PREVALENCE OF SEXUALLY TRANSMITTED INFECTIONS AND FACTORS ASSOCIATED WITH HIV STATUS AMONG VULNERABLE WOMEN IN NORTHERN UGANDA: BASELINE RESULTS FROM PE ATYE KENA COHORT STUDY
Main Article Content
Keywords
Sexually transmitted infections, Female empowerment, Uganda, HIV
Abstract
Background and Objectives: HIV infection among vulnerable women (VW) has been attributed to unfavourable power relations and limited access to sexual and reproductive health information and services. Aim of this work is to report sexually-transmitted infections (STI) prevalence and to assess the impact of HIV awareness, demographic and socio-behavioural factors in a rural area of northern Uganda.
Methods: Pe Atye Kena is a longitudinal cohort, intervention study enrolling young women aged 18-49 years old living in the municipality of Gulu, Uganda. HIV, HBV, syphilis serologic tests and electronic comprehensive questionnaire on sexual high-risk behaviours were administered. Statistical analysis was performed by uni- and multivariable regression models.
Results: 461 VW were enrolled (mean age: 29 (SD7.7)). 40 (8.5%) were found to be positive for HIV, 42 (9.1%) for syphilis and 29 (6.3%) for HBV. Older age (> 34 years vs < 24 years; OR 4.95, 95% CI: 1.7 to 14); having done the last HIV test > 12m before the interview (OR 5.21, 95% CI: 2.3 to 11); suspecting the male sexual partner to be HIV+ (OR 2.2; 95% CI: 1.1 to 4.3); not having used condom at first sexual intercourse (OR 2.6; 95% CI 1.3 to 5.15) were all factors associated with an incident HIV diagnosis.
Conclusions: In this cohort, HIV prevalence is high and sexual high-risk behaviors are multifaced; future interventions will be aimed to reduce HIV/STIs misconceptions and to promote a sense of community, self-determination and female empowerment.
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References
[2] Shisana O, Rehle T, Simbayi L, et al. South African National HIV Prevalence, Incidence and Behaviour Survey, 2012. Cape Town, South Africa: Human Sciences Research Council Press; 2014. http://hdl.handle.net/20.500.11910/2490
[3] UNAIDS. 2020 Global AIDS update. https://www.unaids.org/en/resources/documents/2020/global-aids-report [accessed 2020 Nov 17].
[4] Ministry of Health, Uganda. Uganda Population-based HIV Impact Assessment (UPHIA) 2016-2017: Final Report. Kampala: Ministry of Health; July, 2019. https://phia.icap.columbia.edu/wp-content/uploads/2019/07/UPHIA_Final_Report_Revise_07.11.2019_Final_for-web.pdf
[5] Mabaso M, Sokhela Z, Mohlabane N, et al. Determinants of HIV infection among adolescent girls and young women aged 15-24 years in South Africa: a 2012 population- based national household survey. BMC Public Health. 2018;18(1):183. https://doi.org/10.1186/s12889-018-5051-3
[6] Evans M, Risher K, Zungu N, et al. Age-disparate sex and HIV risk for young women from 2002 to 2012 in South Africa. J Int AIDS Soc. 2016;19(1):21310. https://doi.org/10.7448/IAS.19.1.21310
[7] Topazian HM, Stoner MCD, Edwards JK, Kahn K, et al. Variations in HIV risk by young women’s age and partner age-disparity in rural South Africa (HPTN 068). JAIDS. 2020; 83(4):350-356. doi: 10.1097/QAI.0000000000002270
[8] Maughan-Brown B, Kenyon C, Lurie MN. Partner age differences and concurrency in South Africa: Implications for HIV-infection risk among young women. AIDS Behav. 2014;18(12):2469-2476. https://doi.org/10.1007/s10461-014-0828-6
[9] Maughan-Brown B, George G, Beckett S, Evans M, et al. HIV Risk Among Adolescent Girls and Young Women in Age-Disparate Partnerships: Evidence From KwaZulu-Natal, South Africa. JAIDS. 2018; 78(2):155-162 DOI: 10.1097/QAI.0000000000001656
[10] Santelli JS, Edelstein ZR, Mathur S, Wei Y, Zhang W, Orr MG, et al. Behavioral, biological, and demo- graphic risk and protective factors for new HIV infections among youth in Rakai, Uganda. JAIDS. 2013; 63(3):393–400. doi: 10.1097/QAI.0b013e3182926795
[11] Balkus JE, Brown E, Palanee T, Nair G, Gafoor Z, Zhang J, et al. An Empiric HIV Risk Scoring Tool to Predict HIV-1 Acquisition in African Women. JAIDS. 2016; 72(3):333–43. doi: 10.1097/QAI.0000000000000974
[12] Saul J, Bachman G, Allen S, Toiv NF, Cooney C, Beamon T. The DREAMS core package of interventions: A comprehensive approach to preventing HIV among adolescent girls and young women. PLoS ONE. 2018;13(12): e0208167. https://doi.org/10.1371/journal.pone.0208167
[13] Gaffoor Z, Wand H, Daniels B, Ramjee G. High risk sexual behaviors are associated with sexual violence among a cohort of women in Durban, South Africa. BMC Research Notes. 2013, 6:532 https://doi.org/10.1186/1756-0500-6-532
[14] Maughan-Brown B, Evans M, George G. Sexual behaviour of men and women within age-disparate partnerships in South Africa: implications for young Women’s HIV risk. PLoS One. 2016;11:e0159162. https://doi.org/10.1371/journal.pone.0159162
[15] De Neve JW, Fink G, Subramanian SV, Moyo S, Bor J. Length of secondary schooling and risk of HIV infection in Botswana: evidence from a natural experiment. Lancet Glob Health. 2015; 3(8):e470–e7. DOI: https://doi.org/10.1016/S2214-109X(15)00087-X
[16] Behrman JA. The effect of increased primary schooling on adult women’s HIV status in Malawi and Uganda: Universal Primary Education as a natural experiment. Soc Sci Med. 2015; 127:108–15. https://doi.org/10.1016/j.socscimed.2014.06.034
[17] Maman S, Campbell J, Sweat MD, Gielen AC. The intersections of HIV and violence: Directions for future research and interventions. Soc Sci Med. 2000 Feb;50(4):459-78.
[18] Donald A, Koolwal G, Annan J, Falb K, Goldstein M. Measuring Women’s Agency. World Bank Group. 2017. https://elibrary.worldbank.org/doi/abs/10.1596/1813-9450-8148
[19] Sabin LL, Semrau K, DeSilva M, Le LTT, Beard JJ, et al. Effectiveness of community outreach HIV prevention programs in Vietnam: a mixed methods evaluation BMC Public Health. 2019; 19:1130 DOI: 10.1016/s0277-9536(99)00270-1
[20] UNAIDS. UNAIDS Terminology Guidelines. Geneva, Switzerland: UNAIDS; 2015. https://www.unaids.org/sites/default/files/media_asset/2015_terminology_guidelines_en.pdf
[21] Pettifor A, Bekker LG, Hosek S, DiClemente R, Rosenberg M, Bull SS, et al. Preventing HIV among young people: research priorities for the future. JAIDS. 2013; 63 Suppl 2:S155– 60. DOI: 10.1097/QAI.0b013e31829871fb
[22] UNAIDS. HIV prevention among adolescent girls and young women: Putting HIV prevention among adolescent girls and young women on the Fast-Track and engaging men and boys. UNAIDS Guidance. 2016 https://www.unaids.org/sites/default/files/media_asset/UNAIDS_HIV_prevention_among_adolescent_girls_and_young_women.pdf
[23] UAC (2015) National HIV and AIDS Strategic Plan 2015/2016- 2019/2020, An AIDS free Uganda, My responsibility! Uganda AIDS Commission Secretariat. https://uac.go.ug/sites/default/files/National%20HIV%20and%20AIDS%20Strategic%20Plan%202015-2020.pdf
[24] Pettifor AE, Rees HV, Kleinschmidt I, Steffenson AE, MacPhail C, Hlongwa- Madikizela L, et al. Young people’s sexual health in South Africa: HIV prevalence and sexual behaviors from a nationally representative household survey. AIDS. 2005;19:1525-34. DOI: 10.1097/01.aids.0000183129.16830.06
[25] Hallman K. Gendered socioeconomic conditions and HIV risk behaviours among young people in South Africa. Afr J AIDS Res. 2005;4:37-50. https://doi.org/10.2989/16085900509490340
[26] Joint United Nations Programme on HIV/AIDS (UNAIDS), Interagency Task Team on HIV and Young People. Guidance brief: HIV interventions for most at-risk young people. New York: UNFPA; 2008. https://www.unfpa.org/sites/default/files/pub-pdf/mostatrisk.pdf
[27] Birdthistle I, Schaffnit SB, Kwaro D, Shahmanesh M, Ziraba A, et al. Evaluating the impact of the DREAMS partnership to reduce HIV incidence among adolescent girls and young women in four settings: a study protocol BMC Public Health. 2018; 18:912 https://doi.org/10.1186/s12889-018-5789-7
[28] Ocama P, Seremba E, Apica B, Opio K. Hepatitis B and HIV co-infection is still treated using lamivudine-only antiretroviral therapy combination in Uganda. African Health Sciences. 2015; (15) 2: 328-333. doi: 10.4314/ahs.v15i2.4
[29] Sun HY, Sheng WH, Tsai MS, Lee KY, Chang SY, Hung CC. Hepatitis B virus coinfection in human im- munodeficiency virus-infected patients: A review. World J Gastroenterol. 2014;20:14598-614 doi: 10.3748/wjg.v20.i40.14598
[30] Barth RE, Huijgen Q, Taljaard J, Hoepelman AIM. Hepatitis B/C and HIV in sub-Saharan Africa: an association between highly prevalent infectious diseases. A systematic review and meta-analysis. International Journal of Infectious Diseases. 2010. 14(12):e1024-e1031. https://doi.org/10.1016/j.ijid.2010.06.013
[31] Chiesa A, Ochola E, Oreni L, Vassalini P, Rizzardini G, Galli M. Hepatitis B and HIV coinfection in Northern Uganda: Is a decline in HBV prevalence on the horizon? PLoS ONE 2020. 15(11): e0242278. https://doi.org/10.1371/journal.pone.0242278