Browsing by Author "Hayes, Richard J."

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    Bacterial vaginosis among women at high risk for HIV in Uganda: high rate of recurrent diagnosis despite treatment
    (Sexually transmitted infections, 2016) Francis, Suzanna C.; Looker, Clare; Vandepitte, Judith; Bukenya, Justine; Mayanja, Yunia; Nakubulwa, Susan; Hughes, Peter; Hayes, Richard J.; Weiss, Helen A.; Grosskurth, Heiner
    Bacterial vaginosis (BV) is associated with increased risk for sexually transmitted infections (STIs) and HIV acquisition. This study describes the epidemiology of BV in a cohort of women at high risk for STI/HIV in Uganda over 2 years of follow-up between 2008–2011. Methods 1027 sex workers or bar workers were enrolled and asked to attend 3-monthly follow-up visits. Factors associated with prevalent BV were analysed using multivariate random-effects logistic regression. The effect of treatment on subsequent episodes of BV was evaluated with survival analysis. Results Prevalences of BV and HIV at enrolment were 56% (573/1027) and 37% (382/1027), respectively. Overall, 905 (88%) women tested positive for BV at least once in the study, over a median of four visits. Younger age, a higher number of previous sexual partners and current alcohol use were independently associated with prevalent BV. BV was associated with STIs, including HIV. Hormonal contraception and condom use were protective against BV. Among 853 treated BV cases, 72% tested positive again within 3 months. There was no difference in time to subsequent BV diagnosis between treated and untreated women. Conclusions BV was highly prevalent and persistent in this cohort despite treatment. More effective treatment strategies are urgently needed.
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    The proportion of HIV incidence due to unsafe injections, unsafe blood transfusions and mother to child transmission in rural Masaka, Uganda
    (Proc Natl Acad Sci USA, 2007) White, Richard G.; Kedhar, Anusha; Orroth, Kate K.; Biraro, Sam; Baggaley, Rebecca; Whitworth, Jimmy; Korenromp, Eline L.; Boily, Marie-Claude; Hayes, Richard J.
    To estimate the proportion of all-age HIV incidence attributable to unsafe injections, unsafe blood transfusions and mother-to-child transmission (MTCT) in rural Masaka, Uganda, during the early 1990s.Observed HIV incidence and prevalence, and injection and transfusion rates were calculated using data from a general population cohort study in Masaka (1989-2000). Injection and blood transfusion safety was estimated from observational surveys within Uganda and East Africa. HIV transmission probabilities were estimated from scientific literature review. Model: A model was used to estimate the incidence via unsafe injections (assuming random or age-dependent mixing of injection equipment) and unsafe transfusions. An age-specific model of fertility was used to estimate the incidence via MTCT.Unsafe injections accounted for 5.1% [95% uncertainty bounds (UB) 0.0-10.3] or 12.4% [95%UB 0.0-27.0] of all-age HIV incidence in the random and age-dependent mixing scenarios respectively. Unsafe blood transfusions accounted for 0.4% [95%UB 0.2-0.6], and MTCT accounted for 23.4% [95%UB 15.3-31.5]. 64-71% of all-age HIV incidence was left unexplained by these three routes of transmission. Among 13+ year olds, unsafe injections accounted for 1.4% [95%UB 0.0-2.8] or 12.1% [95%UB 0.0- 26.5] of HIV incidence in the random and age-dependent mixing scenarios respectively. Unsafe blood transfusions accounted for 0.3% [95%UB 0.1-0.4], leaving 87.6-98.3% of HIV incidence left unexplained by these three routes of transmission.This study does not support the hypothesis that unsafe injections or blood transfusions played a major role in HIV transmission in this population during the study period. The safety of both injections and transfusions should be improved to reduce HIV transmission via these routes still further, but particular efforts should be made to reduce the larger proportion of HIV transmission due to MTCT, and among 13+ year olds, the unexplained incidence, presumably primarily due to sexual transmission.
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    Understanding motives for intravaginal practices amongst Tanzanian and Ugandan women at high risk of HIV infection: The embodiment of social and cultural norms and well-being
    (Elsevier Ltd, 2014) Lees, Shelley; Zalwango, Flavia; Bahati, Andrew; Vandepitte, Judith; Seeley, Janet; Hayes, Richard J.; Francis, Suzanna C.
    Some types of intravaginal practices (IVP) may increase the risk for HIV acquisition. This is particularly worrisome for populations with dual high prevalence of HIV and IVP. Women involved in transactional sex are at increased risk for HIV infection in sub-Saharan Africa. Social, cultural and economic influences are strong drivers of IVP in this population. To explore this, we carried out a qualitative research study to investigate the drivers and motivations for using IVP within a large observational study of women at high risk of HIV in Tanzania and Uganda from September 2008 to September 2009. Of the 201 women selected, 176 women took part in a semi-structured in-depth interview. Additionally, in Tanzania, eight focus group discussions among study participants and community members were carried out to obtain information on community norms and expectations. IVP were motivated by overlapping concerns with hygiene, morality, sexual pleasure, fertility, relationship security, and economic security. These motives were driven by the need to meet cultural and social expectations of womanhood, and at the same time attend to personal well-being. Among women involved in transactional sex in East Africa, interventions aimed at modifying or eliminating IVP should attend to local cultural and social norms as well as the individual as an agent of change.
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    Vaginal Practices among Women at High Risk of HIV Infection in Uganda and Tanzania: Recorded Behaviour from a Daily Pictorial Diary
    (Claire Thorne, 2013) Francis, Suzanna C.; Baisley, Kathy; Lees, Shelley S.; Andrew, Bahati; Zalwango, Flavia; Seeley, Janet; Vandepitte, Judith.; T. Ao, Trong; van de Wijgert, Janneke; Watson-Jones, Deborah; Kapiga, Saidi; Grosskurth, Heiner; Hayes, Richard J.
    Background: Intravaginal practices (IVP) are highly prevalent in sub-Saharan African and have been implicated as risk factors for HIV acquisition. However, types of IVP vary between populations, and detailed information on IVP among women at risk for HIV in different populations is needed. We investigated IVP among women who practice transactional sex in two populations: semi-urban, facility workers in Tanzania who engage in opportunistic sex work; and urban, self-identified sex workers and bar workers in Uganda. The aim of the study was to describe and compare IVP using a daily pictorial diary. Methodology/Principal Findings: Two hundred women were recruited from a HIV prevention intervention feasibility study in Kampala, Uganda and in North-West Tanzania. Women were given diaries to record IVP daily for six weeks. Baseline data showed that Ugandan participants had more lifetime partners and transactional sex than Tanzanian participants. Results from the diary showed that 96% of Tanzanian participants and 100% of Ugandan participants reported intravaginal cleansing during the six week study period. The most common types of cleansing were with water only or water and soap. In both countries, intravaginal insertion (e.g. with herbs) was less common than cleansing, but insertion was practiced by more participants in Uganda (46%) than in Tanzania (10%). In Uganda, participants also reported more frequent sex, and more insertion related to sex. In both populations, cleansing was more often reported on days with reported sex and during menstruation, and in Uganda, when participants experienced vaginal discomfort. Participants were more likely to cleanse after sex if they reported no condom use. Conclusions: While intravaginal cleansing was commonly practiced in both cohorts, there was higher frequency of cleansing and insertion in Uganda. Differences in IVP were likely to reflect differences in sexual behaviour between populations, and may warrant different approaches to interventions targeting IVP. Vaginal practices among women at high risk in Uganda and Tanzania: recorded behaviour from a daily pictorial diary