Prevalence of sexually transmitted diseases, HIV/AIDS among female sex workers and acceptability of intravaginal ring in Mukuru, Nairobi, Kenya
Nyanchera, Wakasiaka Sabina
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Human Immunodeficiency Syndrome (HIV and AIDS) has escalated into a humanitarian and developmental crisis. Out of 33.2 million people living positive worldwide, majority (22.5 million) live in Sub Saharan Africa (UNAIDS 2008). Gender roles and responsibilities in African communities bring forth inequalities which often reduce the power of women in negotiating for safer sex. In many African communities, women are care givers. They are expected to care for the spouse, children and the extended family. However, when a woman is infected with HIV, she may be divorced, denied access to family inheritance and care. This prospective cohort study recruited one hundred female sex workers in Mukuru informal settlement in the period between October 2005 to May 2008. The aim of this study was to recruit and characterize individuals for future efficacy clinical trials for HIV Vaccines and Microbicides. Part of the clinical site requirements for such trials is that cohorts must have documented high risk behaviour, high STI prevalence and high retention rates. In order to establish baseline Sexually Transmitted Infections (STI) burden in the community, health care providers were interviewed regarding common STI they treat. Health care providers were asked about their views regarding acceptability of an intravaginal ring which may be used to deliver Microbicides when they become available. Data was analyzed using Statistical Package for Social Sciences (SPSS). Results indicate that Female Sex Workers (FSVV) in the cohort are at a higher risk of contracting STI. Majority FSW (67%) were young, with a mean age of 28. Literacy levels were low with 45% reporting no formal schooling. On average, FSW had three clients per day with the earliest sex debut being 9 years. Almost half (53%) said they used condoms sometimes with primary partners. At baseline HIV prevalence was 11.3%, this is higher than the national prevalence which stands at (7.4%). Vaginal discharge symptoms and Pelvic inflammatory disease were the most common STI seen. Out of 75 symptomatic patients, 30 (40%) reported having vaginal sex in the same period. Only 4% 'reported anal sex during the symptomatic period. Diagnosis of Trichomoniasis correlated significantly with income of more than 200 Kenya shillings per week. In multivariate analysis, diagnosis of STI (Chlamydia, gonorrhea, Trichomoniasis or syphilis) was strongly associated with alcohol use (OR=3.35, P=0.002). Intravaginal rings were well accepted by majority of health care providers who asked for more information regarding the rings and Microhicides. Recruitment, characterization and establishment of this cohort provide an opportunity to access Vaccine and Microbicides strategy for HIV prevention especially for women.