Gender-based violence against female sex workers in Cameroon: Prevalence and associations with sexual HIV risk and access to health services and justice

Abstract

BACKGROUND/OBJECTIVES:

Female sex workers (FSWs) are at risk for HIV and physical and sexual gender-based violence (GBV). We describe the prevalence of lifetime GBV and its associations with HIV risk behaviour, access to health services and barriers in accessing justice among FSWs in Cameroon.

METHODS:

FSWs (n=1817) were recruited for a cross-sectional study through snowball sampling in seven cities in Cameroon. We examined associations of lifetime GBV with key outcomes via adjusted logistic regression models.

RESULTS:

Overall, 60% (1098/1817) had experienced physical or sexual violence in their lifetime. GBV was associated with inconsistent condom use with clients (adjusted OR (AOR) 1.49, 95% CI 1.18 to 1.87), being offered more money for condomless sex (AOR 2.09, 95% CI 1.56 to 2.79), having had a condom slip or break (AOR 1.53, 95% CI 1.25 to 1.87) and difficulty suggesting condoms with non-paying partners (AOR 1.47, 95% CI 1.16 to 1.87). Violence was also associated with fear of health services (AOR 2.25, 95% CI 1.61 to 3.16) and mistreatment in a health centre (AOR 1.66, 95% CI 1.01 to 2.73). Access to justice was constrained for FSWs with a GBV history, specifically feeling that police did not protect them (AOR 1.41, 95% CI 1.12 to 1.78).

DISCUSSION:

Among FSWs in Cameroon, violence is prevalent and undermines HIV prevention and access to healthcare and justice. Violence is highly relevant to FSWs' ability to successfully negotiate condom use and engage in healthcare. In this setting of criminalised sex work, an integrated, multisectoral GBV-HIV strategy that attends to structural risk is needed to enhance safety, HIV prevention and access to care and justice.

Purchase full article at:  http://goo.gl/YZY1Uk

By:  Decker MR¹, Lyons C², Billong SC³, Njindam IM², Grosso A², Nunez GT², Tumasang F⁴, LeBreton M⁵, Tamoufe U⁶, Baral S².

¹Department of Population, Family & Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA Center for Public Health & Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.

²Center for Public Health & Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.

³Comité national de lutte contre le sida (CNLS), Ministère de la Sante Publique (MINSANTE), Yaoundé, Cameroon.

⁴PEPFAR DSF Ministère de la Sante Publique (MINSANTE), Yaoundé, Cameroon.

⁵Global Viral, Yaoundé, Cameroon Mosaic, Yaoundé, Cameroon.

⁶Global Viral, Yaoundé, Cameroon.

Sex Transm Infect. 2016 Jun 8. pii: sextrans-2015-052463. doi: 10.1136/sextrans-2015-052463. [Epub ahead of print]

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Sexual Practices, Fertility Intentions, and Awareness to Prevent Mother-to-Child Transmission of HIV among Infected Pregnant Women at the Yaounde Central Hospital

INTRODUCTION:

The sexual and reproductive health of people living with HIV is fundamental for their well-being. Antiretroviral therapy and reproductive technologies have significantly improved quality of life of people living with HIV in developed countries. In sub-Saharan Africa, the epicenter of HIV, the sexual practices and fertility of women infected with HIV have been understudied.

AIM:

To assess the sexual behavior, fertility intentions, and awareness of preventing mother-to-child transmission of HIV in pregnant women with HIV-negative partners in Yaounde Central Hospital (Yaounde, Cameroon).

METHODS:

A cross-sectional survey using a semistructured, interviewer-administered questionnaire was conducted at the antenatal unit and HIV clinic in 2014.

MAIN OUTCOME MEASURES:

Ninety-four pregnant women infected with HIV provided consistent information on (i) sociodemographic characteristics, (ii) sexual and fertility patterns, (iii) awareness of preventing mother-to-child transmission of HIV, and (iv) their unmet needs.

RESULTS:

Although sexual desire had significantly changed since their HIV diagnosis, the women were highly sexually active. Approximately 19% of women had more than one sexual partner and 40% had regular unprotected sex during the 12-month period before the interviews (P < .0001). Twenty-nine percent of women preferred intermittent sexual intercourse and inconsistent condom use to delay pregnancy, but the abortion rate remained high. Age, marital status, and education affected women's awareness of mother-to-child transmission (P < .05); and no association existed between the number of living children and future pregnancies (r_s = -0.217; P = .036).

CONCLUSION:

HIV-infected women living with HIV-negative partners in Cameroon expressed high sexual and fertility intentions with several unmet needs, including safer sexual practices and conception. Incorporating and supporting safe sexual educational practices and conception services in maternal care can decrease risky sexual behavior and vertical transmission.

Full article at:   http://goo.gl/RE0oku

By:  Kuete M1, Yuan H2, He Q3, Tchoua Kemayou AL4, Ndognjem TP4, Yang F2, Hu Z2, Tian B2, Zhao K2, Zhang H2, Xiong C5.

• 1Family Planning Research Institute, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China; Yaounde Central Hospital, Faculty of Medicine and Biomedical Sciences, The University of Yaounde, Yaounde, Messa, Cameroon.
• 2Family Planning Research Institute, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
• 3Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
• 4Yaounde Central Hospital, Faculty of Medicine and Biomedical Sciences, The University of Yaounde, Yaounde, Messa, Cameroon.
• 5Family Planning Research Institute, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China. Electronic address: clxiong951@sina.com. 
• Sex Med. 2016 Mar 19. pii: S2050-1161(16)00031-3. doi: 10.1016/j.esxm.2016.01.004.

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Failure to Return for Posttest Counseling and HIV Test Results at the Prevention and Voluntary Testing and Counseling Centers of Douala, Cameroon

This study examined the magnitude and time trends in failure to return (FTR) rates and the relation between FTR and individual characteristics, tests procedures, waiting period for the results, and HIV test results among people who were screened for HIV in the prevention and voluntary testing and counseling centers (PVTCCs) of six district hospitals of the city of Douala in Cameroon, between January 2009 and December 2013. It was a retrospective analysis of medical records. 

Among the 32,020 analyzed records, the failure to return (FTR) rate was 14.3%. Overall, people aged 50 years and over, those tested between 2011 and 2012, and those tested in the PVTCC of Bonassama were less likely to return for their results. 

Significant factors associated with FTR included being a housewife, having a positive/undetermined/requiring confirmation result, and provider-initiated testing and counseling (PITC). There was an increasing trend for FTR in the PVTCCs of Bonassama, New-Bell, Nylon, and Cité des Palmiers. 

HIV testing and counseling services in Douala district hospitals must be reorganized such that individuals tested for HIV receive their results on the same day of the test. Also counselors need to better alert clients concerning the importance of returning for their test results.

Full article at:   http://goo.gl/0mDwDh

By:  Ngangue P1, Bedard E2, Ngueta G3, Adiogo D4, Gagnon MP1.

• 1Centre de Recherche du CHUQ, Axe Santé des Populations et Pratiques Optimales en Santé, 10 Rue de l'Espinay, QC, Canada G1L 3L5; Faculté des Sciences Infirmières, Université Laval, QC, Canada.
• 2Faculté des Sciences Infirmières, Université du Québec à Rimouski (UQAR), Campus de Levis, 1595 Boulevard Alphonse Desjardins, Levis, QC, Canada G6V 0A6.
• 3Département de Santé Environnementale et Santé au Travail, Institut de Recherche en Santé Publique de l'Université de Montréal (IRSPUM), Université de Montréal, Montréal, QC, Canada H3T 1A8.
• 4Faculté de Médecine et Sciences Pharmaceutiques, Université de Douala, BP 15253 Douala, Douala, Cameroon. 
• AIDS Res Treat. 2016;2016:9720148. doi: 10.1155/2016/9720148. Epub 2016 Jan 26.

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Prevalence Of & Factors Associated with Prediabetes & Diabetes among HIV-Infected Adults in Cameroon

BACKGROUND:

HIV and certain antiretrovirals (ARVs) are associated with diabetes. Few studies have examined the prevalence of and factors associated with diabetes amongst HIV-infected individuals on combination antiretroviral therapy (cART) in sub-Saharan Africa; some report prevalence estimates between 3.5-26.5% for diabetes in Cameroon and 20.2-43.5% for prediabetes in sub-Saharan Africa.

METHODS:

In a cross-sectional study, HIV-infected individuals (16-65 years old) were screened for diabetes using haemoglobin A_1C (HbA_1C ). We further categorized HbA_1C as normoglycemia (HbA_1C <5.7%), prediabetes (HbA_1C 5.7-6.4%), or diabetes (HbA_1C  ≥6.5%). Dysglycemia was defined as HbA_1C ≥5.7%. Logistic regression modeling was used to assess factors associated with having dysglycemia. .

RESULTS:

Of 500 participants, 363 (72.6%) were female. Median age was 42.5 years [Interquartile Range (IQR):36.5-49.5]. Nineteen (3.8%) were diabetic, and 170 (34%) were prediabetic. One hundred nine (22%) had a CD4+ count <200 cells/mm³ , and 464 (93%) had received >28 days of antiretroviral therapy (ART) at time of screening. Median abdominal circumference for women was 79.5 cm (IQR: 75.5-85.3) and for men, 86.5 cm (IQR: 81.7-90.5). Adjusting for age, sex, socio-economic status, CD4 cell count, being on cART >28 days, BMI, hypertension, history of hypertension, abdominal circumference, and duration of HIV infection, larger abdominal circumference was associated with higher prevalence of prediabetes or diabetes [adjusted Odds Ratio (aOR)=1.07, 95% Confidence Interval (CI):1.03-1.11], while being on cART (aOR=0.46, CI:0.22-0.99) was associated with lower prevalence.

CONCLUSIONS:

There was a high prevalence of Cameroonian HIV-infected adults with dysglycemia. Larger abdominal circumference was associated with higher prevalence, while cART was associated with lower prevalence.

Purchase full article at:   http://goo.gl/V3OmKe

By:  Rhee JY1, Bahtila TD2, Palmer D2, Tih PM2, Aberg JA3, LeRoith D4, Jao J5.

• 1Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
• 2Cameroon Baptist Convention Health Services, Bamenda, Cameroon.
• 3Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
• 4Department of Medicine, Division of Endocrinology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
• 5Department of Medicine, Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA. 
• Diabetes Metab Res Rev. 2016 Feb 17. doi: 10.1002/dmrr.2792

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Integrating Cervical Cancer Screening with HIV Care in Cameroon: Comparative Risk Analysis of Cervical Disease in HIV-Infected Women Receiving Antiretroviral Therapy to Women in the General Population

BACKGROUND:

While the effect of highly active antiretroviral therapy (HAART) on natural history of cervical lesions remains controversial, resource limited countries need to understand the relevance of their own data to their settings. We compared the risk of cervical disease in HAART-experienced women with that in women in the general population of Cameroon.

METHODS:

A retrospective cross sectional survey of women aged 35 years and above, attending a voluntary screening campaign for cervical cancer at the Nkongsamba Regional Hospital in Cameroon between February and May 2014. Squamous intraepithelial lesions (SIL) were determined by Pap smear. Multiple logistic regression was used to compare the odds of SIL in women on HAART to women from the community with unknown HIV status.

RESULTS:

Included were 302 women of whom 131(43.4%) were HIV-infected and receiving HAART on the site while 171 (56.6%) were women from the community. Cervical disease was observed in 51(16.9%) persons of whom 15 (11.5%) cases in the HAART group and 36 (21.1%) cases in the general group (p = 0.027). After controlling for age and other covariates, women in the HAART group had a 67% reduction in the odds of cervical lesions compared with the community group [adjusted odd ratio (aOR) = 0.33, 95%CI: 0.15-0.73, p = 0.006).

CONCLUSION:

HIV-infected women receiving HAART have a lower risk of cancer than women in the general population. This finding may not be attributed to HAART alone but to all the health benefits derived from receiving a comprehensive HIV care.

Below:  Prevalence of abnormal Pap smear cytology in the study groups

Purchase full article at:   http://goo.gl/WwcCDi

By:  Bekolo CE1, O'Bryan G2, Tchago FE3, Nangue C4, Bekoule PS3, Kollo B5.

• 1Centre Médical d'Arrondissement de Baré, Nkongsamba, Cameroon.
• 2International Training & Education Center for Health (I-TECH), Seattle, United States of America.
• 3Regional Hospital of Nkongsamba, Nkongsamba, Cameroon.
• 4University Teaching Hospital, Yaounde, Cameroon.
• 5Department of Public Health, University of Douala, Douala, Cameroon. 
• PLoS One. 2016 Feb 11;11(2):e0149152. doi: 10.1371/journal.pone.0149152. eCollection 2016.

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Retrospective Analysis of Clinical Features, Treatment and Outcome of Coital Injuries of the Female Genital Tract Consecutive to Consensual Sexual Intercourse in the Limbe Regional Hospital

Introduction

Nonobstetrical genital injuries are gradually becoming a common cause of genital injuries. Consensual sex has been reported to be a possible cause of this type of injuries, but its contribution to traumatic lesions of the female genital tract is not well known. It has been suggested that injury consecutive to consensual sex can be extensive and life‐threatening.

Aim

The aim of this study was to analyze the clinical features, treatment modalities, and the outcome of injuries to the female genital tract consecutive to a consensual sexual intercourse.

Methods

A retrospective review of records of female patients admitted in our institution with a complaint of genital injury over a 5‐year period. We collected data regarding patient and injury characteristics, findings of the gynecologic examination, modalities of management and final outcome.

Main Outcome Measures

Anatomic location and nature of injury, modalities of management, admission rate and mortality rate.

Results

Forty six cases could be analyzed. Their mean age was 25.6 years. Almost 35% of patients sustained the injury during their first sexual contact. The majority presented with bleeding, often combined with pain. One patient presented with features of peritonitis. During examination, no anatomic lesions could be identified in 16 (34.8%) of patients. When a lesion was present, it concerned mostly the posterior fornix (28.3%) and the lateral vaginal wall (10%). The most frequently described lesion was a laceration. The majority of patients (83%) were treated with suturing under local anesthesia. The admission rate was 28%, and was significantly higher in patients with a laceration of the posterior fornix. No death was recorded.

Conclusions

Coital injuries following consensual sex often present in the form of a life‐threatening condition and young female with no previous sexual experience are particularly exposed. Most lesions can be treated with a simple suture. 

Clinical characteristics recorded in patients with a coital injury in Limbe Regional Hospital

Clinical characteristic	Number	Percentage
Period of abstinence
Never had sex before	16	34.8
Less than 1 month	13	28.2
1–6 months	4	8.7
More than 6 months	7	15.3
Unknown	6	13.0
Main complaint
Genital pain	39	84.8
Bleeding	31	67.4
Lower abdominal pain	18	39.1
Other	7	15.2
Anatomic location of lesion
Posterior fornix	13	28.3
Lateral vaginal wall	5	10.9
Labia minora	3	6.5
Clitoris	2	4.3
Perineum	2	4.3
Posterior fourchette	1	2.2
Multiple	4	8.7
No identifiable lesion	16	34.8

Full article at:   http://goo.gl/CKYZOu

By:  Robert Tchounzou, MD 1 and Alain Chichom‐Mefire, MD 1

¹Faculty of Health Sciences, University of Buea and Regional Hospital Limbe, Limbe, Cameroon

Corresponding author.

*Corresponding Author: Alain Chichom‐Mefire, MD, Genral Surgeon, Faculty of Health Sciences, University of Buea and Regional Hospital Limbe, P.O. Box 25526, Yaounde, Cameroon. Tel: +237 677 530 532; Fax: +237 677 530 532; E‐mail: moc.liamg@erifemohcihc

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Female Genital Mutilation/Cutting: Risk Management and Strategies for Social Workers and Health Care Professionals

Female genital mutilation/cutting (FGM/C) is a traditional practice originating in Africa. Its worst forms cause irreparable harm to girls and women and have no medical justification. Based on a literature review of global responses to FGM/C and conversations with Australian women who migrated from FGM/C practicing countries, this paper provides some background on FGM/C and its epidemiology, outlining its prevalence, types, and health risks and complications for women and girls. It discusses risk-prevention strategies, first, for health practitioners in identifying, screening, and supporting women affected by FGM/C and, second, for welfare and social workers and health care professionals to identify, work with, and prevent girls from being cut. Consistent with international trends in addressing the risks of FGM/C, the paper suggests practice responses for coordinated responses between professionals, communities from practicing countries, and governments of different countries.

Countries grouped according to prevalence, types I, II, and III and laws against FGM/C

Categories	Prevalence of girls and women of reproductive age who report having been cut, and Type of FGC/M	Countries	Countries with laws against FGM/C
1. Very high prevalence countries, almost universal	Over 80% of girls and women of reproductive age reported having been cut, 30% Type III	Somalia (98%), Guinea (96%), Djibouti (93%), Egypt (91%). Eritrea (89%), Mali (89%), Sierra Leone (88%), Sudan (88%).	Djibouti, Egypt. Eritrea, Guinea, Somalia, Sudan.
2. Moderately high prevalence countries	Between 51% and 80% of girls and women cut, predominantly Types I and II	Gambia (76%), Burkina Faso (76%), Ethiopia (74%), Mauritania (69%), Liberia (66%).	Burkina Faso, Ethiopia, Mauritania.
3. Moderately low prevalence countries	Between 26% and 50% of girls and women cut, predominantly Types I and II	Guinea Bissau (50%), Chad (44%), Cote D’Ivoire (38%), Kenya (27%), Nigeria (27%), Senegal (26%).	Chad, Cote D’Ivoire, Kenya, Senegal, Guinea Bissau, Nigeria.
4. Low prevalence	Between 10 and 25%, predominantly Types I and II	Central African Republic (24%), Yemen (23%), United Republic of Tanzania (15%), Benin (13%).	Central African Republic, Benin, United Republic of Tanzania.
5. Very low prevalence	Below 10%	Iraq (8%), Ghana (4%), Togo (4%), Niger (2%), Cameroon (1%), Uganda (1%).	Ghana, Niger, Togo.

Notes: Data from UNICEF 2013,4 and Macfarlane and Dorkenoo.15

Abbreviation: FGM/C, female genital mutilation/cutting.

Full article at:   http://goo.gl/h2My9U

By:  Susan Costello

School of Global, Urban and Social Studies, RMIT University, Melbourne, VIC, Australia

Correspondence: Susan Costello, School of Global, Urban and Social Studies, RMIT University, 360 Swanston Street, Melbourne 3001, VIC, Australia, Email ua.ude.timr@olletsoc.nasus

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

New HIV Infections among Women (15–24 years old) in Cameroon, 2014

Via:   http://ht.ly/V7ouT  By:  https://twitter.com/unaids

Full slide deck:  http://goo.gl/uS2HNO

Number of People Living with HIV Who Know Their Status and Are Not Receiving Antiretroviral Therapy in Cameroon

Via:   http://ht.ly/V7ouT  By:  https://twitter.com/unaids

Children Living with HIV-Infected Adults: Estimates for 23 Countries in Sub-Saharan Africa

Background

In sub-Saharan Africa many children live in extreme poverty and experience a burden of illness and disease that is disproportionately high. The emergence of HIV and AIDS has only exacerbated long-standing challenges to improving children’s health in the region, with recent cohorts experiencing pediatric AIDS and high levels of orphan status, situations which are monitored globally and receive much policy and research attention. Children’s health, however, can be affected also by living with HIV-infected adults, through associated exposure to infectious diseases and the diversion of household resources away from them. While long recognized, far less research has focused on characterizing this distinct and vulnerable population of HIV-affected children.

Methods

Using Demographic and Health Survey data from 23 countries collected between 2003 and 2011, we estimate the percentage of children living in a household with at least one HIV-infected adult. We assess overlaps with orphan status and investigate the relationship between children and the adults who are infected in their households.

Results

The population of children living in a household with at least one HIV-infected adult is substantial where HIV prevalence is high; in Southern Africa, the percentage exceeded 10% in all countries and reached as high as 36%. This population is largely distinct from the orphan population. Among children living in households with tested, HIV-infected adults, most live with parents, often mothers, who are infected; nonetheless, in most countries over 20% live in households with at least one infected adult who is not a parent.

Conclusion

Until new infections contract significantly, improvements in HIV/AIDS treatment suggest that the population of children living with HIV-infected adults will remain substantial. It is vital to on-going efforts to reduce childhood morbidity and mortality to consider whether current care and outreach sufficiently address the distinct vulnerabilities of these children.

Below: Co-residence of Children 0–17 with HIV-infected Adults and Adult HIV Prevalence (15–49), by Country

Below:  Among Children 0–17 Living with at Least One HIV-infected Adult, Percent Living with HIV-infected Mothers, Fathers, and Others, by Country

Full article at:  http://goo.gl/IAtHln

By:  

Susan E. Short

Department of Sociology and Population Studies and Training Center, Brown University, Providence, RI, United States of America

Rachel E. Goldberg

Department of Sociology, University of California Irvine, Irvine, CA, United States of America

 

More at:  https://twitter.com/hiv_insight

And: http://twitter.com/Prison_Health