Urban Primary Health Care Clinic Research Articles

Association of herpes simplex virus type 2 with the human immunodeficiency virus among urban women in Zimbabwe.

A cross-sectional study at two urban primary health care clinics in Zimbabwe was conducted among 393 consecutive women. The purpose was to determine the seroprevalence of herpes simplex virus type 2 (HSV-2), to identify coinfections and to determine the association between HSV-2, HIV and other sexually transmitted infections (STIs). Sera were tested for HSV-2, HIV and syphilis. Genital specimens were tested for the other STIs. The seroprevalence of ulcerative STIs tested was 42.2% for HSV-2 and 3.9% for syphilis. HSV-2 seropositive women had twice the risk of being HIV infected compared to HSV-2 seronegative women, adjusted OR=2.05 (95% CI=1.29-3.23). HSV-2 seropositivity was also associated with older age, a lower level of education, increase in the number of lifetime sexual partners and history of genital ulcers in the past six or more months. Our data suggest that in this population HSV-2 may contribute more to HIV infection than syphilis because of its high frequency. There is an urgent need for development of an effective HSV-2 vaccine.

CO‐MORBIDITY BETWEEN DERMATOLOGIC DISEASES AND PSYCHIATRIC DISORDERS IN PAPUA NEW GUINEA

Neurodermatitis (now subdivided into lichen simplex chronicus and atopic dermatitis) was included among the psychosomatic disorders. Psychologic causes have been suggested for many skin conditions, such as urticaria, lichen simplex chronicus, atopic dermatitis, psoriasis, alopecia areata, and pruritus. The evidence for psychologic causation is neither strong nor convincing; however, psychiatric disorders are common among people with established skin diseases. Recent investigators have published data reporting co-morbidity between certain psychiatric disorders and skin diseases. The objective of the research was a prospective clinical study of 132 consecutive patients, who attended the dermatologic outpatient clinic of the Port Moresby General Hospital during 1992. The instrument for the study is the "Harding Self-Rating Questionnaire (SRQ) that has been demonstrated to work well as a gross screening instrument in the Urban Primary Health Care Clinic setting. The questionnaire was administered to 132 outpatients by one of the investigators (HM). Those patients who scored above the cut-off point of seven were referred to the second investigator (FYAJ) for examination of their mental state. The results of the study showed all 132 patients were adults, aged between 16 and 75 years. There were 67/132 (50.75%) men and 65/132 (49.24%) women patients. The psychiatric diagnoses for the women patients were: normal variation 17/65, anxiety neurosis 11/65, and neurotic depression 37/65. For the men patients, the psychiatric diagnoses were: normal variation 21/67, anxiety neurosis 15/67, and neurotic depression 30/67. One man with psoriasis also presented with clinical features of schizophrenic psychosis. The results of the study support the hypothesis, that there is a co-morbidity between some psychiatric disorders and some skin diseases.

The effects of HIV/AIDS intervention groups for high-risk women in urban clinics.

This study reports the results of a behavior change intervention offered to women at high risk for human immunodeficiency virus (HIV) infection seen in an urban primary health care clinic. Participants were 197 women randomly assigned to either an HIV/acquired immunodeficiency syndrome (AIDS) risk reduction group or a comparison group. Women in the HIV/AIDS intervention group attended five group sessions focusing on risk education; skills training in condom use, sexual assertiveness, problem solving, and risk trigger self-management; and peer support for change efforts. Women in the comparison group attended sessions on health topics unrelated to AIDS. At the 3-month follow-up, women in the HIV/AIDS intervention group had increased in sexual communication and negotiation skills. Unprotected sexual intercourse had declined significantly and condom use had increased from 26% to 56% of all intercourse occasions. Women in the comparison group showed no change. Socially disadvantaged women can be assisted in reducing their risk of contracting HIV infection. Risk reduction behavior change interventions should be offered routinely in primary health care clinics serving low-income and high-risk patients.

Teaching Zimbabwean medical students an awareness of hidden psychological disorder in an urban outpatient setting.

A one-week attachment to an urban primary health care clinic was introduced into the eight-week psychiatric teaching block for fourth (penultimate) year medical students at the University of Zimbabwe. Its objective was to alert students to underlying psychological disorder in patients presenting, at primary health care level, with physical symptomatology. Students were required to screen patients using a 20-item questionnaire, take a psychosocial history of all high-scoring patients, and make one home visit. The attachment proved both popular and valuable, and it is anticipated that this will now become an integral part of the psychiatric teaching block.