Predictors of Perceived Male Partner Concurrency among Women at Risk for HIV & STI Acquisition in Durban, South Africa

Background

Women in sub-Saharan Africa continue to be at greater risk for HIV acquisition than men. Concurrency, viz. multiple sexual partnerships that overlap over time, has been studied as a possible risk factor for HIV transmission. The aim of this study was to identify predictors of perceived male partner concurrency among sexually active, HIV negative women.

Methods

Socio-demographic and behavioural data from women enrolled in a biomedical HIV prevention clinical trial were assessed in relation to perceived male partner concurrency using the Chi squared test. Univariate and multivariate logistic regression was performed to assess the independent predictors of perceived male partner concurrency. Kaplan–Meier survival estimates were obtained for HIV and STI incidence in relation to male partner concurrency. A Cox Proportional Hazards model was used to assess the association between perceived male partner concurrency and HIV and STI incidence.

Results

The results revealed that 29 % of women reported their male partners to be in concurrent sexual relationships, 22 % reported partners that were not engaging in concurrency, whilst 49 % reported not knowing their partners concurrency status. Older women, having never married, experiencing economic abuse, and women reporting individual concurrency, were found to be significant predictors of perceived male partner concurrency in the studied population. Perceived male partner concurrency was not found to be a significantly associated with incident HIV and STI infections in this analysis.

Conclusions

The study provides insight into predictors of perceived male partner concurrency among women at high risk for STI and HIV acquisition. These results may inform the design of behavioural and biomedical interventions, to address the role of multiple sexual partnerships in HIV prevention.

Below:  Kaplan-Meier survival curve for HIV incidence versus partner concurrency status, among a cohort of women in Durban, South Africa

Below:  Kaplan-Meier survival curve for STI incidence versus partner concurrency status, among a cohort of women in Durban, South Africa

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

By:  Zakir Gaffoor, Handan Wand, Renée A. Street, Nathlee Abbai, and Gita Ramjee

HIV Prevention Research Unit, South African Medical Research Council, Durban, South Africa

The Kirby Institute, University of New South Wales, Sydney, Australia

Zakir Gaffoor, Phone: + (27)-31 242 3600

AIDS Res Ther. 2016; 13: 14. Published online 2016 Mar 8. doi:  10.1186/s12981-016-0098-7

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Biological Factors that Place Women at Risk For HIV: Evidence from a Large-Scale Clinical Trial in Durban

Background

It is well documented that the mucosal linings of the female genital tract (FGT) usually provides a robust barrier that protects against sexually acquired infections. However, to the best of our knowledge there are limited South African studies that have investigated the association between damage to the mucosal linings and the acquisition of HIV infections. We hypothesize that in this cohort of women, a higher rate of HIV seroconversions will be observed for women who present with evidence of mucosal damage.

Methods

We undertook a secondary analysis of the Methods for Improving Reproductive Health in Africa (MIRA) trial that assessed the effectiveness of the latex diaphragm and lubricant gel on HIV prevention among women. Participants underwent a physical examination which included a pelvic examination to detect the presence of mucosal abnormalities. During the physical examinations, the study clinicians examined the genitalia, cervix and vagina for signs of epithelial disruptions and abnormal vaginal discharge. The association between the various genital factors and HIV seroconversion was modeled using Cox proportional hazards regression analysis.

Results

In this cohort of 1485 women that had enrolled to participate in the study, women that had presented with genital epithelial disruptions and abnormal vaginal discharge were shown to be at highest risk for HIV acquisition respectively. In addition, the Kaplan Meier analysis showed that the highest number of seroconversions was observed in women that had disrupted genital epithelia (27 per 100/py) and abnormal vaginal discharge (12 per 100/py). Other significant factors included: genital signs and symptoms and genital ulcers/sores.

Conclusion

We have shown that damage to the mucosal epithelial lining increases a women’s risk of HIV seroconversion. Future studies that provide an in depth understanding of the mechanisms associated with the FGT and mucosal immunity will be most valuable. An understanding of all of these mechanisms will be key in directing the advancement of products most suitable for combating HIV infection in women.

Below:  Kaplan Meier plots showing the survival rates for the individual genital factors with the crude HIV incidence rates calculated for each variable with the respective p-values. a epithelial disruption and b abnormal vaginal discharge

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

By:  Nathlee Samantha Abbai^1*, Handan Wand³ and Gita Ramjee¹²

¹HIV Prevention Research Unit, Medical Research Council, 123 Jan Hofmeyr Road, Westville, Durban 3630, South Africa

²Department of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK

³The Kirby Institute, University of New South Wales, Sydney 2052, NSW, Australia

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Sociodemographic Characteristics of Persons Committing Suicide in Durban, South Africa: 2006–2007

Background

Suicidal behaviour is a leading contributor to the burden of disease worldwide and varies widely between countries. South African figures are amongst the highest in the world, with recent trends indicating a disturbing rise, especially amongst the younger age groups, across all races.

Aim

This study analysed sociodemographic characteristics and trends relating to suicides committed in Durban, South Africa during the period of 2006–2007.

Method

A retrospective analysis of suicidal deaths (during 2006–2007), extracted from autopsy registers at all three government-run mortuaries in Durban, was conducted.

Results

The total number of suicides in Durban increased by 6.68% from 2006 to 2007. Suicide accounted for an average of 8.8% of all non-natural deaths per year of the study. The overall suicide rates of 14.53 (2006) and 15.53 (2007) per 100 000 population are comparable with national and global figures. The majority of suicides occurred in single unemployed persons, men and younger age groups. The largest number of suicides per year was recorded in black people, followed by Indian, white and mixed-race people. Hanging was the preferred method in the majority of victims, followed by self-poisoning, shooting and jumping.

Conclusions

The findings indicate a disturbingly high suicide rate amongst the various population and age groups in Durban. The dominant methods used may be influenced by ease of access. The reported trends may worsen unless there is a swift and decisive public health response and cohesive community-based programmes which include a supportive multidisciplinary network.

Below:  Suicide frequency by month and year

Below:  Number of suicides by race

Below:  Most common suicide methods in (a)2006 and (b) 2007

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

By:  Soornarain S. Naidoo¹ and Lourens Schlebusch²

¹Department of Family Medicine, University of KwaZulu-Natal, South Africa

²Department of Behavioural Medicine, University of KwaZulu-Natal, South Africa

Corresponding author.

Correspondence to: Soornarain Naidoo, Email:Email: az.ca.nzku@97soodian, Postal address: Department of Family Medicine, University of KwaZulu-Natal, Private Bag X7, Congella, Durban, 4013

How to cite this article: Naidoo SS, Schlebusch L. Sociodemographic characteristics of persons committing suicide in Durban, South Africa: 2006–2007. Afr J Prm Health Care Fam Med. 2014;6(1), Art. #568, 7 pages. http://dx.doi.org/10.4102/phcfm.v6i1.568

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Modeling Illicit Drug Use Dynamics and Its Optimal Control Analysis

The global burden of death and disability attributable to illicit drug use, remains a significant threat to public health for both developed and developing nations. 

This paper presents a new mathematical modeling framework to investigate the effects of illicit drug use in the community. In our model the transmission process is captured as a social “contact” process between the susceptible individuals and illicit drug users. We conduct both epidemic and endemic analysis, with a focus on the threshold dynamics characterized by the basic reproduction number. 

Using our model, we present illustrative numerical results with a case study in Cape Town, Gauteng, Mpumalanga and Durban communities of South Africa. In addition, the basic model is extended to incorporate time dependent intervention strategies.

Below:  Model system (2) fitted to data for individuals seeking treatment due to illicit drug use. The blue circles indicate the actual data and the solid line indicates the model fit to the data.

Below:  Dynamics of system (C.3) showing the effects of optimal control strategies on eliminating or reducing illicit drug use in the community

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

By:  Steady Mushayabasa * and Gift Tapedzesa

University of Zimbabwe, Department of Mathematics, P.O. Box MP 167, Harare, Zimbabwe

*Steady Mushayabasa: Email: moc.liamg@ayahsumydaets

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Prevalent Bacterial Vaginosis Infection - A Risk Factor for Incident Sexually Transmitted Infections in Women in Durban, South Africa

The association between bacterial vaginosis (BV) and incident sexually transmitted infections (STIs) in a cohort of high-risk women from Durban, South Africa was investigated in this study. 

We undertook a secondary analysis of the Methods for Improving Reproductive Health in Africa trial that assessed effectiveness of the latex diaphragm and lubricant gel on HIV prevention among women. During study visits, urine specimens were collected for testing for Neisseria gonorrhoeae, Chlamydia trachomatis and Trichomonas vaginalis. The presence of BV was based on vaginal pH and wet mount test assessments. The association between BV and the risk for incident STIs was determined using Cox proportional hazards model. Prevalence of BV was 31% in a cohort of 435 women tested at baseline. Among these women, BV was significantly associated with incident Trichomonas vaginalis (14.6 per 100 PY, p = 0.03) and Chlamydia trachomatis infections (15.8 per 100 PY, p = 0.04). BV remained a significant predictor for Trichomonas vaginalis infections even after adjusting for potential confounders such as age and marital status (HR: 1.60, 95% CI: 1.00, 2.57, p = 0.04). 

Our study showed an association between baseline BV infections and incident Trichomonas vaginalis and Chlamydia trachomatis infections. Women with BV infections should be counselled on the use of condoms and the risk of new STIs.

Purchase full article at:  http://goo.gl/N9zk5S

By: Abbai NS1, Reddy T2, Ramjee G3.

• 1HIV Prevention Research Unit, South African Medical Research Council, Durban, South Africa Nathlee.abbai@mrc.ac.za.
• 2Biostatistics Unit, South African Medical Research Council, Durban, South Africa.
• 3HIV Prevention Research Unit, South African Medical Research Council, Durban, South Africa Department of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.  

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"Bitten By Shyness": Menstrual Hygiene Management, Sanitation, and the Quest for Privacy in South Africa

Little is known about how menstruation is managed in low-income settings and whether existing sanitation systems meet women's needs. Using the 'Photovoice' method with 21 women in participatory workshops and in-depth interviews, we collected data on menstrual hygiene management in three sites in Durban, South Africa. 

All women reported using disposable sanitary pads. Although they were aware that disposable pads were non-biodegradable, incompatible with water-borne flush systems, and fill up pit latrines, they had little experience with reusable products. Considerable energy was devoted to concealing and containing 'menstrual waste', and women expressed concern about inadequate privacy during menstruation. All sites lacked discreet disposal options and reliable water access, while outdoor sanitation facilities were considered unsafe. 

Findings highlight the need for advocacy to improve safety and privacy of facilities for women in this setting.

Purchase full article at: http://goo.gl/Ij5XL0

By: Scorgie F, Foster J, Stadler J, Phiri T, Hoppenjans L, Rees H, Muller N.

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Sexual HIV Risk among Substance-Using Female Commercial Sex Workers in Durban, South Africa

Via:   http://ht.ly/QnGiD HT @MRCza