OBJECTIVE: To study risk factors for HIV infection among women in Nairobi, Kenya, as the epidemic moves beyond high-risk groups. DESIGN: A cross-sectional case-control study among women attending two peri-urban family planning clinics. METHODS: A total of 4404 women were enrolled after giving written informed consent. Information on risk factors was obtained by interview using a structured questionnaire. Blood was taken for HIV and syphilis testing, and genital specimens for gonorrhea and trichomoniasis screening. RESULTS: Two hundred and sixteen women (4.9%; 95% confidence interval, 4.3-5.5) were HIV-1-positive. Although risk of HIV was significantly increased among unmarried women and among women with multiple sex partners, most seropositive women were married and reported only a single sex partner in the last year. Women with a history or current evidence of sexually transmitted disease were at significantly increased risk; however, the prevalence of these exposures was low. Women whose husband or usual sex partner was uncircumcised had a threefold increase in risk of HIV, and this risk was present in almost all strata of potential confounding factors. Only 5.2% of women reported ever having used a condom. CONCLUSIONS: These data suggest that, among women who are not in high-risk groups, risk of HIV infection is largely determined by their male partner's behavior and circumcision status. Interventions designed to change male sexual behavior are urgently needed.
OBJECTIVE: To study risk factors for HIV infection among women in Nairobi, Kenya, as the epidemic moves beyond high-risk groups. DESIGN: A cross-sectional case-control study among women attending two peri-urban family planning clinics. METHODS: A total of 4404 women were enrolled after giving written informed consent. Information on risk factors was obtained by interview using a structured questionnaire. Blood was taken for HIV and syphilis testing, and genital specimens for gonorrhea and trichomoniasis screening. RESULTS: Two hundred and sixteen women (4.9%; 95% confidence interval, 4.3-5.5) were HIV-1-positive. Although risk of HIV was significantly increased among unmarried women and among women with multiple sex partners, most seropositive women were married and reported only a single sex partner in the last year. Women with a history or current evidence of sexually transmitted disease were at significantly increased risk; however, the prevalence of these exposures was low. Women whose husband or usual sex partner was uncircumcised had a threefold increase in risk of HIV, and this risk was present in almost all strata of potential confounding factors. Only 5.2% of women reported ever having used a condom. CONCLUSIONS: These data suggest that, among women who are not in high-risk groups, risk of HIV infection is largely determined by their male partner's behavior and circumcision status. Interventions designed to change male sexual behavior are urgently needed.
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Keywords:
Africa; Africa South Of The Sahara; Behavior; Biology; Case Control Studies; Cross Sectional Analysis; Developing Countries; Diseases; Eastern Africa; Economic Factors; English Speaking Africa; Examinations And Diagnoses; Hiv Infections--women; Kenya; Laboratory Examinations And Diagnoses; Male Circumcision; Marital Status; Nuptiality; Research Report; Risk Factors--women; Sex Behavior--men; Socioeconomic Factors; Studies; Viral Diseases
Authors: Maria J Wawer; Frederick Makumbi; Godfrey Kigozi; David Serwadda; Stephen Watya; Fred Nalugoda; Dennis Buwembo; Victor Ssempijja; Noah Kiwanuka; Lawrence H Moulton; Nelson K Sewankambo; Steven J Reynolds; Thomas C Quinn; Pius Opendi; Boaz Iga; Renee Ridzon; Oliver Laeyendecker; Ronald H Gray Journal: Lancet Date: 2009-07-18 Impact factor: 79.321
Authors: Ronald H Gray; Godfrey Kigozi; David Serwadda; Frederick Makumbi; Fred Nalugoda; Stephen Watya; Laurence Moulton; Michael Z Chen; Nelson K Sewankambo; Noah Kiwanuka; Victor Sempijja; Tom Lutalo; Joseph Kagayii; Fred Wabwire-Mangen; Renée Ridzon; Melanie Bacon; Maria J Wawer Journal: Am J Obstet Gynecol Date: 2008-10-30 Impact factor: 8.661