bluuebunny/crossref_metadata_2025_split huggingface dataset:
P2-S3.07 Responding to problems of sexual violence and vulnerability to HIV/AIDS within crisis and unstable situations: a case study of Kenya's post-election violence
Authors: Musyoka C , Mwendwa A , Kyalo N 
Published: July 2011

Introduction and BackgroundSexual violence and the risk of HIV transmission are clearly linked through multiple pathways underpinned by gender inequalities and poverty like increased genital injury, anal rape, multiple perpetrators and ejaculation all common in sexual violence. It is important therefore to understand and recognise these links between sexual violence and HIV/AIDS as the basis for developing strategies to address the complex interactions at individual, communal and institutional levels.ObjectivesBased on the Kenya's post-election violence of 2008, this study aimed to capture and understand the complex and multiple factors that interact to influence vulnerability to HIV and AIDS. Its holistic framework proposed a macro level model for understanding the risks factors for STIs, and HIV/AIDS transmission within the context of sexual violence. Its main objective was to explore and identify bio-medical and epidemiological factors that act as conduits for the transmission of HIV/AIDS and other STIs within crisis and unstable settings.Methodology and ResultsIt uses a multi-disciplinary approach that simultaneously embraces gender, poverty and biomedical analytical lenses to identify and strategically address emerging links between violence and HIV/AIDS. Interviews and VCT were administered to both multistage cluster and purposively-random sampled sexual violence victims in Kenya—A multiple logistic regression model controlling age, condom use (if any), and biological influences like the routes of exposure—whether vagino-penile or anal-penile—and sex of both victims and assailants was adopted. Overall prevalence for HIV, syphilis and gonorrhoea shot up: 2.3%, 1.1%, and 3.1% respectively among men. For women: 2.7%, 1.9%, and 4.2.0% respectively.Conclusion and RecommendationsSexual violence diminishes people's social capital in terms of social networks, norms, and traditions that could prove to be conducive to the spread of the HIV. We recommend early diagnosis to allow treatment of sexual violence survivors. Post Exposure Prophylaxis (PEP), to address exposure to HIV as a result of sexual violence, emergency contraception and VCT should form the backbone for intervention in order to address the menace of HIV/AIDS. Anti-retroviral regimens dramatically improve rates of mortality and morbidity, prolong lives, improve quality of life, revitalise communities and transform perceptions of HIV/AIDS from a plague to a manageable, chronic illness.
P1-S1.33 Timing of progression ofChlamydia trachomatisinfection to pelvic inflammatory disease - a Mathematical Modelling Study
Authors: Herzog S A , Althaus C L , Heijne J C M , Oakeshott P , Kerry S , Hay P 
Published: July 2011

BackgroundScreening programmes aim to detect and treat asymptomaticChlamydia trachomatis(chlamydia) infections to prevent ongoing transmission and reduce the incidence of pelvic inflammatory disease (PID). The timing of development of PID after chlamydia infection might affect the potential impact of screening to interrupt ascending infection. We used mathematical models to study three hypothetical processes for the timing of progression from chlamydia infection to PID and determine which was most consistent with empirical data.MethodsWe used data from the Prevention of Pelvic Infection (POPI) randomised controlled trial (RCT) that was designed to examine the effect of chlamydia screening on PID incidence over a follow-up period of 1 year. We developed a compartmental model that simulates the RCT results in a Susceptible-Infected-Susceptible framework and tracks the number of PID episodes in the screened and control groups. The model is fitted to the incidence of 1.9% in the absence of screening (POPI control group) and predicts PID rates when screening is implemented. The hypothesised processes were—PID develops at the beginning of an infection with chlamydia; PID can develop throughout the course of a chlamydia infection at a constant rate; and PID happens at the end of chlamydia infection before spontaneous clearance. We predicted the incidence of PID with each process and compared these with the observed cumulative incidence of 1.3% (95% CI 0.7 to 2.1%) in the POPI screened group. We took into account baseline chlamydia prevalence, screening uptake during the RCT, duration of infection and treatment failure.ResultsThe mathematical models suggested that the process by which PID develops during the course of a chlamydia infection was closest to the observed cumulative incidence in the screened group, but the process with PID at the end of chlamydia infection was also compatible with the empirical data. The process where PID develops at the very beginning of a chlamydia infection predicted a higher incidence of PID in the screened than the control group. Our model also allowed us to estimate the proportion of chlamydia infections that develops PID and the reduction in PID incidence due to long-term screening.ConclusionThis study suggests that the development of PID can happen during or, possibly, at the end of a chlamydia infection. This implies that screening for chlamydia might have a direct effect on PID prevention by interrupting ascending infection.
P2-S3.11 STI-related risk behaviours and STI disparity between residents of Baltimore City and other urban cities in the USA
Authors: Villarroel M , Rogers S , Turner C 
Published: July 2011

BackgroundBaltimore City, Maryland, has experienced rates of STDs that are consistently higher than the national average. National surveillance data indicate that in 2000 the rates of gonorrhoea and Chlamydia in Baltimore City were 3.3 and 6.7 times higher than the overall US rate. Among US cities with greater than 200 000 people, Baltimore City ranked among the top four for Chlamydia and gonorrhoea infection rates.ObjectiveTo compare reports of diagnoses of gonorrhoea and Chlamydia among adults residing in Baltimore City to those in other central cities of the US and to assess whether a higher prevalence of sexual and substance use behaviours in Baltimore may account for infection disparity.MethodsWe utilised data collected from a cross-sectional probability telephone survey of the USA (N=1,543) and Baltimore City (N=744) adults aged 18–45 years old in 1999–2000. Respondents were asked about a wide range of STI-related risk behaviours and STI history. Bivariate analysis assessed differences in the prevalence of self-reported history of gonorrhoea and chlamydia, substance use, and sexual risk behaviours among residents of Baltimore City and other central cities of the USA Multivariate logistic regression models measured heterogeneity in self-reported history of gonorrhoea and chlamydia by location of residence, substance use and sexual history, adjusting for race and age.ResultsLifetime prevalence of gonorrhoea and chlamydia was 18.2% (95% CI 14.8% to 22.1%) among Baltimore residents and 9.8% (95% CI 7.3% to 13%) among residents of other central cities (p<0.001). In bivariate analysis, Baltimore residents were no more likely to report a history of cocaine or injection drug use than residents of other urban areas (p=0.774). However, Baltimore residents were more likely to report having six or more lifetime sexual partners (49.1% vs 40.7%, Prev. Ratio 1.21 (95% CI 1.2 to 1.24)), multiple partners in the past year (24.3% vs 16.9%, Prev. Ratio 1.4 (95% CI 1.4 to 1.5)), and a history of paid sex (17.8% vs 8.7%, Prev. Ratio 2.0 (95% CI 1.8 to 2.3)).ConclusionThe higher prevalence of sexual risk behaviours among Baltimore adults is likely to accelerate STI transmission and contribute to the higher incidence of STIs in Baltimore.
P2-S3.13 Effective HIV and AIDS prevention: is factors affecting the spread important?
Authors: Bankole M , Bankole M , Adebowale A , Iboma G , Olonire O 
Published: July 2011

BackgroundThere is no doubt that the last two decades had witnessed a rising trend in the Global efforts at combating HIV and AIDs, more especially through the various treatment measures. However, though a lot had been achieved in the treatment of infected persons, the long and short term side effects of the drugs; patient drug adherence and follow-up issues are often problematic. Therefore, the most appropriate way to address the menace will be rigorous efforts geared towards adopting simple and effective prevention methods the world over. In developing countries such as found in Africa, including Nigeria, there are many factors militating against achieving a good success in reducing the spread of HIV and AIDs. The identified factors include: culture and tradition of the people, peer group influence, large family burden (Economy), marriage and religion. Hence, this work was undertaken to identify the most common factors contributing to the spread of HIV and AIDS in order to adopt adequate, practical and preventive solutions to tackle the identified factors in Lagos, Nigeria.MethodQuestionnaires were distributed to 500 people in different locations in Lagos State, including one tertiary institution, 50 hair dressing and barbing salons, five community groups, 50 patent medicine dealers' shops, National Union of Road Transport Workers and ten randomly selected secondary schools in the five geographical zones in Lagos State between October 2009 and May 2010.ResultOut of the 500 people given questionnaires, only 350 (70%) responded. Out of the 350 respondents, 315 (90%) of them have had sex at one time or another, of which a highly significant (p>0.05) 157 (49.8%) people have had unprotected sex in the past. Of this group, 70 (44.6%) were sex with multiple partners while 87 (55.4%) were sex with single partners. Fifty (31.9%) people in this group adduced their reason for unprotected sex to marriage obligation, 20 (12.7%) to religion, 30 (19.1%) to culture and tradition, 40 (25.5%) to peer influence while 37 (23.6%) were due to economic reasons.ConclusionThere is a large pool of people who are still engaged in unprotected sex especially with multiple sexual partners in Lagos, Nigeria. The reasons include social, economic, religious, marital and religious factors. Hence a lot more concerted effort is needed by the Government, private organizations, religious and traditional leaders to educate and enlighten people on the need for protected sex, especially people with multiple sexual partners in order to reduce the spread of STIs including HIV and AIDS in our communities in Lagos, Nigeria.
P2-S4.05 Acceptability of medical male circumcision among men attending an HIV voluntary counselling and testing center in Mysore, India
Authors: Madhivanan P , Krupp K , Srinivas V , Klausner J 
Published: July 2011

BackgroundThere is currently limited information on the acceptability of medical male circumcision (MMC) in India. This study investigated the acceptability of MMC as a HIV prevention strategy among attendees of an HIV voluntary counselling and testing center (VCT) in Mysore, India.MethodsA cross-sectional survey was conducted among a consecutive sample of 300 men attending the VCT in Mysore, India, between April and August 2009. After obtaining the informed consent in Kannada, an interviewer administered survey collected demographic, sexual risk behaviour, perceived risk and acceptability of MMC information.ResultsMost participants were Hindus (98.2%); 1.5% were Muslims, and 0.3% belonged to other religions. Fifty-three per cent of respondents had less than 7 years of schooling, 27.5% had 8–10 years, 3.0 % had attended high school and 16.0% had more than 12 years. Of participants, 71% were married and 45% made less than 4000 INR per month. About 244(73.9%) said that they had heard of MMC. On being informed about the risks and benefits of male circumcision, 97.9% said that other men should consider MMC to reduce the risk of contracting HIV/STDs. When asked if they would consider being circumcised safely in a hospital or clinic with little/no pain and at low/no cost, only a third (32.1%) said they would consider circumcision. The most important barriers to MMC reported by participants included MMC not being their cultural tradition (90%), fear of stigma and rejection by friends and family (74.8%) and pain (76.7%).ConclusionsWhile MMC has been shown to be protective against heterosexual acquisition of HIV, little is known about whether it could be implemented in this primarily non-circumcising country. While this study found relatively low acceptability for MMC among VCT clinic attendees, more research on MMC acceptability among other populations, particularly those at high risk for HIV, is warranted.
P2-S5.01 A qualitative study of barriers to consistent condom use among HIV-1 serodiscordant couples in Kenya
Authors: Ngure K , Mugo N , Celum C , Baeten J , Morris M , Olungah O , Olenja J , Tamooh H , Shell-Duncan B 
Published: July 2011

BackgroundConsistent condom use reduces HIV-1 risk and is important for HIV-1 serodiscordant couples (where one partner is HIV-1-infected and the other is HIV-1-uninfected). This study explored barriers to consistent condom use among heterosexual HIV-1 serodiscordant couples.MethodsThis qualitative study used 28 in-depth interviews and 9 focus group discussions. The participants were purposively-selected heterosexual HIV-1 serodiscordant couples from Thika and Nairobi districts in Kenya.ResultsA majority of HIV-1 serodiscordant couples reported challenges in consistent condom use. The main barriers to consistent condom use included male partners' reluctance to use condoms regardless of HIV-1 status, female partners' inability to negotiate condom use, poor knowledge of condom use leading to condom breakage, misconceptions about HIV-1 serodiscordance, challenges in disclosing HIV-1 positive results to new sexual partners, desire for conception, and reduced sexual pleasure reported by both male and female partners. Condom use was cited as one of the main challenges of living with HIV-1 serodiscordance.ConclusionsSerodiscordant couples face multiple challenges in using condoms for HIV-1 prevention, and need couples-centred counselling to address barriers to consistent condom use. Specific areas of focus should include provision of information about the substantial risk of HIV-1 transmission within serodiscordant partnerships, development of skills for women to effectively negotiate condom use, disclosure of HIV-1 serostatus to new sexual partners, and strategies for conception that minimise risk of HIV-1 transmission.
P2-S5.02 Confined outreach clinics: increasing utilisation of HIV/STI clinic services by IDUs in hard to reach rural settings: an example from North-East India
Authors: Sono C Z , Lalawmpuii M 
Published: July 2011

IssueClinics in fixed locations have limited effectiveness in HIV/STI prevention programs among injecting drug users (IDUs) in North-East India. Mountainous terrain and poor roads make physical accessibility difficult, and designated IDU clinics are often stigmatised by the general community, reducing acceptability among IDUs.SettingNagaland state in Northeast India has a porous border with Myanmar and is characterised by difficult terrain, poor infrastructure, and a conservative religious climate generally intolerant of IDUs. HIV and STI prevalence rates among IDUs are among the highest in India. HIV prevalence is 1.8% (2008), while syphilis prevalence is as high as 17% (2009) and chlamydia as high as 13% (2009) in some districts.ProjectProject ORCHID, funded by Avahan India, has been implementing HIV/STI targeted interventions among IDUs in Nagaland since 2004. In response to the high prevalence of STIs and the clinic access challenges facing IDUs, an outreach clinic service known as the Confined Outreach Clinic (COC) was developed. The COCs are conducted by trained clinical staff and outreach teams in locations convenient to the IDUs. Timing and locations for the clinics are chosen by the IDU community in consultation with the outreach teams to ensure maximum acceptability and attendance. Clinical services follow standardised national guidelines. They provide STI treatment as well as HIV/STI prevention and referral services. To maximise acceptability, some general medical services are also provided.OutcomesClinic visits more than doubled after introduction of this model, from 1734 (July–December 2009) to 4347 (January–June 2010), while the number of individuals accessing the clinic increased by 68%. The COC model therefore not only increased population coverage but also the number of repeat clinic visits within the reporting period. COCs are a low cost and highly acceptable model of service delivery for IDUs, effective in improving poor service uptake.
P2-S5.04 Behavioural risks and HIV/AIDS knowledge in adolescent street children and their health implications
Authors: Naseem F , Ahmad R , Rashid A 
Published: July 2011

BackgroundIn Pakistan social and ethical bindings are major constraints to launch effective awareness campaign or vaccination trial against HIV transmission. Lack of awareness coupled with high risk behaviour could result in AIDS epidemic among adolescents and street children as in these groups coercive and transactional sex is common. We aimed to examine adolescent's behavioural risks and their knowledge about HIV/AIDS. Sources of information regarding HIV/AIDS were analysed for risk behaviour in relation to social factors.MethodsCross-sectional study was conducted in rural and urban areas of Rawalpindi to gather information from street children (n=148, mean age 17 years). Multivariate analysis was performed to see effect of residential site and gender on AIDS concepts.ResultsAmong surveyed population, 14% had heard of HIV vaccine and 50% believe HIV vaccine could develop infection. About 33% ever had sex and 10% revealed >1 partner per year. 5% had knowledge about HIV status of partner see Abstract P2-S5.04 Table 1. A high degree of risky behaviour activities correlated with those children who lived in rural areas. Urban area street children were found to explore more sources to grasp HIV information. We found limited availability of documented information to compare the present observations.Abstract P2-S5.04 Table 1Multivariate ANOVA for HIV/AIDS knowledgeMain effectInteractionSiteGenderSite × GenderMANOVA test (Pillais F value)2.174.451.43HIV/AIDS transmission route<1<1<1Discussion about HIV/AIDS1.22.211.53Behavior risks<1<12.25ConclusionsBoth the adolescents and street children with poor knowledge about HIV are involved in risky behaviour. Our study propelled the need to consolidate, where relevant, community mobilisation for HIV prevention research throughout the country. Moreover, cross-country documentation must be improved for wider sharing of knowledge. A planned approach with educational sessions seems imperative for developing an effective sexual health safety program.
P2-S5.06 Behavioural interventions for reducing HIV infection in workers in occupational settings, a Cochrane systematic review
Authors: Ojo O , Verbeek J , Rasanen K , Heikkinen J , Isotalo L , Mngoma N , Ruotsaalainen E 
Published: July 2011

BackgroundHIV in the workforce has a negative impact on economic growth and development of affected countries. The workplace provides an important avenue to prevent HIV by providing easy access to workers who might have similar high risk sexual behaviour because of the nature of their work. Objective of this systematic review is to evaluate the effect of behavioural interventions on high risk sexual behaviour to prevent HIV among workers.MethodsWe searched electronic databases to locate studies. Only randomised control studies in occupational settings or among workers identified as high risk groups were included. The outcome measures were: indicators of high risk sexual behaviours, uptake of Voluntary Counselling and Testing (VCT), and incident cases of HIV. We excluded health workers, sex workers, injection drug users and Men who have sex with men because these are already in other reviews.ResultsWe included 4 studies but we had incomplete data from one. All the studies were from developing countries in Asia and Africa with a total of 7994 participants. We grouped the studies in the following comparisons: Uptake of VCT was increased when provided in workplace compared to voucher for testing only, RR=14.0 (95% CI 11.8 to 16.7), HIV incidence was not reduced, RR=1.4 (95% CI 0.7 to 2.7). Education caused a non-significant decrease in sex with extra partner RR=0.7 (95% CI 0.3 to 1.8) and unprotected sex, RR=0.9 (95% CI 0.5 to 1.4). More intensive Information, motivation and behavioural (IMB) skills training increased the use of condom, RR=2.8 (95% CI 1.6 to 4.1) and decreased sex with commercial sex workers, RR=0.8 (95% CI 0.80 to 0.96) in a very high risk group of truck drivers.ConclusionVCT might not be effective in reducing HIV incidence in workplace intervention, and delivering voluntary counselling and testing on-site at workplace increases the uptake of VCT. However, education, and Information, motivation and behavioural (IMB) skills training might be worthwhile in reducing risky sexual behaviour and increasing condom use, especially when delivered with high intensity in the workplace.
P2-S5.07 Cost of the Avahan HIV prevention programme for high risk groups: results from 23 districts from four southern states in India
Authors: Chandrashekar S , Vassall A , Reddy B , Shetty G , Alary M , Vickerman P 
Published: July 2011

BackgroundIt is estimated that 2.27 million people are living with HIV or AIDS in India. The epidemic is concentrated and predominately driven by marginalised groups. The Avahan Programme in India is one of the largest HIV prevention programmes targeted at high risk populations within a single country in the world. It provides grants to state lead partners (SLPs), who in turn provide grants to non-government organsiations (NGOs) at the district level to deliver multi-component interventions (including peer outreach, STI services, and structural interventions). This study presents the costs of implementing these interventions to female sex workers, men who have sex with men and transgender from 23 districts in the four Southern states of India over 4 years.MethodsFinancial and economic costs were prospectively collected. Costs by input and activity, unit costs of interventions between 2004 and 2008 were analysed. Economic costs are presented in US $ 2008 using 3% discount rate.ResultsThe total economic cost of the intervention over 4 years for 23 districts was US$ 27 341 121(range per district US$307 597–US$3 147 790) for an estimated target population of 93 345. In year 4, the average annual economic cost per estimated population at the NGO level across the 23 districts was US$70 (US$30–174). The average annual financial cost at current prices was US$59. Over the four years, at the NGO level, capital costs accounted for 10% of total costs. The main recurrent costs were personnel costs (46%) and the materials and supplies for sexually transmitted infections (STI) services (13%). Examining both SLP and NGO costs, programme management, information and grant management costs activities accounted for 27% of total cost; followed by capacity building (20%), STI services (19%), peer outreach (including behaviour change communication, condom provision) (16%) and structural interventions (11%). The proportion of cost that was spent on direct services such as peer outreach and STI services increased as the programme scaled up. Costs for structural activities also increased from 5% in year 1 to 11% by year 4.ConclusionsAssessing costs over the life of the project helps to identify how costs vary with the changing needs and strategies of the programme. We will conduct further analysis to examine which factors most influence costs (local price/wages, programme intensity, community involvement etc). This cost data can assist the realistic planning of large scale long term HIV prevention programmes in the future.