Young Women In sub-Saharan Africa Research Articles

An Overview of Antiretroviral Pre‐Exposure Prophylaxis of HIV Infection

Despite improvements in access to antiretroviral therapy and the use of simplified dosing regimens, HIV infection is still an important global public health problem. As a consequence, significant research efforts have been focused on the development of strategies to prevent the acquisition of HIV infection. These efforts have begun to produce results. The HPTN-052 study demonstrated the effectiveness of treating infected individuals as a means to prevent onward transmission of HIV infection. In addition, Phase 2B/3 studies have shown that the use of oral and topical antiretroviral pre-exposure prophylaxis (PrEP) can significantly reduce the acquisition of HIV infection in serodiscordant couples, young women in sub-Saharan Africa, men who have sex with men, and intravenous drug users. Despite these successes, challenges remain. Adherence to daily PrEP is variable, and some large studies have failed to demonstrate the effectiveness of PrEP in reducing HIV acquisition. Novel PrEP technologies, including sustained delivery intravaginal rings and long-acting injectable products, are being developed to try and circumvent adherence problems associated with daily PrEP regimens. The purpose of this article is to briefly summarize recent progress in the development of antiretroviral PrEP.

Disclosure of Microbicide Gel Use to Sexual Partners: Influence on Adherence in the CAPRISA 004 Trial

Young women in sub-Saharan Africa are disproportionately affected by HIV, making the development of women initiated and controlled methods of prevention, including microbicides, a priority. Adherence is pivotal to microbicide efficacy and partner related factors are known to impact adherence. An analysis of disclosure of gel use to sexual partners and adherence in CAPRISA 004 women was conducted to better understand this relationship. Partner disclosure was significantly associated with a modest 4.2 % increased adherence (71.0 vs. 66.8 %, p = 0.03). Most women rated the experience of disclosure as positive, despite 6.7 % of partners expressing a negative reaction.Participants who disclosed were more likely to reside with their regular partner (14.4 vs. 8.4 %; p = 0.01) and reported consistent condom use at baseline (32.9 vs. 20.9 %; p < 0.01). Partner disclosure needs to be better understood as a potential facilitator or barrier to microbicide adherence.

Integrated strategies for combination HIV prevention: principles and examples for men who have sex with men in the Americas and heterosexual African populations.

Combination HIV prevention is of high priority for increasing the impact of partially efficacious HIV prevention interventions for specific populations and settings. Developing the package requires critical review of local epidemiology of HIV infection regarding most-impacted populations and those at high risk of HIV transmission and acquisition, drivers of HIV infection, and available interventions to address these risk factors. Interventions should be considered in terms of the evidence basis for efficacy, potential synergies, and feasibility of delivery at scale, which is important to achieve high coverage and impact, coupled with high acceptability to populations, which will impact uptake, adherence, and retention. Evaluation requires process measures of uptake, adherence, retention, and outcome measures of reduction in HIV infectiousness and acquisition. Three examples of combination prevention concepts are summarized for men who have sex with men in the Americas, young women in sub-Saharan Africa, and HIV serodiscordant couples.

HIV infection and sexual partnerships and behaviour among adolescent girls in Nairobi, Kenya

Early sexual partnerships place young women in sub-Saharan Africa at high risk for HIV. Few studies have examined both individual- and partnership-level characteristics of sexual relationships among adolescent girls. A cross-sectional survey of sexual history and partnerships was conducted among 761 adolescent girls aged 15-19 years in Nairobi, Kenya. Rapid HIV testing was conducted and correlates of HIV infection were determined using multivariate logistic regression. The HIV prevalence was 7% and seropositive adolescents had a younger age at sexual debut (P < 0.01), more sexual partners in 12 months (P = 0.03), and were more likely to report transactional or non-consensual sex (P < 0.01). Girls who reported not knowing their partner's HIV status were 14 times as likely to be HIV-seropositive than girls who knew their partner's status (adjusted odds ratio: 14.2 [1.8, 109.3]). Public health messages to promote HIV testing and disclosure within partnerships could reduce sexual risk behaviours and HIV transmission among adolescents.

Paying to prevent HIV infection in young women?

Between a quarter and a third of young women in sub-Saharan Africa are infected with HIV by the time they reach their early 20s. Structural factors such as poor education poverty and gender and power inequalities are important determinants of young womens vulnerability to HIV infection. However until now no rigorously assessed intervention targeting this group has significantly reduced HIV infection and no intervention that targets structural factors has directly affected HIV infection. In The Lancet Sarah Baird and colleagues report the results of a randomized controlled trial done with adolescent girls in rural Malawi examining the effects of a cash transfer program on risk of HIV infection. The investigators report that schoolgirls who received monthly cash payments of varying amounts were significantly less likely than girls who did not receive payments to be infected with HIV (12% vs 30%; OR 036 95% CI 014-091) and HSV-2 (07% vs 30%; OR 024 009-065) to have an older male partner (05% vs 25%; OR 020 007-059) and to have sexual intercourse once per week (30% vs 65%; OR 046 026-082) at follow-up (18 months for biological outcomes and 12 months for behavioral outcomes).

Social Exchange and Sexual Behavior in Young Women's Premarital Relationships in Kenya

Transactional sex, or the exchange of money and gifts for sexual activities within nonmarital relationships, has been widely considered a contributing factor to the disproportionate prevalence of HIV/AIDS among young women in sub-Saharan Africa. This study applied social exchange theory to premarital relationships in order to investigate the linkages between a variety of young women's resources-including employment and material transfers from male partners-and sexual behaviors. Data on the first month of premarital relationships (N=551 relationships) were collected from a random sample of young adult women ages 18-24 in Kisumu, Kenya, using a retrospective life history calendar. Consistent with the hypotheses, results showed that young women's income increases the likelihood of safer sexual activities, including delaying sex and using condoms consistently. Material transfers from the male partner displayed the opposite effect, supporting the view that resources obtained from within the relationship decrease young women's negotiating power.

Factors associated with uptake of subdermal contraceptive implants in a young Kenyan population

Background Subdermal contraceptive implants may be a reasonable option for young women in sub-Saharan Africa; little is known about factors associated with method uptake in this subpopulation. Study Design Four hundred women aged 18–24 years who sought short-acting hormonal contraception were offered an opportunity to use an implant instead. Cross-tabulations and logistic regression analysis were used to examine participant characteristics and other factors associated with choosing an implant. Results Twenty-four percent of participants chose the implant. Participants with greater than 4 years of contraceptive need were over three times more likely to choose an implant [odds ratio (OR), 3.4; 95% confidence interval (CI), 1.6–6.9]. Women with health concerns over short-acting hormonal methods (OR, 2.2; 95% CI, 1.3–3.6) and those who expressed some difficulty returning to a clinic (OR, 1.9; 95% CI, 1.1–3.1) were about twice as likely to choose an implant. Product attributes such as long-acting protection and convenience were cited reasons for choosing an implant. Conclusions The implant appears to be an attractive option for a fairly large proportion of young women in Kenya. Within this age group of implant users, homogeneity of demographic characteristics relative to short-acting users suggests that the product has broad appeal.

Urogenital Schistosomiasis in Women of Reproductive Age in Tanzania's Lake Victoria Region

We conducted a community-based study of 457 women aged 18-50 years living in eight rural villages in northwest Tanzania. The prevalence of female urogenital schistosomiasis (FUS) was 5% overall but ranged from 0% to 11%. FUS was associated with human immunodeficiency virus (HIV) infection (odds ratio [OR] = 4.0, 95% confidence interval [CI] = 1.2-13.5) and younger age (OR = 5.5 and 95% CI = 1.2-26.3 for ages < 25 years and OR = 8.2 and 95% CI = 1.7-38.4 for ages 25-29 years compared with age > 35 years). Overall HIV prevalence was 5.9% but was 17% among women with FUS. We observed significant geographical clustering of schistosomiasis: northern villages near Lake Victoria had more Schistosoma mansoni infections (P < 0.0001), and southern villages farther from the lake had more S. haematobium (P = 0.002). Our data support the postulate that FUS may be a risk factor for HIV infection and may contribute to the extremely high rates of HIV among young women in sub-Saharan Africa.

Afebrile Plasmodium falciparum parasitemia decreases absorption of fortification iron but does not affect systemic iron utilization: a double stable-isotope study in young Beninese women

Iron deficiency anemia (IDA) affects many young women in sub-Saharan Africa. Its etiology is multifactorial, but the major cause is low dietary iron bioavailability exacerbated by parasitic infections such as malaria. We investigated whether asymptomatic Plasmodium falciparum parasitemia in Beninese women would impair absorption of dietary iron or utilization of circulating iron. Iron absorption and utilization from an iron-fortified sorghum-based meal were estimated by using oral and intravenous isotope labels in 23 afebrile women with a positive malaria smear (asexual P. falciparum parasitemia; > 500 parasites/μL blood). The women were studied while infected, treated, and then restudied 10 d after treatment. Iron status, hepcidin, and inflammation indexes were measured before and after treatment. Treatment reduced low-grade inflammation, as reflected by decreases in serum ferritin, C-reactive protein, interleukin-6, interleukin-8, and interleukin-10 (P < 0.05); this was accompanied by a reduction in median serum hepcidin of ≈ 50%, from 2.7 to 1.4 nmol/L (P < 0.005). Treatment decreased serum erythropoietin and growth differentiation factor 15 (P < 0.05). Clearance of parasitemia increased geometric mean dietary iron absorption (from 10.2% to 17.6%; P = 0.008) but did not affect systemic iron utilization (85.0% compared with 83.1%; NS). Dietary iron absorption is reduced by ≈ 40% in asymptomatic P. falciparum parasitemia, likely because of low-grade inflammation and its modulation of circulating hepcidin. Because asymptomatic parasitemia has a protracted course and is very common in malarial areas, this effect may contribute to IDA and blunt the efficacy of iron supplementation and fortification programs. This trial was registered at clinicaltrials.gov as NCT01108939.

Preventing HIV infection: turning the tide for young women

In sub-Saharan Africa the burden of HIV infection falls largely on women who represent about 60% of all people living with the infection in the region. Young women are at particular risk; in some areas the prevalence of infection in women aged 15-24 years is nearly three times that of young men. This heightened vulnerability is driven by social economic and cultural factors that include transactional partnerships with older men who are more likely to be infected. In gender-inequitable and transactional sexual relationships decisions about behavioral change and condom use are mainly controlled by men and thus prevention approaches have not greatly reduced the risk of HIV infection for young women in sub-Saharan Africa.

Increased levels of immune activation in the genital tract of healthy young women from sub-Saharan Africa

To determine whether healthy, young women in sub-Saharan Africa have a more activated immune milieu in the genital tract (i.e. activated CD4 T cells) than a similar population in the United States. A cross-sectional study nested in a phase 1 microbicide trial. Cervical cytobrushes were collected from 18 to 24-year-old women in San Francisco, California, USA (n = 18) and Kisumu, Kenya (n = 36) at enrollment into a phase 1 microbicide trial. All participants tested negative for HIV, herpes simplex virus 2, gonorrhea, chlamydia, and trichomonas, and had abstained from sex for at least 7 days prior to enrollment. Cryopreserved T-cell populations were assayed by flow cytometry in a central laboratory. Secretory leukocyte protease inhibitor levels were assayed in cervicovaginal lavage samples. The Wilcoxon rank-sum test was used to compare immune parameters between sites. The total number of endocervical CD4(+) T cells was slightly higher in participants from San Francisco, but participants from Kisumu had a substantially higher number and proportion of CD4(+) T cells expressing the early activation marker CD69, with and without the HIV coreceptor C-C chemokine receptor type 5, and a greater proportion of activated CD8(+) T cells. Median (interquartile range) genital levels of secretory leukocyte protease inhibitor were lower in participants from Kisumu compared with those from San Francisco [190 (96-519) vs. 474 (206 817) pg/ml, P < 0.03]. Activated mucosal T cells were increased in the genital tract of young, sexually transmitted infection/HIV-free Kenyan women, independent of common genital coinfections, and secretory leukocyte protease inhibitor levels were reduced. The cause of these mucosal immune differences is not known, but could partly explain the high HIV incidence in young women from sub-Saharan Africa.

Highly efficient HIV transmission to young women in South Africa

Young women in sub-Saharan Africa are at very high risk of HIV acquisition, and high prevalence levels have been observed among women reporting one lifetime partner and few sexual contacts. Such findings have led to hypotheses that the probability of HIV transmission from men to women must be far higher than previously appreciated. We used the data from a cross-sectional national household survey of HIV among South African women aged 15-24 years to estimate the per-partnership transmission probability from men to women. Estimates were obtained using maximum likelihood methods and a transmission probability model allowing for random error in the self-reported number of lifetime partners. Sensitivity analyses were employed to assess the robustness of the per-partnership transmission probability estimates to the assumed HIV prevalence in male partners. HIV prevalence in women was 21.2% (95% confidence interval 17.9-24.5). The mean reported number of lifetime partners was 2.3. A significant increase in prevalence was observed with increasing lifetime partner numbers (P = 0.02). For a range of plausible values of the partner prevalence, the estimated per-partnership transmission probability varied from 0.74 to 1.00 with 95% confidence intervals ranging from 0.56 to 1.00. The per-partnership probability of HIV transmission from men to women in this population was very high. Before this, the majority of studies examining per-partnership transmission probabilities estimated values below 50%. Identifying the factors that may drive the efficient spread of HIV in sub-Saharan Africa is essential for the development of effective prevention interventions.

Trends in Protective Behaviour among Single vs. Married Young Women in Sub-Saharan Africa: The Big Picture

The trends in contraceptive uptake and condom use among single and married young women show distinct patterns in sub-Saharan Africa. A large median increase of 1.4 percentage points per year in condom use by single young women for pregnancy prevention was witnessed in 18 countries based on Demographic and Health Survey data from 1993 to 2001. In contrast, a modest increase in condom use was noted for married or cohabiting young women. Condom promotion in Africa has been, therefore, a success for single women. Its promotion for pregnancy prevention offers even greater potential, as pregnancy prevention is the main or partial motive of most single women who use condoms. While a myriad of research studies on condom use among young single people have been conducted and published, the needs of the married and cohabiting population have been neglected by researchers and programme staff alike, despite the fact that more than half of HIV infections in the severe epidemics of Southern and East Africa are occurring in this group. The barriers to condom adoption by married couples may not be as severe as is often assumed.RésuméLes tendances dans la prise de contraceptifs et l’utilisation de préservatifs chez les jeunes femmes célibataires et mariées présentent des caractéristiques distinctes en Afrique subsaharienne. De 1993 à 2001, les enquêtes démographiques et sanitaires de 18 pays ont révélé une forte croissance médiane de 1,4 point par année de l’utilisation de préservatifs chez les jeunes femmes célibataires souhaitant éviter une grossesse. Par contre, chez les jeunes femmes mariées ou en cohabitation, cette augmentation a été modeste. La promotion des préservatifs en Afrique a donc été un succès chez les femmes célibataires. Leur promotion pour la prévention des grossesses présente un potentiel encore plus grand, puisque le motif principal ou partiel de la plupart des femmes célibataires utilisant des préservatifs est d’éviter une grossesse. Alors qu’une multitude d’études ont été publiées sur l’emploi des préservatifs chez les jeunes célibataires, les besoins des couples mariés ou qui cohabitent ont été négligés aussi bien par les chercheurs que par le personnel des programmes, alors que plus de la moitié des infections à VIH dans les graves épidémies d’Afrique australe et orientale se produisent dans ce groupe. Les obstacles à l’adoption de préservatifs par les couples mariés ne sont peut-être pas aussi insurmontables qu’on ne le suppose souvent.ResumenLas tendencias en la aceptación de anticonceptivos y en el uso del condón entre las mujeres jóvenes, tanto solteras como casadas, muestran patrones marcados en Africa subsahariana. Con base a los datos de la Encuesta de Demografía y Salud realizada desde 1993 hasta 2001 en 18 países, se presenció un gran aumento promedio del 1.4 por ciento al año en el uso del condón por las mujeres jóvenes para evitar el embarazo. En cambio, entre las casadas o entre las jóvenes en cohabitación, se observó un pequeño aumento. Por tanto, la promoción del condón en Africa ha tenido éxito entre las mujeres solteras. Su promoción para la prevención del embarazo ofrece aun más potencial, dado que éste es el motivo principal o parcial de la mayoría de las mujeres solteras que usan condones. Aunque se han realizado y publicado diversos estudios de investigación sobre el uso del condón entre la gente joven soltera, las necesidades de la población casada y en cohabitación han sido descuidadas tanto por los investigadores como por el personal de programas, pese al hecho de que este grupo presenta más de la mitad de las infecciones por VIH en las graves epidemias de Africa meridional y oriental. Las barreras a la adopción del condón por parte de las parejas casadas posiblemente no sean tan grandes como suele suponerse.

Management of breast lumps in Maiduguri, Nigeria

Background: Reported changes in the demography, modes of presentation and histological variants of tumors of the breast have been published in developed and some developing countries. Although benign lesions have persistently accounted for most breast tumors, the incidence of malignant breast lesion in young women in sub-Saharan Africa has been disturbingly high. We reviewed the demographics, pattern and management of breast lumps excised at University of Maiduguri Teaching Hospital (UMTH) over a 6 year period. Patients and Methods: A retrospective study of patients with breast lumps at UMTH was carried out between January 2005 and December 2010. Details of their bio-data, clinical, and histopathology details were analyzed using descriptive statistics. Results: A total of 913 patients, comprising 887 females (97.2%) and 26 males (2.8%) were reviewed. The mean age was 33.1 ± 14.6 years (range: 12-80 years) and the mean duration of symptoms was 8 ± 2.14 months (range: 2-23 months). 359 (39.3%) were malignant and 577 (63.2%) were benign. The mean ages of women and men with invasive carcinomas of the breast were 45.58 ± 13.22 and 49.75 ± 18.28 years, respectively. The mean age of women with benign breast disease was 28.4 ± 10.0 for fibrocystic disease and 21.8 ± 5.31 years for fibroadenoma. Mode of presentations included ulcers (8.7%), axillary lymph node enlargement (30.0%), nipple discharge (13.0%) and breast pain (21.7%). The most common histological diagnoses were carcinoma of the breast, N = 340 (37.2%), fibroadenoma, N = 276 (30.2%) and fibrocystic disease, N = 199 (21.8%). The least common pathology was tuberculosis of the breast, N = 6; (0.7%). Conclusion: Though benign diseases are still more common, a high percentage of breast lumps in Maiduguri are due to malignant disease and this is frequent in younger women.