care contributed to a high acceptance of HIV testing. Kenya is using this
            experience to inform national response and advocate wide PITC implementation
            in settings faced with the TB-HIV epidemic.


Role of governmental and non-governmental organizations in mitigation
of stigma and discrimination among HIV/AIDS persons in Kibera,
Kenya.
Author:     Odindo, M. A. and Mwanthi, M. A.

Source:     East Afr J Public Health. 2008 Apr; 5(1):1-5.

Abstract:   Objective:
            This study assessed the role of governmental and non-governmental
            organizations in mitigation of stigma and discrimination among people infected
            and affected by HIV/AIDS in informal settlements of Kibera.

            Methods:
            This was a descriptive cross-sectional study and used a multi stage stratified
            sampling method. The study was conducted in Kibera, an informal settlement
            with a population of over one million people which makes it the largest slum not
            only in Kenya but in sub-Saharan Africa. The study targeted infected
            individuals, non-infected community members, managers of the organizations
            implementing HIV/AIDS programmes and service providers. In the process
            1331 households were interviewed using qualitative and quantitative data
            collection instruments. Statistical Package for Social Sciences (SPSS) and Nudist 4
            packages were used to analyze the quantitative and qualitative data respectively.

            Results:
            More than 61% of the respondents had patients in their households. Fifty five
            percent (55%) of the households received assistance from governmental and non-
            governmental organizations in taking care of the sick. Services provided
            included awareness, outreach, counseling, testing, treatment, advocacy, home
            based care, assistance to the orphans and legal issues. About 90% of the
            respondents perceived health education, counseling services and formation of
            post counseling support groups to combat stigma and discrimination to be
            helpful.




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            Conclusion:
            Stigma and discrimination affects the rights of People Living with HIV/AIDS
            (PLWHAs). Such stigmatization and discrimination goes beyond and affects
            those who care for the PLWHAs, and remains the biggest impediment in the
            fight against HIV/AIDS in Kibera. Governmental and non-governmental
            organizations continue to provide key services in the mitigation of stigma and
            discrimination in Kibera. However, personal testimonies by PLWHAs showed
            that HIV positive persons still suffer from stigma and discrimination.
            Approximately 43% of the study population experienced stigma and
            discrimination.


Secrecy, disclosure and accidental discovery: perspectives of diaphragm
users in Mombasa, Kenya.
Author:     Okal, J.; Stadler, J.; Ombidi, W.; Jao, I.; Luchters, S.; Temmerman, M., and
            Chersich, M. F.

Source:     Cult Health Sex. 2008 Jan; 10(1):13-26.

Abstract:   The diaphragm is receiving renewed attention as a promising female-controlled
            method of preventing HIV and other sexually-transmitted infections. It is
            anticipated that female-controlled technologies will reduce women's biological
            susceptibility and assist in counteracting their sociocultural vulnerability to HIV.
            Understanding the subjective experiences of diaphragm users in different
            settings has the potential to inform the development and promotion of such
            methods. This paper explores the perspectives of female sex workers and women
            attending sexual and reproductive health services in Mombasa, Kenya. Data are
            reported from focus group discussions and in-depth interviews with women and
            men, following a prospective study investigating diaphragm continuation rates
            over six months. Discussions highlighted covert use of the diaphragm, during
            sex work or with casual partners, and coital independence as favourable
            attributes. These features were especially pronounced compared with male
            condoms. Few difficulties with diaphragm use were reported, although its
            insertion and removal occasionally presented problems. Many women--
            especially those in long term partnerships--wished to disclose its use but found
            the disclosure process highly problematic. Accidental discovery often resulted in
            partner conflict. Although future uptake of the diaphragm may be high in this
            setting, its use may be limited to certain types of relationships and relationship
            context




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Maternal knowledge on mother-to-child transmission of HIV and
breastmilk alternatives for HIV positive mothers in Homa Bay District
Hospital, Kenya.
Author:     Omwega, A. M.; Oguta, T. J., and Sehmi, J. K.

Source:     East Afr Med J. 2006 Nov; 83(11):610-8.

Abstract:   Background:
            Mother- to- Child Transmission (MTCT) of HIV is a relatively new concept in
            rural populations and despite the huge amount of work that has been done on
            the HIV/AIDS, there still remains a dearth of information in knowledge of
            mothers on this concept especially in areas related to appropriate feeding
            methods for infants born to mothers infected with the virus.

            Objectives:
            To determine maternal knowledge on MTCT of HIV in the rural setting and to
            examine viable breastmilk alternatives for mothers who would be HIV positive.

            Design:
            A cross- sectional study, supported by an observational study.

            Setting:
            A rural district community and Homa-Bay District Hospital in South Western
            Kenya.

            Subjects:
            One hundred and twelve non-tested mothers having infants aged 0-12 months in
            the community and a sub-group (10%) of HIV positive mothers from the District
            Hospital.

            Results:
            Maternal knowledge on MTCT of HIV was as low as 8.9% in the study area. The
            MTCT knowledge was found to influence the alternative feeding choice as
            mentioned by the non-tested mothers (p = 0.001; OR = 1.41; 95%CI, 1.04-3.86).
            Those with high MTCT knowledge tended to be more receptive and considered
            feeding alternatives other than cowmilk like expressed breastmilk (p = 0.1 5),
            formula (p = 0.036; OR = 2.44; 95%CI, 1.66-6.04) and milk from milk bank (p =
            0.015; OR = 1.34; 95%CI, 1.13-5.50) than their counterparts with low MTCT
            knowledge. Cowmilk, formula and wet-nursing were the three feeding
            alternatives that were viable with varying socio-cultural, economic and/or
            nutritional constraints.

            Conclusion:
            Maternal MTCT knowledge influences the choice of alternative infant feeding
            option but not breastfeeding practices. Cowmilk is the most common, socio-



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            culturally acceptable and accessible breastmilk alternative in this community. It
            is recommended that in order to improve MTCT knowledge, health education
            and nutrition counselling be intensified in PMTCT programmes, VCT centers
            and ANC clinics. Concurrently, effort should be made to increase the supply of
            cowmilk within the community so as to make it more readily available and
            affordable.


HIV/AIDS and home-based health care.
Author:     Opiyo, P. A.; Yamano, T., and Jayne, T. s.

Source:     Int J Equity Health. 2008; 7:8.

Abstract:   This paper highlights the socio-economic impacts of HIV/AIDS on women. It
            argues that the socio-cultural beliefs that value the male and female lives
            differently lead to differential access to health care services. The position of
            women is exacerbated by their low financial base especially in the rural
            community where their main source of livelihood, agricultural production does
            not pay much. But even their active involvement in agricultural production or
            any other income ventures is hindered when they have to give care to the sick
            and bedridden friends and relatives. This in itself is a threat to household food
            security. The paper proposes that gender sensitive policies and programming of
            intervention at community level would lessen the burden on women who bear
            the brunt of AIDS as caregivers and livelihood generators at household level.
            Improvement of medical facilities and quality of services at local dispensaries is
            seen as feasible since they are in the rural areas. Other interventions should
            target freeing women's and girls' time for education and involvement in income
            generating ventures. Two separate data sets from Western Kenya, one being
            quantitative and another qualitative data have been used.


Understanding the differences between contrasting HIV epidemics in
east and west Africa: results from a simulation model of the Four Cities
Study.
Author:     Orroth, K. K.; Freeman, E. E.; Bakker, R.; Buve, A.; Glynn, J. R.; Boily, M. C.;
            White, R. G.; Habbema, J. D., and Hayes, R. J.

Source:     Sex Transm Infect. 2007 Aug; 83 Suppl 1:i5-16.

Abstract:   Objective:
            To determine if the differences in risk behaviours, the proportions of males
            circumcised and prevalences of sexually transmitted infections (STIs) observed in
            two African cities with low prevalence of HIV (Cotonou, Benin, and Yaounde,




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                           STIs, HIV and AIDS: 2005 - 2008

           Cameroon) and two cities with high prevalence (Kisumu, Kenya, and Ndola,
           Zambia) could explain the contrasting HIV epidemics in the four cities.

           Methods:
           An individual-based stochastic model, STDSIM, was fitted to the demographic,
           behavioural and epidemiological characteristics of the four urban study
           populations based on data from the Four Cities Study and other relevant sources.
           Model parameters pertaining to STI and HIV natural history and transmission
           were held constant across the four populations. The probabilities of HIV,
           syphilis and chancroid acquisition were assumed to be doubled among
           uncircumcised males. A priori plausible ranges for model inputs and outputs
           were defined and sexual behaviour characteristics, including those pertaining to
           commercial sex workers (CSWs) and their clients, which were allowed to vary
           across the sites, were identified based on comparisons of the empirical data from
           the four sites. The proportions of males circumcised in the model, 100% in
           Cotonou and Yaounde, 25% in Kisumu and 10% in Ndola, were similar to those
           observed. A sensitivity analysis was conducted to assess how changes in critical
           parameters may affect the model fit.

           Results:
           Population characteristics observed from the study that were replicated in the
           model included younger ages at sexual debut and marriage in east Africa
           compared with west Africa and higher numbers of casual partners in the past 12
           months in Yaounde than in the other three sites. The patterns in prevalence of
           STIs in females in the general population and CSWs were well fitted. HIV
           prevalence by age and sex and time trends in prevalence in the model were
           consistent with study data with the highest simulated prevalences in Kisumu
           and Ndola, intermediate in Yaounde and lowest in Cotonou. The sensitivity
           analysis suggested that the effect of circumcision on the development of the HIV
           epidemics may have been mediated indirectly by its effect on ulcerative STI.

           Conclusions:
           The contrasting HIV epidemics in east and west Africa could be replicated in our
           model by assuming that male circumcision reduced susceptibility to HIV,
           syphilis and chancroid. Varying rates of male circumcision may have played an
           important role in explaining the strikingly different HIV epidemics observed in
           different parts of sub-Saharan Africa.


Vasculitis in HIV: report of eight cases.
Author:    Otedo, A. E.; Oyoo, G. O.; Obondi, J. O., and Otieno, C. F.

Source:    East Afr Med J. 2005 Dec; 82(12):656-9.




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                             STIs, HIV and AIDS: 2005 - 2008

Abstract:   Objective:
            To describe vasculitis in HIV patients, their CD4 levels, anatomical sites affected
            and clinical patterns. DESIGN: Prospective, descriptive study.

            Setting:
            Kisumu District Hospital and Nairobi Rheumatology Clinic between January
            2002 and May 2005.

            Subjects:
            Eight patients with HIV and vasculitis. RESULTS: Eight patients (four males and
            four females) were recruited with an age range of 24-61 years, mean 33.13 years.
            Five had central nervous system vasculitis and three had peripheral vasculitis.
            The CD4 counts were low, range 2-200 cells/mm3 (mean of 79.25 cells/mm3),
            normal levels of CD4 are 355-1298 cells/mm3, indicating severe
            immunosuppression. Two patients tested positive for HBV (hepatitis B virus).

            Conclusion:
            HIV associated vasculitis is recognised and may be complicated by coinfection
            with hepatitis viruses. It occurs at low CD4 counts. Central nervous system
            involvement is a common site. Management is multidisciplinary.


HIV-1 disease progression in breast-feeding and formula-feeding
mothers: a prospective 2-year comparison of T cell subsets, HIV-1 RNA
levels, and mortality.
Author:     Otieno, P. A.; Brown, E. R.; Mbori-Ngacha, D. A.; Nduati, R. W.; Farquhar, C.;
            Obimbo, E. M.; Bosire, R. K.; Emery, S.; Overbaugh, J.; Richardson, B. A., and
            John-Stewart, G. C.

Source:     J Infect Dis. 2007 Jan 15; 195(2):220-9.

Abstract:   Background:
            There is conflicting evidence regarding the effects of breast-feeding on maternal
            mortality from human immunodeficiency virus type 1 (HIV-1) infection, and
            little is known about the effects of breast-feeding on markers of HIV-1 disease
            progression.

            Methods:
            HIV-1-seropositive women were enrolled during pregnancy and received short-
            course zidovudine. HIV-1 RNA levels and CD4 cell counts were determined at
            baseline and at months 1, 3, 6, 12, 18, and 24 postpartum and were compared
            between breast-feeding and formula-feeding mothers.




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                            STIs, HIV and AIDS: 2005 - 2008

            Results:
            Of 296 women, 98 formula fed and 198 breast-fed. At baseline, formula-feeding
            women had a higher education level and prevalence of HIV-1-related illness than
            did breast-feeding women; however, the groups did not differ with respect to
            CD4 cell counts and HIV-1 RNA levels. Between months 1 and 24 postpartum,
            CD4 cell counts decreased 3.9 cells/ microL/month (P<.001), HIV-1 RNA levels
            increased 0.005 log(10) copies/mL/month (P=.03), and body mass index (BMI)
            decreased 0.03 kg/m(2)/month (P<.001). The rate of CD4 cell count decline was
            higher in breast-feeding mothers (7.2 cells/ microL/month) than in mothers who
            never breast-fed (4.0 cells/ microL/month) (P=.01). BMI decreased more rapidly
            in breast-feeding women (P=.04), whereas HIV-1 RNA levels and mortality did
            not differ significantly between breast-feeding and formula-feeding women.

            Conclusions:
            Breast-feeding was associated with significant decreases in CD4 cell counts and
            BMI. HIV-1 RNA levels and mortality were not increased, suggesting a limited
            adverse impact of breast-feeding in mothers receiving extended care for HIV-1
            infection.


Using VCT statistics from Kenya in understanding the association
between gender and HIV.
Author:     Otwombe, K. N.; Ndindi, P.; Ajema, C., and Wanyungu, J.

Source:     SAHARA J. 2007 Nov; 4(3):707-10.

Abstract:   This paper demonstrates the importance of utilising official statistics from the
            voluntary counselling and testing centres (VCT) to determine the association
            between gender and HIV infection rates in Kenya.The study design adopted was
            a record based survey of data collected from VCT sites in Kenya between the
            second quarter of 2001 and the second quarter of 2004. Of those who were
            tested, significantly more females tested positive (P<0.0001) and had twice as
            high a chance of being infected by HIV (Odds ratio 2.27 with CI 2.23 to 2.31) than
            males.We conclude that VCT statistics may lead to better planning of services
            and gender sensitive interventions if utilised well.


Improving national data collection systems from voluntary counselling
and testing centres in Kenya.
Author:     Otwombe, K. N.; Wanyungu, J.; Nduku, K., and Taegtmeyer, M.

Source:     Bull World Health Organ. 2007 Apr; 85(4):315-8.




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                             STIs, HIV and AIDS: 2005 - 2008

Abstract:   Problem:
            Voluntary counselling and testing (VCT) data from the registered sites in Kenya
            have been fraught with challenges, leading to insufficient statistics in the national
            office for planning purposes. An exercise was carried out to determine the
            barriers to the flow of data in VCT sites in Kenya.

            Approach:
            A record-based survey was conducted at 332 VCT sites in Kenya. Data from on-
            site records were compared with those in the national office. The exercise was
            conducted in 2004 between 5 September and 15 October.

            Local setting:
            All registered VCT sites in Kenya. RELEVANT CHANGES: After the exercise,
            various measures to enhance VCT data collection and reporting were
            implemented. They include the provision of a uniform data collection and
            reporting tool to all the districts in the country, the strengthening of a feedback
            mechanism to update provinces and districts on their reporting status and
            increased support to the data component of the national quality assurance for
            VCT.

            Lessons learned:
            Periodical field visits by the national officials to offer on-the-job training about
            data management to data collectors and to address data quality issues can
            dramatically improve the quality and completeness of VCT reports. The
            perceived relevance of the data and the data collection process to those working
            at the sites is the critical factor for data quality and timeliness of reporting.


An integrative bioinformatic approach for studying escape mutations in
human immunodeficiency virus type 1 gag in the Pumwani Sex Worker
Cohort.
Author:     Peters, H. O.; Mendoza, M. G.; Capina, R. E.; Luo, M.; Mao, X.; Gubbins, M.;
            Nagelkerke, N. J.; Macarthur, I.; Sheardown, B. B.; Kimani, J.; Wachihi, C.;
            Thavaneswaran, S., and Plummer, F. A.

Source:     J Virol. 2008 Feb; 82(4):1980-92.

Abstract:   Human immunodeficiency virus type 1 (HIV-1) is able to evade the host
            cytotoxic T-lymphocyte (CTL) response through a variety of escape avenues.
            Epitopes that are presented to CTLs are first processed in the presenting cell in
            several steps, including proteasomal cleavage, transport to the endoplasmic
            reticulum, binding by the HLA molecule, and finally presentation to the T-cell
            receptor. An understanding of the potential of the virus to escape CTL responses
            can aid in designing an effective vaccine. To investigate such a potential, we
            analyzed HIV-1 gag from 468 HIV-1-positive Kenyan women by using several



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            bioinformatic approaches that allowed the identification of positively selected
            amino acids in the HIV-1 gag region and study of the effects that these
            mutations could have on the various stages of antigen processing. Correlations
            between positively selected residues and mean CD4 counts also allowed study of
            the effect of mutation on HIV disease progression. A number of mutations that
            could create or destroy proteasomal cleavage sites or reduce binding affinity of
            the transport antigen processing protein, effectively hindering epitope
            presentation, were identified. Many mutations correlated with the presence of
            specific HLA alleles and with lower or higher CD4 counts. For instance, the
            mutation V190I in subtype A1-infected individuals is associated with HLA-
            B*5802 (P = 4.73 x 10(-4)), a rapid-progression allele according to other studies,
            and also to a decreased mean CD4 count (P = 0.019). Thus, V190I is a possible
            HLA escape mutant. This method classifies many positively selected mutations
            across the entire gag region according to their potential for immune escape and
            their effect on disease progression.


Examination of a second region of the HIV type 1 genome reveals
additional cases of superinfection.
Author:     Piantadosi, A.; Ngayo, M. O.; Chohan, B., and Overbaugh, J.

Source:     AIDS Res Hum Retroviruses. 2008 Sep; 24(9):1221.

Abstract:   HIV-1 superinfection may occur at a rate similar to that of initial infection, aising
            concerns for HIV-1 vaccine strategies predicated on eliciting immune responses
            similar to those in natural infection. Because of the high rate of recombination
            during HIV-1 replication, studies examining only one region of the HIV-1
            genome are likely to miss cases of HIV-1 superinfection. We examined HIV-1
            gag sequences from 14 high-risk Kenyan women in whom superinfection was
            not detected in a previous study of env sequences. We detected two additional
            cases of HIV-1 superinfection: one intersubtype superinfection that occurred
            between 1046 and 1487 days postinfection (DPI) and one intrasubtype
            superinfection that occurred between 341 and 440 DPI. Our results suggest that
            studies that examine only small genome regions may lead to underestimates of
            the risk of superinfection, highlighting the need for more extensive studies
            examining multiple regions of the HIV-1 genome



Circumcision and HIV transmission.
Author:     Quinn, T. C.

Source:     Curr Opin Infect Dis. 2007 Feb; 20(1):33-8.




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                            STIs, HIV and AIDS: 2005 - 2008

Abstract:   Purpose Of Review:
            To review the recent literature on male circumcision and its effect on HIV
            acquisition.

            Recent findings:
            The report from the randomized clinical trial of male circumcision in South
            Africa demonstrating a 60% protective effect in preventing HIV acquisition
            provided the first clinical trial evidence of efficacy of male circumcision in
            protecting men against HIV infection. This protective effect was consistent with
            both ecological and epidemiologic studies which also show a protective effect of
            50-70% in men at high risk for HIV infection. Biological studies also demonstrate
            an increased number of HIV receptor cells in the mucosa of foreskin providing
            additional evidence of HIV susceptibility in the uncircumcised male. Male
            circumcision may also have a beneficial effect in preventing HIV acquisition in
            women and lowering selected sexually transmitted infections in both sexes.

            Summary:
            The results of two ongoing randomized clinical trials of male circumcision in
            Kenya and Uganda are awaited with interest, however male circumcision should
            be carefully considered as a potential public health tool in preventing HIV
            acquisition. If other trials confirm the results of the South African trial,
            implementation of this surgical procedure will need to be carefully scaled up and
            integrated into other prevention programs with emphasis on surgical training,
            aseptic techniques, acceptability, availability and cultural considerations.


No evidence for rapid subtype C spread within an epidemic in which
multiple subtypes and intersubtype recombinants circulate.
Author:     Rainwater, S.; DeVange, S.; Sagar, M.; Ndinya-Achola, J.; Mandaliya, K.; Kreiss, J.
            K., and Overbaugh, J.

Source:     AIDS Res Hum Retroviruses. 2005 Dec; 21(12):1060-5.

Abstract:   There are multiple subtypes of HIV-1 circulating worldwide, but recently,
            subtype C has become highly prevalent, particularly in certain geographic
            regions. It is unclear whether the dominance of subtype C or other subtypes is
            due to increased fitness of certain subtypes for transmission, or a founder effect
            in new, rapidly growing epidemics. To examine whether the prevalence of one
            subtype increases over the course of an expanding epidemic that includes several
            circulating subtypes, we examined the distribution of HIV-1 subtypes in Kenya
            from 1986 to 2000. We found no evidence for an increase in the prevalence of
            subtype C, which remained low throughout this approximately 15-year period.
            Interestingly, the percentage of subtype D present in the population decreased
            significantly over that period, with a slight increase in subtype A. Throughout
            that period, intersubtype recombinant viruses were detected, including at the
            early stages of the epidemic. This latter finding suggests that reinfection may


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            have occurred in high-risk groups early in the epidemic, leading to intersubtype
            recombinant viruses that underwent secondary spread.


Does the private sector care about AIDS? Evidence from firm surveys in
East Africa.
Author:     Ramachandran, V.; Shah, M. K., and Turner, G. L.

Source:     AIDS. 2007 Jul; 21 Suppl 3:S61-72.

Abstract:   Objective:
            Our objective was to identify the determinants of HIV/AIDS prevention activity
            and pre-employment health checks by private firms in Kenya, Uganda and
            Tanzania.

            Design:
            We used data from the World Bank Enterprise Surveys for Uganda, Kenya and
            Tanzania, encompassing 860 formally registered firms in the manufacturing
            sector.

            Methods:
            Econometric analysis of firm survey data was used to identify the determinants
            of HIV/AIDS prevention including condom distribution and voluntary
            counselling and testing (VCT). Multivariate regression analysis was the main tool
            used to determine statistical significance.

            Results:
            Approximately a third of enterprises invest in HIV/AIDS prevention.
            Prevention activity increases with size, most likely because larger firms and firms
            with higher skilled workers have greater replacement costs. Even in the category
            of larger firms, less than 50% provide VCT. We found that the propensity of
            firms to carry out pre-employment health checks of workers also varies by the
            size of firm and skill level of the workforce. Finally, data from worker surveys
            showed a high degree of willingness on the part of workers to be tested for HIV
            in the three East African countries.


Psychological distress symptoms of individuals seeking HIV-related
psychosocial support in western Kenya.
Author:     Reece, M.; Shacham, E.; Monahan, P.; Yebei, V.; Ong'or, W. O.; Omollo, O., and
            Ojwang, C.

Source:     AIDS Care. 2007 Nov; 19(10):1194-200.




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                            STIs, HIV and AIDS: 2005 - 2008

Abstract:   While researchers in many western countries have documented the nature of
            psychological distress that is commonly present among individuals living with
            HIV, there has been virtually no research on the same topic among other high
            prevalence areas of the world, particularly in countries like Kenya. This study
            sought to document the nature of psychological distress among 397 individuals
            living with HIV in western Kenya and who were participating in psychosocial
            support groups in conjunction with their enrollment in HIV-related treatment.
            Psychological distress was assessed using the Brief Symptom Inventory (BSI), a
            53-item self-report psychological inventory that asks individuals to recall
            symptoms experienced in the prior seven days. The levels of psychological
            distress in this sample were moderate with a substantial proportion of
            participants meeting the criteria that suggested a need for further psychiatric
            evaluation. Findings support the need for further assessments of the range and
            nature of psychological distress among the diverse communities of countries like
            Kenya and the need for greater attention to the inclusion of mental health
            services in the rapidly developing treatment and prevention programs in this
            region of the world.


HIV/AIDS: the first 25 years--a view from Nairobi.
Author:     Rees, P. H.

Source:     East Afr Med J. 2008 Jun; 85(6):292-300.

Abstract:   HIV infections are zoonoses occurring in communities that hunt chimpanzees
            (HIV 1) and sooty mangabeys (HIV 2) in the forests of equatorial and West Africa
            respectively. Most cross species transmission to man probably fizzles out, but the
            transmission of HIV 1 type M around 1930 eventually resulted in a pandemic
            that has spread around the world. HIV 2 types A and B have caused epidemics in
            West Africa. HIV infections are characterised by three phases (i) an initial,
            primary infective phase with rising viraemia, asymptomatic and silent, lasting
            for some 10 weeks, (ii) a long quiescent phase with the viraemia and illness
            mostly held in check by the immune response and lasting some 10 years in HIV 1
            and 20 years or so in HIV 2 and (iii) a terminal third phase lasting some 10
            months with rising viraemia, falling CD4 levels and multiple opportunistic
            infections recognised in a community by the onset of a florid AIDS epidemic. The
            silent primary epidemic reached Nairobi around 1980, with the florid secondary
            AIDS epidemic peaking here around 1992 and overwhelming the hospitals and
            other health services. The introduction of highly active antiretroviral therapy
            (HAART) has dramatically improved the prognosis for individual patients with
            AIDS, but it has been education and a changing attitude to condoms that has led
            to a progressive fall in incidence, so that the worst of the epidemic may now be
            over. Modifying the immunological response during the quiescent phase with
            the hope of prolonging this phase indefinitely may be the way forward for those
            who are already infected. Steroids have been shown to have a possible role here
            rather than anti-retroviral drugs (ARVs) which are not curative and prone to the


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            development of drug resistance. Limited personal experience suggests that
            steroids may also have a role in salvaging critically ill AIDS patients, who need
            to be treated as emergencies. With an educated public and attention to
            alternative routes of infection such as blood transfusion, the epidemic should be
            increasingly contained during the next 25 years, and may even fizzle out.


The private sector and HIV/AIDS in Africa: taking stock of 6 years of
applied research.
Author:     Rosen, S.; Feeley, F.; Connelly, P., and Simon, J.

Source:     AIDS. 2007 Jul; 21 Suppl 3:S41-51.

Abstract:   Background:
            Until recently, little was known about the costs of the HIV/AIDS epidemic to
            businesses in Africa or about business responses to the epidemic. This paper
            synthesizes the results of a set of studies conducted between 1999 and 2006.

            Methods:
            Data for the studies included were drawn from human resource, financial, and
            medical records of 16 large companies and from 7 surveys of small, medium-
            sized, and large companies in South Africa, Uganda, Kenya, Zambia, Ethiopia,
            and Rwanda.

            Results:
            Estimated workforce HIV prevalence ranged from 5 to 37%. The average cost per
            employee lost to AIDS varied from 0.5 to 5.6 times the average annual
            compensation of the employee affected. Labor cost increases were estimated at
            0.6-10.8% but exceeded 3% at only two of 14 companies. Antiretroviral treatment
            at a cost of US$360/patient per year was found to have positive financial returns
            for most but not all companies. Managers of small and medium-sized
            enterprises (SME) reported low AIDS-related employee attrition, little concern
            about the impacts of AIDS, and relatively little interest in taking action. AIDS
            was estimated to increase the average operating costs of SME by less than 1%.

            Conclusion:
            For most companies, AIDS is causing a moderate increase in labor costs, with
            costs determined mainly by HIV prevalence, employee skill level, and
            employment policies. Treatment of HIV-positive employees is a good investment
            for many large companies. Small companies have less capacity to respond to
            workforce illness and little concern about it. Research on the effectiveness of
            workplace interventions is needed.




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Field experiences integrating family planning into programs to prevent
mother-to-child transmission of HIV.
Author:     Rutenberg, N. and Baek, C.

Source:     Stud Fam Plann. 2005 Sep; 36(3):235-45.

Abstract:   This article reviews field experiences with provision of family planning services
            in prevention of mother-to-child transmission (PMTCT) programs in ten
            countries in Africa, Asia, and Latin America. Family planning is a standard
            component of most antenatal care and maternal-child health programs within
            which PMTCT programs are offered. Yet PMTCT sites often miss opportunities
            to provide HIV-positive clients with family planning counseling. Demand for
            family planning among HIV-positive women varies depending on the extent of
            communities' openness about HIV/AIDS, fertility norms, and knowledge of
            PMTCT programs. In Kenya and Zambia, no differences were observed in use of
            contraceptives between HIV-positive and HIV-negative women in the study
            communities, but HIV-positive women have more affirmative attitudes about
            condoms and use them significantly more frequently than do their HIV-negative
            counterparts. In the Dominican Republic, India, and Thailand, where HIV
            prevalence is low and sterilization rates are high, HIV-positive women are
            offered sterilization, which most women accept. This article draws out the policy
            implications of these findings and recommends that policies be based on respect
            for women's right to informed reproductive choice in the context of HIV/AIDS.


The future of HIV prevention: control of sexually transmitted infections
and circumcision interventions.
Author:     Sahasrabuddhe, V. V. and Vermund, S. H.

Source:     Infect Dis Clin North Am. 2007 Mar; 21(1):241-57, xi.

Abstract:   Prevention and control of sexually transmitted infections (STIs) has proven
            effective in reducing HIV infection when treatment is available promptly for
            symptomatic persons in conditions of an emerging epidemic. Biologically, it is
            assumed that reduced genital tract inflammation reduces infectiousness for HIV
            as well as reducing susceptibility in HIV-uninfected persons. Male circumcision
            has been demonstrated effective in reducing risk for HIV infection in three
            separate trials from South Africa, Kenya, and Uganda. Global expansion of STI
            treatment and male circumcision programs are vital tools for control of HIV
            infection; current evidence is reviewed and research priorities are presented.




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Impact of HIV on novel therapies for tuberculosis control.
Author:     Sanchez, M. S.; Lloyd-Smith, J. O.; Porco, T. C.; Williams, B. G.; Borgdorff, M. W.;
            Mansoer, J.; Salomon, J. A., and Getz, W. M.

Source:     AIDS. 2008 May 11; 22(8):963-72.

Abstract:   Objective And Design:
            The increased risk for tuberculosis in HIV-infected people has fueled a
            worldwide resurgence of tuberculosis. A major hindrance to controlling
            tuberculosis is the long treatment duration, leading to default, jeopardizing cure,
            and generating drug resistance. We investigated how tuberculosis is impacted by
            reducing treatment duration alone or combined with enhanced case detection
            and/or cure under different HIV prevalence levels.

            Methods:
            Our model includes HIV stages I-IV and was calibrated to long-term tuberculosis
            and HIV data from Kenya. Benefits were assessed in terms of absolute and
            relative reductions in new tuberculosis cases and deaths.

            Results:
            Compared with present-day strategies, at 3-20% HIV prevalence we attain a 6-
            20% decrease in incidence and mortality in 25 years when reducing treatment
            duration alone; benefits exceed 300% when combined with increased detection
            and cure. Benefits vary substantially according to HIV status and prevalence.
            Challenges arise because in absolute terms the number of infected people and
            deaths increases dramatically with increasing HIV prevalence, and because the
            relative efficacy of tuberculosis control policies displays a nonlinear pattern
            whereby they become less effective on a per capita basis at HIV prevalence levels
            greater than 15%. Benefits of reducing treatment duration may even be reversed
            at extreme HIV prevalence levels. Benefits of increasing cure versus detection
            increase as HIV prevalence increases.

            Conclusion:
            Reducing tuberculosis treatment duration, alone or in combination with other
            control strategies, can provide enormous benefits at high HIV prevalence.
            Tuberculosis control policies need to account for HIV levels because the efficacy
            of different interventions varies substantially with HIV prevalence.


HIV-1 infection in high risk men who have sex with men in Mombasa,
Kenya.
Author:     Sanders, E. J.; Graham, S. M.; Okuku, H. S.; van der Elst, E. M.; Muhaari, A.;
            Davies, A.; Peshu, N.; Price, M.; McClelland, R. S., and Smith, A. D.




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                             STIs, HIV and AIDS: 2005 - 2008

Source:     AIDS. 2007 Nov 30; 21(18):2513-20.

Abstract:   Background:
            The role of homosexuality and anal sex practices in the African HIV -1 epidemic
            is not well described. We aimed to assess the risk factors for prevalent HIV-1
            infection among men who have sex with men (MSM) to guide HIV-1 prevention
            efforts.

            Methods:
            Socio-behavioural characteristics, signs and symptoms of sexually transmitted
            diseases (STD), and serological evidence of HIV-1 were determined for 285 MSM
            at enrolment into a vaccine preparedness cohort study. We used multivariate
            logistic regression to assess risk factors for prevalent HIV-1 infection. RESULTS:
            HIV-1 prevalence was 43.0% [49/114, 95% confidence interval (CI), 34-52%] for
            men who reported sex with men exclusively (MSME), and 12.3% (21/171, 95%
            CI, 7-17%) for men who reported sex with both men and women (MSMW).
            Eighty-six (75%) MSME and 69 (40%) MSMW reported recent receptive anal sex.
            Among 174 MSM sexually active in the last week, 44% reported no use of
            condoms with casual partners. In the previous 3 months, 210 MSM (74%)
            reported payment for sex, and most clients (93%) were local residents. Prevalent
            HIV-1 infection was associated with recent receptive anal sex [odds ratio (OR),
            6.1; 95% CI, 2.4-16], exclusive sex with men (OR, 6.3; 95% CI, 2.3-17), and
            increasing age (OR, 1.1 per year; 95% CI, 1.04-1.12). Only four MSM reported
            injecting drug use.

            Conclusions:
            The high prevalence of HIV-1 in Kenyan MSM is probably attributable to
            unprotected receptive anal sex. There is an urgent need for HIV-1 prevention
            programmes to deliver targeted risk-reduction interventions and STD services to
            MSM in Kenya.


Short- and long-term efficacy of modified directly observed
antiretroviral treatment in Mombasa, Kenya: a randomized trial.
Author:     Sarna, A.; Luchters, S.; Geibel, S.; Chersich, M. F.; Munyao, P.; Kaai, S.;
            Mandaliya, K. N.; Shikely, K. S.; Temmerman, M., and Rutenberg, N.

Source:     J Acquir Immune Defic Syndr. 2008 Aug 15; 48(5):611-9.

Abstract:   Objectives:
            To determine short- and long-term efficacy of modified directly observed
            therapy (m-DOT) on antiretroviral adherence.

            Design:        Randomized controlled trial.




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                             STIs, HIV and AIDS: 2005 - 2008

            Setting and analytic approach:
            From September 2003 to November 2004, 234 HIV-infected adults were assigned
            m-DOT (24 weeks of twice weekly health center visits for nurse-observed pill
            ingestion, adherence support, and medication collection) or standard care.
            Follow-up continued until week 72. Self-reported and pill-count adherence and,
            secondarily, viral suppression and body mass index measures are reported.
            Generalized estimating equations adjusted for intraclient clustering and
            covariates were used.

            Results:
            During weeks 1-24, 9.1% (9/99) of m-DOT participants reported missing doses
            compared with 19.1% (20/105) of controls (P = 0.04) and 96.5% (517/571) of m-
            DOT pill-count measures were >or=95% compared with 86.1% (445/517) in
            controls [adjusted odds ratio = 4.4; 95% confidence interval (CI) = 2.6 to 7.5; P <
            0.001. Adherence with m-DOT was 4.8 times greater (95% CI = 2.7 to 8.6; P <
            0.001) with adjustment for depression and HIV-related hospitalization. In weeks
            25-48, adherence with m-DOT (488/589) was similar to controls (507/630). Viral
            suppression at 48 weeks was 2.0 times (95% CI = 0.8 to 5.2; P = 0.13) as likely in
            m-DOT participants as controls. M-DOT patients had larger body mass index
            increases at 24 weeks (2.2 vs 1.4 kg/m3; P = 0.014). Viral suppression was more
            likely at week 48 (21/25 vs 13/22; P = 0.057) and week 72 (27/30 vs 15/23; P =
            0.027) among depressed participants receiving m-DOT.

            Conclusions:
            M-DOT increased adherence, most notably among depressed participants.



Sexual risk behaviour and HAART: a comparative study of HIV-infected
persons on HAART and on preventive therapy in Kenya.

Author:     Sarna, A.; Luchters, S. M.; Geibel, S.; Kaai, S.; Munyao, P.; Shikely, K. S.;
            Mandaliya, K.; van Dam, J., and Temmerman, M.

Source:     Int J STD AIDS. 2008 Feb; 19(2):85-9.

Abstract:   Unprotected sex (UPS) among persons receiving highly active antiretroviral
            therapy (HAART) remains a concern because of the risk of HIV-transmission. A
            cross-sectional study comparing the sexual risk behaviour of 179 people living
            with HIV/AIDS (PLHA) receiving HAART with that of 143 PLHA receiving
            preventive therapy (PT) with cotrimoxazole/isoniazid was conducted in
            Mombasa, Kenya. Forty-five percent of all participants were sexually active in
            the last six months. Participants receiving PT were more likely to report > or =2
            partners (13% vs.1%; P = 0.006). Participants receiving PT reported more UPS
            with regular partners (odds ratio [OR]: 3.9; 95% confidence interval [CI]: 1.8-8.4)
            and also more sexually transmitted infections (STI) symptoms (OR: 1.7; 95% CI:
            1.0-2.8; P = 0.059). More than 40% of all participants did not know the HIV-


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                             STIs, HIV and AIDS: 2005 - 2008

            status of regular partners. Therefore, HAART was not associated with increased
            sexual risk behaviours though considerable risk of HIV-transmission remains.
            HIV-care services need to emphasize partner testing and consistent condom use
            with all partners.


Epidemiology of HIV-1 infection in agricultural plantation residents in
Kericho, Kenya: preparation for vaccine feasibility studies.

Author:     Sateren, W. B.; Foglia, G.; Renzullo, P. O.; Elson, L.; Wasunna, M.; Bautista, C. T.,
            and Birx, D. L.

Source:     J Acquir Immune Defic Syndr. 2006 Sep; 43(1):102-6.

Abstract:   A cross-sectional study was performed to determine the prevalence and risk
            factors for HIV-1 infection among agricultural plantation residents in Kericho,
            Kenya. Volunteers were recruited, interviewed, and phlebotomized for HIV-1
            serologic testing. Sex-specific adjusted odds ratios were estimated using logistic
            regression. The overall HIV-1 prevalence was 9.9% (81/820), with prevalence in
            women more than twice that in men (17.4% vs 8.0%, P=0.001). Among men,
            elevated HIV-1 prevalence was seen with increasing age, peaking in those older
            than 30 years (10.3%), marriage (10.4%), Luo tribe affiliation (23.5%),
            employment (8.9%), travel (11.0%), and being uncircumcised (29.2%). Among
            women, elevated HIV-1 prevalence was seen in those with no formal education
            (36.8%) and those who received goods in exchange for sex (36.0%). More than
            97% of volunteers expressed a willingness to participate in future HIV-1 studies
            requiring semiannual visits. HIV prevention efforts have been implemented,
            along with further research to characterize this population for future cohort
            feasibility studies and HIV-1 vaccine efficacy trials.


Characterization of intersubtype recombinant HIV type 1 genomes using
a nonradioactive heteroduplex tracking assay.
Author:     Schroeder, T. L.; Burger, H.; Weiser, B.; Bengualid, V.; Kimani, J.; Anzala, A. O.;
            Parker, M. M.; Lamson, D., and Philpott, S. M.

Source:     AIDS Res Hum Retroviruses. 2005 Apr; 21(4):314-8.

Abstract:   The HIV-1 epidemic is characterized by the dominance of distinct viral subtypes
            in different regions of the world, and intersubtype recombinants are common.
            Traditional subtyping methods analyze only a small fragment of the HIV-1
            genome, so the true extent of diversity and recombination has been difficult to
            examine. We developed a heteroduplex tracking assay (HTA) to identify viral
            subtypes and rapidly detect recombinant HIV-1 genomes. By using probes that
            target seven regions across the HIV-1 genome, HTAs can identify intersubtype


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            recombinants on the basis of the heteroduplex mobility pattern. We used this
            method to analyze HIV-1 strains from 12 patients from the United States and
            Kenya, comparing the results with those obtained by sequencing. HTA analysis
            correctly identified the subtype of each region of the genome, revealing that
            several isolates were recombinants. This method is suitable for studies of HIV-1
            diversity and recombination in areas of the world where multiple subtypes are
            found.


Anal and dry sex in commercial sex work, and relation to risk for
sexually transmitted infections and HIV in Meru, Kenya.
Author:     Schwandt, M.; Morris, C.; Ferguson, A.; Ngugi, E., and Moses, S.

Source:     Sex Transm Infect. 2006 Oct; 82(5):392-6.

Abstract:   Objective:
            To examine the practices of anal intercourse and dry sex within a cohort of
            female sex workers (FSWs) in Kenya, focusing on the prevalence and perceived
            risk of the practices, demographic and behavioural correlates, and association
            with sexually transmitted infections (STI).

            Methods:
            A survey was conducted among FSWs in Meru, Kenya, with 147 participants
            randomly sampled from an existing cohort of self identified FSWs.

            Results:
            40.8% of participants reported ever practising anal intercourse and 36.1%
            reported ever practising dry sex. Although the majority of women surveyed
            believed anal intercourse and dry sex to be high risk practices for HIV infection
            compared with vaginal sex, about one third of women reported never or rarely
            using condoms during anal intercourse, and about 20% never or rarely using
            condoms during dry sex. Reported consistent condom use was lower with both
            of these practices than with penile-vaginal intercourse. Anal intercourse was
            associated with experience of recent forced sexual intercourse, while dry sex was
            not. Anal intercourse was almost always initiated by clients, whereas dry sex was
            likely to be initiated by the women themselves. Sex workers reported charging
            higher fees for both practices than for vaginal intercourse. Both practices were
            associated with reported symptoms and diagnoses of STI.

            Conclusions:
            Both anal intercourse and dry sex were common in this sample, and although
            perceived as high risk practices, were not adequately protected with condom
            use. Education and other interventions regarding these high risk sexual
            behaviours need to be translated into safer practices, particularly consistent
            condom use, even in the face of financial vulnerability.



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Can data from programs for the prevention of mother-to-child
transmission of HIV be used for HIV surveillance in Kenya?
Author:     Seguy, N.; Hladik, W.; Munyisia, E.; Bolu, O.; Marum, L. H., and Diaz, T.

Source:     Public Health Rep. 2006 Nov-2006 Dec 31; 121(6):695-702.

Abstract:   Objective:
            In Africa, HIV surveillance is conducted among antenatal clinic (ANC) attendees
            using unlinked-anonymous testing (UAT). In Kenya, the utility of prevention of
            mother-to-child transmission (PMTCT) program data for HIV surveillance was
            evaluated.

            Methods:
            UAT and PMTCT data were compared at the same clinics and for the same time
            (2003 UAT survey) period. The HIV testing uptake for PMTCT was defined as
            the number of ANC attendees tested for HIV out of those who had their first
            ANC visit during the ANC surveillance period. Odds ratios and 95% confidence
            intervals were calculated to determine associations between demographic
            characteristics and HIV testing acceptance.

            Results:
            Of 39 ANC-UAT sites, six had PMTCT data. PMTCT data were recorded across
            several logbooks with varying quality. For PMTCT, 2,239 women were offered
            HIV testing and 1,258 (56%) accepted; for UAT, 1,852 women were sampled.
            Median UAT-based HIV prevalence was 12.8% (range, 8.1%-26.3%) compared
            with 14.4% (range, 7.0%-27.2%) in PMTCT. HIV testing acceptance for PMTCT
            ranged from 48% to 69% across clinics, and was more likely among
            primigravidae than multigravidae.

            Conclusion:
            Because of varying PMTCT data quality and varying HIV testing acceptance for
            PMTCT, PMTCT-based HIV prevalence estimates cannot currently replace UAT-
            based estimates in Kenya.


Report and policy brief from the 4th Africa Conference on Social Aspects
of HIV/AIDS Research: innovations in access to prevention, treatment
and care in HIV/AIDS, Kisumu, Kenya.
Author:     Setswe, G.; Peltzer, K.; Banyini, M.; Skinner, D.; Seager, J.; Maile, S.; Sedumedi, S.;
            Gomis, D., and van der Linde, I.

Source:     SAHARA J. 2007 Aug; 4(2):640-51.



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                            STIs, HIV and AIDS: 2005 - 2008

Abstract:   About 520 delegates from all over Africa and 21 countries attended the
            conference.This report and policy brief summarises the key findings and
            suggested policy options that emerged from rapporteur reports of conference
            proceedings including the following themes: (1) Orphans and vulnerable
            children, (2) Treatment, (3) Prevention, (4) Gender and male involvement, (5)
            Male circumcision, (6) People living with HIV/AIDS, (7) Food and nutrition, (8)
            Socioeconomics, and (9) Politics/policy. Two (11.8%) of the 17 OVC projects from
            the three countries were classified as best practice interventions. Of the 83
            abstracts that were accepted at the conference, only 7 (8.4%) were dealing with
            antiretroviral therapy (ART). There has been tremendous effort by various
            organisations to provide information about prevention of HIV/AIDS.
            Information received by adolescents has been effective in increasing their
            knowledge, but without positive sexual behaviour change. The conference noted
            the contribution of gender discrimination and violence to the HIV epidemic and
            the different risks that men and women face in relation to the epidemic. Social
            scientists need to study the deep cultural meanings attached to male
            circumcision among different ethnic groups to be able to guide the debate on the
            latest biomedical findings on the protective effect of circumcision against HIV.
            Palliative care and support is crucial for coping among people living with
            HIV/AIDS (PLWHA) in order to deal with medical and psychological issues.
            Results from several countries have helped researchers to explore alternative
            ways of examining poverty in the context of HIV and AIDS. Policy frameworks
            which are likely to succeed in combating HIV/AIDS need to be updated to cover
            issues of access, testing, disclosure and stigma. In general, the conference was
            successful in identifying innovations in access to prevention, treatment and care
            in HIV/AIDS.


Characteristics of psychosocial support seeking during HIV-related
treatment in western Kenya.
Author:     Shacham, E.; Reece, M.; Ong'or, W. O.; Omollo, O.; Monahan, P. O., and Ojwang,
            C.

Source:     AIDS Patient Care STDS. 2008 Jul; 22(7):595-601.

Abstract:   While the characteristics of those who seek psychosocial support following an
            HIV diagnosis have been well documented in western countries where linkages
            between HIV-related treatment and psychosocial support programs are well
            established, little is known about those who become engaged with such services
            in countries of the world where comprehensive HIV-related care and prevention
            systems are continuing to develop. Data were collected from 397 individuals
            who had enrolled in HIV-related psychosocial support groups in western Kenya
            in November 2005. Demographic and HIV-related characteristics, as well as
            assessments of psychological distress, were collected from each participant and
            analyzed by gender in order to document the characteristics of those seeking



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            psychosocial care in conjunction with their participation in an HIV-related
            treatment and prevention program. Those seeking psychosocial support were
            primarily female (72%), living with HIV for an average of 2.5 years, and
            unemployed (70%). Women were younger and more likely to be either widowed
            or never married; while men were more likely to have advanced HIV disease,
            including lower CD4 counts and an AIDS diagnosis. Across all participants, HIV
            serostatus disclosure was rarely reported to sex partners, family members, and
            friends. Symptoms of psychological distress were more prevalent among
            women on multiple measures, including depression, anxiety, paranoid ideation,
            interpersonal sensitivity, and somatization. An increased understanding of the
            characteristics of those likely to seek psychosocial support groups will help HIV
            program managers to develop protocols necessary for facilitating linkages to
            psychosocial support for those enrolled in HIV-related treatment programs.
            Patient engagement in psychosocial support may facilitate improvements in
            psychological function and support an individual's maintenance of HIV
            treatment and prevention behaviors.


The protective effect of circumcision on HIV incidence in rural low-risk
men circumcised predominantly by traditional circumcisers in Kenya:
two-year follow-up of the Kericho HIV Cohort Study.
Auhtor:     Shaffer, D. N.; Bautista, C. T.; Sateren, W. B.; Sawe, F. K.; Kiplangat, S. C.;
            Miruka, A. O.; Renzullo, P. O.; Scott, P. T.; Robb, M. L.; Michael, N. L., and Birx,
            D. L.

Source:     J Acquir Immune Defic Syndr. 2007 Aug 1; 45(4):371-9.

Abstract:   Background:
            Three randomized controlled trials (RCTs) have demonstrated that male
            circumcision prevents female-to-male HIV transmission in sub-Saharan Africa.
            Data from prospective cohort studies are helpful in considering generalizability
            of RCT results to populations with unique epidemiologic/cultural
            characteristics.

            Methods:
            Prospective observational cohort sub-analysis. A total of 1378 men were
            evaluated after 2 years of follow-up. Baseline sociodemographic and
            behavioral/HIV risk characteristics were compared between 270 uncircumcised
            and 1108 circumcised men. HIV incidence rates (per 100 person-years) were
            calculated, and Cox proportional hazards regression analyses estimated hazard
            rate ratios (HRs).

            Results:
            Of the men included in this study, 80.4% were circumcised; 73.9% were
            circumcised by traditional circumcisers. Circumcision was associated with tribal



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            affiliation, high school education, fewer marriages, and smaller age difference
            between spouses (P < 0.05). After 2 years of follow-up, there were 30 HIV
            incident cases (17 in circumcised and 13 in uncircumcised men). Two-year HIV
            incidence rates were 0.79 (95% confidence interval [CI]: 0.46 to 1.25) for
            circumcised men and 2.48 (95% CI: 1.33 to 4.21) for uncircumcised men
            corresponding to a HR = 0.31 (95% CI: 0.15 to 0.64). In one model controlling for
            sociodemographic factors, the HR increased and became non-significant (HR =
            0.55; 95% CI: 0.20 to 1.49).

            Conclusions:
            Circumcision by traditional circumcisers offers protection from HIV infection in
            adult men in rural Kenya. Data from well-designed prospective cohort studies in
            populations with unique cultural characteristics can supplement RCT data in
            recommending public health policy.



Equitable treatment for HIV/AIDS clinical trial participants: a focus
group study of patients, clinician researchers, and administrators in
Western Kenya.

Author:     Shaffer, D. N.; Yebei, V. N.; Ballidawa, J. B.; Sidle, J. E.; Greene, J. Y.; Meslin, E.
            M.; Kimaiyo, S. J., and Tierney, W. M.

Source:     J Med Ethics. 2006 Jan; 32(1):55-60.

Abstract:   Objectives:
            To describe the concerns and priorities of key stakeholders in a developing
            country regarding ethical obligations held by researchers and perceptions of
            equity or "what is fair" for study participants in an HIV/AIDS clinical drug trial.

            Design: Qualitative study with focus groups.

            Setting:
            Teaching and referral hospital and rural health centre in Western Kenya.

            Participants:
            Potential HIV/AIDS clinical trial participants, clinician researchers, and
            administrators. RESULTS: Eighty nine individuals participated in a total of 11
            focus groups over a four month period. The desire for continued drug therapy,
            most often life long, following an HIV/AIDS clinical trial was the most common
            priority expressed in all focus groups. Patients with and without HIV/AIDS also
            thought subsidizing of drug therapies and education were critical forms of
            compensation for clinical trial participation. Financial incentives were considered
            important primarily for purchasing drug therapy as well as obtaining food.
            Patients noted a concern for the potential mismanagement of any money offered.
            Clinician researchers and administrators felt strongly that researchers have a


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            moral obligation to participants following a trial to provide continued drug
            therapy, adverse event monitoring, and primary care. Finally, clinician
            researchers and administrators stressed the need for thorough informed consent
            to avoid coercion of study participants.

            Conclusions:
            Kenyan patients, clinician researchers, and administrators believe that it would
            be unfair to stop antiretroviral therapy following an HIV/AIDS clinical trial and
            that researchers have a long term obligation to participants.


HIV immunosuppression and antimalarial efficacy: sulfadoxine-
pyrimethamine for the treatment of uncomplicated malaria in HIV-
infected adults in Siaya, Kenya.
Author:     Shah, S. N.; Smith, E. E.; Obonyo, C. O.; Kain, K. C.; Bloland, P. B.; Slutsker, L.,
            and Hamel, M. J.

Source:     J Infect Dis. 2006 Dec 1; 194(11):1519-28.

Abstract:   Background:
            The altered immune response of persons with human immunodeficiency virus
            (HIV) infection could result in increased rates of antimalarial treatment failure.
            We investigated the influence of HIV infection on the response to sulfadoxine-
            pyrimethamine treatment.

            Methods:
            Febrile adults with Plasmodium falciparum parasitemia were treated with
            sulfadoxine-pyrimethamine and were monitored for 28 days. HIV status and
            CD4 cell count were determined at study enrollment.

            Results:
            Of the adults enrolled in the study, 508 attended all follow-up visits, including
            130 HIV-uninfected adults, 256 HIV-infected adults with a high CD4 cell count (>
            or =200 cells/ micro L), and 122 HIV-infected adults with a low CD4 cell count
            (<200 cells/ micro L). The hazard of treatment failure at day 28 of follow-up was
            significantly higher for HIV-infected adults with a low CD4 cell count (20.5%)
            than for HIV-uninfected adults (7.7%). Anemia (hemoglobin level, <110 g/L)
            modified the effect of HIV status on treatment failure. When we controlled for
            fever and parasite density, the hazard of treatment failure for HIV-infected
            adults with a low CD4 cell count and anemia was 3.4 times higher than that for
            HIV-uninfected adults (adjusted hazard ratio, 3.38; 95% confidence interval,
            1.56-7.34).




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            Conclusions:
            HIV-infected persons with a low CD4 cell count and anemia have an increased
            risk of antimalarial treatment failure. The response to malaria treatment in HIV-
            infected persons must be carefully monitored. Proven measures for the control
            and prevention of malaria must be incorporated into the basic package of
            services provided by HIV/acquired immunodeficiency syndrome care and
            treatment programs in malarious areas



Mucosal Neisseria gonorrhoeae coinfection during HIV acquisition is
associated with enhanced systemic HIV-specific CD8 T-cell responses.
Author:     Sheung, A.; Rebbapragada, A.; Shin, L. Y.; Dobson-Belaire, W.; Kimani, J.; Ngugi,
            E.; MacDonald, K. S.; Bwayo, J. J.; Moses, S.; Gray-Owen, S., and Kaul, R.

Source:     AIDS. 2008 Sep 12; 22(14):1729-37.

Abstract:   Background:
            The host immune response against mucosally acquired pathogens may be
            influenced by the mucosal immune milieu during acquisition. As Neisseria
            gonorrhoeae can impair dendritic cell and T-cell immune function, we
            hypothesized that coinfection during HIV acquisition would impair subsequent
            systemic T-cell responses.

            Methods:
            Monthly screening for sexually transmitted infections was performed in high
            risk, HIV seronegative Kenyan female sex workers as part of an HIV prevention
            trial. Early HIV-specific CD8 T-cell responses and subsequent HIV viral load set
            point were assayed in participants acquiring HIV, and were correlated with the
            presence of prior genital infections during HIV acquisition.

            Results:
            Thirty-five participants acquired HIV during follow-up, and 16 out of 35 (46%)
            had a classical sexually transmitted infection at the time of acquisition. N.
            gonorrhoeae coinfection was present during HIV acquisition in 6 out of 35 (17%),
            and was associated with an increased breadth and magnitude of systemic HIV-
            specific CD8 T-cell responses, using both interferon-gamma gamma and MIP-1
            beta as an output. No other genital infections were associated with differences in
            HIV-specific CD8 T-cell response, and neither N. gonorrhoeae nor other genital
            infections were associated with differences in HIV plasma viral load at set point.

            Conclusion:
            Unexpectedly, genital N. gonorrhoeae infection during heterosexual HIV
            acquisition was associated with substantially enhanced HIV-specific CD8 T-cell
            responses, although not with differences in HIV viral load set point. This may
            have implications for the development of mucosal HIV vaccines and adjuvants.



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Bronchoscopic study on aetiology of chronic cough in HIV-infected
adults with negative sputum smears for Mycobacterium tuberculosis.
Author:     Siika, A. M.; Chakaya, J. M.; Revathi, G.; Mohamed, S. S., and Bhatt, K. M.

Source:     Kenyatta National Hospital, Nairobi. East Afr Med J. 2006 Jun; 83(6):295-305.

Abstract:   objective:
            To establish the aetiology of chronic cough in HIV-infected patients with
            negative sputum smears for Acid Fast Bacilli (AFB).

            Design: A cross-sectional descriptive study.

            Setting: Kenyatta National Hospital, a tertiary referral centre in Kenya

            Subjects:
            Sixty five HIV-infected adults presenting with chronic cough and negative
            sputum smears for AFBs.

            Results:
            Sixty-two patients were included in the final analysis. Aetiology of chronic cough
            was established in 42 (68%) patients. Pneumocystis jiroveci, bacterial pneumonia
            and Mycobacterium tuberculosis were diagnosed in 22 (35.5%), 17 (27.4%) and 14
            (22.5%) patients respectively. Majority (98%) of patients with a diagnosis had
            multiple causes established in them. Ciprofloxacin had activity against 91% of
            the isolated organisms while Penicillin was active against 35% only.

            Conclusion:
            This study documents Pneumocystis jiroveci pneumonia as a common cause of
            morbidity in a subset of HIV infected patients with chronic cough and negative
            sputum smears for AFB in Kenya.


An electronic medical record system for ambulatory care of HIV-infected
patients in Kenya.
Author:     Siika, A. M.; Rotich, J. K.; Simiyu, C. J.; Kigotho, E. M.; Smith, F. E.; Sidle, J. E.;
            Wools-Kaloustian, K.; Kimaiyo, S. N.; Nyandiko, W. M.; Hannan, T. J., and
            Tierney, W. M.

Source:     Int J Med Inform. 2005 Jun; 74(5):345-55.

Abstract:   Administering and monitoring therapy is crucial to the battle against HIV/AIDS
            in sub-Saharan Africa. Electronic medical records (EMRs) can aid in
            documenting care, monitoring drug adherence and response to therapy, and
            providing data for quality improvement and research. Faculty at Moi University



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            in Kenya and Indiana and University in the USA opened adult and pediatric
            HIV clinics in a national referral hospital, a district hospital, and six rural health
            centers in western Kenya using a newly developed EMR to support
            comprehensive outpatient HIV/AIDS care. Demographic, clinical, and HIV risk
            data, diagnostic test results, and treatment information are recorded on paper
            encounter forms and hand-entered into a central database that prints summary
            flowsheets and reminders for appropriate testing and treatment. There are
            separate modules for monitoring the Antenatal Clinic and Pharmacy. The EMR
            was designed with input from clinicians who understand the local community
            and constraints of providing care in resource poor settings. To date, the EMR
            contains more than 30,000 visit records for more than 4000 patients, almost half
            taking antiretroviral drugs. We describe the development and structure of this
            EMR and plans for future development that include wireless connections, tablet
            computers, and migration to a Web-based platform.


Building Upendo Village: a global effort.
Author:     Sister Beatrice Hernandez; Sister Sheila Kinsey, and Rocole, T.

Source:     Health Prog. 2006 Jul-2006 Aug 31; 87(4):33-6.

Abstract:   What began as a conversation in 2000 between two women religious on how to
            help Kenyans affected by HIV/AIDS has evolved into a far-reaching ministry
            supported by the Wheaton Franciscan sisters. Inspired by the parable of the
            Good Samaritan, Sr. Florence Muia, ASN, a native of Kenya, explored with Sr.
            Marge Zulaski, OSF, a Wheaton Franciscan sister, how to offer assistance and
            support to Kenyans with HIV/AIDS. The two began by establishing a
            partnership involving the Wheaton, IL, congregation; the Assumption Sisters of
            Nairobi; and community members in Kenya. These partners have worked
            together closely to secure local community members' buy-in for a care program,
            study models for success, build a program infrastructure, secure funds, staff up,
            and interact with government agencies. The result? Upendo Village, a program
            that helps ensure the physical, economic, and emotional safety of people
            suffering from HIV/AIDS. This partnership has enabled the Wheaton
            Franciscans, the Assumption Sisters, and the Kenyan community to live out a
            simple principle: We are called to help each other.


A reverse transcriptase assay for early diagnosis of infant HIV infection
in resource-limited settings.
Author:     Sivapalasingam, S.; Patel, U.; Itri, V.; Laverty, M.; Mandaliya, K.; Valentine, F.,
            and Essajee, S.

Source:     J Trop Pediatr. 2007 Oct; 53(5):355-8.



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Abstract:   Early diagnosis of pediatric HIV infection is confounded by persistence of
            maternal antibodies until 18 months, necessitating the use of expensive assays
            such as HIV-1 DNA PCR, an untenable option in resource-limited settings. This
            is the first report of a low-cost, commercial, reverse transcriptase (RT) assay for
            the diagnosis of HIV-1 infection in infants. RT assays were performed on 42
            samples from 30 HIV-exposed Kenyan infants under 15 months of age. When
            correlated with serologic testing conducted after 18 months, the sensitivity,
            specificity, positive and negative predictive values of the RT assay were 92%,
            93%, 87% and 96%. A low-cost assay for infant HIV diagnosis is urgently needed,
            and these results merit further evaluation.


Modified vaccinia Ankara expressing HIVA antigen stimulates HIV-1-
specific CD8 T cells in ELISpot assays of HIV-1 exposed infants.
Author:     Slyker, J. A.; Lohman, B. L.; Mbori-Ngacha, D. A.; Reilly, M.; Wee, E. G.; Dong,
            T.; McMichael, A. J.; Rowland-Jones, S. L.; Hanke, T., and John-Stewart, G.

Source:     Vaccine. 2005 Sep 7; 23(38):4711-9.

Abstract:   Recombinant modified vaccinia virus Ankara expressing HIV-1 antigens
            (MVA.HIVA) was used in ELISpot assays to monitor HIV-1-specific T cell
            responses in infants. Responses to MVA.HIVA and HIV-1 peptides were
            examined in 13 infected and 81 exposed uninfected infants in Nairobi, Kenya.
            Responses to MVA.HIVA (38%) and peptide stimulation (38%) were similar in
            frequency (p=1.0) and magnitude (mean 176 versus 385 HIVSFU/10(6), p=0.96)
            in HIV-1 infected infants. In exposed uninfected infants, MVA.HIVA detected
            more positive responses and higher magnitude responses as compared to
            peptide. MVA.HIVA ELISpot is a sensitive method for quantification of HIV-1-
            specific CD8+ T cell responses in HIV-1 exposed infants. These results
            demonstrate the relevance of HIV-1 clade A consensus-derived immunogen
            HIVA for the viruses currently circulating in Nairobi.


Should rapid tests for HIV infection now be mandatory during
pregnancy? Global differences in scarcity and a dilemma of
technological advance.
Author:     Smith, C. B.; Battin, M. P.; Francis, L. P., and Jacobson, J. A.

Source:     Dev World Bioeth. 2007 Aug; 7(2):86-103.

Abstract:   Since testing for HIV infection became possible in 1985, testing of pregnant
            women has been conducted primarily on a voluntary, 'opt-in' basis. Faden, Geller
            and Powers, Bayer, Wilfert, and McKenna, among others, have suggested that


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            with the development of more reliable testing and more effective therapy to
            reduce maternal-fetal transmission, testing should become either routine with
            'opt-out' provisions or mandatory. We ask, in the light of the new rapid tests for
            HIV, such as OraQuick, and the development of antiretroviral treatment that can
            reduce maternal-fetal transmission rates to <2%, whether that time is now.
            Illustrating our argument with cases from the United States (US), Kenya, Peru,
            and an undocumented Mexican worker in the US, we show that when testing is
            accompanied by assured multi-drug therapy for the mother, the argument for
            opt-out or mandatory testing for HIV in pregnancy is strong, but that it is
            problematic where testing is accompanied by adverse events such as spousal
            abuse or by inadequate intrapartum or follow-up treatment. The difference is not
            a 'double standard', but reflects the presence of conflicts between the health
            interests of the mother and the fetus--conflicts that would be abrogated by the
            assurance of adequate, continuing multi-drug therapy. In light of these conflicts,
            where they still occur, careful processes of informed consent are appropriate,
            rather than opt-out or mandatory testing.


An evaluation of intravaginal rings as a potential HIV prevention device
in urban Kenya: behaviors and attitudes that might influence uptake
within a high-risk population.
Author:     Smith, D. J.; Wakasiaka, S.; Hoang, T. D.; Bwayo, J. J.; Del Rio, C., and Priddy, F.
            H.

Source:     J Womens Health (Larchmt). 2008 Jul-2008 Aug 31; 17(6):1025-34.

Abstract:   Purpose:
            We sought to assess the potential acceptability of intravaginal rings (IVRs) as an
            HIV prevention method among at-risk women and men.

            Methods:
            We conducted a qualitative assessment of initial attitudes toward IVRs, current
            HIV prevention methods, and common behavioral practices among female sex
            workers (FSWs) and men who frequent FSWs in Mukuru, an urban slum
            community in Nairobi, Kenya. Nineteen women and 21 men took part in six
            focus group discussions.

            Results:
            Most participants, both male and female, responded positively to the concept of
            an IVR as a device for delivering microbicides. Women particularly liked the
            convenience offered by its slow-release capacity. Some female respondents raised
            concerns about whether male customers would discover the ring and respond
            negatively, whereas others thought it unlikely that their clients would feel the
            ring. Focus groups conducted with male clients of FSWs suggested that many
            would be enthusiastic about women, and particularly sex workers, using a



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                            STIs, HIV and AIDS: 2005 - 2008

            microbicide ring, but that women's fears about negative responses to covert use
            were well founded. Overall, this high-risk population of FSWs and male clients
            in Nairobi was very open to the IVR as a potential HIV prevention device.

            Conclusion:
            Themes that emerged from the focus groups highlight the importance of
            understanding attitudes toward IVRs as well as cultural practices that may
            impact IVR use in high-risk populations when pursuing clinical development of
            this potential HIV prevention device.


Plasma and mucosal fluid from HIV type 1-infected patients but not
from HIV type 1-exposed uninfected subjects prevent HIV type 1-
exposed DC from infecting other target cells.
Author:     Soderlund, J.; Hirbod, T.; Smed-Sorensen, A.; Johansson, U.; Kimani, J.; Plummer,
            F.; Spetz, A. L.; Andersson, J.; Kaul, R., and Broliden, K.

Source:     AIDS Res Hum Retroviruses. 2007 Jan; 23(1):101-6.

Abstract:   Highly exposed persistently seronegative (HEPS) individuals have previously
            been shown to mount HIV-1-specific humoral and cellular immune responses in
            the mucosa, despite their uninfected status. It is thus possible that HEPS
            individuals are protected from HIV-1 infection at the mucosal level. Recent work
            supports the hypothesis that dendritic cells are involved in the establishment of a
            mucosal HIV-1 infection as well as the dissemination to other target cells.
            However, no previous study has investigated if samples collected from HEPS
            individuals have the capacity to prevent HIV-1 infection in the presence of
            dendritic cells in vitro. We therefore established an assay that measures HIV-1
            neutralization in cocultures of HIV-1-exposed dendritic cells (DC) and PBMC.
            Plasma and cervicovaginal lavage (CVL) samples from HIV-1-infected patients
            and HEPS individuals, enrolled in a well-characterized sex worker cohort in
            Kenya, were evaluated. Most plasma and CVL samples of HIV-1-infected
            patients neutralized HIV-1 in the DC/PBMC cocultures. Neither plasma nor CVL
            samples of most HEPS individuals had this capacity. However, they readily
            neutralized HIV-1 infection of PBMC alone. This may suggest that protection
            against HIV-1 infection in HEPS individuals occurs prior to interaction between
            HIV-1-exposed DC and other target cells.




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Efficacy of highly active antiretroviral therapy in HIV-1 infected children
in Kenya.
Author:     Song, R.; Jelagat, J.; Dzombo, D.; Mwalimu, M.; Mandaliya, K.; Shikely, K., and
            Essajee, S.

Source:     Pediatrics. 2007 Oct; 120(4):e856-61.

Abstract:   Objective:
            Few studies have investigated the efficacy of antiretroviral therapy among HIV-
            infected children in resource-poor settings. This observational, retrospective
            analysis describes the clinical, immunologic, and virologic effects of highly active
            antiretroviral therapy in treatment-naive, HIV-infected children in Mombasa,
            Kenya. In keeping with a public health approach, all children were treated by
            using a simplified, nationally approved, triple-drug regimen.

            Methods:
            Clinical data and stored plasma samples from 29 children who were followed
            prospectively between April 2003 and October 2004 were analyzed. All children
            received generic formulations of nevirapine, zidovudine, and lamivudine and
            were evaluated at baseline and at 3, 6, 9, 12, and 15 months. At each visit, weight
            and CD4 lymphocyte counts were measured and plasma samples were stored for
            analysis. HIV RNA load was determined retrospectively at baseline and 9
            months after initiation of therapy.

            Results:
            The mean age of the children was 8.5 years (range: 2-16 years). At baseline, the
            mean CD4 count (+/-SD) was 182.3 x 10(6) cells per microL (+/-145.6). On
            treatment, CD4 counts increased step-wise by a mean of 187 x 10(6) cells per
            microL at 3 months, 293 cells per microL at 6 months, 308 cells per microL at 9
            months, 334 cells per microL at 12 months, and 363 cells per microL at 15
            months. The mean plasma viral load decreased from a baseline level of 622,712 to
            35,369 copies per mL, and at 9 months was undetectable in 55% of the patients.
            Mean z scores for weight for age increased from a baseline of -1.61 to -1.12 at 12
            months into therapy.

            Conclusions:
            A public health approach using 1 treatment regimen in generic form showed
            excellent efficacy among treatment-naive, HIV-infected children in a resource-
            limited country. Clinical and immunologic improvement occurred in all patients,
            but 9 months after the start of therapy, only 55% of the children had an
            undetectable viral load.




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                             STIs, HIV and AIDS: 2005 - 2008


Implementation of an antiretroviral access program for HIV-1-infected
individuals in resource-limited settings: clinical results from 4 African
countries.
Author:     Sow, P. S.; Otieno, L. F.; Bissagnene, E.; Kityo, C.; Bennink, R.; Clevenbergh, P.;
            Wit, F. W.; Waalberg, E.; Rinke de Wit, T. F., and Lange, J. M.

Source:     J Acquir Immune Defic Syndr. 2007 Mar 1; 44(3):262-7.

Abstract:   Background:
            We assessed the effectiveness and safety of highly active antiretroviral therapy
            (HAART) in HIV-1-infected patients in resource-limited African countries. HIV-1
            screening, therapy, counseling, monitoring, training, and education were
            provided free of charge.

            Methods:
            In an open-label cohort program, 206 antiretroviral-naive HIV-1-infected patients
            who could not afford HAART were recruited in 4 urban clinics in Senegal, Cote
            d'Ivoire, Uganda, and Kenya and were treated with saquinavir boosted with
            ritonavir (1600/100 mg once daily), lamivudine (150 mg twice daily), and
            zidovudine (300 mg twice daily). The primary outcome was a plasma viral load
            (pVL) of <400 copies/mL after 96 weeks of treatment. Secondary analyses
            included CD4 cell count changes and the occurrence of treatment-emergent
            adverse events.

            Results:
            The median age of the patient group was 36 years, 38% were male, 35% of the
            patients had AIDS, the median CD4 count was 119 cells/microL, and the median
            pVL was 304,210 copies/mL. Overall, 65%/52% (on treatment [OT]/intent to
            treat [ITT]) of the patients had a pVL <400 copies/mL after 96 weeks of follow-
            up. This proportion varied significantly between sites, however; although in
            Nairobi and Dakar, 51%/40% and 56%/46% (OT/ITT) were found, respectively,
            Abidjan and Kampala showed proportions of 69%/54% and 83%/69% (OT/ITT),
            respectively. The median increase in the CD4 count was 198 cells/microL
            (interquartile range: 86-319 cells/microL), ranging from 191 to 292 cells/microL
            between the sites. Fourteen patients (6.8%) died between 8 and 96 weeks of
            follow-up, whereas 18 (9%) developed an AIDS-defining event between 8 and 96
            weeks of follow-up. Non-HIV-related serious adverse events occurred in 55
            patients (26.7%), of whom 13 were diagnosed with severe anemia. Thirty-five
            patients (17%) changed treatment for toxicity reasons.

            Conclusions:
            Although a statistically significant difference was observed between sites with
            respect to virologic success, overall virologic and immunologic responses to
            HAART in resource-limited African settings can be as good as in Western
            settings. There were some difficulties (eg, laboratory, logistics, proper training)



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            during the early phase of the program. Therefore, provision of adequate medical
            care, counseling, proper instruction, and education of patients and medical staff
            during the entire study is warranted in such programs, with special care in the
            early phase.



Piloting post-exposure prophylaxis in Kenya raises specific concerns for
the management of childhood rape.

Author:     Speight, C. G.; Klufio, A.; Kilonzo, S. N.; Mbugua, C.; Kuria, E.; Bunn, J. E., and
            Taegtmeyer, M.

Source:     Trans R Soc Trop Med Hyg. 2006 Jan; 100(1):14-8.

Abstract:   Thika District, Kenya, is the site of an operational research study on the
            provision of comprehensive post-rape care, including the free provision of HIV
            post-exposure prophylaxis (PEP). It is a typical rural Kenyan district in terms of
            resources and patient throughput. The high rate of children attending for post-
            rape services was unexpected and had significant programming implications. An
            age-disaggregated analysis of existing quantitative data from the first 8 months
            of service provision was conducted. Ninety-four case records were reviewed, of
            whom 48 (51%) were in the age range 1.5-17 years inclusive. All three cases of
            male rape were in children. Children were more likely to know their assailant
            than adults and were more likely to be HIV-negative at baseline. The majority
            (86%) of children presented in time for PEP, with adherence and completion
            rates similar to adults but lower rates of 6-week follow-up. The use of weight
            bands to determine drug dosages greatly simplified the appropriate and early
            administration of paediatric PEP. The high rates of childhood rape and demand
            for post-rape services were an enormous challenge for service providers and
            policy-makers.


Analysis of HIV-1 sequences vertically transmitted to infants in Kisumu,
Kenya.
Author:     Steain, M. C.; Wang, B., and Saksena, N. K.

Source:     J Clin Virol. 2006 Aug; 36(4):298-302.

Abstract:   Background:
            HIV-1 prevalence in Kenya among women aged between 15-19 years is
            approximately 23%. These women are prospective mothers and therefore can
            play an important role in mother-to-child transmission of HIV. The risk of a
            seropositve mother transmitting the virus to her infant is 25-35% in developing
            countries, such as Kenya, where antiretroviral drugs are not readily available.



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                             STIs, HIV and AIDS: 2005 - 2008



            Objectives:
            This study was undertaken to evaluate the molecular nature of HIV-1 strains,
            assess recombination and it's relevance in mother-to-child transmission in Kenya.

            Study design:
            HIV-1 gag and gp120 sequences were derived from peripheral blood
            mononuclear cells (PBMC) of 16 infected mothers and infants, from Kisumu,
            Kenya. PCR, cloning, and phylogenetic analyses were conducted to examine any
            sequence differences between HIV-1 strains derived from mother-infant pairs.

            Results:
            The cohort consisted of seven pairs harboring possible subtype A/D
            recombinants, eight pairs with apparent pure A or D strains and one possible
            dual infection. This dual infection comprised of a pure subtype A region and an
            A/D recombinant, and was detected in one of the mother's sample.
            Interestingly, only the recombinant virus was detected in the paired baby
            sample.

            Conclusions:
            This study shows that HIV-1 inter-subtype recombinants can be effectively
            transmitted vertically to infants, and could possibly be favored in this setting
            where multiple subtypes infect women. Together, dual infections and the co-
            existence of multiple HIV-1 subtypes is encouraging the emergence of
            recombinant HIV strains and their rapid dispersal.


HIV type 1 sequence diversity and dual infections in Kenya. AIDS Res
Hum Retroviruses.
Author:     Steain, M. C.; Wang, B.; Yang, C.; Shi, Y. P.; Nahlen, B.; Lal, R. B., and Saksena, N.
            K.

Abstract:   As vertical transmission of HIV-1 is an ongoing problem in East Africa, we
            analyzed HIV-1 strains of infected mothers, from Kisumu, Kenya. We sequenced
            the gag and gp120 regions from peripheral blood mononuclear cells (PBMC) of
            15 HIV-infected mothers attending an antenatal clinic. PCR, cloning,
            bootscanning, using the program Simplot, and phylogenetic analyses were
            conducted to assign subtypes and identify recombinants. Our analyses showed
            two dual infections from patients who had infections with pure subtypes and
            recombinants subtype D. In addition, we also noted the presence of subsubtype
            A1 and A2, as well as unique recombinants in this area. These results imply that
            the HIV epidemic in western Kenya is a dynamic one and is continually
            evolving. Therefore, continued monitoring of the epidemic in this region is
            necessary if a vaccine for the area is to be developed.




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Evaluation of two commercially available alternatives for HIV-1 viral
load testing in resource-limited settings.
Author:     Steegen, K.; Luchters, S.; De Cabooter, N.; Reynaerts, J.; Mandaliya, K.; Plum, J.;
            Jaoko, W.; Verhofstede, C., and Temmerman, M.

Source:     Virol Methods. 2007 Dec; 146(1-2):178-87.

Abstract:   There is an urgent need for low-cost assays for HIV-1 quantitation to ensure
            adequate follow-up of HIV-infected patients on antiretroviral therapy (ART) in
            resource-limited countries. Two low-cost viral load assays are evaluated, a
            reverse transcriptase activity assay (ExavirLoad v2, Cavidi) and a real-time
            reverse transcriptase PCR assay (Generic HIV viral load, Biocentric). Both tests
            were compared with the ultrasensitive HIV Amplicor Monitor assay. Samples
            were collected in Mombasa, Kenya, from 20 HIV-1 seronegative and 150 HIV-1
            seropositive individuals of whom 50 received antiretroviral treatment (ART). The
            ExavirLoad and the Generic HIV viral load assay were performed in a local
            laboratory in Mombasa, the Amplicor Monitor assay (version 1.5, Roche
            Diagnostics) was performed in Ghent, Belgium. ExavirLoad and Generic HIV
            viral load reached a sensitivity of 98.3% and 100% and a specificity of 80.0% and
            90.0%, respectively. Linear regression analyses revealed good correlations
            between the Amplicor Monitor and the Generic HIV viral load (r=0.935, p<0.001)
            with high accuracy (100.1%), good precision (5.5%) and a low percent similarity
            coefficient of variation (5.4%). Bland-Altman analysis found 95% of the samples
            within clinically acceptable limits of agreement (-1.19 to 0.87logcopies/ml).
            Although, the ExavirLoad also showed a good linear correlation with the
            Amplicor Monitor (r=0.901, p<0.001), a problem with false positive results was
            more significant. The cost per test remains relatively high (US$ 30 for ExavirLoad
            and US$ 20 for the Generic HIV viral load). Hence, false positive results and the
            need for an expensive PCR instrument for the Generic HIV viral load assays still
            limit the implementation of these tests in less equipped, less experienced
            laboratories.


The ABCs of HIV prevention in men: associations with HIV risk and
protective behaviors.
Author:     Steele, M. S.; Bukusi, E.; Cohen, C. R.; Shell-Duncan, B. A., and Holmes, K. K.

Source:     J Acquir Immune Defic Syndr. 2006 Dec 15; 43(5):571-6.

Abstract:   Objective:
            To elucidate associations between beliefs in abstinence, fidelity, and condom use
            (the "ABCs" of preventing HIV and other sexually transmitted infections) and
            associated self-reported risk behaviors among Kenyan men.




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                             STIs, HIV and AIDS: 2005 - 2008

            Methods:
            We assessed associations of beliefs in the ABCs with sociodemographic
            characteristics and sexual risk behaviors in a respondent-driven sample of 500
            men in Nairobi.

            Results:
            Younger age, single marital status, and higher education were associated with
            beliefs in abstinence and condom use as "best" prevention methods; and older
            age and marriage were associated with belief in fidelity. Many of these and other
            associations persisted in multivariate models. Men citing abstinence or fidelity
            belief less often reported sex with a female sex worker (FSW) ever or recent
            concurrent partnerships less often. Belief in fidelity was negatively associated
            with reported use of condoms ever. Belief in condom use to prevent HIV was
            most common among those having recent concurrent partnerships.

            Conclusions:
            Beliefs in abstinence, fidelity ("being faithful"), or condom use were associated, in
            plausible directions, with life stages and other demographic factors and with
            corresponding risk and preventive behaviors. Context-specific and selective
            educational promotion of individual ABC components rather than
            comprehensive education from an early age in a wide repertoire of prevention
            strategies ignores the evolution of sexual behaviors and the relative utility of
            different approaches throughout the life course.


A peer-led HIV counselling and testing programme for the deaf in
Kenya.
Author:     Taegtmeyer, M.; Hightower, A.; Opiyo, W.; Mwachiro, L.; Henderson, K.;
            Angala, P.; Ngare, C., and Marum, E.

Source:     Disabil Rehabil. 2008 May 28; 1-7.

Abstract:   Purpose. To describe and evaluate the establishment of the first VCT services for
            the Deaf in Africa. Method. Operational research methods were used to
            document programme establishment. The demographics of deaf VCT clients
            were compared with hearing clients at the same sites as well as where clients
            had learned of the service, HIV risks, and HIV test results. Univariate and
            multivariate analyses were used. Results. During the two year period (January
            2004 to December 2005) 1709 Deaf and 1649 hearing clients were seen at three
            Deaf VCT sites. The majority of Deaf clients in this sample learned of the services
            through the peer education programme. Data indicate that Deaf VCT clients are
            as much at risk of HIV from sexual transmission as their hearing counterparts
            and that Deaf persons seeking VCT services have an HIV prevalence of 7%,
            similar to the national rate of 6.7%. Conclusions. The Deaf in Kenya are at risk of
            HIV and there is an urgent need for Deaf-friendly HIV services, supplemented



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            by peer education programmes. This is the first published report describing HIV
            services run by the Deaf for the Deaf in the developing world.


Using gender analysis to build voluntary counselling and testing
responses in Kenya.
Author:     Taegtmeyer, M.; Kilonzo, N.; Mung'ala, L.; Morgan, G., and Theobald, S.

Source:     Trans R Soc Trop Med Hyg. 2006 Apr; 100(4):305-11.

Abstract:   The rapid expansion of voluntary counselling and testing (VCT) for HIV in sub-
            Saharan Africa has led to concerns over the quality and equity of the services.
            Kenya has seen an unprecedented scale-up of VCT, and valuable lessons have
            been learnt at national as well as at district and community levels. We combined
            quantitative and qualitative research methodology and showed how the results
            of gender analysis can be used to develop equity in VCT scale-up. A gender-
            disaggregated analysis of VCT client data was conducted for the first 8 months of
            2003. These quantitative data revealed that despite an increased vulnerability to
            HIV, women are underrepresented in VCT sites in all settings in Kenya. Our
            data also showed that women were also less likely to use condoms or to take
            home condoms after a VCT visit than their male counterparts. Further
            exploration through in-depth qualitative work with women and men allowed a
            better understanding of the reasons behind gender differences in Kenyan VCT
            sites and helped to develop strategies to address gender inequity. We conclude
            that there is an ongoing need to mainstream gender in monitoring and
            evaluation strategies to ensure services meet the needs and priorities of all
            groups.


Working with risk: occupational safety issues among healthcare workers
in Kenya.
Author:     Taegtmeyer, M.; Suckling, R. M.; Nguku, P. M.; Meredith, C.; Kibaru, J.; Chakaya,
            J. M.; Muchela, H., and Gilks, C. F.

Source:     AIDS Care. 2008 Mar; 20(3):304-10.

Abstract:   The objective of this study was to explore knowledge of, attitudes towards and
            practice of post-exposure prophylaxis (PEP) among healthcare workers (HCWs)
            in the Thika district, Kenya. We used site and population-based surveys,
            qualitative interviews and operational research with 650 staff at risk of
            needlestick injuries (NSIs). Research was conducted over a 5-year period in five
            phases: (1) a bio-safety assessment; (2) a staff survey: serum drawn for
            anonymous HIV testing; (3) interventions: biosafety measures, antiretrovirals for
            PEP and hepatitis B vaccine; (4) a repeat survey to assess uptake and


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            acceptability of interventions; in-depth group and individual interviews were
            conducted; and (5) health system monitoring outside a research setting. The main
            outcome measures were bio-safety standards in clinical areas, knowledge,
            attitudes and practice as regards to PEP, HIV-sero-prevalence in healthcare
            workers, uptake of interventions, reasons for poor uptake elucidated and
            sustainability indicators. Results showed that HCWs had the same HIV sero-
            prevalence as the general population but were at risk from poor bio-safety. The
            incidence of NSIs was 0.97 per healthcare worker per year. Twenty-one percent
            had had an HIV test in the last year. After one year there was a significant drop
            in the number of NSIs (OR: 0.4; CI: 0.3-0.6; p<0.001) and a significant increase in
            the number of HCWs accessing HIV testing (OR: 1.55; CI: 1.2-2.1; p=0.003). In
            comparison to uptake of hepatitis B vaccination (88% of those requiring vaccine)
            the uptake of PEP was low (4% of those who had NSIs). In-depth interviews
            revealed this was due to HCWs fear of HIV testing and their perception of NSIs
            as low risk. We concluded that Bio-safety remains the most significant
            intervention through reducing the number of NSIs. Post-exposure prophylaxis
            can be made readily available in a Kenyan district. However, where HIV testing
            remains stigmatised uptake will be limited - particularly in the initial phases of a
            programme.


A prospective study assessing the effects of introducing the female
condom in a sex worker population in Mombasa, Kenya.
Author:     Thomsen, S. C.; Ombidi, W.; Toroitich-Ruto, C.; Wong, E. L.; Tucker, H. O.;
            Homan, R.; Kingola, N., and Luchters, S.

Source:     Sex Transm Infect. 2006 Oct; 82(5):397-402.

Abstract:   Objective:
            To assess the impact and costs of adding female condoms to a male condom
            promotion and distribution peer education programme for sex workers in
            Mombasa, Kenya.

            Design:        A 12 month, prospective study of 210 female sex workers.

            Methods:
            We interviewed participants about their sexual behaviour every 2 months for a
            total of seven times and introduced female condoms after the third interview. We
            also collected cost data and calculated the cost and cost effectiveness of adding
            the female condom component to the existing programme.

            Results:
            Introduction of the female condom in an HIV/AIDS prevention project targeting
            sex workers led to small, but significant, increases in consistent condom use with
            all sexual partners. However, there was a high degree of substitution of the
            female condom for male condoms. The cost per additional consistent condom


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            user at a programme level is estimated to be 2160 dollars (1169 pounds sterling,
            1711 euros) (95% CI: 1338 to 11 179).

            Conclusions:
            The female condom has some potential for reducing unprotected sex among sex
            workers. However, given its high cost, and the marginal improvements seen
            here, governments should limit promotion of the female condom in populations
            that are already successfully using the male condom. More research is needed to
            identify effective methods of encouraging sex workers to practise safer sex with
            their boyfriends.


The AMPATH medical record system: creating, implementing, and
sustaining an electronic medical record system to support HIV/AIDS care
in western Kenya.
Author:     Tierney, W. M.; Rotich, J. K.; Hannan, T. J.; Siika, A. M.; Biondich, P. G.; Mamlin,
            B. W.; Nyandiko, W. M.; Kimaiyo, S.; Wools-Kaloustian, K.; Sidle, J. E.; Simiyu,
            C.; Kigotho, E.; Musick, B.; Mamlin, J. J., and Einterz, R. M.

Source:     Stud Health Technol Inform. 2007; 129(Pt 1):372-6.

Abstract:   Providing high-quality HIV/AIDS care requires high-quality, accessible data on
            individual patients and visits. These data can also drive strategic decision-
            making by health systems, national programs, and funding agencies. One major
            obstacle to HIV/AIDS care in developing countries is lack of electronic medical
            record systems (EMRs) to collect, manage, and report clinical data. In 2001, we
            implemented a simple primary care EMR at a rural health centre in western
            Kenya. This EMR evolved into a comprehensive, scalable system serving 19
            urban and rural health centres. To date, the AMPATH Medical Record System
            contains 10 million observations from 400,000 visit records on 45,000 patients.
            Critical components include paper encounter forms for adults and children,
            technicians entering/managing data, and modules for patient registration,
            scheduling, encounters, clinical observations, setting user privileges, and a
            concept dictionary. Key outputs include patient summaries, care reminders, and
            reports for program management, operating ancillary services (e.g., tracing
            patients who fail to return for appointments), strategic planning (e.g., hiring
            health care providers and staff), reports to national AIDS programs and funding
            agencies, and research.




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Anti-viral activity of the extracts of a Kenyan medicinal plant Carissa
edulis against herpes simplex virus.
Author:     Tolo, F. M.; Rukunga, G. M.; Muli, F. W.; Njagi, E. N.; Njue, W.; Kumon, K.;
            Mungai, G. M.; Muthaura, C. N.; Muli, J. M.; Keter, L. K.; Oishi, E., and Kofi-
            Tsekpo, M. W.

Source:     J Ethnopharmacol. 2006 Mar 8; 104(1-2):92-9.

Abstract:   Herpes simplex virus (HSV) infection is a major opportunistic infection in
            immunosuppressed persons. It is therefore a serious disease in high HIV/AIDS
            prevalence areas as in sub-Saharan Africa where infections due to HSV have
            risen significantly. The development of resistant strains of HSV to the available
            drugs for infection management, as is evident in the first drug of choice
            acyclovir, has further compounded this situation. There is therefore an urgent
            need to identify and develop new alternative agents for management of HSV
            infections, more so, for those due to resistant strains. We report here on an
            aqueous total extract preparation from the roots of Carissa edulis (Forssk.) Vahl
            (Apocynaceae), a medicinal plant locally growing in Kenya that has exhibited
            remarkable anti-HSV activity in vitro and in vivo for both wild type and resistant
            strains of HSV. The extract significantly inhibited formation of plaques in Vero
            E6 cells infected with 100PFU of wild type strains of HSV (7401H HSV-1 and Ito-
            1262 HSV-2) or resistant strains of HSV (TK(-) 7401H HSV-1 and AP(r) 7401H
            HSV-1) by 100% at 50 microg/ml in vitro with minimal cell cytotoxicity
            (CC(50)=480 microg/ml). When the extract was examined for in vivo efficacy in a
            murine model using Balb/C mice cutaneously infected with wild type or
            resistant strains of HSV, the extract at an oral dose of 250 mg/kg significantly
            delayed the onset of HSV infections by over 50%. It also increased the mean
            survival time of treated infected mice by between 28 and 35% relative to the
            infected untreated mice (p<0.05 versus control by Student's t-test). The mortality
            rate for mice treated with extract was also significantly reduced by between 70
            and 90% as compared with the infected untreated mice that exhibited 100%
            mortality. No acute toxicity was observed in mice at the oral therapeutic dose of
            250 mg/kg. These results suggest that this herbal extract has potent anti-viral
            agents against herpes simplex viruses that can be exploited for development of
            an alternative remedy for HSV infections.


Effects of HIV/AIDS on maternity care providers in Kenya.
Author:     Turan, J. M.; Bukusi, E. A.; Cohen, C. R.; Sande, J., and Miller, S.

Source:     J Obstet Gynecol Neonatal Nurs. 2008 Sep-2008 Oct 31; 37(5):588-95.




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Abstract:   Objective:
            To explore the impact of HIV/AIDS on maternity care providers in labor and
            delivery in a high HIV-prevalence setting in sub-Saharan Africa.

            Design:
            Qualitative one-on-one in-depth interviews with maternity care providers.

            Setting:
            Four health facilities providing labor and delivery services (2 public hospitals, a
            public health center, and a small private maternity hospital) in Kisumu, Nyanza
            Province, Kenya.

            Participants:
            Eighteen maternity care providers, including 14 nurse/midwives, 2 physician
            assistants, and 2 physicians (ob/gyn specialists).

            Results:
            The HIV/AIDS epidemic has had numerous adverse effects and a few positive
            effects on maternity care providers in this setting. Adverse effects include
            reductions in the number of health care providers, increased workload, burnout,
            reduced availability of services in small health facilities when workers are absent
            due to attending HIV/AIDS training programs, difficulties with confidentiality
            and unwanted disclosure, and maternity care providers' fears of becoming HIV
            infected and the resulting stigma and discrimination. Positive effects include
            improved infection control procedures on maternity wards and enhanced
            maternity care provider knowledge and skills.

            Conclusion:
            A multifaceted package including policy, infrastructure, and training
            interventions is needed to support maternity care providers in these settings and
            ensure that they are able to perform their critical roles in maternal healthcare
            and prevention of HIV/AIDS transmission.


HIV/AIDS and maternity care in Kenya: how fears of stigma and
discrimination affect uptake and provision of labor and delivery
services.
Author:     Turan, J. M.; Miller, S.; Bukusi, E. A.; Sande, J., and Cohen, C. R.

Source:     AIDS Care. 2008 Sep; 20(8):938-45.

Abstract:   Although policies and programs exist to promote safe motherhood in sub-
            Saharan Africa, maternal health has not improved and may be deteriorating in
            some countries. Part of the explanation may be the adverse effects of HIV/AIDS
            on maternity care. We conducted a study in Kisumu, Kenya to explore how fears



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            related to HIV/AIDS affect women's uptake and health workers' provision of
            labor and delivery services. In-depth qualitative interviews with 17 maternity
            workers, 14 pregnant or postpartum women, four male partners and two
            traditional birth attendants; as well as structured observations of 22 births; were
            conducted at four health facilities. Participants reported that fears of HIV testing;
            fears of involuntary disclosure of HIV status to others, including spouses; and
            HIV/AIDS stigma are among the reasons that women avoid delivering in health
            facilities. Maternity workers now have to take into account the HIV status of the
            women they serve (as well as their own fears of becoming infected and
            stigmatized) but do not seem to be adequately prepared to handle issues related
            to consent, confidentiality and disclosure. Importantly, it appeared that women
            of unknown HIV status during labor and delivery were likely to be targets of
            stigma and discriminatory practices and that these women were not receiving
            needed counseling services. The findings suggest that increasing infection
            control precautions will not be enough to address the challenges faced by
            maternity care providers in caring for women in high-HIV-prevalence settings.
            Maternity workers need enhanced culturally sensitive training regarding
            consent, confidentiality and disclosure. Furthermore, this study points to the
            necessity of paying more attention to the care of women of unknown HIV-
            serostatus during labor and delivery. Such interventions may improve the
            quality of maternity care, increase utilization and contribute to overall
            improvements in maternal health, while also enhancing prevention of mother-to-
            child-transmission and HIV care.


Reasons for unsatisfactory acceptance of antiretroviral treatment in the
urban Kibera slum, Kenya.
Author:     Unge, C.; Johansson, A.; Zachariah, R.; Some, D.; Van Engelgem, I., and Ekstrom,
            A. M.

Source:     AIDS Care. 2008 Feb; 20(2):146-9.

Abstract:   The aim of this study was to explore why patients in the urban Kibera slum,
            Nairobi, Kenya, offered free antiretroviral treatment (ART) at the Medecins Sans
            Frontiers (MSF) clinic, choose not to be treated despite signs of AIDS. Qualitative
            semi-structured interviews were conducted with 26 patients, 9 men and 17
            women. Six main reasons emerged for not accepting ART: a) fear of taking
            medication on an empty stomach due to lack of food; b) fear that side-effects
            associated with ART would make one more ill; c) fear of disclosure and its
            possible negative repercussions; d) concern for continuity of treatment and care;
            e) conflicting information from religious leaders and community, and seeking
            alternative care (e.g. traditional medicine); f) illiteracy making patients unable to
            understand the information given by health workers




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                             STIs, HIV and AIDS: 2005 - 2008


Evaluation of TB and HIV services prior to introducing TB-HIV activities
in two rural districts in western Kenya.
Author:     Van't Hoog, A. H.; Onyango, J.; Agaya, J.; Akeche, G.; Odero, G.; Lodenyo, W.,
            and Marston, B. J.

Source:     Int J Tuberc Lung Dis. 2008 Mar; 12(3 Suppl 1):32-8.

Abstract:   Setting:
            Health facilities providing tuberculosis (TB) treatment in two districts in rural
            western Kenya with a high TB and human immunodeficiency virus (HIV)
            burden.

            Objective:
            To evaluate TB and HIV/acquired immune-deficiency syndrome (AIDS) services
            at the facilities and identify barriers to providing quality diagnostic HIV testing
            and counseling (DTC) and HIV treatment for TB patients in anticipation of the
            introduction of TB-HIV collaborative services.

            Methods:
            We performed a standard interview with health workers responsible for TB care,
            inspected the facilities and collected service delivery data. A self-administered
            questionnaire on training attended was given to all health workers. Results were
            shared with stakeholders and plans for implementation were developed.

            Results:
            Of the 59 facilities, 58 (98%) provided TB treatment, 19 (32%) offered sputum
            microscopy and 24 (41%) HIV testing. Most facilities (72%) advised HIV testing
            only if TB patients were suspected of having AIDS. Barriers identified included
            unaccommodating TB clinic schedules and lack of space, which was an obstacle
            to holding confidential discussions. The need to refer for HIV testing and/or HIV
            care was a perceived barrier to recommending these services. Activities
            implemented following the assessment aimed 1) to provide HIV testing and
            cotrimoxazole prophylaxis at all TB treatment clinics, 2) to increase availability of
            HIV treatment services, and 3) to address structural needs at each facility.

            Conclusion:
            This evaluation identified barriers to the implementation of HIV testing and care
            services within facilities providing TB treatment.




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The impact of pre-exposure prophylaxis (PrEP) on HIV epidemics in
Africa and India: a simulation study.
Author:     Vissers, D. C.; Voeten, H. A.; Nagelkerke, N. J.; Habbema, J. D., and de Vlas, S. J.

Source:     PLoS ONE. 2008; 3(5):e2077.

Abstract:   Background:
            Pre-exposure prophylaxis (PrEP) is a promising new HIV prevention method,
            especially for women. An urgent demand for implementation of PrEP is expected
            at the moment efficacy has been demonstrated in clinical trials. We explored the
            long-term impact of PrEP on HIV transmission in different HIV epidemics.

            Methodology/principal findings:
            We used a mathematical model that distinguishes the general population, sex
            workers and their clients. PrEP scenarios varying in effectiveness, coverage and
            target group were modeled in the epidemiological settings of Botswana, Nyanza
            Province in Kenya, and Southern India. We also studied the effect of condom
            addition or condom substitution during PrEP use. Main outcome was number of
            HIV infections averted over ten years of PrEP use. PrEP strategies with high
            effectiveness and high coverage can have a substantial impact in African settings.
            In Southern India, by contrast, the number of averted HIV infections in different
            PrEP scenarios would be much lower. The impact of PrEP may be strongly
            diminished or even reversed by behavioral disinhibition, especially in scenarios
            with low coverage and low effectiveness. However, additional condom use
            during low coverage and low effective PrEP doubled the amount of averted HIV
            infections.

            Conclusions/significance:
            The public health impact of PrEP can be substantial. However, this impact may
            be diminished, or even reversed, by changes in risk behavior. Implementation of
            PrEP strategies should therefore come on top of current condom campaigns, not
            as a substitution.


Female sex workers and unsafe sex in urban and rural Nyanza, Kenya:
regular partners may contribute more to HIV transmission than clients.
Author:     Voeten, H. A.; Egesah, O. B.; Varkevisser, C. M., and Habbema, J. D.

Source:     Trop Med Int Health. 2007 Feb; 12(2):174-82.

Abstract:   Objectives:
            To compare the sexual behaviour of female sex workers in urban and rural areas
            in Nyanza province in Kenya, and to compare their unsafe sex with clients and
            with regular partners.



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            Methods:
            In a cross-sectional study among 64 sex workers (32/32 in urban/rural areas),
            sex workers kept a sexual diary for 14 days after being interviewed face-to-face.

            Results:
            Most sex workers were separated/divorced and had one or two regular partners,
            who were mostly married to someone else. Sex workers in Kisumu town were
            younger, had started sex work at an earlier age, and had more clients in the past
            14 days than rural women (6.6 vs. 2.4). Both groups had an equal number of sex
            contacts with regular partners (4.7). With clients, condom use was fairly frequent
            (75%) but with regular partners, it was rather infrequent (<40%). For both urban
            and rural areas, the mean number of sex acts in which no condom was used was
            greater for regular partners (3.2 and 2.8 respectively) than for clients (1.9 and 1.0
            respectively).

            Conclusions:
            Sex workers in urban and rural areas of Nyanza province practise more unsafe
            sex with regular partners than with clients. Interventions for sex workers should
            also focus on condom use in regular partnerships.


Association of antiretroviral and clinic adherence with orphan status
among HIV-infected children in Western Kenya.
Author:     Vreeman, R. C.; Wiehe, S. E.; Ayaya, S. O.; Musick, B. S., and Nyandiko, W. M.

Source:     J Acquir Immune Defic Syndr. 2008 Oct 1; 49(2):163-70.

Abstract:   Background:
            Pediatric adherence to antiretroviral therapy (ART) is not well studied in
            resource-limited settings. Reported ART adherence may be influenced by
            contextual factors, such as orphan status.

            Objectives:
            The objectives of this study were to describe self- and proxy-reported pediatric
            ART adherence in a resource-limited population and to investigate associated
            contextual factors.

            Patients and methods:
            This was a retrospective study involving pediatric, HIV-infected patients in
            Western Kenya. We included patients aged 0-14 years, who were on ART and
            had at least 1 adherence measurement (N = 1516). We performed logistic
            regression to assess the association between orphan status and odds of imperfect
            adherence, adjusting for sex, age, clinic site, number of adherence measures, and
            ART duration, stratified by age and ART duration.



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            Results:
            Of the 1516 children, only 33% had both parents living when they started ART.
            Twenty-one percent had only father dead, 28% had only mother dead, and 18%
            had both parents dead. Twenty-nine percent reported imperfect ART adherence.
            The odds of ART nonadherence increase for children with both parents dead.
            Fifty-seven percent of children had imperfect clinic adherence. There was no
            significant association between orphan status and imperfect clinic adherence.

            Conclusions:
            The majority of pediatric patients in this resource-limited setting maintained
            perfect ART adherence, though only half kept all scheduled clinic appointments.
            Understanding contextual factors, such as orphan status, will strengthen
            adherence interventions.


Morbidity among HIV-1-infected mothers in Kenya: prevalence and
correlates of illness during 2-year postpartum follow-up.
Author:     Walson, J. L.; Brown, E. R.; Otieno, P. A.; Mbori-Ngacha, D. A.; Wariua, G.;
            Obimbo, E. M.; Bosire, R. K.; Farquhar, C.; Wamalwa, D., and John-Stewart, G. C.

Source:     J Acquir Immune Defic Syndr. 2007 Oct 1; 46(2):208-15.

Abstract:   Background:
            Much of the burden of morbidity affecting women of childbearing age in sub-
            Saharan Africa occurs in the context of HIV-1 infection. Understanding patterns
            of illness and determinants of disease in HIV-1-infected mothers may guide
            effective interventions to improve maternal health in this setting.

            Methods:
            We describe the incidence and cofactors of comorbidities affecting peripartum
            and postpartum HIV-1-infected women in Kenya. Women were evaluated by
            clinical examination and standardized questionnaires during pregnancy and for
            up to 2 years after delivery.

            Results:
            Five hundred thirty-five women were enrolled in the cohort (median CD4 count
            of 433 cells/mm) and accrued 7736 person-months of follow-up. During 1-year
            follow-up, the incidence of upper respiratory tract infections was 161 per 100
            person-years, incidence of pneumonia was 33 per 100 person-years, incidence of
            tuberculosis (TB) was 11 per 100 person-years, and incidence of diarrhea was 63
            per 100 person-years. Immunosuppression and HIV-1 RNA levels were
            predictive for pneumonia, oral thrush, and TB but not for diarrhea; CD4 counts
            <200 cells/mm(3) were associated with pneumonia (relative risk [RR] = 2.87, 95%
            confidence interval [CI]: 1.71 to 4.83), TB (RR = 7.14, 95% CI: 2.93 to 17.40) and
            thrush. The risk of diarrhea was significantly associated with crowding (RR =
            1.86, 95% CI: 1.19 to 2.92) and breast-feeding (RR = 1.71, 95% CI: 1.19 to 2.44).


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            Less than 10% of women reported hospitalization during 2-year follow-up;
            mortality risk in the cohort was 1.9% and 4.8% for 1 and 2 years, respectively.

            Conclusions:
            Mothers with HIV-1, although generally healthy, have substantial morbidity as a
            result of common infections, some of which are predicted by immune status or
            by socioeconomic factors. Enhanced attention to maternal health is increasingly
            important as HIV-1-infected mothers transition from programs targeting the
            prevention of mother-to-child transmission to HIV care clinics.


Albendazole treatment of HIV-1 and helminth co-infection: a
randomized, double-blind, placebo-controlled trial.
Author:     Walson, J. L.; Otieno, P. A.; Mbuchi, M.; Richardson, B. A.; Lohman-Payne, B.;
            Macharia, S. W.; Overbaugh, J.; Berkley, J.; Sanders, E. J.; Chung, M. H., and
            John-Stewart, G. C.

Source:     AIDS. 2008 Aug 20; 22(13):1601-9.

Abstract:   Objective:
            Several co-infections have been shown to impact the progression of HIV-1
            infection. We sought to determine if treatment of helminth co-infection in HIV-1-
            infected adults impacted markers of HIV-1 disease progression.

            Design:
            To date, there have been no randomized trials to examine the effects of soil-
            transmitted helminth eradication on markers of HIV-1 progression.

            Methods:
            A randomized, double-blind, placebo-controlled trial of albendazole (400 mg
            daily for 3 days) in antiretroviral-naive HIV-1-infected adults (CD4 cell count
            >200 cells/microl) with soil-transmitted helminth infection was conducted at 10
            sites in Kenya (Clinical Trials.gov NCT00130910). CD4 and plasma HIV-1 RNA
            levels at 12 weeks following randomization were compared in the trial arms
            using linear regression, adjusting for baseline values.

            Results:
            Of 1551 HIV-1-infected individuals screened for helminth infection, 299 were
            helminth infected. Two hundred and thirty-four adults were enrolled and
            underwent randomization and 208 individuals were included in intent-to-treat
            analyses. Mean CD4 cell count was 557 cells/microl and mean plasma viral load
            was 4.75 log10 copies/ml at enrollment. Albendazole therapy resulted in
            significantly higher CD4 cell counts among individuals with Ascaris
            lumbricoides infection after 12 weeks of follow-up (+109 cells/microl; 95%
            confidence interval +38.9 to +179.0, P = 0.003) and a trend for 0.54 log10 lower



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            HIV-1 RNA levels (P = 0.09). These effects were not seen with treatment of other
            species of soil-transmitted helminths.

            Conclusion:
            Treatment of A. lumbricoides with albendazole in HIV-1-coinfected adults
            resulted in significantly increased CD4 cell counts during 3-month follow-up.
            Given the high prevalence of A. lumbricoides infection worldwide, deworming
            may be an important potential strategy to delay HIV-1 progression.


Early response to highly active antiretroviral therapy in HIV-1-infected
Kenyan children.
Author:     Wamalwa, D. C.; Farquhar, C.; Obimbo, E. M.; Selig, S.; Mbori-Ngacha, D. A.;
            Richardson, B. A.; Overbaugh, J.; Emery, S.; Wariua, G.; Gichuhi, C.; Bosire, R.,
            and John-Stewart, G.

Source:     J Acquir Immune Defic Syndr. 2007 Jul 1; 45(3):311-7.

Abstract:   Objectives:
            To describe the early response to World Health Organization (WHO)-
            recommended nonnucleoside reverse transcriptase inhibitor (NNRTI)-based
            first-line highly active antiretroviral therapy (HAART) in HIV-1-infected Kenyan
            children unexposed to nevirapine. DESIGN: Observational prospective cohort.

            Methods:
            HIV-1 RNA level, CD4 lymphocyte count, weight for age z score, and height for
            age z score were measured before the initiation of HAART and every 3 to 6
            months thereafter. Children received no nutritional supplements.

            Results:
            Sixty-seven HIV-1-infected children were followed for a median of 9 months
            between August 2004 and November 2005. Forty-seven (70%) used zidovudine,
            lamivudine (3TC), and an NNRTI (nevirapine or efavirenz), whereas 25% used
            stavudine (d4T), 3TC, and an NNRTI. Nevirapine was used as the NNRTI by 46
            (69%) children, and individual antiretroviral drug formulations were used by 63
            (94%), with only 4 (6%) using a fixed-dose combination of d4T, 3TC, and
            nevirapine (Triomune; Cipla, Mumbai, India). In 52 children, the median height
            for age z score and weight for age z score rose from -2.54 to -2.17 (P<0.001) and
            from -2.30 to -1.67 (P=0.001), respectively, after 6 months of HAART.
            Hospitalization rates were significantly reduced after 6 months of HAART (17%
            vs. 58%; P<0.001). The median absolute CD4 count increased from 326 to 536
            cells/microL (P<0.001), the median CD4 lymphocyte percentage rose from 5.8%
            before treatment to 15.4% (P<0.001), and the median viral load fell from 5.9 to 2.2
            log10 copies/mL after 6 months of HAART (P<0.001). Among 43 infants, 47%
            and 67% achieved viral suppression to less than 100 copies/mL and 400
            copies/mL, respectively, after 6 months of HAART.


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            Conclusion:
            Good early clinical and virologic response to NNRTI-based HAART was
            observed in HIV-1-infected Kenyan children with advanced HIV-1 disease.


Audio computer-assisted self-interviewing (ACASI) may avert socially
desirable responses about infant feeding in the context of HIV.
Author:     Waruru, A. K.; Nduati, R., and Tylleskar, T.

Source:     BMC Med Inform Decis Mak. 2005; 5:24.

Abstract:   Background:
            Understanding infant feeding practices in the context of HIV and factors that put
            mothers at risk of HIV infection is an important step towards prevention of
            mother to child transmission of HIV (PMTCT). Face-to-face (FTF) interviewing
            may not be a suitable way of ascertaining this information because respondents
            may report what is socially desirable. Audio computer-assisted self-interviewing
            (ACASI) is thought to increase privacy, reporting of sensitive issues and to
            eliminate socially desirable responses. We compared ACASI with FTF
            interviewing and explored its feasibility, usability, and acceptability in a PMTCT
            program in Kenya.

            Methods:
            A graphic user interface (GUI) was developed using Macromedia Authorware
            and questions and instructions recorded in local languages Kikuyu and
            Kiswahili. Eighty mothers enrolled in the PMTCT program were interviewed
            with each of the interviewing mode (ACASI and FTF) and responses obtained in
            FTF interviews and ACASI compared using McNemar's chi2 for paired
            proportions. A paired Student's t-test was used to compare means of age,
            marital-time and parity when measuring interview mode effect and two-sample
            Student's t-test to compare means for samples stratified by education level -
            determined during the exit interview. A Chi-Square (chi2test) was used to
            compare ability to use ACASI by education level.

            Results:
            Mean ages for intended time for breastfeeding as reported by ACASI were 11
            months by ACASI and 19 months by FTF interviewing (p < 0.001). Introduction
            of complementary foods at <or=3 months was reported more frequently by
            respondents in ACASI compared to FTF interviews for 7 of 13 complementary
            food items commonly utilized in the study area (p < 0.05). More respondents
            reported use of unsuitable utensils for infant feeding in ACASI than in FTF
            interviewing (p = 0.001). In other sensitive questions, 7% more respondents
            reported unstable relationships with ACASI than when interviewed FTF (p =
            0.039). Regardless of education level, respondents used ACASI similarly and
            majority (65%) preferred it to FTF interviewing mainly due to enhanced usability


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            and privacy. Most respondents (79%) preferred ACASI to FTF for future
            interviewing.

            Conclusion:
            ACASI seems to improve quality of information by increasing response to
            sensitive questions, decreasing socially desirable responses, and by preventing
            null responses and was suitable for collecting data in a setting where formal
            education is low.


Power brokering, empowering, and educating: the role of home-based
care professionals in the reduction of HIV-related stigma in Kenya.
Author:     Waterman, H.; Griffiths, J.; Gellard, L.; O'Keefe, C.; Olang, G.; Ayuyo, J.;
            Obwanda, E.; Ogwethe, V., and Ondiege, J.

Source:     Qual Health Res. 2007 Oct; 17(8):1028-39.

Abstract:   In this article the authors report on how home-based care (HBC) professionals
            reduce stigmatizing behavior in Kenya. This study was part of an action research
            project that evaluated the introduction of HBC. HBC professionals coordinate the
            delivery of HIV/AIDS services at a district level and educate community-based
            health workers in HBC. Understanding how HBC professionals reduce stigma is
            crucial to reduce, prevent, and treat HIV/AIDS. Fifty HBC professionals
            participated in 27 focus group interviews over 18 months. Stigma featured
            strongly when they discussed barriers to the introduction of HBC. Using
            sociological theory, the authors organized the data into five themes: Power
            broking and mobilization, Stigma as a social construction, Community and
            structural interventions, Educating and training people, and Historical context.
            The HBC professionals appear to operate at mostly individual and community
            levels in their efforts to challenge stigma, and in spite of the difficulties they
            appear to be having some impact.


Initial outcomes of an emergency department rapid HIV testing program
in western Kenya.
Author:     Waxman, M. J.; Kimaiyo, S.; Ongaro, N.; Wools-Kaloustian, K. K.; Flanigan, T. P.,
            and Carter, E. J.

Source:     AIDS Patient Care STDS. 2007 Dec; 21(12):981-6.

Abstract:   This paper reports the initial operational outcomes of an emergency department-
            based HIV testing program in a high-prevalence and resource-limited setting by
            describing (1) the number and percentage of patients approached, tested, and
            found to be HIV positive and (2) the linkage of care to the HIV clinic. A


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            retrospective log and chart review of the initial 5 months (January 2006 to April
            2006) of the HIV testing program was performed. Patients were selected for HIV
            testing by routine screening and by provider initiated referrals. Out of the 1371
            patients who were approached for HIV testing, 1339 (97.7%) patients were tested
            for HIV. Three hundred twelve (22.7%) of the patients tested were HIV positive.
            Within a sample group of patients newly diagnosed with HIV in the department,
            82% were compliant with their initial HIV clinic visit and 65% were compliant
            with a 1-month follow-up visit. The implementation of an emergency
            department-based HIV testing program in a high HIV prevalence and resource
            poor country is feasible with a high percentage of patients accepting HIV testing
            and a high percentage of positive patients presenting to follow-up care.
            Establishment of rapid HIV testing in emergency departments can identify
            significant numbers of HIV-positive patients who would otherwise remain
            undiagnosed and provides an education opportunity for those patients who are
            HIV negative.


Determinants of Consistent Condom Use Vary by Partner Type among
Young Men in Kisumu, Kenya: A Multi-level Data Analysis.
Author:     Westercamp, N.; Mattson, C. L.; Madonia, M.; Moses, S.; Agot, K.; Ndinya-
            Achola, J. O.; Otieno, E.; Ouma, N., and Bailey, R. C.

Source:     AIDS Behav. 2008 Sep 13.

Abstract:   To evaluate whether determinants of consistent condom use vary by partner type
            among young sexually active Kenyan men, we conducted a cross-sectional
            assessment of lifetime sexual histories from a sub-sample of men enrolled in a
            clinical trial of male circumcision. 7913 partnerships of 1370 men were analyzed.
            262 men (19%) reported never, 1018 (74%) sometimes and 92 (7%) always using
            a condom with their partners. Condoms were always used in 2672 (34%) of the
            total relationships-212 (70%) of the relationships with sex workers, 1643 (40%) of
            the casual and 817 (23%) of the regular/marital relationships. Factors
            influencing condom use varied significantly by partner type, suggesting that HIV
            prevention messages promoting condom use with higher-risk partners have
            achieved a moderate level of acceptance. However, in populations of young,
            single men in generalized epidemic settings, interventions should promote
            consistent condom use in all sexual encounters, independently of partner type
            and characteristics.




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Renal disease in an antiretroviral-naive HIV-infected outpatient
population in Western Kenya.
Author:     Wools-Kaloustian, K.; Gupta, S. K.; Muloma, E.; Owino-Ong'or, W.; Sidle, J.;
            Aubrey, R. W.; Shen, J.; Kipruto, K.; Zwickl, B. E., and Goldman, M.

Source:     Nephrol Dial Transplant. 2007 Aug; 22(8):2208-12.

Abstract:   Background:
            Several commonly used antiretrovirals (ARVs) require dose adjustments to
            prevent toxicities in the presence of renal insufficiency. Because no prospective
            studies of the prevalence or risk factors for kidney disease in stable outpatient
            human immunodeficiency virus (HIV)-infected indigenous African populations
            have been published to date, it is not known if already scarce resources should be
            allocated to detect renal dysfunction, in those without risk factors for kidney
            disease, prior to initiation of increasingly available antiretrovirals in developing
            countries.

            Methods:
            A cross-sectional study to determine the prevalence of and risk factors for renal
            disease in a cohort of medically stable, HIV-infected, antiretroviral-naive adults,
            without diabetes or hypertension, presenting to an HIV clinic in western Kenya.

            Results:
            Of 373 patients with complete data, renal insufficiency (CrCl <60 ml/min) was
            identified in 43 (11.5%) [18 (4.8%) had a CrCl <50 ml/min]. Despite high
            correlation coefficients between the three renal function estimating equations
            used, when compared to creatinine clearance as calculated by Cockcroft-Gault,
            lower rates of moderate to severe renal insufficiency were identified by the
            Modification of Diet in Renal Disease equations. Proteinuria, defined as a urine
            dipstick protein of equal to or greater than 1+, was detected in only 23 subjects
            (6.2%).

            Conclusions:
            Renal insufficiency is not uncommon, even in stable patients without diabetes or
            hypertension. Conversely, proteinuria was unexpectedly infrequent in this
            population. Utilizing resources to assess renal function prior to initiation of
            antiretrovirals in order to identify those likely to benefit from dosage adjustment
            is justified.




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Viability and effectiveness of large-scale HIV treatment initiatives in
sub-Saharan Africa: experience from western Kenya.
Author:     Wools-Kaloustian, K.; Kimaiyo, S.; Diero, L.; Siika, A.; Sidle, J.; Yiannoutsos, C.
            T.; Musick, B.; Einterz, R.; Fife, K. H., and Tierney, W. M.

Source:     AIDS. 2006 Jan 2; 20(1):41-8.

Abstract:   Objectives:
            To determine the clinical and immunological outcomes of a cohort of HIV-
            infected patients receiving antiretroviral therapy.

            Design:
            Retrospective study of prospectively collected data from consecutively enrolled
            adult HIV-infected patients in eight HIV clinics in western Kenya.

            Methods:
            CD4 cell counts, weight, mortality, loss to follow-up and adherence to
            antiretroviral therapy were collected for the 2059 HIV-positive non-pregnant
            adult patients treated with antiretroviral drugs between November 2001 and
            February 2005.

            Results:
            Median duration of follow-up after initiation of antiretroviral therapy was 40
            weeks (95% confidence interval, 38-43); 111 patients (5.4%) were documented as
            deceased and 505 (24.5%) were lost to follow-up. Among 1766 (86%) evaluated
            for adherence to their antiretroviral regimen, 78% reported perfect adherence at
            every visit. Although patients with and without perfect adherence gained
            weight, patients with less than perfect adherence gained 1.04 kg less weight than
            those reporting perfect adherence (P = 0.059). CD4 cell counts increased by a
            mean of 109 cells/microl during the first 6 weeks of therapy and increased more
            slowly thereafter, resulting in overall CD4 cell count increases of 160, 225 and 297
            cells/microl at 12, 24, and 36 months respectively. At 1 year, a mean increase of
            170 cells/microl was seen among patients reporting perfect adherence compared
            with 123 cells/microl among those reporting some missed doses (P < 0.001).

            Conclusions:
            Antiretroviral treatment of adult Kenyans in this cohort resulted in significant
            and persistent clinical and immunological benefit. These findings document the
            viability and effectiveness of large-scale HIV treatment initiatives in resource-
            limited settings.




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Payment for antiretroviral drugs is associated with a higher rate of
patients lost to follow-up than those offered free-of-charge therapy in
Nairobi, Kenya.
Author:     Zachariah, R.; Van Engelgem, I.; Massaquoi, M.; Kocholla, L.; Manzi, M.; Suleh,
            A.; Phillips, M., and Borgdorff, M.

Source:     Trans R Soc Trop Med Hyg. 2008 Mar; 102(3):288-93.

Abstract:   This retrospective analysis of routine programme data from Mbagathi District
            Hospital, Nairobi, Kenya shows the difference in rates of loss to follow-up
            between a cohort that paid 500 shillings/month (approximately US$7) for
            antiretroviral drugs (ART) and one that received medication free of charge. A
            total of 435 individuals (mean age 31.5 years, 65% female) was followed-up for
            146 person-years: 265 were in the 'payment' cohort and 170 in the 'free' cohort.
            The incidence rate for loss to follow-up per 100 person-years was 47.2 and 20.5,
            respectively (adjusted hazard ratio 2.27, 95% CI 1.21-4.24, P=0.01). Overall risk
            reduction attributed to offering ART free of charge was 56.6% (95% CI 20.0-76.5).
            Five patients diluted their ART regimen to one tablet (instead of two tablets)
            twice daily in order to reduce the monthly cost of medication by half. All these
            patients were from the payment cohort. Payment for ART is associated with a
            significantly higher rate of loss to follow-up, as some patients might be unable to
            sustain payment over time. In resource-limited settings, ART should be offered
            free of charge in order to promote treatment compliance and prevent the
            emergence of drug resistance.


AIDS in Kenya: trends, interventions and impact. 7th edition.
Abstract:   Over two decades since the first AIDS case was described in Kenya, HIV/AIDS
            still remains a huge problem for the country in its efforts for social and economic
            development. Responses to the pandemic have evolved over time as people
            became aware of this new disease, as they experienced illness and death among
            family members, and as services have developed to confront this epidemic.
            Initially many segments of society expressed denial of the disease. Early in the
            epidemic in Kenya political commitment was limited. While awareness of AIDS
            has been nearly universal for more than a decade, misconceptions still abound
            and many still have not dealt with this disease at a personal or community level.
            This 7th edition of AIDS in Kenya comes at a crossroads in response to the
            epidemic. In the last 5 years HIV-related health services have expanded
            dramatically; they include the widespread availability of testing and counselling,
            and treatment with antiretroviral drugs, both to prevent mother-to-child
            transmission and to improve health and prolong life for people with advanced
            HIV infection and AIDS. While HIV remains an incurable infection, Kenya has
            now entered an era in which there is new hope in treating and caring for people
            with AIDS. This hope also offers new, effective opportunities for preventing HIV


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            infection, as people with HIV infection learn they are infected and learn how to
            better protect their loved ones. (ex


Community-Based HIV / AIDS Prevention Care and Support Project
(COPHIA).
Source:     Project No. 623-A-00-99-000045-00. Final report: July 1999 - June 2005.

Abstract:   Prior to COPHIA's commencement, when discharged from a hospital most
            Kenyans with AIDS were cared for by family, friends or volunteers with limited
            nursing knowledge and skills, no professional backup, and very little
            understanding of the virus and its consequences. Fear of the disease and stigma
            aimed at those infected by household and community members and even
            healthcare workers, meant that many HIV-infected people received little or no
            care and were simply left to die. To address the overwhelming need for home-
            based care, USAID/Kenya awarded Pathfinder International a cooperative
            agreement to launch the Community-Based HIV/AIDS Care, Support, and
            Prevention (COPHIA) project in June 1999. COPHIA was designed to meet the
            entire spectrum of needs experienced by People Living With HIV/AIDS
            (PLWHA) and their families-physical, social, psychological, emotional, and
            spiritual-by providing comprehensive home-based care. And in doing so,
            COPHIA responded to the devastating toll the HIV/AIDS pandemic has taken
            on Kenyan families and communities, both in terms of human and development
            losses. Initially envisioned as a three-year, $2 million initiative, the program
            evolved into a $7.5 million, 6-year program, which continued beyond this project
            period with funding from other sources. (excerpt)


Corporate partners support vocational programs for orphans and
vulnerable children in Kenya.
Source:     Pathways. 2005 Jun; 5.

Abstract:   The story of Laban Liboyi, a 20-year-old Kenyan youth, is like many others in his
            homeland, AIDS-ravaged Western Province of Kenya. Having lost first his father,
            then his mother, to AIDS by the age of 17, he became the sole support for his
            three little brothers and two sisters. Relatives and neighbors already burdened
            with the epidemic and too many dependents withdrew their support, and the
            chances of survival for Laban and his siblings grew slim. However, Laban’s
            experience diverges from the 650,000 orphans and vulnerable children (OVC) in
            Kenya whose support networks have been decimated by the AIDS epidemic.
            One day in July 2003, Laban met a community health worker at the market, who
            urged him to register with the Kabras Jua Kali Association (KJKA). Under an
            initiative led by Pathfinder International and Barclay’s Bank of Kenya, Ltd.,
            KJKA runs a program for orphans and vulnerable children ages 15-21 years. The


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            program trains them in vocational skills such as carpentry and tailoring, and
            links them to jobs and resources, such as micro credit groups. Laban soon
            enrolled. (excerpt)


Early infant diagnosis of HIV through dried blood spot testing:
Pathfinder International / Kenya's Prevention of Mother to Child
Transmission project.
Abstract:   Without treatment, an infant infected with HIV in Africa has a 35 percent chance
            of dying by his first birthday and a 53 percent chance of dying before the age of
            two. But if the baby receives prophylactic antibiotics, such as cotrimoxazole, soon
            after birth and Antiretroviral Therapy (ART) as soon as is medically indicated, he
            has a good chance of surviving childhood and living a long, healthy life. The
            challenge in resource-limited settings is identifying HIV-infected infants and
            providing early access to this lifesaving medicine. Access to Antiretroviral (ARV)
            drugs has improved in Kenya in the last few years, spurred in large part by the
            introduction of the President's Emergency Plan for AIDS Relief. But until very
            recently, little could be done to diagnose infants' HIV status in their first year of
            life. (excerpt)


Evaluations of five programs for orphans and vulnerable children in
Kenya and Tanzania.
Abstract:   In sub-Saharan Africa, an estimated 12 million children 17 years of age or
            younger have lost one or both parents to AIDS. Many more children live with
            one or more chronically ill parent. Despite the recognition of the magnitude and
            negative consequences of this problem, there is little empirical evidence on "what
            works" to improve the well-being of children affected by HIV and AIDS.
            Governments, program managers, and service providers need strategic
            information on how to reach more orphans and vulnerable children (OVC) with
            services that improve their well-being. Information on effectiveness and costs of
            interventions for OVC can help donors, policymakers, and program managers
            make better informed decisions on the allocation of scarce resources. In an
            attempt to fill these knowledge gaps, MEASURE Evaluation with U.S. President's
            Emergency Plan for AIDS Relief funds from the U.S. Agency for International
            Development (USAID) will conduct evaluations of four programs for OVC in
            Kenya and Tanzania. There will also be a costing component of the study that
            will inform resource allocation and help estimate the costs of scaling up
            programs. (excerpt)




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Financing framework: resource requirement for the Kenya National
AIDS Strategic Plan (KNASP), 2005-2010.
Abstract:   The following report provides a summary analysis of the resources required to
            achieve the broad objectives outlined in Kenya's National AIDS Strategic Plan
            (KNASP). The report specifically provides summary information on the key
            interventions as laid out in the KNASP (2005-2010) and the financial resources
            required for a credible response to the epidemic. The report also includes the best
            estimates on the current coverage of those interventions; the current assumptions
            about HIV/AIDS capacity required to scale up coverage; the best current
            estimates; and the current and projected HIV/AIDS resources. The data specific
            to Kenya were obtained using a combination of: 1) key informant interviews with
            representatives from government, US government agencies, UN institutions, and
            local universities; 2) a review of six existing HIV/AIDS budgets in Kenya; 3)
            review of international literature; and 4) various demographic and economic
            surveys conducted on HIV/AIDS interventions in Kenya. (excerpt)


HIV / AIDS and sexually transmitted infection in Kenya. Behavioural
surveillance survey 2002. Summary report.
Abstract:   The government of Kenya through the National AIDS/STI Control Program
            (NASCOP) of the Ministry of Health in collaboration with Family Health
            International (FHI), the Centers for Disease Control and Prevention (CDC), and
            the Central Bureau of Statistics (CBS) conducted a national behavioural
            surveillance survey of HIV/AIDS and sexually transmitted infection in Kenya in
            late 2002 in order to understand the behaviour dynamics driving the HIV
            epidemic. The behavioural surveillance survey is a monitoring and evaluation
            tool to track trends in HIV/AIDS knowledge, attitudes and behaviour in
            populations at particular risk of HIV infection, such as youth, female sex workers
            and migrant men. It is envisaged that this survey will be repeated every two or
            three years to monitor trends and changes in HIV and sexually transmitted
            infection risky behaviour in the country. The populations selected to participate
            in the first round of the national behavioural surveillance survey were out-of-
            school youth, youth in school, female sex workers, women in low-income
            settings, matatu or mini-van drivers and their touts or helpers, bodaboda or
            bicycle taxi cyclists, policemen, and men in large worksites. Questionnaires were
            developed in both English and Kiswahili. They were administered to
            respondents in the selected groups by trained interviewers under close
            supervision of a team of supervisors. High standards of conducting the survey
            were adhered to in terms of a well-planned data collection strategy and a
            commitment to establish high-quality data systems. EpiData software was used
            for data entry and processing, and a statistical software package for social
            sciences was used for data analysis. (excerpt)




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HIV and AIDS Planning Workshop report.
Abstract:   This is a report of the first workshop ever held in Kenya for HIV-positive
            teachers, between 13th and 18th December 2004. It was organised by the Kenya
            Network of Positive Teachers (KENEPOTE) and the POLICY Project with
            support from USAID. The 60 HIV-positive teachers attending came from all
            Kenyan provinces. The top leadership of the Ministry of Education, Science and
            Technology (MOEST) and Kenya National Union of Teachers (KNUT)
            participated in the opening and closing ceremonies of the Workshop while the
            Director of the Teachers Service Commission/ AIDS Control Unit (TSC/ACU)
            attended throughout. USAID officer responsible for its HIV and AIDS programs
            in Kenya attended the closing ceremony. (excerpt


HIV notes from MEASURE DHS.
Abstract:   The Kenya HIV Service Provision Assessment (SPA) survey, the first SPA to look
            at national HIV/AIDS health care delivery services, has just been published in
            Kenya. The 2004 KSPA includes a nationally representative sample of 440 health
            care facilities ranging from stand alone VCT sites to provincial and national
            referral hospitals. Survey results show a complex picture of uneven availability
            and quality but also provide clear evidence of PEPFAR funds at work. Almost 10
            percent of Kenya health care facilities and just over 50 percent of its hospitals
            now provide antiretroviral treatment (ART). NGO and private for-profit facilities
            are more likely to offer ART than government-managed facilities. 24 percent of
            facilities offer some element of PMTCT. Only 13 percent offer the full PMTCT
            package with HIV counseling and testing, counseling on infant feeding and
            family planning, and ARV prophylaxis for the infant. Just 4 percent of facilities
            nationwide offer PMTCT+. (excerpt)


Hormonal Contraception and HIV: Science and Policy.
Source:     Africa Regional Meeting, Nairobi 19-21 September 2005. Statement (final).

Abstract:   The World Health Organization Headquarters Office and Regional Office for
            Africa, in partnership with the Reproductive Health and HIV Research Unit of
            the University of Witwatersrand in South Africa (a WHO Collaborating Centre),
            International Planned Parenthood Federation Africa Region and Family Health
            International (FHI), convened a meeting of 72 representatives from 17
            francophone, lusophone and Anglophone sub-Saharan African countries on
            “Hormonal Contraception and HIV: Science and Policy”. The participants
            included policymakers and programme managers involved with family
            planning, sexual and reproductive health, and HIV/AIDS, women’s health
            advocates, people living with HIV and scientists and clinicians involved with
            family planning and HIV research. They were joined by 13 representatives from



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            international donor and non-governmental organizations and agencies. The goal
            of the meeting was to promote evidence-based discussion and decision-making
            in response to new information on any potential association between hormonal
            contraceptive use and the acquisition of HIV. (excerpt)


USAID's Implementing AIDS Prevention and Care (IMPACT) project.
Source:     Kenya final report, September 1999 - September 2007.

Abstract:   The project design included activities to support the HIV/AIDS program at the
            national level. It involved mobilizing private and parastatal businesses to initiate
            HIV interventions; supporting nongovernmental organizations (NGOs) and
            other networks to expand coverage; improving blood safety; strengthening sero-
            surveillance and behavioral surveillance; and supporting prevention and care
            initiatives. In 2000, with USAID's Leadership and Investing in Fighting an
            Epidemic (LIFE) Initiative, FHI expanded IMPACT/Kenya's geographic
            coverage from five to ten community sites in the three provinces and broadened
            its focus to include activities linking prevention, care, and psychosocial support.
            In 2003, IMPACT/Kenya adapted to address priorities put forth by the U.S.
            President's Emergency Plan for AIDS Relief (PEPFAR). As a result, IMPACT
            increased its focus on care and treatment and linked it to the prevention, care,
            and support program. Likewise, the communication response evolved from
            purely a preventionprogram to include treatment and support messages and
            prevention in the care setting. Nairobi was also added as a priority region.
            (excerpt)


Estimating expenditures on general health and HIV / AIDS care.
Source:     Kenya National Health Accounts 2002:

Abstract:   The government of Kenya (GoK) faces the dilemma of combating a growing
            burden of disease, regulating quality, and improving equity in health care
            distribution within the context of declining public financing that is forcing
            rationalization of health service delivery. To help resolve the dilemma, Kenyan
            policymakers need a comprehensive understanding of the organization and
            financing of the country’s health care system, including the expenditures on
            health care made by donors, public sector entities, and the private sector,
            particularly households. One tool that the government is using to understand
            health care expenditures is National Health Accounts (NHA), an internationally
            accepted framework for tracking the expenditures from their sources to their end
            uses. (excerpt




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Kenya Network of HIV-Positive Teachers (KENEPOTE).
Abstract:   Teachers interact with many people as they perform their many and varied roles,
            in classrooms and at school, as teachers, counsellors, role models and parents.
            They are also leaders in the church and the community, holding responsible
            positions, and are held in high esteem. Their countrywide distribution enables
            them to effectively advocate behaviour change since HIV and AIDS is a
            behavioural disease. "A teacher can save more lives than a doctor". KENEPOTE
            is a network of HIV-positive teachers founded in September 2003 by two HIV-
            positive teachers (Elsa Ouko, now retired, and living in Kitale, and Margaret
            Wambete, a teacher at Sosiani Primary School in Eldoret Municipality) after
            attending the International Conference on Sexually Transmitted Diseases and
            AIDS in Sub-Saharan Africa (ICASA) in Nairobi. The idea of the network had
            been muted earlier by a number of teachers both in the work place and others
            who had retired or forced to retire because of their HIV status. Some of these
            teachers have dedicated their time to running Community Based Organizations
            (CBOs) for people living with HIV and AIDS (PLWHAs); and providing support
            for orphans and vulnerable children (OVCs). (excerpt)


Kenyan national guidelines on nutrition and HIV / AIDS.
Abstract:   People infected with HIV are at greater risk of malnutrition than those who are
            not infected. HIV and opportunistic infections interfere with the desire and
            ability to eat thus reducing dietary intake; causing mal-absorption of nutrients;
            increasing energy demand thus increasing nutrient requirements; and causing
            abnormal use of protein. Limited food security and inadequate knowledge of
            good nutrition in regions of Kenya where HIV is prevalent, makes the situation
            worse. The fundamental nutritional concerns for HIV-infected people include:
            the availability of a balanced diet on a continuous basis; factors that negatively
            impact food intake and utilization; drug/nutrient interactions; and interventions
            to help cope with nutrition-related, chronic conditions such as diabetes mellitus.
            HIV infection and associated malnutrition progressively weaken the immune
            system, lowering quality of life and odds for survival, thus infected persons and
            caregivers need clear, concise information on nutritional careand support.
            Nutritional care, as an adjunctive intervention to ART viral treatment, will
            enhance rehabilitation, optimize antiretroviral therapy, and enhance adherence
            to ART. The purpose of these Guidelines is to: Provide simple and practical ways
            to assess the nutritional status of HIV-infected clients and assess the risk of
            malnutrition; Assist service providers to identify locally-appropriate, sustainable
            ways of increasing dietary intake by those who are infected with HIV; and
            Mainstream nutrition interventions into the national HIV/AIDS response.
            (excerpt)




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Lessening the burden of HIV / AIDS.
Source:     Ray of Hope: A Newsletter of the Hope for African Children Initiative. 2006 Mar;
            10.

Abstract:   Every Friday, Members of Tupendane Support Group gather at the Fish Group
            Office in Manyatta Sub-location in Kisumu to make aloe vera soap. Tupendane is
            a Swahili word for "let's love one another" and the members try to live up to the
            name by assisting one another in difficult times. Brought to together by a
            common goal -- to prevent early death from HIV/AIDS and support their
            families -- the group has learnt to work as a solid unit. "When we meet, we share
            our experiences and give one another a shoulder to lean on. This has helped
            strengthen our group and lessen the burden of HIV/AIDS on individual
            members,'' says Rachel Nyagweth, a member of the group. The Group, founded
            by the Fish Group and benefiting from HACI support, brings together forty
            people living with HIV/AIDS. According to Rachel, a resident of Kano Kasule
            Village in Kisumu's Winam Division, the group provides invaluable support to
            people infected with the HIV virus. "When I tested positive for HIV in 2004, I
            thought my world would crumble. I lost hope and started worrying about how
            my neighbors and friends would react to the news. However, the support group
            gave me the hope to live and the resolve to defy early death. Now I am alive and
            I want to see my children complete their studies,'' says Rachel, a mother of five
            who lost her husband to the virus in 2003. (excerpt


Letting them fail: government neglect and the right to education for
children affected by AIDS.
Abstract:   This report is based on detailed interviews with dozens of children affected by
            HIV/AIDS and their caregivers in three sub-Saharan African countries--Kenya,
            South Africa, and Uganda. Their testimonies revolve around a common theme:
            neglect and abuse within families, in communities, and by schools and
            governments have hindered AIDS-affected children's ability to enroll, remain, or
            advance in school. Children whose parents were terminally ill dropped out of
            school to act as caregivers to their parents and younger siblings. The successive
            death of multiple family members to HIV/AIDS led to the gradual erosion of
            children's extended-family safety net, resulting in inadequate financial support
            for schooling. Parental illness or exploitation by subsequent caregivers led
            children to work long hours to offset lost family income or provide basic
            sustenance. The stigma associated with HIV led to taunting by peers, and made
            it difficult for children to communicate with their teachers about illness or death
            in the family. Children who were themselves HIV-positive experienced
            prolonged absences from school due to ill-health, poor access to essential
            medicines, and AIDS-related stigma and discrimination. (excerpt)




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Male circumcision for HIV prevention: Research implications for policy
and programming WHO / UNAIDS technical consultation 6 -- 8 March
2007 conclusions and recommendations (excerpts).
Source:     Reproductive Health Matters. 2007 May; 15(29):11-14.

Abstract:   A number of observational studies indicate that circumcised men have lower
            levels of HIV infection than uncircumcised men. On 13 December 2006, the US
            National Institutes of Health announced that two trials assessing the impact of
            male circumcision on HIV risk would be stopped on the recommendation of the
            Data Safety and Monitoring Board. The trials being carried out in Kisumu,
            Kenya, and Rakai District, Uganda revealed at least a 53% and 51% reduction in
            risk of acquiring HIV infection, respectively. These results support findings
            published in 2005 from the South Africa Orange Farm Intervention Trial,
            sponsored by the French National Agency for Research on AIDS, which
            demonstrated at least a 60% reduction in HIV infection among men who were
            circumcised. WHO and UNAIDS convened an international consultation to
            review the results of the three randomised controlled trials and other evidence
            on male circumcision and HIV prevention, to discuss the policy and programme
            implications, and to make recommendations regarding public health issues. This
            document summarizes the principal conclusions and recommendations of the
            meeting. The international consultation was attended by experts representing a
            wide range of stakeholders, including government representatives, researchers,
            civil society representatives, gender experts, human rights and women's health
            advocates, young people, funding agencies and implementing partners. (excerpt)


Missing the target. Off target for 2010: how to avoid breaking the
promise of universal access. Update to ITPC's AIDS treatment report
from the frontlines.
Abstract:   Actions by governments and multilateral institutions over the last year helped
            lay the foundation for gradual expansion of AIDS treatment access. Yet the world
            is on a trajectory that will fall significantly short of the internationally endorsed
            universal access goal for 2010, leaving millions without lifesaving care and
            hundreds of thousands of people with HIV/AIDS facing the prospect of
            imminent death. In December 2005, the "3 by 5" initiative came to an end, having
            helped spur treatment expansion but falling 1.7 million people below its goal. In
            the wake of this failure the international community has made new promises,
            developed new plans, and is experimenting with new systems of operating.
            Despite these positive developments, no one should be fooled that the current
            pace or magnitude of the response will come close to achieving the universal
            access pledge that will be solemnly reaffirmed at the UNGASS Review meeting
            in May 2006. According to the World Health Organization (WHO), about 600,000
            more people gained treatment access in 2005. At that rate fewer than half of those



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            who need AIDS treatment will have access in 2010. An international alliance of
            civil society advocates has called for setting a new global AIDS treatment target
            of "10 by 10" - 10 million people accessing treatment by 2010. But the
            international community seems to have gone out of its way to avoid setting
            explicit global treatment targets that would focus attention on specific outcomes,
            acknowledge the responsibilities of global institutions as well as countries, and
            drive accountability. (excerpt)


Models of Care Project. Linking HIV / AIDS treatment, care and support
in sexual and reproductive health care settings: examples in action.
Abstract:   IPPF wishes to showcase different models using a variety of entry points to bring
            SRH closer to HIV/AIDS. The three types of examples in action covered in this
            booklet use these entry points: Better linking of prevention and care through
            providing ARVs and opportunistic infection (OI) services (our case studies on
            the Dominican Republic, Kenya and Rwanda); Working with and developing
            programmes to reach specific populations (our case study on Colombia);
            Strengthening programming to address HIV/AIDS vulnerability and young
            people (our youth course). (excerpt)


Newer approaches to HIV prevention [editorial].
Source:     Lancet. 2007 Feb 24; 369(9562):615.

Abstract:   The publication of two randomised trials in today's Lancet signals a new era for
            HIV prevention. The studies, in Uganda and Kenya, show that male circumcision
            halves the risk of adult males contracting HIV through heterosexual intercourse.
            This success is extremely welcome news. The results of these trials, along with
            the findings of a preliminary South African trial published in 2005, now provide
            a solid evidence-base to inform health policy. Large-scale implementation of
            male circumcision has the potential to substantially reduce HIV transmission,
            particularly in sub-Saharan Africa. But, as an accompanying Comment and
            Viewpoint highlight, this new intervention presents many opportunities but also
            raises many questions. One such question is the effect of male circumcision on
            women. Initially, wide-scale implementation of male circumcision will lower
            HIV infection in men. But modelling studies suggest that over time women could
            benefit from an effect similar to the herd immunity seen with mass
            immunisation. Male circumcision might also directly protect against male-to-
            female transmission of HIV. A trial to test this hypothesis is under way in
            Uganda, with results expected in 2008. (excerpt)




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Prevention and Treatment Access (PTA): a comprehensive HIV / AIDS
program for Kenyan teachers. Award Number 623-A-00-05-00006-00.
Final performance report.
Abstract:   The Prevention and Treatment Access (PTA) project of the American Federation
            of Teachers Educational Foundation (AFTEF) is a public-private partnership
            designed to increase the capacity of the Kenya National Union of Teachers
            (KNUT) to address HIV and AIDS issues among teachers and learners in Kenya.
            The two year project begun in November 2004 was extended by five months for
            the purpose of conducting an end-of-project evaluation, which was completed in
            March 2007. The project ended on April 30, 2007. In addition to providing direct
            technical assistance to KNUT, several joint interventions were used to achieve
            the project goal, including: establishing teacher peer education (study circles) in
            647 primary, secondary and teacher training colleges in 14 high risk
            administrative districts (Meru Central, Busia, Malindi, Bondo, Kakamega,
            Machakos, Garrisa, Nairobi, Kericho, Uasin Gishu, Kirinyaga, Kisumu, Nakuru
            and Mombasa); training and supporting head teachers, principles and teachers
            implementing theMinistry of Education's policy on HIV and AIDS in 636
            educational institutions; conducting a national HIV and AIDS policy advocacy
            campaign under the leadership of the KNUT National Executive Council; and,
            integrating HIV and AIDS issues into KNUT negotiations with the Ministry of
            Education (MOE) and the Teachers Service Commission (TSC). (excerpt)


Quantification workbook for GOK NASCOP ARVs.
Abstract:   This quantification workbook is a tool to assist the pharmacy staff at Coast
            Provincial General Hospital (CPGH) to quantify needs of ARVs for the GOK
            ART Program. The workbook is designed to take the pharmacy staff through the
            process step by step. Each step has a table to be completed which either requires
            data to be collected or a calculation to be done. Some of the tables require data to
            be collected over a number of months (usually the last six months). It is
            anticipated that during the scale up phase that CPGH will place an order for
            ARVs every month – therefore a quantification workbook will be completed
            every month. Use the data collected for the previous workbook to complete the
            data collection tables for each new workbook to minimise work. Some of the
            calculations e.g. for estimating the quantities needed for new patients, will not
            need to be done every month. Once the program has stabilised you can use the
            same estimates from month to month making adjustments for fluctuations in
            recruitment if needed. It is suggested that you review this data every 3 to 6
            months after the program has stabilised. When instructed to round up or down
            to the nearest whole number, for numbers where the first decimal place is 0.5 or
            higher round up (e.g. for 6.7 round up to 7) and where the first decimal place is
            less than 0.5 round down (e.g. for 3.3 round down to 3). When instructed to
            round up or down to 2 decimal places, for numbers where the third decimal
            place is 0.005 or higher round up (e.g. for 1.008 round up to 1.01) and where the


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            third decimal place is less than 0.005 round down (e.g. for 0.033 round down to
            0.03) (excerpt)


Refocusing on HIV prevention. Operations research in Kenya and South
Africa targets key populations.
Source:     Horizons Report. 2005 Dec; [2] p.

Abstract:   In 2005 AIDS claimed another 3 million lives, and it relentlessly threatens
            millions more. Despite global and national efforts to quell the pandemic, 40.3
            million people are currently living with HIV--the highest level ever. Nearly 5
            million new cases occur each year, with almost every region of the world
            reporting increasing numbers. Yet amid the grim statistics there are some
            encouraging signs. Although far below the World Health Organization's target
            goal of reaching 3 million people by 2005, about one million people in low- to
            middle-income countries are receiving antiretroviral therapy, which has
            prevented an estimated 250,000 to 300,000 deaths this year. Further, a few
            countries, including Kenya and Zimbabwe, were able to lower their HIV
            prevalence rates through a heavy investment in prevention programs. (excerpt)


Rescued from the grip of death.
Source:     Ray of Hope: A Newsletter of the Hope for African Children Initiative. 2006 Mar;
            2.

Abstract:   Grace Aoko Onyango's story is heartbreaking. Since 1999, her family has been
            stalked by death, which has claimed her husband, daughter, cowife, and her
            brother in-law and his wife. With too many graves around her house, she had to
            move to a new place to escape the curse of death. According to her Luo culture,
            one is not supposed to live near a graveyard lest he or she dies too. No sooner
            had she settled in her new home than the spell of sickness started afflicting her.
            Grace knew her co-wife, husband and two women he had inherited had died of
            HIV/AIDS. So when she fell ill, she knew her turn to die had come. "My illness
            defied all forms of treatment and I knew I would soon die,'' she says. (excerpt)


Responding to HIV / AIDS through health system strengthening: results
and lessons.
Abstract:   Strengthening health systems is essential to establish, expand, and sustain
            preventive and curative services for HIV/AIDS. There has been a lack of
            recognition and understanding of the links between the provision of HIV/AIDS
            services and the broader health system requirements to ensure an effective
            response to the epidemic over the long term. PHRplus has contributed to the


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            fight against HIV/AIDS by: Providing policymakers with tools and technical
            assistance to design programs and mobilize resources needed to mount
            responses to combat HIV/AIDS; Building financial analysis skills to improve
            effective use of scarce resources; Increasing access to HIV/AIDS services through
            community-based health financing (CBHF); Assisting countries with their
            proposals to the Global Fund to Fight AIDS, Tuberculosis (TB) and Malaria
            (Global Fund); Promoting evidence-based antiretroviral treatment (ART) policy
            development in low-resource countries; and Studying the effects of the sudden
            surge in donor funding for HIV/AIDS on country health systems. (excerpt)


Reuniting families.
Source:     Ray of Hope: A Newsletter of the Hope for African Children Initiative. 2006 Mar;
            11.

Abstract:   George Owino's wife ran away when he became very ill and he was left alone,
            bedridden and heart-broken. He lost all hope and thought he would die soon.
            For days, he led a solitary life in his hut, wondering when his time to die would
            come. "It was the most difficult time in my life. I lost a lot of weight and I knew
            only God's intervention would save me from dead,'' says George. However,
            when volunteers of DADRA, a HACI-supported community-based organization
            in Migori District of Kenya's Nyanza Province learnt of his predicament, they
            helped nurse him back to health and assisted him get back his wife. "DADRA is a
            good friend. It not only stood by me when I was going through difficult times,
            but it also helped me get back my wife. Through counseling, my wife and I have
            been able to have a harmonious relationship once again," he says. Today, George
            has turned into voluntary work, assisting people affected by HIV/AIDS. "I
            realized that if it were not for DADRA, I would be dead by now. It gave me hope
            when I thought my world had collapsed, and I feel obliged to assist those who
            are facing tough situations, especially those infected with HIV/AIDS.'' (excerpt


Shaping children's future.
Source:     Ray of Hope: A Newsletter of the Hope for African Children Initiative. 2006 Mar;
            9.

Abstract:   When Tom Omondi Oselu joined the Fish Group, a church-based organization in
            western Kenya's Kisumu City, his motive was to benefit from its spiritual and
            social guidance. "Members of the Fish Group were always associated with good
            virtues and deeds and I wanted to be like them,'' he says. Ten years later, Oselu
            has found himself with the daunting task of not only transferring the good
            virtues to the youth, but also providing guidance as well as emotional and
            psychological support to children impacted by HIV/AIDS. Everyday, he sets out
            in the morning to homes and schools to see the children, some of whom have no



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            adults to look up to for guidance and protection. "Most orphans have a lot of
            problems. They often go without food, and suffer emotional and psychological
            problems, which are exacerbated by lack of parental guidance and protection.
            Even those who are lucky enough to go to school always lag behind in their
            school work because of numerous challenges which take away their attention
            from class work,'' he says. (excerpt)


Statement on Kenyan and Ugandan trial findings regarding male
circumcision and HIV. Male circumcision reduces the risk of becoming
infected with HIV, but does not provide complete protection.
Abstract:   The Joint United Nations Programme on HIV/AIDS and its Cosponsors, WHO,
            UNFPA, UNICEF and the World Bank, note with considerable interest today's
            announcement by the US National Institutes of Health that two trials assessing
            the impact of male circumcision on HIV risk are being stopped on the
            recommendation of the NIH Data Safety and Monitoring Board (DSMB). The two
            trials, funded by the US National Institutes of Health, were carried out in
            Kisumu, Kenya, among men aged 18-24 years and in Rakai, Uganda, among men
            aged 15-49 years. The trials, which completed enrolment of patients in 2005, were
            stopped by the DSMB evaluating the results of interim analyses. The role of the
            DSMB is to assess progress of the trials and recommend whether to continue,
            modify or terminate them. Although no detailed results have been released at
            this time, the National Institutes of Health statement makes it clear that the
            studies are being stopped because they revealed an approximate halving of risk
            of HIV infection in men who were circumcised. The results support the findings
            of the South Africa Orange Farm Intervention Trial, funded by the French
            Agence Nationale de Recherches sur le SIDA (ANRS) and published in late 2005,
            which demonstrated at least a 60% reduction in HIV infection among
            circumcised men. (excerpt


UN System HIV workplace programmes. HIV prevention, treatment and
care for UN System employees and their families.
Abstract:   Today, more than 20 years since the first cases of HIV infection were recognized,
            the epidemic continues to expand relentlessly. Despite early and ongoing efforts
            to contain its spread and to find a cure, 20 million people have died and an
            estimated 40.3 million people worldwide are living with HIV. In the latter half of
            2004, the number of people on antiretroviral therapy in low-income and
            transitional countries increased dramatically, but still only about 12% of the 5.8
            million people in developing and transitional countries who need treatment are
            getting treatment. The far-reaching social and economic consequences of the
            epidemic are having an impact on individuals, communities and the workplace.
            The UN, like many employers all over the world, is faced with major challenges
            related to the direct and indirect costs of the epidemic: increasing medical costs,


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            absenteeism related to illness, high staff turnover, increasing recruitment and
            training costs, strained labour relations and the ever-increasing erosion of human
            capital. Many UN staff come from and/or work in countries with high HIV
            prevalence and perform duties that may put them at increased risk of exposure
            to the virus. The UN recognizes its duty as a socially responsible employer and
            has thus committed to protecting the rights of its staff by making HIV in the UN
            workplace a priority. (excerpt


Paediatric HIV and neurodevelopment in sub-Saharan Africa: a
systematic review.
Author:     Abubakar, A.; Van Baar, A.; Van de Vijver, F. J.; Holding, P., and Newton, C. R.

Source:     Trop Med Int Health. 2008 Jul; 13(7):880-7.

Abstract:   Objective:
            To determine the degree of motor, cognitive, language and social-emotional
            impairment related to HIV infection in children living in sub-Saharan Africa
            (SSA).

            Methods:
            Literature searches using MEDLINE and PsycINFO. Additionally, the reference
            lists of previous reviews were checked to ensure that all eligible studies were
            identified. Cohen's d, a measure of effect size, was computed to estimate the
            level of impairment.

            Results:
            Six reports met the inclusion criteria. In infancy a consistent delay in motor
            development was observed with a median value of Cohen's d = 0.97 at 18
            months, indicating a severe degree of impairment. Mental development showed
            a moderate delay at 18 months, with a median value d = 0.67. Language delay
            did not appear until 24 months of age, d = 0.91. Less clear findings occurred in
            older subjects.

            Conclusion:
            Although HIV has been shown to affect all domains of child functioning, motor
            development is the most apparent in terms of severity, early onset, and
            persistence across age groups. However, motor development has been the most
            widely assessed domain while language development has been less vigorously
            evaluated in SSA, hence an accurate quantitative estimate of the effect cannot yet
            be made.




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Men's condom use in higher-risk sex: Trends and determinants in five
Sub-Saharan countries.
Author:     Adair, T.

Abstract:   This paper examines men's condom use at last higher-risk sex (i.e., nonmarital,
            noncohabiting partner) in five sub-Saharan countries: Burkina Faso, Cameroon,
            Kenya, Tanzania, and Zambia. The two most recent Demographic and Health
            Surveys (DHS) in each country are analyzed to show trends in various indicators.
            Condom use is an important way to prevent the transmission of HIV, the virus
            that causes AIDS. Encouragingly, use of condoms has increased substantially in
            Burkina Faso, Cameroon, and Tanzania, with smaller increases in Kenya and
            Zambia. At the same time, levels of higher-risk sex have declined in four of the
            five countries, although use of a condom at last higher-risk sex remains below 50
            percent in Kenya and Zambia. Multivariate analysis shows that higher education
            is a consistently strong, positive predictor of condom use at last higher-risk sex,
            whereas higher wealth status is not significant in most surveys. Knowledge that
            use of condoms can reduce the risk of HIV transmission is a consistently strong,
            positive predictor of condom use, but urban-rural residence and region are
            significant only in some surveys. Comparing the two most recent DHS surveys in
            each of the five countries, there are no clear patterns of change in the predictive
            strength of explanatory variables. However, there is evidence of widening gaps
            in condom use by level of education in Cameroon and by urban-rural residence
            in Kenya. One important policy finding that emerged from this study is that low
            wealth status is not a barrier to condom use in most countries, but lack of
            education is. (author's)


Male circumcision in Siaya and Bondo Districts, Kenya: prospective
cohort study to assess behavioral disinhibition following circumcision.
Auhthor:    Agot, K. E.; Kiarie, J. N.; Nguyen, H. Q.; Odhiambo, J. O.; Onyango, T. M., and
            Weiss, N. S.

Source:     J Acquir Immune Defic Syndr. 2007 Jan 1; 44(1):66-70.

Abstract:   Background:
            Evidence for efficacy of male circumcision as an HIV prevention measure is
            increasing, but there is serious concern that men who are circumcised may
            subsequently adopt more risky sexual behaviors.

            Methods:
            Using a prospective cohort study, we compared sexual behaviors of 324 recently
            circumcised and 324 uncircumcised men at 1, 3, 6, 9, and 12 months after
            circumcision/study enrollment. The main outcome indicators were incidence of
            sexual behaviors known to place men at increased risk of acquiring HIV,


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            namely, having sex with partners other than their wife/wives for married men
            or other than "regular" girlfriends for unmarried men.

            Results:
            During the first month following circumcision, men were 63% and 61% less
            likely to report having 0 to 0.5 and >0.5 risky sex acts/week, respectively, than
            men who remained uncircumcised. This difference disappeared during the
            remainder of follow-up, with no excess of reported risky sex acts among
            circumcised men. Similar results were observed for risky unprotected sex acts,
            number of risky sex partners, and condom use.

            Discussion:
            During the first year post-circumcision, men did not engage in more risky sexual
            behaviors than uncircumcised men, suggesting that any protective effect of male
            circumcision on HIV acquisition is unlikely to be offset by an adverse behavioral
            impact.


Characterization of CD8 T-cell responses in HIV-1-exposed seronegative
commercial sex workers from Nairobi, Kenya.
Author:     Alimonti, J. B.; Kimani, J.; Matu, L.; Wachihi, C.; Kaul, R.; Plummer, F. A., and
            Fowke, K. R.

Source:     Immunol Cell Biol. 2006 Oct; 84(5):482-5.

Abstract:   CD8+ T-lymphocyte responses are crucial to the control of HIV-1; therefore,
            studying the CD8+ immune response in a naturally resistant population could
            provide valuable insights into an effective anti-HIV response in healthy
            uninfected individuals. Approximately 5-10% of the women in the Pumwani
            Commercial Sex Worker cohort in Nairobi, Kenya, have been highly exposed to
            HIV-1 yet remain HIV-IgG-seronegative and HIV-PCR negative (HIV(ES)). As
            IFN-gamma production correlates to cytotoxic function, the CD8+ T-lymphocyte
            IFN-gamma response to HIV p24 peptides was compared in HIV(ES) and HIV-
            infected (HIV+) individuals. Almost 40% of the HIV(ES) had a CD8+ IFN-
            gamma+ response that was five times lower in magnitude than that of the HIV+
            group. The breadth of the response in HIV(ES) was very narrow and focused
            primarily on one peptide that is similar to the protective KK10 peptide. In the
            HIV+ group, low peripheral CD4+ counts negatively influenced the number of
            CD8+ cells producing IFN-gamma, which may undermine the ability to control
            HIV. Overall, many of the HIV(ES) women possess a HIV-1 p24-specific CD8+
            IFN-gamma response, providing evidence to the specificity needed for an
            effective HIV vaccine.




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CD4+ T cell responses in HIV-exposed seronegative women are
qualitatively distinct from those in HIV-infected women.
Author:     Alimonti, J. B.; Koesters, S. A.; Kimani, J.; Matu, L.; Wachihi, C.; Plummer, F. A.,
            and Fowke, K. R.

Source:     J Infect Dis. 2005 Jan 1; 191(1):20-4.

Abstract:   The immune response of human immunodeficiency virus (HIV)-exposed
            seronegative (ESN) women may be qualitatively different from that in those
            infected with HIV (HIV(+)). In a cohort of female commercial sex workers in
            Nairobi, Kenya, we found significantly lower (P< or =.01) levels of CD4(+)-
            specific immune activation and apoptosis in the ESN women compared with
            those in the HIV(+) women. Compared with the HIV(+) women, a lower
            proportion of the ESN women showed p24 peptide pool responses by the short-
            term, CD4(+)-specific, interferon (IFN)- gamma intracellular cytokine staining
            assay, whereas the proportion showing responses by the long-term, CD8(+)-
            depleted T cell proliferation assay was similar. Interestingly, the ESN responders
            had a 4.5-fold stronger proliferation response (P=.002) than the HIV(+) group.
            These data suggest that, compared with those in HIV(+) women, CD4(+) T cells
            in ESN women have a much greater ability to proliferate in response to p24
            peptides.


Widowhood in the era of HIV/AIDS: a case study of Siaya District,
Kenya.
Author:     Ambasa-Shisanya, C. R.

Source:     SAHARA J. 2007 Aug; 4(2):606-15.

Abstract:   Luo women are believed to acquire contagious cultural impurity after the death
            of their husbands that is perceived as dangerous to other people. To neutralise
            this impure state, a sexual cleansing rite is observed. In the indigenous setting,
            the ritual was observed by a brother-in-law or cousin of the deceased husband
            through a guardianship institution. However, with the emergence of HIV/AIDS,
            many educated brothers-in-law refrain from the practice and instead hire
            professional cleansers as substitutes. If the deceased spouses were HIV positive,
            the ritual places professional cleansers at risk of infection. Thereafter, they could
            act as a bridge for HIV/AIDS transmission to other widows and to the general
            population. This paper provides insights into reasons for continuity of
            widowhood rites in Siaya District. Twelve focus group discussions and 20 in-
            depth interviews were conducted.The cultural violence against Luo widows
            could spread HIV/AIDS, but Christianity and condoms act as coping
            mechanisms.




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Putting on a brave face: the experiences of women living with HIV and
AIDS in informal settlements of Nairobi, Kenya.
Author:     Amuyunzu-Nyamongo M; Okeng'o L; Wagura A, and Mwenzwa, E.

Source:     AIDS Care. 2007 Feb; 19 Suppl 1:S25-S34.

Abstract:   This paper examines two key dimensions of HIV and AIDS in sub-Saharan
            Africa, namely poverty and gender, within the particular context of informal
            settlements. The study, conducted in five informal settlements of Nairobi, Kenya
            explored the challenges facing women living with HIV and AIDS (WLWA) in
            informal settlements in Nairobi in terms of the specific risk environments of
            informal settlements, the support they receive and their perceptions of their
            future. The data were gathered through an interviewer-based questionnaire
            administered to 390 WLWA and 20 key informant interviews with Kenya
            Network of Women with AIDS (KENWA) project personnel. The results show
            that for WLWA in informal settlements, poverty and poor living conditions
            combine to increase the risk environment for HIV infection and other
            opportunistic infections and that the WLWA then face HIV- and AIDS-related
            problems that are exacerbated by poverty and by the poor living environments.
            In response, the WLWA had devised coping strategies that were largely centred
            on survival, including commercial sex work and the sale of illicit liquor, thus
            increasing their susceptibility to re-infections. Insecurity in informal settlements
            curtailed their participation in income generating activities (IGAs) and increased
            their risk of rape and HIV reinfection. Recognising the disadvantaged position of
            communities in informal settlements, the non-governmental organizations
            (NGOs), community-based organizations (CBOs) and faith-based organizations
            (FBOs) provide a range of services including HIV and AIDS information and
            therapy. Paradoxically, living in urban informal settlements was found to
            increase WLWA's access to HIV and AIDS prevention and treatment services
            through NGOs and social networks that are not found in more established
            residential areas. The sustainability of these services is, however, questioned,
            given the lack of local resources, weak state support and high donor
            dependency. We suggest that the economic and tenure insecurity found among
            WLWA demands in response consistent support through comprehensive,
            sustainable HIV and AIDS services complemented by social networks and
            community sensitisation against stigma and discrimination. Fundamentally, the
            upgrading of informal settlements would address the wider risk environments
            that exacerbate the poor health of the WLWA who line in them. (author's)




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Integrating family planning into VCT services.
Author:     Aradhya, K. W.

Source:     Guest editorial. Pop Reporter. 2005 Jan 31; 5(5):1-2.

Abstract:   As efforts begin to integrate family planning into HIV/AIDS services, voluntary
            counseling and testing (VCT) centers are emerging as primary targets for
            integration. Research from Africa and the Caribbean shows that such integration
            is feasible and acceptable, and large-scale integration efforts are being launched
            and expanded there. VCT services have become one of the most common means
            of preventing, detecting, and improving access to care and support for
            HIV/AIDS. And VCT services are likely to greatly expand with support from the
            five-year U.S. President's Emergency Plan for AIDS Relief (PEPFAR), which
            focuses on fighting the HIV/AIDS epidemic in 15 resource-poor countries,
            mostly in Africa and the Caribbean. (excerpt)


Clinical screening for HIV in a health centre setting in urban Kenya: an
entry point for voluntary counselling, HIV testing and early diagnosis of
HIV infection?
Author:     Arendt, V.; Mossong, J.; Zachariah, R.; Inwani, C.; Farah, B.; Robert, I.;
            Waelbrouck, A., and Fonck, K.

Source:     Trop Doct. 2007 Jan; 37(1):45-7.

Abstract:   A study was conducted among patients attending a public health centre in
            Nairobi, Kenya in order to (a) verify the prevalence of HIV, (b) identify clinical
            risk factors associated with HIV and (c) determine clinical markers for clinical
            screening of HIV infection at the health centre level. Of 304 individuals involved
            in the study,107(35%) were HIV positive. A clinical screening algorithm based
            on four clinical markers, namely oral thrush, past or present TB, past or present
            herpes zoster and prurigo would pick out 61 (57%) of the 107 HIV-positive
            individuals. In a resource-poor setting, introducing a clinical screening algorithm
            for HIV at the health centre level could provide an opportunity for targeting
            voluntary counselling and HIV testing, and early access to a range of prevention
            and care interventions




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                            STIs, HIV and AIDS: 2005 - 2008


Behaviour change in clients of health centre-based voluntary HIV
counselling and testing services in Kenya.

Author:     Arthur, G.; Nduba, V.; Forsythe, S.; Mutemi, R.; Odhiambo, J., and Gilks, C.

Source:     Sex Transm Infect. 2007 Dec; 83(7):541-6.

Abstract:   Objective:
            To explore behaviour change, baseline risk behaviour, perception of risk, HIV
            disclosure and life events in health centre-based voluntary counselling and
            testing (VCT) clients.

            Design and setting:
            Single-arm prospective cohort with before-after design at three (one urban and
            two rural) government health centres in Kenya; study duration 2 years, 1999-
            2001. SUBJECTS: Consecutive eligible adult clients.

            Main outcome measures:
            Numbers of sexual partners, partner type, condom use, reported symptoms of
            sexually transmitted infection, HIV disclosure and life events.

            Results:
            High rates of enrollment and follow-up provided a demographically
            representative sample of 401 clients with mean time to follow-up of 7.5 months.
            Baseline indicators showed that clients were at higher risk than the general
            population, but reported a poor perception of risk. Clients with multiple partners
            showed a significant reduction of sexual partners at follow-up (16% to 6%;
            p<0.001), and numbers reporting symptoms of sexually transmitted infection
            decreased significantly also (from 40% to 15%; p<0.001). Condom use improved
            from a low baseline. Low rates of disclosure (55%) were reported by HIV-
            positive clients. Overall, no changes in rates of life events were seen.

            Conclusion:
            This study suggests that significant prevention gains can be recorded in clients
            receiving health centre-based VCT services in Africa. Prevention issues should be
            considered when refining counselling and testing policies for expanding
            treatment programmes.




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Potential impact of infant feeding recommendations on mortality and
HIV-infection in children born to HIV-infected mothers in Africa: a
simulation.
Author:     Atashili, J.; Kalilani, L.; Seksaria, V., and Sickbert-Bennett, E. E.

Source:     BMC Infect Dis. 2008; 8:66.

Abstract:   Background:
            Although breast-feeding accounts for 15-20% of mother-to-child transmission
            (MTCT) of HIV, it is not prohibited in some developing countries because of the
            higher mortality associated with not breast-feeding. We assessed the potential
            impact, on HIV infection and infant mortality, of a recommendation for shorter
            durations of exclusive breast-feeding (EBF) and poor compliance to these
            recommendations.

            Methods:
            We developed a deterministic mathematical model using primarily parameters
            from published studies conducted in Uganda or Kenya and took into account
            non-compliance resulting in mixed-feeding practices. Outcomes included the
            number of children HIV-infected and/or dead (cumulative mortality) at 2 years
            following each of 6 scenarios of infant-feeding recommendations in children born
            to HIV-infected women: Exclusive replacement-feeding (ERF) with 100%
            compliance, EBF for 6 months with 100% compliance, EBF for 4 months with
            100% compliance, ERF with 70% compliance, EBF for 6 months with 85%
            compliance, EBF for 4 months with 85% compliance

            Results:
            In the base model, reducing the duration of EBF from 6 to 4 months reduced HIV
            infection by 11.8% while increasing mortality by 0.4%. Mixed-feeding in 15% of
            the infants increased HIV infection and mortality respectively by 2.1% and 0.5%
            when EBF for 6 months was recommended; and by 1.7% and 0.3% when EBF for
            4 months was recommended. In sensitivity analysis, recommending EBF resulted
            in the least cumulative mortality when the a) mortality in replacement-fed
            infants was greater than 50 per 1000 person-years, b) rate of infection in
            exclusively breast-fed infants was less than 2 per 1000 breast-fed infants per
            week, c) rate of progression from HIV to AIDS was less than 15 per 1000 infected
            infants per week, or d) mortality due to HIV/AIDS was less than 200 per 1000
            infants with HIV/AIDS per year.

            Conclusion:
            Recommending shorter durations of breast-feeding in infants born to HIV-
            infected women in these settings may substantially reduce infant HIV infection
            but not mortality. When EBF for shorter durations is recommended, lower
            mortality could be achieved by a simultaneous reduction in the rate of




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            progression from HIV to AIDS and or HIV/AIDS mortality, achievable by the
            use of HAART in infants.


Estimating the resources needed and savings anticipated from roll-out of
adult male circumcision in Sub-Saharan Africa.
Author:     Auvert, B.; Marseille, E.; Korenromp, E. L.; Lloyd-Smith, J.; Sitta, R.; Taljaard, D.;
            Pretorius, C.; Williams, B., and Kahn, J. G.

Source:     PLoS ONE. 2008; 3(8):e2679.

Abstract:   Background:
            Trials in Africa indicate that medical adult male circumcision (MAMC) reduces
            the risk of HIV by 60%. MAMC may avert 2 to 8 million HIV infections over 20
            years in sub-Saharan Africa and cost less than treating those who would have
            been infected. This paper estimates the financial and human resources required
            to roll out MAMC and the net savings due to reduced infections.

            Methods:
            We developed a model which included costing, demography and HIV
            epidemiology. We used it to investigate 14 countries in sub-Saharan Africa
            where the prevalence of male circumcision was lower than 80% and HIV
            prevalence among adults was higher than 5%, in addition to Uganda and the
            Nyanza province in Kenya. We assumed that the roll-out would take 5 years and
            lead to an MC prevalence among adult males of 85%. We also assumed that
            surgery would be done as it was in the trials. We calculated public program cost,
            number of full-time circumcisers and net costs or savings when adjusting for
            averted HIV treatments. Costs were in USD, discounted to 2007. 95% percentile
            intervals (95% PI) were estimated by Monte Carlo simulations.

            Results:
            In the first 5 years the number of circumcisers needed was 2 282 (95% PI: 2 018 to
            2 959), or 0.24 (95% PI: 0.21 to 0.31) per 10,000 adults. In years 6-10, the number of
            circumcisers needed fell to 513 (95% PI: 452 to 664). The estimated 5-year cost of
            rolling out MAMC in the public sector was $919 million (95% PI: 726 to 1 245).
            The cumulative net cost over the first 10 years was $672 million (95% PI: 437 to
            1,021) and over 20 years there were net savings of $2.3 billion (95% PI: 1.4 to 3.4).

            Conclusion:
            A rapid roll-out of MAMC in sub-Saharan Africa requires substantial funding
            and a high number of circumcisers for the first five years. These investments are
            justified by MAMC's substantial health benefits and the savings accrued by
            averting future HIV infections. Lower ongoing costs and continued care savings
            suggest long-term sustainability.




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Wealth status and risky sexual behaviour in ghana and kenya.
Author:     Awusabo-Asare, K. and Annim, S. K.

Source:     Appl Health Econ Health Policy. 2008; 6(1):27-39.

Abstract:   Background:
            Emerging evidence seems to suggest that there is some association between
            individual socioeconomic status and sexual risk-taking behaviour in sub-Saharan
            Africa. A number of broad associations have emerged, among them, positive,
            neutral and negative relationships between wealth status and sexual risk-taking
            behaviour. Reduction in the number of sex partners as a behavioural change has
            been advocated as an important tool in HIV prevention, and affecting such a
            change requires an understanding of some of the factors that can influence social
            behaviour, interactions and activities of subpopulations.

            Objectives:
            To further explore the determinants of sexual risk-taking behaviour (individuals
            having multiple sex partners), especially the effects that variations in household
            wealth status, gender and different subpopulation groups have on this
            behaviour.

            Methods:
            The relationship between wealth status and sexual risk-taking behaviour in the
            context of HIV/AIDS infection in Ghana and Kenya was assessed using raw data
            from the 2003 Demographic and Health Surveys of each country. Wealth
            quintiles were used as a proxy for economic status, while non-marital and non-
            cohabiting sexual partnerships were considered indicators for risky sexual
            behaviour.

            Results:
            For females, there appears to be an increasing probability of sexual risk taking by
            wealth status in Kenya, while, in Ghana, an inverted J-shaped relationship is
            shown between wealth status and sexual risk taking. When controlled for other
            variables, the relationship between wealth status and sexual risk-taking
            behaviour disappears for females in the two countries. For males, there is no
            clearly discernable pattern between wealth status and sexual risk-taking
            behaviour in Ghana, while there is a general trend towards increasing sexual
            risk-taking behaviour by wealth status in Kenya. For Ghana, the highest
            probabilities are among the highest and the middle wealth quintiles; in Kenya,
            high probabilities were found for the two highest wealth quintiles. Controlling
            for the effects of other factors, the pattern for Ghana is further blurred (not
            statistically significant), but the relationship continues to show in the case of
            Kenya, and is significant for the highest quintile. In general, for both Ghana and
            Kenya, men in the highest wealth quintile were found to be more likely to have
            multiple sexual partners than the other groups.



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                             STIs, HIV and AIDS: 2005 - 2008

            Conclusion:
            The changing phases of HIV infection indicate that it is no longer poverty that
            drives the epidemic. Rather, it is wealth and a number of other
            sociodemographic factors that explain sexual risk-taking behaviour that puts
            people at risk. Understanding local specific factors that predispose individuals
            towards sexual risk taking could help to expand the range of information and
            services needed to combat the HIV pandemic.


HIV-1 subtype D infection is associated with faster disease progression
than subtype A in spite of similar plasma HIV-1 loads.
Author:     Baeten, J. M.; Chohan, B.; Lavreys, L.; Chohan, V.; McClelland, R. S.; Certain, L.;
            Mandaliya, K.; Jaoko, W., and Overbaugh, J.

Source:     J Infect Dis. 2007 Apr 15; 195(8):1177-80.

Abstract:   We investigated the effect of human immunodeficiency virus type 1 (HIV-1)
            subtype on disease progression among 145 Kenyan women followed from the
            time of HIV-1 acquisition. Compared with those infected with subtype A,
            women infected with subtype D had higher mortality (hazard ratio, 2.3 [95%
            confidence interval, 1.0-5.6]) and a faster rate of CD4 cell count decline (P=.003).
            The mortality risk persisted after adjustment for plasma HIV-1 load. There were
            no differences in plasma viral load by HIV-1 subtype during follow-up. HIV-1
            subtype D infection is associated with a >2-fold higher risk of death than subtype
            A infection, in spite of similar plasma HIV-1 loads.


Female-to-male infectivity of HIV-1 among circumcised and
uncircumcised Kenyan
Author:     Baeten, J. M.; Richardson, B. A.; Lavreys, L.; Rakwar, J. P.; Mandaliya, K.; Bwayo,
            J. J., and Kreiss, J. K. men.

Source:     J Infect Dis. 2005 Feb 15; 191(4):546-53.

Abstract:   Background:
            A lack of male circumcision has been associated with increased risk of human
            immunodeficiency virus type 1 (HIV-1) acquisition in a number of studies, but
            questions remain as to whether confounding by behavioral practices explains
            these results. The objective of the present study was to model per-sex act
            probabilities of female-to-male HIV-1 transmission (i.e., infectivity) for
            circumcised and uncircumcised men, by use of detailed accounts of sexual
            behavior in a population with multiple partnerships.




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            Methods:
            Data were collected as part of a prospective cohort study of HIV-1 acquisition
            among 745 Kenyan truck drivers. Sexual behavior with wives, casual partners,
            and prostitutes was recorded at quarterly follow-up visits. Published HIV-1
            seroprevalence estimates among Kenyan women were used to model HIV-1 per-
            sex act transmission probabilities.

            Results:
            The overall probability of HIV-1 acquisition per sex act was 0.0063 (95%
            confidence interval, 0.0035-0.0091). Female-to-male infectivity was significantly
            higher for uncircumcised men than for circumcised men (0.0128 vs. 0.0051;
            P=.04). The effect of circumcision was robust in subgroup analyses and across a
            wide range of HIV-1 prevalence estimates for sex partners.

            Conclusions:
            After accounting for sexual behavior, we found that uncircumcised men were at
            a >2-fold increased risk of acquiring HIV-1 per sex act, compared with
            circumcised men. Moreover, female-to-male infectivity of HIV-1 in the context of
            multiple partnerships may be considerably higher than that estimated from
            studies of HIV-1-serodiscordant couples. These results may explain the rapid
            spread of the HIV-1 epidemic in settings, found throughout much of Africa, in
            which multiple partnerships and a lack of male circumcision are common.



HIV-1 infection alters the retinol-binding protein: transthyretin ratio
even in the absence of the acute phase response.
Author:     Baeten, J. M.; . = Wener MH; Bankson DD; Lavreys L, and Richardson BA.

Source:     Journal of Nutrition. 2006 Jun; 136(6):1624-1629.

Abstract:   The ratio of retinol-binding protein (RBP) to transthyretin (TTR) has been
            proposed as an indirect method with which to assess vitamin A status in the
            context of inflammation. Few studies have been conducted among adults, and
            none examined the effect of HIV-1 infection. Our goal was to assess the RBP:TTR
            ratio among adults, including the effects of HIV-1 and the acute phase response.
            We used data from a cross-sectional study of 600 Kenyan women, of whom 400
            had HIV-1. The effect of vitamin A supplementation among the HIV-1-infected
            participants was subsequently assessed in a randomized trial. Among HIV-1-
            uninfected women without an acute phase response, a RBP:TTR cut-off value of
            0.25 had ~80% sensitivity and specificity to detect vitamin A deficiency (retinol <
            0.70 µmol/L). No RBP:TTR cut-off value demonstrated both high sensitivity and
            specificity among HIV-1 infected women without evidence of inflammation.
            HIV-1 infection and advanced HIV-1 disease were associated with higher
            RBP:TTR ratios. The effect of HIV-1 was independent of the acute phase
            response, which also increased the RBP:TTR ratio. Serum retinol increased with



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            vitamin A supplementation among those with a low RBP:TTR ratio, although the
            effect was small and was not present among those with concurrent inflammation.
            Thus, the RBP:TTR ratio has modest ability to predict vitamin A deficiency
            among healthy adults, but HIV-1 infection alters the ratio, even in the absence of
            the acute phase response. Our results raise questions about the utility of this
            measurement given the high prevalence of HIV-1 infection in areas where
            vitamin A deficiency is common. (author's)


Assessment of clinical and traditional male circumcision services in
Bungoma District, Kenya: complication rates and operational needs.
Author:     Bailey, R. C. and . = Egesah O.

Source:     Special report.

Abstract:   Over 40 observational studies and one clinical trial have found that male
            circumcision (MC) has a protective effect against HIV acquisition of between 40%
            and 88%. Most recently, Auvert et al. (2005) found in a randomized controlled
            trial (RCT) in Orange Farm, South Africa, that MC had a protective effect of 60%
            in intention to treat analysis. When the dissolution effect of cross-overs was
            taken into account in a per protocol analysis, the protective effect was found to
            be 76%. Currently, there are two additional RCTs of MC underway in sub-
            Saharan Africa - one in Rakai, Uganda and the other in Kisumu, Kenya. The
            results of these two additional trials are expected to be available in 2006-2007. If
            these trials find MC to be effective in reducing HIV incidence, the results,
            combined with the evidence from observational studies and biological
            investigations showing high susceptibility of human foreskin to HIV infection,
            are likely to compel the international health community to consider promotion of
            MC in countries where circumcision is little practiced and the epidemic is
            primarily among heterosexuals. However, lack of crucial information concerning
            the feasibility, safety and costs of implementing MC services is likely to impede
            progress toward building support for timely introduction of MC as an HIV
            prevention strategy. History has shown repeatedly, whether in the arena of HIV
            prevention or other health-related interventions, that the time from discovery to
            implementation of effective interventions has been tragically long due to the
            years necessary to collect information crucial for addressing operational issues
            and for building political will. (excerpt)




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                            STIs, HIV and AIDS: 2005 - 2008


Cost effectiveness and delivery study for future HIV vaccines.
Author:     Barth-Jones, D. C.; Cheng, H.; Kang, L. Y.; Kenya, P. R.; Odera, D.; Mosqueira, N.
            R.; Mendoza, W.; Portela, M. C.; Brito, C.; Tangcharoensathien, V.; Akaleephan,
            C.; Supantamart, S.; Patcharanarumol, W.; de Macedo Brigido, L. F.; Fonseca, M.
            G.; Sanchez, M.; Chang, M. L.; Osmanov, S.; Avrett, S.; Esparza, J., and Griffiths,
            U.

Source:     AIDS. 2005 Sep 2; 19(13):w1-6.

Abstract:   Research teams from five countries, Brazil, China, Kenya, Peru and Thailand,
            have initiated a policy-maker survey on vaccine delivery, cost studies for future
            HIV vaccination programmes, and associated simulation modeling exercises
            analysing the relative cost-effectiveness of potential HIV vaccination strategies.
            The survey assesses challenges and opportunities for future country-level HIV
            vaccination strategies, providing data on the vaccine characteristics (e.g. vaccine
            efficacies for susceptibility, infectiousness and disease progression) and
            vaccination programme strategies to be considered in the cost-effectiveness
            modeling analyses. The study will provide decision-makers with modeling data
            on vaccination policy considerations that will assist in developing country-level
            capacities for future HIV vaccine policy adoption and effective delivery systems,
            and will help delineate the long-term financial requirements for sustainable HIV
            vaccination programmes. The WHO-UNAIDS HIV Vaccine Initiative and the
            collaborating researchers welcome comments or questions from policy makers,
            health professionals and other stakeholders in the public and private sectors
            about this effort to help advance policy and capacity related to future potential
            HIV vaccines.


Economic growth, education, and AIDS in Kenya.
Author:     Bell C; Bruhns R, and Gersbach, H.

Source:     Development Outreach. 2007 Jun; [7] p.

Abstract:   An AIDS epidemic threatens Kenya with a long wave of premature adult
            mortality, and thus with an enduring setback to the formation of human capital
            and economic growth. According to UNAIDS (2004), about 1.2 million Kenyans
            were HIV-positive (out of a population of just over 30 million) in 2003, roughly
            150,000 died of the disease in that year, and some 650,000 children had been left
            as orphans. One independent estimate puts the cumulative number of deaths
            due to AIDS in Kenya from 1984 to 2000 at no less than 1.5 million. We
            developed a model to analyze the prospects for the formation of human capital
            and economic growth in Kenya, even as the AIDS epidemic threatens that
            country with a long wave of premature adult mortality. The model is then used




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            to analyze the social profitability of programs to promote education and combat
            the epidemic. (excerpt)


Economic growth, education and AIDS in Kenya: a long-run analysis.
Abstract:   The AIDS epidemic threatens Kenya with a long wave of premature adult
            mortality, and thus with an enduring setback to the formation of human capital
            and economic growth. To investigate this possibility, we develop a model with
            three overlapping generations, calibrate it to the demographic and economic
            series from 1950 until 1990, and then perform simulations for the period ending
            in 2050 under alternative assumptions about demographic developments,
            including the counterfactual in which there is no epidemic. Although AIDS does
            not bring about a catastrophic economic collapse, it does cause large economic
            costs - and very many deaths. Programs that subsidize post-primary education
            and combat the epidemic are both socially profitable - the latter strikingly so, due
            to its indirect effects on the expected returns to education - and a combination of
            the two interventions profits from a modest long-run synergy effect. (author's)


Quantification of genital human immunodeficiency virus type 1 (HIV-1)
DNA in specimens from women with low plasma HIV-1 RNA levels
typical of HIV-1 nontransmitters.
Author:     Benki, S.; McClelland, R. S.; Emery, S.; Baeten, J. M.; Richardson, B. A.; Lavreys,
            L.; Mandaliya, K., and Overbaugh, J.

Source:     J Clin Microbiol. 2006 Dec; 44(12):4357-62.

Abstract:   Studies of human immunodeficiency virus type 1 (HIV-1) transmission suggest
            that genital HIV-1 RNA and DNA may both be determinants of HIV-1
            infectivity. Despite its potential role in HIV-1 transmission, there are limited
            quantitative data on genital HIV-1 DNA. Here we validated an in-house real-
            time PCR method for quantification of HIV-1 DNA in genital specimens. In
            reactions with 100 genomes to 1 genome isolated from a cell line containing one
            HIV-1 provirus/cell, this real-time PCR assay is linear and agrees closely with a
            commercially available real-time PCR assay specific for a cellular housekeeping
            gene. In mock genital samples spiked with low numbers of HIV-1-infected cells
            such that the expected HIV-1 DNA copy number/reaction was 100, 10, or 5, the
            average copy number/reaction was 80.2 (standard deviation [SD], 28.3), 9.1 (SD,
            5.4), or 3.1 (SD, 2.1), respectively. We used this method to examine genital HIV-1
            DNA levels in specimens from women whose low plasma HIV-1 RNA levels are
            typical of HIV-1 nontransmitters. The median HIV-1 DNA copy number in
            endocervical secretions from these women (1.8 HIV-1 DNA copies/10,000 cells)
            was lower than that for women with higher plasma HIV-1 RNA levels (16.6 HIV-
            1 DNA copies/10,000 cells) (P=0.04), as was the median HIV-1 DNA copy


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            number in vaginal secretions (undetectable versus 1.0 HIV-1 DNA copies/10,000
            cells). These data suggest that women with low plasma HIV-1 RNA and thus a
            predicted low risk of HIV-1 transmission have low levels of genital HIV-1 cell-
            associated virus. The assay described here can be utilized in future efforts to
            examine the role of cell-associated HIV-1 in transmission.


Prevalence of malnutrition in human immunodeficiency virus/acquired
immunodeficiency syndrome orphans in the Nyanza province of Kenya:
a comparison of conventional indexes with a composite index of
anthropometric failure.
Author:     Berger, M. R.; Fields-Gardner, C.; Wagle, A., and Hollenbeck, C. B.

Source:     J Am Diet Assoc. 2008 Jun; 108(6):1014-7.

Abstract:   The prevalence of undernutrition in children is commonly reported using a
            conventional index, which identifies three conventional categories: stunting,
            underweight, and wasting. Recently, a composite index of anthropometric failure
            was developed to categorize undernutrition into seven mutually exclusive
            categories, including single failures (stunting, underweight, or wasting) and
            multiple failures (stunting and underweight, stunting and wasting, underweight
            and wasting, and stunting and underweight and wasting). This cross-sectional
            study used baseline data gathered during a feeding program targeting orphans
            and vulnerable children impacted by human immunodeficiency virus and/or
            acquired immunodeficiency syndrome (HIV/AIDS) in Kenya to compare the
            conventional index with the composite index of anthropometric failure. Children
            younger than 5 years of age who participated in the feeding trial were included
            in the analysis (n=170). The conventional index found that the prevalence of
            undernutrition included 31.2% stunted, 14.1% underweight, and 5.9% wasted
            children, whereas the composite index of anthropometric failure estimated a
            more severe overall prevalence rate (38.2%); thus, the conventional index did not
            uncover the complexity of malnutrition experienced. Of the 53 children classified
            as stunted by the conventional index, the composite index of anthropometric
            failure identified 36 (67.9%) as stunted and 17 (32.1%) as stunted and
            underweight. Thus, the composite index of anthropometric failure was able to
            distinguish children with multiple anthropometric failures. In total, multiple
            anthropometric failures were found in 22 of the 65 children with anthropometric
            failure. These data suggest that the complexity and prevalence of undernutrition
            may be underestimated using the conventional index because it does not identify
            children experiencing multiple anthropometric failures. The ability of the
            composite index of anthropometric failure to identify children with multiple
            anthropometric failures may have profound implications for prioritizing,
            designing, and targeting nutritional interventions.




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Mombasa Antiretroviral Therapy Program: monitoring and evaluation
plan for pharmaceutical and laboratory capacity building activities,
February 2004.
Author:     Bhattarai, H. R. and Walkowiak H.

Abstract:   The Mombasa ART Program proposal document, jointly proposed by a
            partnership of FHI/IMPACT Project, Population Council/Horizons Project and
            MSH/RPM Plus already contains the outline of the overarching monitoring and
            evaluation framework and some indicators. This document is intended to
            supplement the original proposal to describe in detail the monitoring and
            evaluation (M&E) of pharmaceutical and laboratory capacity building activities
            for which RPM Plus is responsible. This document outlines the M&E procedures
            and indicators for monitoring the pharmaceutical and laboratory capacity
            building activities and also the link with the envisaged unified M&E system of
            the program. Although this is a supplemental document, primary program goals
            and objectives are repeated below so that the document can serve as a stand
            alone reference. (excerpt)


Infant feeding practices among HIV infected women receiving
prevention of mother-to-child transmission services at Kitale District
Hospital, Kenya.
Source:     East Afr Med J. 2008 Apr; 85(4):156-61.

Abstract:   Objectives:
            To determine the types and modes of infant feeding practices among the HIV
            infected mothers on prevention of mother-to-child transmission (PMTCT) and
            attending MCH-FP clinic at Kitale District Hospital, Kenya.

            Design: Descriptive cross-sectional study.

            Setting:
            Kitale District Hospital in Western Kenya within the maternal and child health
            and family planning (MCH-FP) and comprehensive care clinics.

            Subjects:
            A total of 146 respondents who had delivered 150 babies were recruited for this
            study.

            Results:
            Thirty five percent (52/150) of the babies were exclusively breastfed while 50%
            (75/150) were not breastfed at all and 14% (21/150) of the babies received mixed
            feeding. The length of exclusive breastfeeding ranged from 1-6 months with most
            (53%) women exclusively breastfeeding for two to three months. Only 13% of the


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            women exclusively breastfed for five to six months. There was a strong
            relationship between mode of infant feeding and spouse's awareness of HIV
            status. Mothers who had disclosed their HIV status to their spouses were more
            likely not to breastfeed than mothers who had not disclosed their status (p <
            0.05%). The choice of infant feeding method was also influenced by the socio-
            economic status of the mothers and nevirapine uptake. The level of education
            did not influence the mode of infant feeding.

            Conclusion:
            Infant feeding decisions were mainly influenced by the male partner's
            involvement and the socio economic status of the mother. Half of the
            respondents did not breastfeed at all. The duration of exclusive breastfeeding
            rarely reached six months. To encourage women to adhere to good infant feeding
            practices, involvement of their partners, family members as well as the
            community for support should be encouraged.


Self-reported adherence to single dose nevirapine in the prevention of
mother to child transmission of HIV at Kitale District Hospital.
Source:     East Afr Med J. 2007 Dec; 84(12):571-6.

Abstract:   Objectives:
            To evaluate the uptake and adherence to single dose nevirapine among HIV
            positive mothers.

            Design:
            Descriptive cross-sectional study.

            Setting:
            The maternal and child health and family planning (MCH-FP) clinics in Kitale
            district hospital, Western Kenya.

            Subjects:
            HIV positive postnatal women attending MCH-FP clinic who had gone through
            the PMTCT programme.

            Results:
            A total of 146 respondents were recruited for this study. Most (90%) of them
            reported swallowing their nevirapine tablets, however only 55 swallowed their
            tablets within 4-12 hours before delivery. The most important factor affecting
            nevirapine adherence was place or delivery (p<0.05). Most (71%) of mothers who
            did not swallow their nevirapine delivered at home. Women attending ANC for
            two times or less young women under 20 years of age and single women were
            also less likely to swallow their nevirapine (p < 0.05). Most (91%) of the babies
            received their nevirapine syrup with 98% of them getting it within 72 hours of
            delivery. Eighty eight percent of babies who did not take their nevirapine were


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            delivered at home. Babies whose mothers did not take their nevirapine were also
            more likely to miss it.

            Conclusions:
            Self reported adherence to take home nevirapine is high. However mothers who
            deliver in a health facility were more likely to access nevirapine both for
            themselves and their babies than those delivering at home.


Enhancing exposure of HIV-1 neutralization epitopes through mutations
in gp41.
Author:     Blish, C. A.; Nguyen, M. A., and Overbaugh, J.

Source:     PLoS Med. 2008 Jan 3; 5(1):e9.

Abstract:   Background:
            The generation of broadly neutralizing antibodies is a priority in the design of
            vaccines against HIV-1. Unfortunately, most antibodies to HIV-1 are narrow in
            their specificity, and a basic understanding of how to develop antibodies with
            broad neutralizing activity is needed. Designing methods to target antibodies to
            conserved HIV-1 epitopes may allow for the generation of broadly neutralizing
            antibodies and aid the global fight against AIDS by providing new approaches to
            block HIV-1 infection. Using a naturally occurring HIV-1 Envelope (Env) variant
            as a template, we sought to identify features of Env that would enhance exposure
            of conserved HIV-1 epitopes.

            Methods and findings:
            Within a cohort study of high-risk women in Mombasa, Kenya, we previously
            identified a subtype A HIV-1 Env variant in one participant that was unusually
            sensitive to neutralization. Using site-directed mutagenesis, the unusual
            neutralization sensitivity of this variant was mapped to two amino acid
            mutations within conserved sites in the transmembrane subunit (gp41) of the
            HIV-1 Env protein. These two mutations, when introduced into a neutralization-
            resistant variant from the same participant, resulted in 3- to >360-fold enhanced
            neutralization by monoclonal antibodies specific for conserved regions of both
            gp41 and the Env surface subunit, gp120, >780-fold enhanced neutralization by
            soluble CD4, and >35-fold enhanced neutralization by the antibodies found
            within a pool of plasmas from unrelated individuals. Enhanced neutralization
            sensitivity was not explained by differences in Env infectivity, Env concentration,
            Env shedding, or apparent differences in fusion kinetics. Furthermore,
            introduction of these mutations into unrelated viral Env sequences, including
            those from both another subtype A variant and a subtype B variant, resulted in
            enhanced neutralization susceptibility to gp41- and gp120-specific antibodies,
            and to plasma antibodies. This enhanced neutralization sensitivity exceeded
            1,000-fold in several cases.



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            Conclusions:
            Two amino acid mutations within gp41 were identified that expose multiple
            discontinuous neutralization epitopes on diverse HIV-1 Env proteins. These
            exposed epitopes were shielded on the unmodified viral Env proteins, and
            several of the exposed epitopes encompass desired target regions for protective
            antibodies. Env proteins containing these modifications could act as a scaffold
            for presentation of such conserved domains, and may aid in developing methods
            to target antibodies to such regions.


Constructing a stigma and discrimination index: hopes, dreams, and
lessons learned.
Author:     Bollinger, L.

Abstract:   Without a consistent methodology to measure stigma and discrimination (S&D),
            it is difficult to monitor and evaluate reduction interventions. Although some
            indices have been developed, no standardized method has been adopted that
            encompasses all relevant dimensions of S&D. This activity's objectives were to
            design an index on HIV/AIDS-related stigma and discrimination based on
            existing studies of S&D indicators, prepare and test a survey, field the survey in
            various countries, and finally, create an index for each of the countries surveyed.
            The indicators were developed in conjunction with the USAID Interagency
            Working Group (IWG) on Stigma and Discrimination and formed part of an
            effort headed by the UNAIDS Secretariat and International Planned Parenthood
            Federation, which were designing a similar index. This index was different than
            other indices developed by Futures Group, which are calculated based on expert
            opinion obtained through surveys. For this index, much larger samples were
            needed, including three different population groups (community,
            facility/provider, persons living with HIV). Thus, instead of gathering expert
            opinions, existing studies that reported results for the relevant indicators were
            reviewed, and the index was constructed based on these results. The survey was
            implemented and studies were gathered in Mexico, Kenya, South Africa, and
            Tanzania. These countries were selected because they were most likely to have
            relevant studies. (excerpt)


Utility of antenatal HIV surveillance data to evaluate prevention of
mother-to-child HIV transmission programs in resource-limited settings.

Author:     Bolu, O.; Anand, A.; Swartzendruber, A.; Hladik, W.; Marum, L. H.; Sheikh, A.
            A.; Woldu, A.; Ismail, S.; Mahomva, A.; Greby, S., and Sabin, K.

Source:     Am J Obstet Gynecol. 2007 Sep; 197(3 Suppl):S17-25.




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Abstract:   Prevention of mother-to-child human immunodeficiency virus (HIV)
            transmission (PMTCT) programs are expanding in resource-limited countries
            and are increasingly implemented in antenatal clinics (ANC) in which HIV
            sentinel surveillance is conducted. ANC sentinel surveillance data can be used to
            evaluate the first visit of a pregnant woman to PMTCT programs. We analyzed
            data from Kenya and Ethiopia, where information on PMTCT test acceptance
            was collected on the 2005 ANC sentinel surveillance forms. For Zimbabwe, we
            compared the 2005 ANC sentinel surveillance data to the PMTCT program data.
            ANC surveillance data allowed us to calculate the number of HIV-positive
            women not participating in the PMTCT program. The percentage of HIV-positive
            women missed by the PMTCT program was 17% in Kenya, 57% Ethiopia, and
            59% Zimbabwe. The HIV prevalence among women participating in PMTCT
            differed from women who did not. ANC sentinel surveillance can be used to
            evaluate and improve the first encounter in PMTCT programs. Countries should
            collect PMTCT-related program data through ANC surveillance to strengthen
            the PMTCT program.


Longitudinal comparison of chemokines in breastmilk early postpartum
among HIV-1-infected and uninfected Kenyan women.
Author:     Bosire, R.; Guthrie, B. L.; Lohman-Payne, B.; Mabuka, J.; Majiwa, M.; Wariua, G.;
            Mbori-Ngacha, D.; Richardson, B.; John-Stewart, G., and Farquhar, C.

Source:     Breastfeed Med. 2007 Sep; 2(3):129-38.

Abstract:   Breastmilk chemokines have been associated with increased HIV-1 RNA levels in
            breastmilk and altered risk of mother-to-child HIV-1 transmission. To
            characterize CC and CXC chemokines in breastmilk postpartum, we collected
            breastmilk specimens at regular intervals for 6 months after delivery from
            women with and without HIV-1 infection and used commercial ELISA kits to
            measure breastmilk concentrations of MIP-1alpha, MIP-1beta, RANTES, and
            SDF-1alpha. Among 54 HIV-1-infected and 26 uninfected women, mean
            chemokine levels were compared cross-sectionally and longitudinally at days 5
            and 10, and months 1 and 3 postpartum. For both HIV-1-infected and uninfected
            women, breastmilk chemokine levels were highest at day 5 for MIP-1alpha, MIP-
            1beta, and SDF-1alpha, and subsequently decreased. RANTES levels remained
            constant over the follow-up period among HIV-1-uninfected women, and
            increased moderately among HIV-1-infected women. For MIP-1beta and
            RANTES, breastmilk levels were significantly higher among HIV-1-infected
            women compared to uninfected women early postpartum. In addition, HIV-1-
            infected women transmitting HIV-1 to their infant had consistently higher
            breastmilk RANTES levels than those who did not transmit, with the greatest
            difference observed at 1 month (2.68 vs. 2.21 log10 pg/mL, respectively; p =
            0.007). In summary, all four chemokines were most elevated within the first
            month postpartum, a period of high transmission risk via breastmilk. MIP-1beta



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            and RANTES levels in breastmilk were higher among HIV-1-infected women
            than among uninfected women, and breastmilk RANTES was positively
            associated with vertical transmission in this study, consistent with results from
            our earlier cohort.


Breast milk alpha-defensins are associated with HIV type 1 RNA and CC
chemokines in breast milk but not vertical HIV type 1 transmission.
Author:     Bosire, R.; John-Stewart, G. C.; Mabuka, J. M.; Wariua, G.; Gichuhi, C.; Wamalwa,
            D.; Ruzinski, J.; Goodman, R.; Lohman, B.; Mbori-Ngacha, D. A.; Overbaugh, J.,
            and Farquhar, C.

Source:     AIDS Res Hum Retroviruses. 2007 Feb; 23(2):198-203.

Abstract:   Alpha-defensins are proteins exhibiting in vitro anti-HIV-1 activity that may
            protect against mother-to-child transmission of HIV-1 via breast milk. Correlates
            of alpha-defensins in breast milk and transmission risk were determined in a
            cohort of HIV-1-infected pregnant women in Nairobi followed for 12 months
            postpartum with their infants. Maternal blood was collected antenatally and at
            delivery for HIV-1 viral load and infant HIV-1 infection status was determined <
            48 h after birth and at months 1, 3, 6, 9, and 12. Breast milk specimens collected at
            month 1 were assayed for alpha-defensins, HIV-1 RNA, subclinical mastitis, and
            CC and CXC chemokines. We detected alpha-defensins in breast milk specimens
            from 108 (42%) of 260 HIV-1-infected women. Women with detectable alpha-
            defensins (> or =50 pg/ml) had a median concentration of 320 pg/ml and
            significantly higher mean breast milk HIV-1 RNA levels than women with
            undetectable alpha-defensins (2.9 log(10) copies/ml versus 2.5 log(10) copies/ml,
            p = 0.003). Increased alpha-defensins concentrations in breast milk were also
            associated with subclinical mastitis (Na (+)/K(+) ratio > 1) and increased breast
            milk chemokine levels. Overall, 40 (15%) infants were HIV-1 uninfected at birth
            and subsequently acquired HIV-1. There was no significant association between
            month 1 alpha-defensins and risk of HIV-1 transmission. In conclusion, alpha-
            defensins were associated with breast milk HIV-1 viral load, chemokine levels,
            and subclinical mastitis, all of which may alter risk of infant HIV-1 acquisition.
            Despite these associations there was no significant relationship between breast
            milk alpha-defensins and mother-to-child transmission, suggesting a complex
            interplay between breast milk HIV-1, inflammation, and antiinfective factors.


Circumcision-related HIV risk and the unknown mechanism of effect in
the male circumcision trials [letter].
Author:     Brewer, D. D.; . = Potterat JJ; Roberts JM Jr, and Brody S.

Source:     Annals of Epidemiology. 2007 Nov; 17(11):928-929.


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Abstract:   We welcome Westreich and colleagues' and Adams and colleagues' comments on
            our article, in which we reported that circumcised male and female adolescents
            and virgins in Kenya, Lesotho, and Tanzania were consistently and substantially
            more likely to be HIV infected than their uncircumcised counterparts. Moreover,
            we found that this relationship inverts in adults, such that circumcised adult men
            and women are less likely to be infected than uncircumcised adults. Westreich
            and colleagues and Adams and colleagues raise objections to our results that
            suggest HIV transmission occurs through circumcision practices in eastern and
            southern Africa. Specifically, they argue that our measurement of virginity and
            the number of HIV-infected virgins have probably biased our results. In our
            analyses, the positive association between circumcision and HIV infection in
            adolescents remained unchanged after statistically adjusting for self-reported
            sexual experience. Thus, there is no evidence that underreporting of sexual
            experience would affect the interpretation of the positive relationship between
            circumcision and HIV infection in virgins or sexually experienced youth. Indeed,
            the measurement of sexual behavior is entirely irrelevant to the positive
            association between circumcision and HIV infection in Kenyan, Lesothoan, and
            Tanzanian adolescents, regardless of virginity status. We also found that
            adolescent males who denied sexual experience were as likely or slightly more
            likely to be infected as those who acknowledged it. (excerpt)



Effect of CCR2 chemokine receptor polymorphism on HIV type 1
mother-to-child transmission and child survival in Western Kenya.
Author:     Brouwer, K. C.; Yang, C.; Parekh, S.; Mirel, L. B.; Shi, Y. P.; Otieno, J.; Lal, A. A.,
            and Lal, R. B.

Source:     AIDS Res Hum Retroviruses. 2005 May; 21(5):358-62.

Abstract:   The effect of CCR2 polymorphism on HIV-1 mother-to-child transmission and
            disease progression has not been explored in depth within Africa. As the CCR2-
            64I variant of this putative HIV coreceptor has been associated with slower
            progression to AIDS in adults, the current study was undertaken to examine the
            relationship between CCR2 polymorphism and HIV-1 perinatal transmission and
            child survival in western Kenya. CCR2 genotype was determined for 445 HIV-
            seropositive mothers and their infants. The CCR2-64I allele frequency of both
            mothers and children did not differ by HIV-1 transmission status, regardless of
            maternal viral load, viral subtype, immune status, or placental malaria status.
            For infants who acquired HIV perinatally (n = 78), there was no association
            between CCR2 genotype and viral load upon infection or survival rate over the
            2-year follow-up. Our results do not indicate an effect of CCR2-64I on perinatal
            HIV transmission and survival in Kenyan children.




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Safety, acceptability, and tolerability of 3 topical microbicides among
heterosexual Kenyan men.
Author:     Bukusi, E. A.; Steele, M.; Cohen, C. R.; Nguti, R.; Maingi, C. W.; Thomas, K. K.,
            and Holmes, K. K.

Source:     J Acquir Immune Defic Syndr. 2007 Apr 1; 44(4):423-8.

Abstract:   Objectives:
            To compare the acceptability, tolerability, and safety of 3 topical microbicide
            formulations (62% ethyl alcohol in emollient gel and 0.1% and 0.4%
            benzalkonium chloride on a sanitary wipe) for use on male genitalia.

            Design:
            This triple-randomized crossover study among men attending a sexually
            transmitted disease (STD) clinic in Nairobi, Kenya assigned individuals without
            clinical evidence of an STD to apply products to the penis in a predetermined
            random order, each for a 2-week period with a 1-week washout period between
            each product. Men recorded side effects and were examined for adverse events.

            Results:
            Of 39 participants, 33 (84%) completed 6 clinic visits plus 3 home visits by
            community health workers. Participants reported use of 62% ethanol gel and
            0.1% and 0.4% benzalkonium on 99%, 99%, and 96% of daily scheduled
            applications; 99%, 98%, and 97% of preintercourse applications, and 99%, 94%,
            and 98% of postintercourse applications. All participants said they would
            recommend all 3 products to a friend; 72% preferred the 62% ethanol gel, 17% the
            0.1% benzalkonium, and 11% the 0.4% benzalkonium. One person developed
            objective signs of a genital ulcer after 14 days of 0.4% benzalkonium wipe use.

            Conclusions:
            Two of the 3 topical microbicides had minimal reported adverse effects, and no
            adverse effects were observed during use of the ethanol gel, which was preferred
            by most men.



Identification of differentially expressed proteins in the cervical mucosa
of HIV-1-resistant sex workers.
Author:     Burgener, A.; Boutilier, J.; Wachihi, C.; Kimani, J.; Carpenter, M.; Westmacott, G.;
            Cheng, K.; Ball, T. B., and Plummer, F.

Source:     J Proteome Res. 2008 Oct; 7(10):4446-54.

Abstract:   Novel tools are necessary to understand mechanisms of altered susceptibility to
            HIV-1 infection in women of the Pumwani Sex Worker cohort, Kenya. In this


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            cohort, more than 140 of the 2000 participants have been characterized to be
            relatively resistant to HIV-1 infection. Given that sexual transmission of HIV-1
            occurs through mucosal surfaces such as that in the cervicovaginal environment,
            our hypothesis is that innate immune factors in the genital tract may play a role
            in HIV-1 infection resistance. Understanding this mechanism may help develop
            microbicides and/or vaccines against HIV-1. A quantitative proteomics
            technique (2D-DIGE: two-dimensional difference in-gel electrophoresis) was
            used to examine cervical mucosa of HIV-1 resistant women ( n = 10) for
            biomarkers of HIV-1 resistance. Over 15 proteins were found to be differentially
            expressed between HIV-1-resistant women and control groups ( n = 29), some
            which show a greater than 8-fold change. HIV-1-resistant women overexpressed
            several antiproteases, including those from the serpin B family, and also cystatin
            A, a known anti-HIV-1 factor. Immunoblotting for a selection of the identified
            proteins confirmed the DIGE volume differences. Validation of these results on a
            larger sample of individuals will provide further evidence these biomarkers are
            associated with HIV-1 resistance and could help aid in the development of
            effective microbicides against HIV-


Our sexuality, our stores: Experiences of HIV-positive women in Kenya.
Author:     Burris, M. A. and . = Wanjala M.

Source:     Exchange on HIV / AIDS, Sexuality and Gender. 2007; (3):13-15.

Abstract:   In July 2006, a group of HIV-positive Kenyan women from Women Fighting
            AIDS in Kenya (WOFAK), Society for Orphans Against AIDS (SOAN), and
            Kibera Community Self-Help Programme (KICOSHEP) began meeting at the
            Trust for Indigenous Culture and Health (TICAH) in Nairobi, Kenya to talk
            about their needs. Soon, they realized that the issue of sexuality was central to
            their lives and that they yearned to learn more about it and discuss it with other
            women. This initiative has now evolved into the establishment of collectives of
            women and men who are meeting regularly to talk about sex. Two women
            involved in these collectives share their experiences in this article. (author's)


Correlation of CD4 counts and CD4/CD8 ratio with HIV-infection
associated oral manifestations.
Author:     Butt, F. M.; Vaghela, V. P., and Chindia, M. L.

Source:     East Afr Med J. 2007 Aug; 84(8):383-8.

Abstract:   Background:
            The relationship between oral lesions arising from HIV infection and CD4/CD8
            cell ratios is of relevance in clinical assessment of immune suppression.



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            Objective:
            To correlate the prevalence of oral manifestations arising from HIV infection and
            the levels of CD4/CD8 cell ratios.

            Design: A cross-sectional study.

            Setting: Kenyatta National Hospital, Nairobi, Kenya.

            Subjects:
            Two hundred and seven HIV-infected patients in medical wards were recruited
            in the study.

            Results:
            Seventy eight (37.7%) were male and 129 (62.3%) female, with an age range of 18-
            73 years (mean=34.81 years). Oral manifestations encountered with highest
            prevalence in the oral cavity included: hyperplastic candidosis (labial mucosa)
            15%, erythematous candidosis (gingival) 5%, angular cheilitis 32.4%, herpes
            simplex (corner of the mouth) 0.5%, persistent oral ulceration (labial mucosa)
            0.5%, Parotid enlargement 2% and Kaposis sarcoma (hard/soft palate) 2.9%.

            Conclusion:
            The prevalence of oral manifestations was higher with low CD4 count <200
            cell/mm3 and mean CD4/CD8<0.39(95%CI 0.32-0.48).


Integrating nutrition security with treatment of people living with HIV:
lessons from Kenya.
Author:     Byron, E.; Gillespie, S., and Nangami, M.

Source:     Food Nutr Bull. 2008 Jun; 29(2):87-97.

Abstract:   Background:
            The increased caloric requirements of HIV-positive individuals, undesirable side
            effects of treatment that may be worsened by malnutrition (but alleviated by
            nutritional support), and associated declines in adherence and possible increased
            drug resistance are all justifications for developing better interventions to
            strengthen the nutrition security of individuals receiving antiretroviral
            treatment.

            Objective:
            To highlight key benefits and challenges relating to interventions aimed at
            strengthening the nutrition security of people living with HIV who are receiving
            antiretroviral treatment.




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                            STIs, HIV and AIDS: 2005 - 2008

            Methods:
            Qualitative research was undertaken on a short-term nutrition intervention
            linked to the provision of free antiretroviral treatment for people living with HIV
            in western Kenya in late 2005 and early 2006.

            Results:
            Patients enrolled in the food program while on treatment regimens self-reported
            greater adherence to their medication, fewer side effects, and a greater ability to
            satisfy increased appetite. Most clients self-reported weight gain, recovery of
            physical strength, and the resumption of labor activities while enrolled in dual
            (food supplementation and treatment) programs. Such improvements were seen
            to catalyze increased support from family and community.

            Conclusions:
            These findings provide further empirical support to calls for a more holistic and
            comprehensive response to the coexistence of AIDS epidemics with chronic
            nutrition insecurity. Future work is needed to clarify ways of bridging the gap
            between short-term nutritional support to individuals and longer-term
            livelihood security programming for communities affected by AIDS. Such
            interdisciplinary research will need to be matched by intersectoral action on the
            part of the agriculture and health sectors in such environments.


Lessons learned in the conduct, validation, and interpretation of national
population based HIV surveys.
Author:     Calleja, J. M.; Marum, L. H.; Carcamo, C. P.; Kaetano, L.; Muttunga, J., and Way,
            A.

Source:     AIDS. 2005 May; 19 Suppl 2:S9-S17.

Abstract:   In the past few years several countries have conducted national population-
            based HIV surveys. Survey methods, levels of participation bias from absence or
            refusal and lessons learned conducting such surveys are compared in four
            national population surveys: Mali, Kenya, Peru and Zambia. In Mali, Zambia,
            and Kenya, HIV testing of adult women and men was included in the national-
            level demographic and health surveys carried out regularly in these countries,
            whereas in Peru the national HIV survey targeted young people in 24 cities with
            populations over 50 000.The household response rate was above 90% in all
            countries, but some individuals were absent for interviews. HIV testing rates
            were between 70 and 79% of those eligible, with higher test rates for women.
            Three critical questions in this type of survey need to be answered: who did the
            surveys miss; how much it matters that they were missed; and what can be done
            to increase the participation of respondents so the coverage rates are adequate.
            The level of representativeness of the populations tested was adequate in each
            survey to provide a reliable national estimate of HIV prevalence that
            complements other methods of HIV surveillance. Different lessons were learned


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            from each survey.These population-based HIV seroprevalence surveys
            demonstrate that reliable and useful results can be obtained, although they
            require careful planning and increased financial and human resource investment
            to maximize responses at the household and individual level, which are key
            elements to validate survey results.This review was initiated through an
            international meeting on 'New strategies for HIV/AIDS Surveillance in
            Resource-constrained Countries' held in Addis Ababa on 26-30 January 2004 to
            share and develop recommendations to guide future surveys.


Public-private mix for control of tuberculosis and TB-HIV in Nairobi,
Kenya: outcomes, opportunities and obstacles.
Author:     Chakaya, J.; Uplekar, M.; Mansoer, J.; Kutwa, A.; Karanja, G.; Ombeka, V.;
            Muthama, D.; Kimuu, P.; Odhiambo, J.; Njiru, H.; Kibuga, D., and Sitienei, J.

Source:     Int J Tuberc Lung Dis. 2008 Nov; 12(11):1274-1278.

Abstract:   Setting:
            Nairobi, the capital of Kenya.

            Objective:
            To promote standardised tuberculosis (TB) care by private health providers and
            links with the public sector.

            Design and methods:
            A description of the results of interventions aimed at engaging private health
            providers in TB care and control in Nairobi. Participating providers are
            supported to provide TB care that conforms to national guidelines. The standard
            surveillance tools are used for programme monitoring and evaluation.

            Results:
            By the end of 2006, 26 of 46 (57%) private hospitals and nursing homes were
            engaged. TB cases reported by private providers increased from 469 in 2002 to
            1740 in 2006. The treatment success rate for smear-positive pulmonary TB treated
            by private providers ranged from 76% to 85% between 2002 and 2005. Of the
            1740 TB patients notified by the private sector in 2006, 732 (42%) were tested for
            human immunodeficiency virus (HIV), of whom 372 (51%) were positive. Of the
            372 HIV-positive TB patients, 227 (61%) were provided with cotrimoxazole
            preventive treatment (CPT) and 136 (37%) with antiretroviral treatment (ART).

            Conclusion:
            Private providers can be engaged to provide TB-HIV care conforming to national
            norms. The challenges include providing diagnostics, CPT and ART and the
            capacity to train and supervise these providers.




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National scale-up of HIV testing and provision of HIV care to
tuberculosis patients in Kenya.
Author:     Chakaya, J. M.; Mansoer, J. R.; Scano, F.; Wambua, N.; L'Herminez, R.; iambo, J.;
            Mohamed, I.; Kangangi, J.; Ombeka, V.; Akeche, G.; Adala, S.; Gitau, S.; Maina, J.;
            Kibias, S.; Langat, B.; Abdille, N.; Wako, I.; Kimuu, P., and Sitienei, J.

Source:     Int J Tuberc Lung Dis. 2008 Apr; 12(4):424-9.

Abstract:   Setting:
            Kenya, one of the 22 tuberculosis (TB) high-burden countries, whose TB burden
            is fuelled by the human immunodeficiency virus (HIV).

            Objective:
            To monitor and evaluate the implementation of HIV testing and provision of
            HIV care to TB patients in Kenya through the establishment of a routine TB-HIV
            integrated surveillance system.

            Design:
            A descriptive report of the status of implementation of HIV testing and provision
            of HIV interventions to TB patients one year after the introduction of the revised
            TB case recording and reporting system.

            Results:
            From July 2005 to June 2006, 88% of 112835 TB patients were reported to the
            National Leprosy and TB Control Programme, 98773 (87.9%) of whom were
            reported using a revised recording and reporting system that included TB-HIV
            indicators. HIV testing of TB patients increased from 31.5% at the beginning of
            this period to 59% at the end. Of the 46428 patients tested for HIV, 25558 (55%)
            were found to be HIV-positive, 85% of whom were provided with cotrimoxazole
            preventive treatment and 28% with antiretroviral treatment.

            Conclusion:
            A country-wide integrated TB-HIV surveillance system in TB patients can be
            implemented and provides essential data to monitor and evaluate TB-HIV
            related interventions.


Correlates of delayed disease progression in HIV-1-infected Kenyan
children.
Author:     Chakraborty, R.; Morel, A. S.; Sutton, J. K.; Appay, V.; Ripley, R. M.; Dong, T.;
            Rostron, T.; Ogola, S.; Palakudy, T.; Musoke, R.; D'Agostino, A.; Ritter, M., and
            Rowland-Jones, S. L.

Source:     J Immunol. 2005 Jun 15; 174(12):8191-9.



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Abstract:   Without treatment most HIV-1-infected children in Africa die before their third
            birthday (>89%) and long-term nonprogressors are rare. The mechanisms
            underlying nonprogression in HIV-1-infected children are not well understood.
            In the present study, we examined potential correlates of delayed HIV disease
            progression in 51 HIV-1-infected African children. Children were assigned to
            progression subgroups based on clinical characterization. HIV-1-specific
            immune responses were studied using a combination of ELISPOT assays,
            tetramer staining, and FACS analysis to characterize the magnitude, specificity,
            and functional phenotype of HIV-1-specific CD8(+) and CD4(+) T cells. Host
            genetic factors were examined by genotyping with sequence-specific primers.
            HIV-1 nef gene sequences from infecting isolates from the children were
            examined for potential attenuating deletions. Thymic output was measured by T
            cell rearrangement excision circle assays. HIV-1-specific CD8(+) T cell responses
            were detected in all progression groups. The most striking attribute of long-term
            survivor nonprogressors was the detection of HIV-1-specific CD4(+) Th
            responses in this group at a magnitude substantially greater than previously
            observed in adult long-term nonprogressors. Although long-term survivor
            nonprogressors had a significantly higher percentage of CD45RA(+)CD4(+) T
            cells, nonprogression was not associated with higher thymic output. No
            protective genotypes for known coreceptor polymorphisms or large sequence
            deletions in the nef gene associated with delayed disease progression were
            identified. In the absence of host genotypes and attenuating mutations in HIV-1
            nef, long-term surviving children generated strong CD4(+) T cell responses to
            HIV-1. As HIV-1-specific helper cells support anti-HIV-1 effector responses in
            active disease, their presence may be important in delaying disease progression.


Evidence for population level declines in adult HIV prevalence in
Kenya.
Author:     Cheluget, B.; Baltazar, G.; Orege, P.; Ibrahim, M.; Marum, L. H., and Stover, J.

Source:     Sex Transm Infect. 2006 Apr; 82 Suppl 1:i21-6.

Abstract:   The HIV/AIDS epidemic in Kenya has been tracked through annual sentinel
            surveillance in antenatal clinics since 1990. The system started with 13 sites and
            now has over 35. Behaviours have been measured through national
            Demographic and Health Surveys in 1993, 1998, and 2003. The surveillance data
            indicate that prevalence has declined substantially starting in 1998 in five of the
            original 13 sites and starting in 2000 in another four sites. No decline is evident in
            the other five original sites although the 2004 estimate is the lowest recorded.
            Nationally, adult prevalence has declined from 10% in the late 1990s to under 7%
            today. Surveys indicate that both age at first sex and use of condoms are rising
            and that the percentage of adults with multiple partners is falling. It is clear that
            HIV prevalence is now declining in Kenya in a pattern similar to that seen in



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            Uganda but seven or eight years later. Although the coverage of preventive
            interventions has expanded rapidly since 2000 this expansion was too late to
            account for the beginnings of the decline in prevalence. More work is needed to
            understand fully the causes of this decline, but it is encouraging to see Kenya join
            the small list of countries experiencing significant declines in HIV prevalence.


Optimizing paediatric HIV care in Kenya: challenges in early infant
diagnosis.
Author:     Cherutich, P.; Inwani, I.; Nduati, R., and Mbori-Ngacha, D.

Source:     Bull World Health Organ. 2008 Feb; 86(2):155-60.

Abstract:   Problem:
            In 2003, the goal of the Kenyan Ministry of Health was to avail antiretroviral
            treatment (ART) to 50% of the estimated 250 000 eligible individuals by the end
            of 2005. By July 2005, 45 000 adults and more than 2000 children were on
            treatment. A study was conducted to determine the barriers to identification of
            HIV-infected children.

            Approach:
            Existing government policies were reviewed and the ART register of the Kenya
            National AIDS Control Programme was used to identify facilities providing
            ART. This paper reports the findings around diagnosis and staging of HIV
            infection in children.

            Local setting:
            At the time of the study, 58 health facilities were providing ART to children.
            Only one institution had achieved universal HIV testing in the antenatal clinics.
            Six facilities systematically followed up HIV-exposed children. HIV antibody
            testing was not readily available to the children. Although four research centres
            were capable of carrying out diagnostic HIV polymerase chain reaction (PCR),
            the services were restricted to research purposes. Other constraints were
            inadequate physical infrastructure, inadequate systems for quality control in the
            laboratories and shortage of staff.

            Lessons learnt:
            The policy framework to support identification of HIV-infected children had
            been established, albeit with narrow focus on sick children. The assessment
            identified the weaknesses in the structures for systematic diagnosis of HIV
            through laboratory or clinical-based algorithms. The researchers concluded that
            health staff training and implementation of a systematic standard approach to
            identification of HIV-infected children is urgently required.




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Selection for human immunodeficiency virus type 1 envelope
glycosylation variants with shorter V1-V2 loop sequences occurs during
transmission of certain genetic subtypes and may impact viral RNA
levels.
Author:     Chohan, B.; Lang, D.; Sagar, M.; Korber, B.; Lavreys, L.; Richardson, B., and
            Overbaugh, J.

Source:     J Virol. 2005 May; 79(10):6528-31.

Abstract:   Designing an effective human immunodeficiency virus type 1 (HIV-1) vaccine
            will rely on understanding which variants, from among the myriad of circulating
            HIV-1 strains, are most commonly transmitted and determining whether such
            variants have an Achilles heel. Here we show that heterosexually acquired
            subtype A HIV-1 envelopes have signature sequences that include shorter V1-V2
            loop sequences and fewer predicted N-linked glycosylation sites relative to the
            overall population of circulating variants. In contrast, recently transmitted
            subtype B variants did not, and this was true for cases where the major risk
            factor was homosexual contact, as well as for cases where it was heterosexual
            contact. This suggests that selection during HIV-1 transmission may vary
            depending on the infecting subtype. There was evidence from 23 subtype A-
            infected women for whom there was longitudinal data that those who were
            infected with viruses with fewer potential N-linked glycosylation sites in V1-V2
            had lower viral set point levels. Thus, our study also suggests that the extent of
            glycosylation in the infecting virus could impact disease progression.


Infant feeding in the time of HIV: rapid assessment of infant feeding
policy and programmes in four African countries scaling up prevention
of mother to child transmission programmes.

Author:     Chopra, M. and Rollins, N.

Source:     Arch Dis Child. 2008 Apr; 93(4):288-91.

Abstract:   Objective:
            To assess the infant feeding components of prevention of mother to child HIV
            transmission (PMTCT) programmes.

            Methods:
            Assessments were performed across Botswana, Kenya, Malawi and Uganda. 29
            districts offering PMTCT were selected by stratified random sampling with rural
            and urban strata. All health facilities in the selected PMTCT district were
            assessed. The facility level manager and the senior nurse in charge of maternal
            care were interviewed. 334 randomly selected health workers involved in the



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            PMTCT programme completed self-administered questionnaires. 640 PMTCT
            counselling observations were carried out and 34 focus groups were conducted
            amongst men and women.

            Results:
            Most health workers (234/334, 70%) were unable to correctly estimate the
            transmission risks of breastfeeding irrespective of exposure to PMTCT training.
            Infant feeding options were mentioned in 307 of 640 (48%) observations of
            PMTCT counselling sessions, and in only 35 (5.5%) were infant feeding issues
            discussed in any depth; of these 19 (54.3%) were rated as poor. Several health
            workers also reported receiving free samples of infant formula in contravention
            of the International Code on Breastmilk Substitutes. National HIV managers
            stated they were unsure about infant feeding policy in the context of HIV.
            Finally, there was an almost universal belief that an HIV positive mother who
            breastfeeds her child will always infect the child and intentional avoidance of
            breastfeeding by the mother indicates that she is HIV positive.

            Conclusion:
            These findings underline the need to implement and support systematic infant
            feeding policies and programme responses in the context of HIV programmes.


Breast milk HIV-1 suppression and decreased transmission: a
randomized trial comparing HIVNET 012 nevirapine versus short-course
zidovudine.
Author:     Chung, M. H.; Kiarie, J. N.; Richardson, B. A.; Lehman, D. A.; Overbaugh, J., and
            John-Stewart, G. C.

Source:     AIDS. 2005 Sep 2; 19(13):1415-22.

Abstract:   Objective:
            To compare the effect of perinatal regimens of short-course nevirapine (HIVNET
            012) and zidovudine [Thai-Centers for Disease Control and Prevention (CDC)
            regimen] on breast milk viral shedding and perinatal transmission during the
            first 6 weeks postpartum in a randomized clinical trial.

            Design: Randomized clinical trial.

            Methods:
            Pregnant HIV-1 seropositive women in Nairobi, Kenya who planned to
            breastfeed were randomized to HIVNET 012 or Thai-CDC regimens. Two to
            four breast milk samples were collected each week between delivery and 6 weeks
            postpartum. Breast milk HIV-1 RNA was quantified using the Gen-Probe TMA
            assay. Infants were tested for HIV-1 DNA at birth and 6 weeks.




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            Results:
            From March to October 2003, 76 women were enrolled and 795 breast milk
            samples were collected from 60 women who were randomized and followed
            after delivery. Between 3 and 21 days postpartum, nevirapine was associated
            with significantly greater suppression of breast milk log10 HIV-1 RNA: days 3 to
            7 (1.98 versus 2.42, P = 0.1); days 8 to 14 (1.78 versus 2.48, P = 0.005); days 15 to 21
            (1.90 versus 2.97, P = 0.003). At 6 weeks, the HIV-1 perinatal transmission rate
            was significantly lower among those who took nevirapine than zidovudine (6.8%
            versus 30.3%, P = 0.02).

            Conclusions:
            Compared to a peripartum zidovudine regimen, nevirapine was significantly
            more likely to decrease HIV-1 RNA in breast milk during the first week and
            through the third week postpartum following single-dose administration, and
            corresponded with decreased transmission risk at 6 weeks. Sustained breast milk
            HIV-1 suppression may contribute to the ability of nevirapine to decrease
            perinatal transmission of HIV-1.


Highly active antiretroviral therapy versus zidovudine/nevirapine effects
on early breast milk HIV type-1 Rna: a phase II randomized clinical trial.
Author:     Chung, M. H.; Kiarie, J. N.; Richardson, B. A.; Lehman, D. A.; Overbaugh, J.;
            Kinuthia, J.; Njiri, F., and John-Stewart, G. C.

Source:     Antivir Ther. 2008; 13(6):799-807.

Abstract:   Background:
            Defining the effect of antiretroviral regimens on breast milk HIV type-1 (HIV-1)
            levels is useful to inform the rational design of strategies to decrease perinatal
            HIV-1 transmission.

            Methods:
            Pregnant HIV-1 seropositive women (CD4+ T-cell count >250 and <500
            cells/mm3) electing to breastfeed in Nairobi, Kenya were randomized to highly
            active antiretroviral therapy (HAART; zidovudine [ZDV], lamivudine and
            nevirapine [NVP]) during pregnancy and 6 months post-partum or to short-
            course ZDV plus single-dose NVP (ZDV/NVP). Breast milk samples were
            collected two to three times per week in the first month post-partum.

            Results:
            Between November 2003 and April 2006, 444 breast milk samples were collected
            from 58 randomized women during the first month after delivery. Between 3 and
            14 days post-partum, women in the HAART and ZDV/NVP arms had a similar
            prevalence of undetectable breast milk HIV-1 RNA. From 15 to 28 days post-
            partum, women in the HAART arm had significantly lower levels of breast milk
            HIV-1 RNA than women randomized to ZDV/NVP (1.7 log10 copies/ml [limit


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                            STIs, HIV and AIDS: 2005 - 2008

            of detection] versus >2.10 log10 copies/ml, P<0.001). In contrast to breast milk
            HIV-1 RNA, suppression of plasma HIV-1 RNA during the neonatal period was
            consistently several log10 greater in the HAART arm compared with the
            ZDV/NVP arm.

            Conclusions:
            HAART resulted in lower breast milk HIV-1 RNA than ZDV/NVP; however,
            ZDV/NVP yielded comparable breast milk HIV-1 RNA levels in the first 2 weeks
            post-partum. Breast milk HIV-1 RNA remained suppressed in the ZDV/NVP
            arm despite increased plasma HIV-1 levels, which might reflect local drug effects
            or compartmentalization.


Independent effects of nevirapine prophylaxis and HIV-1 RNA
suppression in breast milk on early perinatal HIV-1 transmission.
Author:     Chung, M. H.; Kiarie, J. N.; Richardson, B. A.; Lehman, D. A.; Overbaugh, J.;
            Njiri, F., and John-Stewart, G. C.

Source:     J Acquir Immune Defic Syndr. 2007 Dec 1; 46(4):472-8.

Abstract:   Background:
            The mechanism of action of single-dose nevirapine on reducing mother-to-child
            transmission of HIV-1 may involve reduction of maternal HIV-1 or prophylaxis
            of infants.

            Methods:
            In a study that randomized pregnant mothers to HIVNET 012 nevirapine versus
            short-course antenatal zidovudine, we compared breast milk HIV-1 RNA viral
            shedding and administration of single-dose nevirapine between mothers who
            transmitted HIV-1 to their infants at 6 weeks postpartum and those who did not.

            Results:
            In multivariate analyses, maximum breast milk HIV-1 RNA levels (hazard ratio
            [HR] = 2.50, 95% confidence interval [CI]: 1.25 to 4.99; P = 0.01) and nevirapine
            use (HR = 0.12, 95% CI: 0.02 to 0.97; P = 0.05) were each independently associated
            with perinatal transmission at 6 weeks postpartum. Mothers who transmitted
            HIV-1 to their infants had significantly higher HIV-1 RNA levels in their breast
            milk between the second day and sixth week postpartum. Among mothers with
            maximum breast milk virus levels less than a median of 3.5 log(10) copies/mL,
            the administration of nevirapine further decreased HIV-1 transmission risk from
            22.2% to 0.0% (P = 0.04).

            Conclusions:
            Peripartum administration of single-dose nevirapine to mother and infant
            decreases early perinatal HIV-1 transmission by means of breast milk HIV-1



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            RNA suppression and, independently, by providing the infant with exposure
            prophylaxis.


Male circumcision is not a panacea for HIV prevention.
Source:     BMJ. British Medical Journal. 2006 Aug 26; 333(7565):409.

Abstract:   Male circumcision was a hot topic at the 16th international conference on AIDS,
            on 13-18 August, in Toronto, accompanied by passionate debate on both sides.
            Delegates heard from scientists that new HIV infections in men could be
            substantially reduced and million of lives saved if male circumcision were to be
            introduced. Critics argued that male circumcision will not be the quick fix for
            HIV prevention unless cultural beliefs are included in the equation. The World
            Health Organization and UNAIDS have so far refused to endorse male
            circumcision as a prevention tool until more evidence is produced. Last year the
            first clinical trial of male circumcision was halted prematurely because early
            results showed that circumcision gave men a 61% protective effect against HIV
            infection compared with men who weren't circumcised. All eyes are on two other
            trials, one in Uganda and one in Kenya, which are expected to end in 2007.
            (excerpt)


Mycoplasma genitalium infection and persistence in a cohort of female
sex workers in Nairobi, Kenya.
Author:     Cohen, C. R.; Nosek, M.; Meier, A.; Astete, S. G.; Iverson-Cabral, S.; Mugo, N. R.,
            and Totten, P. A.

Source:     Sex Transm Dis. 2007 May; 34(5):274-9.

Abstract:   Objective:
            The objective of this study was to assess the risk factors for and persistence of
            Mycoplasma genitalium (MG) in a highly exposed female population in Kenya.

            Study design:
            Two hundred fifty-eight sex workers in Nairobi, Kenya, 18 to 35 years of age,
            were enrolled. Every 2 months, cervical samples were collected for MG,
            Chlamydia trachomatis (CT), and Neisseria gonorrhoeae (GC) testing by
            polymerase chain reaction.

            Results:
            At enrollment, 16% were infected with MG. Seventy-seven subjects acquired 107
            MG infections, giving an incidence of 22.7 per 100 women-years. Incident CT
            (adjusted hazard ratio [HR] = 2.4; 95% confidence interval [CI] = 1.5-4.0), GC (HR
            = 2.0; 95% CI = 1.2-3.5), and HIV infection (adjusted HR = 2.2; 95% CI = 1.3-3.7)



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                             STIs, HIV and AIDS: 2005 - 2008

            were associated with an increased risk of MG. Seventeen percent, 9%, and 21% of
            MG infections persisted 3, 5, and >or=7 months, respectively.

            Conclusion:
            The high incidence of MG, greater than that for both CT (14.0%) and GC (8%),
            association with common sexually transmitted infection risk factors, and
            persistence in the female genital tract supports its role as a common sexually
            transmitted infection in Kenyan women.


High probability of female-to-male HIV-1 transmission for
uncircumcised men with multiple partners.
Author:     Crabb, C.

Source:     AIDS. 2005; 19(10):N1.

Abstract:   Compared to circumcised men, uncircumcised men are more than twice as likely
            to acquire HIV-1 each time they have unprotected sex with an infected woman,
            according to a team of researchers in the US and Kenya. The study----the first to
            measure infectivity, or the probability of HIV-1 transmission per sex act, in a
            context of multiple partnerships----also found that infectivity among men,
            whether circumcised or not, who have several female partners is many fold
            higher than estimates based on monogamous HIV-1 discordant couples. Jared
            Baeten of the University of Washington in Seattle and his colleagues calculated
            infectivity from data collected during a 4-year prospective study of 745 male
            employees of six trucking companies in Mombasa, Kenya. Ninety-five of the men
            were uncircumcised. In quarterly check-ups at a mobile research clinic that
            visited the companies on a weekly basis, each participant reported his sexual
            behavior with wives, casual partners and prostitutes during the previous 3
            months. (excerpt)


Cost, affordability and cost-effectiveness of strategies to control
tuberculosis in countries with high HIV prevalence.
Author:     Currie, C. S.; Floyd, K.; Williams, B. G., and Dye, C.

Source:     BMC Public Health. 2005; 5:130.

Abstract:   Background:
            The HIV epidemic has caused a dramatic increase in tuberculosis (TB) in East
            and southern Africa. Several strategies have the potential to reduce the burden
            of TB in high HIV prevalence settings, and cost and cost-effectiveness analyses
            can help to prioritize them when budget constraints exist. However, published
            cost and cost-effectiveness studies are limited.


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                             STIs, HIV and AIDS: 2005 - 2008

            Methods:
            Our objective was to compare the cost, affordability and cost-effectiveness of
            seven strategies for reducing the burden of TB in countries with high HIV
            prevalence. A compartmental difference equation model of TB and HIV and
            recent cost data were used to assess the costs (year 2003 USD prices) and effects
            (TB cases averted, deaths averted, DALYs gained) of these strategies in Kenya
            during the period 2004-2023.

            Results:
            The three lowest cost and most cost-effective strategies were improving TB cure
            rates, improving TB case detection rates, and improving both together. The
            incremental cost of combined improvements to case detection and cure was
            below USD 15 million per year (7.5% of year 2000 government health
            expenditure); the mean cost per DALY gained of these three strategies ranged
            from USD 18 to USD 34. Antiretroviral therapy (ART) had the highest
            incremental costs, which by 2007 could be as large as total government health
            expenditures in year 2000. ART could also gain more DALYs than the other
            strategies, at a cost per DALY gained of around USD 260 to USD 530. Both the
            costs and effects of treatment for latent tuberculosis infection (TLTI) for HIV+
            individuals were low; the cost per DALY gained ranged from about USD 85 to
            USD 370. Averting one HIV infection for less than USD 250 would be as cost-
            effective as improving TB case detection and cure rates to WHO target levels.

            Conclusion:
            To reduce the burden of TB in high HIV prevalence settings, the immediate goal
            should be to increase TB case detection rates and, to the extent possible, improve
            TB cure rates, preferably in combination. Realising the full potential of ART will
            require substantial new funding and strengthening of health system capacity so
            that increased funding can be used effectively.


CTL epitope distribution patterns in the Gag and Nef proteins of HIV-1
from subtype A infected subjects in Kenya: use of multiple peptide sets
increases the detectable breadth of the CTL response.
Author:     Currier, J. R.; Visawapoka, U.; Tovanabutra, S.; Mason, C. J.; Birx, D. L.;
            McCutchan, F. E., and Cox, J. H.

Source:     BMC Immunol. 2006; 7:8.

Abstract:   Background:
            Subtype A is a major strain in the HIV-1 pandemic in eastern Europe, central
            Asia and in certain regions of east Africa, notably in rural Kenya. While
            considerable effort has been focused upon mapping and defining
            immunodominant CTL epitopes in HIV-1 subtype B and subtype C infections,
            few epitope mapping studies have focused upon subtype A.



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                            STIs, HIV and AIDS: 2005 - 2008

            Results:
            We have used the IFN-gamma ELIspot assay and overlapping peptide pools to
            show that the pattern of CTL recognition of the Gag and Nef proteins in subtype
            A infection is similar to that seen in subtypes B and C. The p17 and p24 proteins
            of Gag and the central conserved region of Nef were targeted by CTL from HIV-
            1-infected Kenyans. Several epitope/HLA associations commonly seen in
            subtype B and C infection were also observed in subtype A infections. Notably,
            an immunodominant HLA-C restricted epitope (Gag 296-304; YL9) was
            observed, with 8/9 HLA-CW0304 subjects responding to this epitope. Screening
            the cohort with peptide sets representing subtypes A, C and D (the three most
            prevalent HIV-1 subtypes in east Africa), revealed that peptide sets based upon
            an homologous subtype (either isolate or consensus) only marginally improved
            the capacity to detect CTL responses. While the different peptide sets detected a
            similar number of responses (particularly in the Gag protein), each set was
            capable of detecting unique responses not identified with the other peptide sets.

            Conclusion:
            Hence, screening with multiple peptide sets representing different sequences,
            and by extension different epitope variants, can increase the detectable breadth
            of the HIV-1-specific CTL response. Interpreting the true extent of cross-
            reactivity may be hampered by the use of 15-mer peptides at a single
            concentration and a lack of knowledge of the sequence that primed any given
            CTL response. Therefore, reagent choice and knowledge of the exact sequences
            that prime CTL responses will be important factors in experimentally defining
            cross-reactive CTL responses and their role in HIV-1 disease pathogenesis and
            validating vaccines aimed at generating broadly cross-reactive CTL responses.


National resource flows for HIV / AIDS in Kenya, Rwanda, and Zambia:
a comparative analysis.

Author:     De S and Dmytraczenko, T.

Abstract:   An effective fight against HIV/AIDS necessitates a comprehensive
            understanding of existing financing of national HIV/AIDS services (including
            public, private, and donor components). Yet many countries most affected by the
            epidemic lack data, which increases the risk of inappropriate allocation of funds,
            and suspension of donor funding. National Health Accounts (NHA) is a policy
            tool for tracking national spending on health care. The NHA HIV/AIDS
            subaccounts framework allows for more detailed examinations of spending on
            HIV/AIDS, which can inform national HIV/AIDS strategic plans and then
            measure progress toward planned goals. With the NHA tool rapidly becoming
            institutionalized in many countries that also receive major international
            HIV/AIDS grants, the subaccount framework can be used for the financial
            monitoring that these grants require. This paper reports on subaccount findings
            for 2002 from Kenya, Rwanda, and Zambia, all of which face generalized



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                             STIs, HIV and AIDS: 2005 - 2008

            HIV/AIDS epidemics. Estimates show that their resource envelopes for
            HIV/AIDS were quite sizeable even prior to the surge in donor funds for
            treatment. Expenditures for HIV/AIDS health care - in 2002, primarily treatment
            of opportunistic infections and programs for prevention and public health -
            represented approximately 1 percent of national gross domestic product (GDP)
            levels, this in countries where overall health care resources accounted for only 4-
            5 percent of the GDP. Although donor financing accounted for the largest share
            of resources (usually more than half), most of these funds were targeted to
            programmatic activities, leaving households to pay for at least half of all medical
            care services. Indeed, people living with HIV/AIDS paid 3-6 times more out-of-
            pocket for health services than did the general population. Perhaps reflective of
            the direction in which the response to HIV/AIDS is managed, fund flows in
            Rwanda are increasingly channeled through the nongovernmental sector. This
            raises questions about government stewardship of the fight against the epidemic.
            (author's)


HIV infection among couples in Burkina Faso, Cameroon, Ghana, Kenya,
and Tanzania.
Author:     de Walque, D. Discordant couples.

Abstract:   Most analyses of the determinants of HIV infection are performed at the
            individual level. The recent Demographic and Health Surveys which include
            results from HIV tests allow studying HIV infection at the level of the cohabiting
            couple. This paper exploits this feature of the data for Burkina Faso, Cameroon,
            Ghana, Kenya and Tanzania. The analysis yields two surprising findings about
            the dynamics of the HIV/AIDS epidemic which have important implications for
            policy. First, at least two-thirds of the infected couples are discordant couples, i.e.
            couples where only one of the two partners is infected. This implies that there is
            scope for prevention efforts among infected couples. Second, between 30 and 40
            percent of the infected couples are couples where the female partner only is
            infected. This is at odds with levels of self-reported marital infidelity by females
            and with the common perception that unfaithful males are the main link between
            high risk groups and the general population. This study investigates and
            confirms the robustness of these findings. For example, even among couples
            where the woman has been in only one union for ten years or more, the fraction
            of couples where only the female partner is infected remains high. These results
            indicate that extramarital sexual activity among cohabiting women, whatever its
            causes, is a substantial source of vulnerability to HIV that should be, as much as
            male infidelity, targeted by prevention efforts. Moreover, this paper uncovers
            several inconsistencies between the sexual behaviors reported by male and
            female partners, suggesting that, as much as possible, prevention policies should
            rely on evidence including objectively measured HIV status. (author's)




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                            STIs, HIV and AIDS: 2005 - 2008


Do unsafe tetanus toxoid injections play a significant role in the
transmission of HIV/AIDS? Evidence from seven African countries.

Source:     Sex Transm Infect. 2008 Apr; 84(2):122-5.

Abstract:   Objectives:
            Although sexual transmission is generally considered to be the main factor
            driving the HIV/AIDS epidemic in Africa, recent studies have claimed that
            iatrogenic transmission should be considered as an important source of HIV
            infection. In particular, receipt of tetanus toxoid injections during pregnancy has
            been reported to be associated with HIV infection in Kenya. The objective of this
            paper is to assess the robustness of this association among women in nationally
            representative HIV surveys in seven African countries.

            Methods:
            The association between prophylactic tetanus toxoid injections during pregnancy
            and HIV infection was analysed, using individual-level data from women who
            gave birth in the past five years. These data are from the nationally
            representative Demographic and Health Surveys, which included HIV testing in
            seven African countries: Burkina Faso 2003 (N = 2424), Cameroon 2004 (N =
            2600), Ethiopia 2005 (N = 2886), Ghana 2003 (N = 2560), Kenya 2003 (N = 1617),
            Lesotho 2004 (N = 1278) and Senegal 2005 (N = 2126).

            Results:
            Once the odds ratios (OR) were adjusted for five-year age groups and for ethnic,
            urban and regional indicators, the association between prophylactic tetanus
            toxoid injections during pregnancy and HIV infection was never statistically
            significant in any of the seven countries. Only in Cameroon was there an
            association between previous tetanus toxoid injection and HIV positivity but it
            became weaker (OR 1.53, 95% CI 0.91 to 2.57) once urban location and ethnic
            group were adjusted for.

            Conclusions:
            Although the risk of HIV infection through unsafe injections and healthcare
            should not be ignored and should be reduced, it does not seem that there is, at
            present and in the seven countries studied, strong evidence supporting the claim
            that unsafe tetanus toxoid injections are a major factor driving the HIV epidemic.


Sero-discordant couples in five African countries: Implications for
prevention strategies.
Author:     De Walque, D.

Source:     Population and Development Review. 2007 Sep; 33(3):501-523.



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                            STIs, HIV and AIDS: 2005 - 2008

Abstract:   THE HIV/AIDS EPIDEMIC is one of the greatest challenges facing Africa.
            According to UNAIDS (2006), as of December 2006, between 21.8 and 27.7
            million people in sub-Saharan Africa were infected by HIV/AIDS. This
            represents around 62.5 percent of the estimated worldwide total and implies that
            between 5.2 and 6.7 percent of adults living in that region are HIV positive.
            Between 1.8 and 2.4 million sub-Saharan Africans died from the virus in 2006
            and between 2.4 and 3.2 million became newly infected. Only recently have
            individual-level data, including HIV test results, become available for nationally
            representative samples in Africa and other developing regions. Previously,
            studies of the HIV epidemic relied either on aggregate data or on HIV status data
            from nonrepresentative samples or on data from self-reported sexual behavior.
            The new wave of Demographic and Health Surveys (DHS), which include HIV
            status, now permits analysis of the socioeconomic determinants of HIV infection
            for nationally representative samples. The present study of sero-discordant
            couples uses an additional feature of the data available in the Demographic and
            Health Surveys. The data make it possible to assess the HIV status of cohabiting
            couples (formally married or not) and to compare sexual behavior reported by
            the man and the woman. (excerpt)


Quality and quantity of antenatal HIV counselling in a PMTCT
programme in Mombasa, Kenya.
Author:     Delva, W.; Mutunga, L.; Quaghebeur, A., and Temmerman, M. 2006 Apr;
            18(3):189-93.

Abstract:   A recent report from a PMTCT implementation study in Mombasa, Kenya,
            points at an important gap between the efficacy in clinical trial circumstances
            and the effectiveness of PMTCT programmes when implemented in real life.
            Hence, the quality and quantity of antenatal HIV counselling in a routine setting
            were appraised. The counsellors' social and communicative skills, duration and
            topics covered during pre- and post-test counselling sessions were assessed by
            means of the VCT assessment tools published by UNAIDS. A total of 14 group
            educational sessions, 66 pre-test counselling sessions and 50 post-test counselling
            sessions were observed and assessed. In general, the frequency and duration of
            the counselling was low. Crucial topics such as window period and partner
            involvement and follow-up support were covered haphazardly. The counsellor's
            social and communicative skills were given high marks, yet information was
            rarely repeated or summarized. The limited time dedicated to women receiving
            antenatal VCT contrasts with the heavy and comprehensive load of health
            information and advice they are supposed to receive. Ample pre- and post-test
            counselling including follow-up should be pursued for optimal effectiveness of
            PMTCT. We propose a number of health system interventions preceded and
            guided by ongoing audit.




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                             STIs, HIV and AIDS: 2005 - 2008


The role of sexually transmitted infections in male circumcision
effectiveness against HIV--insights from clinical trial simulation.
Author:     Desai, K.; Boily, M. C.; Garnett, G. P.; Masse, B. R.; Moses, S., and Bailey, R. C.

Source:     Emerg Themes Epidemiol. 2006; 3:19.

Abstract:   Background:
            A landmark randomised trial of male circumcision (MC) in Orange Farm, South
            Africa recently showed a large and significant reduction in risk of HIV infection,
            reporting MC effectiveness of 61% (95% CI: 34%-77%). Additionally, two further
            randomised trials of MC in Kisumu, Kenya and Rakai, Uganda were recently
            stopped early to report 53% and 48% effectiveness, respectively. Since MC may
            protect against both HIV and certain sexually transmitted infections (STI), which
            are themselves cofactors of HIV infection, an important question is the extent to
            which this estimated effectiveness against HIV is mediated by the protective
            effect of circumcision against STI. The answer lies in the trial data if the
            appropriate statistical analyses can be identified to estimate the separate
            efficacies against HIV and STI, which combine to determine overall effectiveness.

            Objectives and methods:
            Focusing on the MC trial in Kisumu, we used a stochastic prevention trial
            simulator (1) to determine whether statistical analyses can validly estimate
            efficacy, (2) to determine whether MC efficacy against STI alone can produce
            large effectiveness against HIV and (3) to estimate the fraction of all HIV
            infections prevented that are attributable to efficacy against STI when both
            efficacies combine.

            Results:
            Valid estimation of separate efficacies against HIV and STI as well as MC
            effectiveness is feasible with available STI and HIV trial data, under Kisumu trial
            conditions. Under our parameter assumptions, high overall effectiveness of MC
            against HIV was observed only with a high MC efficacy against HIV and was not
            possible on the basis of MC efficacy against STI alone. The fraction of all HIV
            infections prevented which were attributable to MC efficacy against STI was
            small, except when efficacy of MC specifically against HIV was very low. In the
            three MC trials which reported between 48% and 61% effectiveness (combining
            STI and HIV efficacies), the fraction of HIV infections prevented in circumcised
            males which were attributable to STI was unlikely to be more than 10% to 20%.

            Conclusion:
            Estimation of efficacy, attributable fraction and effectiveness leads to improved
            understanding of trial results, gives trial results greater external validity and is
            essential to determine the broader public health impact of circumcision to men
            and women.




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The evidence for health-care transmission of HIV in Africa should
determine prevention priorities [letter].

Author:     Deuchert E and Brody, S.

Source:     International Journal of STD and AIDS. 2007 Apr; 18(4):290-291.

Abstract:   Our results are consistent with many other sources of evidence, including the
            recent report by St. Lawrence et al. of HIV risks in Zambian women: 'Medically
            administered intramuscular(IM) or intravenous injections in the past five years
            (but not blood transfusions) were overwhelmingly correlated with HIV
            prevalence' (p 607) (OR for IM/ intravenous injections in the past five years =
            2.59 [95% CI = 2.15-3.11]). In the multivariate model incorporating injection
            exposures, they also found that more frequent sexual intercourse was 'protective'
            against HIV, which is inconsistent with penile-vaginal intercourse being a risk
            per se. Further support was provided by the finding that condom use with non-
            primary partners was not protective against HIV (their finding that 'occasional',
            but not frequent or always use with the primary partner was protective argues
            against a direct effect and in favour of being a marker for other, perhaps non-
            sexual factors). Other recent research has also shown a significant HIV risk
            associated with medical injections but not number of sexual partners in India.
            Thus, our recommendation to reallocate resources to address health-care
            transmission of HIV/AIDS in sub-Saharan Africa is not only supported by our
            data but also by that of other well-conducted studies. This evidence should
            determine prevention priorities. (excerpt).


The protective effect of male circumcision on HIV infection in a sample
of Kenyan men.
Author:     Djamba, Y. K. and . = Davis LS.

Source:     African Journal of AIDS Research. 2007; 6(3):199-204.

Abstract:   This article examines the association between male circumcision and HIV
            infection in a national sample. The analysis is based on the 2003 Kenya
            Demographic and Health Survey (KDHS), a nationally representative household-
            based population survey of adults, in which male respondents self-reported their
            circumcision status. In addition, in some households eligible for individual
            interview, blood samples were subsequently anonymously obtained for HIV
            testing, making this the first study linking socio-demographic information to
            HIV status at the national level. The study sample is limited to 3 413 men aged
            15-54 years who gave valid information on their circumcision and HIV statuses.
            Nearly 5% of the men were HIV-positive, and 86% had been circumcised. HIV
            prevalence was significantly higher among the uncircumcised men (12%) than
            among the circumcised men (3%). This indication of the protective effect of male


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            circumcision on HIV infection remained statistically significant (OR 0.15; 95%CI:
            0.09-0.23) even after controlling for the effects of socio-demographic variables,
            age at first sexual intercourse, and use of paid sex. Based on these results, we
            recommend that HIV-prevention advocates and activists, scholars, bio-medical
            communities and political leaders find ways to include this oldest surgical
            procedure in their HIV/AIDS discourses and programmes in sub-Saharan
            Africa. (author's)


The protective effect of male circumcision on HIV infection in Kenya.
Author:     Djamba, Y. K. and . = Davis TS.

Abstract:   This paper uses data from the 2003 Kenya Demographic and Health Survey, a
            nationally representative sample, to examine the association between male
            circumcision and HIV infection. The results show that 4.6 percent of men were
            HIV positive; 86 percent of all men in the sample were circumcised. The
            prevalence of HIV was significantly higher among uncircumcised men (12%), as
            compared to the circumcised ones (3%). We also found significantly higher
            prevalence of HIV among richer men. The logistic regression results show that
            male circumcision is the most important and significant predictor of HIV in
            Kenya. Net of the effects of socio-demographic variables, age at first sexual
            intercourse and use of paid sex, uncircumcised men were 86 percent more likely
            to be HIV positive than circumcised men. Given this strong protective effect of
            male circumcision, we recommend that HIV advocates and activists, scholars,
            bio-medical communities, and political leaders find ways to include this oldest
            surgical procedure in their HIV/AIDS discourses and programs in sub-Saharan
            Africa. (author's)


Herpes simplex virus type 2 and risk of intrapartum human
immunodeficiency virus transmission.
Author:     Drake, A. L.; John-Stewart, G. C.; Wald, A.; Mbori-Ngacha, D. A.; Bosire, R.;
            Wamalwa, D. C.; Lohman-Payne, B. L.; Ashley-Morrow, R.; Corey, L., and
            Farquhar, C.

Source:     Obstet Gynecol. 2007 Feb; 109(2 Pt 1):403-9.

Abstract:   Objective:
            To determine whether herpes simplex virus type 2 (HSV-2) infection was
            associated with risk of intrapartum human immunodeficiency virus type 1 (HIV-
            1) transmission and to define correlates of HSV-2 infection among HIV-1-
            seropositive pregnant women.




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            Methods:
            We performed a nested case control study within a perinatal cohort in Nairobi,
            Kenya. Herpes simplex virus type 2 serostatus and the presence of genital ulcers
            were ascertained at 32 weeks of gestation. Maternal cervical and plasma HIV-1
            RNA and cervical HSV DNA were measured at delivery.

            Results:
            One hundred fifty-two (87%) of 175 HIV-1-infected mothers were HSV-2-
            seropositive. Among the 152 HSV-2-seropositive women, nine (6%) had genital
            ulcers at 32 weeks of gestation, and 13 (9%) were shedding HSV in cervical
            secretions. Genital ulcers were associated with increased plasma HIV-1 RNA
            levels (P=.02) and an increased risk of intrapartum HIV-1 transmission (16% of
            transmitters versus 3% of nontransmitters had ulcers; P = .003), an association
            which was maintained in multivariable analysis adjusting for plasma HIV-1
            RNA levels (P=.04). We found a borderline association for higher plasma HIV-1
            RNA among women shedding HSV (P=.07) and no association between cervical
            HSV shedding and either cervical HIV-1 RNA levels or intrapartum HIV-1
            transmission (P=.4 and P=.5, [corrected] respectively).

            Conclusion:
            Herpes simplex virus type 2 is the leading cause of genital ulcers among women
            in sub-Saharan Africa and was highly prevalent in this cohort of pregnant
            women receiving prophylactic zidovudine. After adjusting for plasma HIV-1
            RNA levels, genital ulcers were associated with increased risk of intrapartum
            HIV-1 transmission. These data suggest that management of HSV-2 during
            pregnancy may enhance mother-to-child HIV-1 prevention efforts. LEVEL OF
            EVIDENCE: II.


Seizing the big missed opportunity: linking HIV and maternity care
services in sub-Saharan Africa.
Author:     Druce, N. and Nolan, A.

Source:     Reprod Health Matters. 2007 Nov; 15(30):190-201.

Abstract:   This paper draws on two reviews commissioned by the UK Department for
            International Development in 2006-2007 that explore progress in linking HIV
            prevention and maternity services in sub-Saharan Africa. Although pilot and
            demonstration projects have been successful, progress in scaling up PMTCT has
            been slow, reaching just 11% of pregnant HIV positive women in much of Africa,
            less than half the percentage of coverage achieved by antiretroviral treatment
            programmes for adults in need. Despite ongoing efforts to promote
            comprehensive approaches, significant policy, financing and institutional
            barriers, and weak co-ordination and leadership, continue to hamper progress.
            Maternal health services face human and financial resource shortages which
            affect their capacity to integrate HIV prevention. Both HIV and maternal health


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            programmes often receive targeted financial and technical assistance that does
            not take the other into account. However, proposals in 2007 from a number of
            countries to the Global Fund to Fight AIDS, TB and Malaria incorporate sexual
            and reproductive health programming that will have an impact on HIV,
            including certain maternity services. Moreover, Botswana, Kenya and Rwanda
            have shown that progress can be made where national commitment and
            increased resources are enabling maternal and newborn care to address HIV.


Education and HIV / AIDS prevention: evidence from a randomized
evaluation in western Kenya.
Author:     Duflo E; Dupas P; Kremer M, and Sinei, S.

Abstract:   We report results from a randomized evaluation comparing three school-based
            HIV/AIDS interventions in Kenya: 1) training teachers in the Kenyan
            Government's HIV/AIDS-education curriculum; 2) encouraging students to
            debate the role of condoms and to write essays on how to protect themselves
            against HIV/AIDS; and 3) reducing the cost of education. Our primary measure
            of the effectiveness of these interventions is teenage childbearing, which is
            associated with unprotected sex. We also collected measures of knowledge,
            attitudes, and behavior regarding HIV/AIDS. After two years, girls in schools
            where teachers had been trained were more likely to be married in the event of a
            pregnancy. The program had little other impact on students' knowledge,
            attitudes, and behavior, or on the incidence of teen childbearing. The condom
            debates and essays increased practical knowledge and self-reported use of
            condoms without increasing self-reported sexual activity. Reducing the cost of
            education by paying for school uniforms reduced dropout rates, teen marriage,
            and childbearing. (author's)


Severe gynecomastia in an African boy with perinatally acquired human
immunodeficiency virus infection receiving highly active antiretroviral
therapy.
Author:     Dzwonek, A.; Clapson, M.; Withey, S.; Bates, A., and Novelli, V.

Source:     Pediatr Infect Dis J. 2006 Feb; 25(2):183-4.

Abstract:   Highly active antiretroviral therapy (HAART) slows the progression of human
            immunodeficiency virus (HIV) disease and lowers mortality and morbidity in
            children. Coincident with these advances, an increasing number of side effects
            are being reported. We describe an adolescent boy with perinatally acquired HIV
            infection who developed significant bilateral breast enlargement as a result of
            HAART. He required bilateral mastectomies. Pediatricians need to be aware of
            less common side effects of HAART.


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                             STIs, HIV and AIDS: 2005 - 2008


Orphans and schooling in Africa: a longitudinal analysis.
Author:     Evans, D. K. and Miguel, E.

Source:     Demography. 2007 Feb; 44(1):35-57.

Abstract:   AIDS deaths could have a major impact on economic development by affecting
            the human capital accumulation of the next generation. We estimate the impact
            of parent death on primary school participation using an unusual five-year panel
            data set of over 20,000 Kenyan children. There is a substantial decrease in school
            participation following a parent death and a smaller drop before the death
            (presumably due to pre-death morbidity). Estimated impacts are smaller in
            specifications without individual fixed effects, suggesting that estimates based
            on cross-sectional data are biased toward zero. Effects are largest for children
            whose mothers died and, in a novel finding, for those with low baseline
            academic performance.


Pediatric HIV type 1 vaccine trial acceptability among mothers in Kenya.
Author:     Farquhar, C.; John-Stewart, G. C.; John, F. N.; Kabura, M. N., and Kiarie, J. N.

Source:     AIDS Res Hum Retroviruses. 2006 Jun; 22(6):491-5.

Abstract:   Vaccination of infants against human immunodeficiency virus type 1 (HIV-1)
            may prevent mother-to-child HIV-1 transmission. Successful trials and
            immunization efforts will depend on the willingness of individuals to participate
            in pediatric vaccine research and acceptance of infant HIV-1 vaccines. In a cross-
            sectional study, pregnant women presenting to a Nairobi antenatal clinic for
            routine care were interviewed regarding their attitudes toward participation in
            research studies and HIV-1 vaccine acceptability for their infants. Among 805
            women, 782 (97%) reported they would vaccinate their infant against HIV-1 and
            729 (91%) reported willingness to enroll their infant in a research study.
            However, only 644 (80%) would enroll their infants if HIV- 1 testing was
            required every 3 months and 513 (64%) would agree to HIV-1 vaccine trial
            participation. Reasons for not wanting to enroll in a pediatric HIV-1 vaccine trial
            included concerns about side effects (75%), partner objection (34%), and fear of
            discrimination (10%), HIV-1 acquisition (8%), or false-positive HIV-1 results
            (5%). The strongest correlate of pediatric vaccine trial participation was maternal
            willingness to be a vaccine trial participant herself; in univariate and multivariate
            models this was associated with a 17-fold increased likelihood of participation
            (HR 17.1; 95% CI 11.7-25; p < 0.001). We conclude from these results that
            immunizing infants against HIV-1 and participation in pediatric vaccine trials
            are generally acceptable to women at high risk for HIV-1 infection. It will be
            important to address barriers identified in this study and to include male




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            partners when mobilizing communities for pediatric HIV-1 vaccine trials and
            immunization programs.


Mapping transactional sex on the Northern Corridor highway in Kenya.
Author:     Ferguson, A. G. and Morris, C. N.

Source:     Health Place. 2007 Jun; 13(2):504-19.

Abstract:   Even in generalized HIV/AIDS epidemics, vulnerable populations such as sex
            workers and truckers require special attention in programming. Combining a
            number of elicitation methods, centred on Geographical Information Systems
            (GIS) mapping, the Kenyan section of the Northern Corridor highway was
            studied to characterize the 'hot spots' where transactional sex is concentrated and
            to provide estimates of numb