Browsing by Author "Whitworth, Jimmy"

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    Effect of Human Immunodeficiency Virus (HIV) Type 1 Envelope Subtypes A and D on Disease Progression in a Large Cohort of HIV-1–Positive Persons in Uganda
    (The Journal of Infectious Diseases, 2002) Kaleebu, Pontiano; French, Neil; Mahe, Cedric; Yirrell, David; Watera, Christine; Lyagoba, Fred; Nakiyingi, Jessica; Rutebemberwa, Alleluiah; Morgan, Dilys; Weber, Jonathan; Gilks, Charles; Whitworth, Jimmy
    The effect of human immunodeficiency virus (HIV) type 1 envelope subtypes A and D on disease progression was investigated in 1045 adults in Uganda. At enrollment and every 6 months, a clinical history, examination, and laboratory investigations that included CD4 cell counts were done. HIV-1 envelope subtype was assessed mainly by peptide serology supplemented by heteroduplex mobility assay and DNA sequencing. A multivariate analysis of survival was performed to assess the prognostic value of HIV-1 subtype on death. A marginal general linear model also determined the effect of subtype on CD4 cell count during follow-up. Subtype D was associated with faster progression to death (relative risk, 1.29; 95% confidence interval, 1.07–1.56; P ¼ .009) and with a lower CD4 cell count during follow-up (P ¼ .001), compared with subtype A, after adjusting for CD4 cell count at enrollment. In Africa, envelope subtype D is associated with faster disease progression, compared with subtype A
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    Men’s Attitudes To Condoms And Female Controlled Means Of Protection Against HIV And STDS In South-Western Uganda
    (Culture, Health & Sexuality, 2000) Pool, Robert; Hart, Graham; Green, Gillian; Harrison, Susan; Nyanzi, Stella; Whitworth, Jimmy
    There is widespread demand for the development of female controlled methods of protection against sexually transmitted diseases (STDs) and HIV. The success of such methods will not only depend on their acceptability to women but also to their male partners. This paper reports on men's attitudes to female controlled methods in south west Uganda. Data was gathered in individual interviews with 50 men and 7 focus group discussions with 42 men. Male attitudes to the male condom, the female condom and female controlled methods of protection generally were characterized by ambiguity and anxiety. They liked the male condom because it protects against infection and unwanted pregnancy, but were worried by rumours that it was unreliable. The central theme in the discussions was men's anxiety about retaining control over their female partners. The men wanted women to be protected (and therefore safe as potential partners) but they also wanted to remain in control, at least to some extent, of the means of protection. Once suitable female controlled methods have been identified, it will be necessary to use education and social marketing in such a way that men can be reassured of the positive benefits of these products to them, as well as to women.
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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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    Women who fall by the roadside: gender, sexual risk and alcohol in rural Uganda
    (Addiction, 2006) Wolff, Brent; Busza, Joanna; Bufumbo, Leonard; Whitworth, Jimmy
    To investigate community perceptions about the different relationship between alcohol consumption and sexual risk-taking for men and women in a high HIV prevalence African setting Design and setting Participatory learning and action (PLA) activities were conducted in five rural villages in south-western Uganda in 2002. For each village, discussions and visualization activities over the course of 5 days explored local concepts of fun, drinking alcohol and HIV-related behavioural risks. Twelve focus group discussions (FGDs) investigated emerging themes. Analysis is based on visual outputs, observation notes and focus group transcripts. Participants Attendance at sex-segregated PLA sessions was open to all village residents. FGDs were purposively sampled from drinkers and general population groups. Findings For men, drinking is conducted invariably outside the home, usually at night in bars, emphasizing independence, masculinity and freedom from domestic responsibilities. For women, drinking outside male supervision challenges feminine ideals of domesticity and signifies potential sexual vulnerability. Accepting drinks from men was viewed as signifying assent to sex and refusal could justify men resorting to sexual coercion. Even though drinking is seen to promote sexual risk, HIV prevention campaigns were considered unwelcome in bars. Communities preferred seminars involving drinkers and non-drinkers alike. Conclusions Public drinking in this community serves as a marker for men willing to exercise privileges of independence (sexual and otherwise) and women willing to defy gender norms (and risk the sexual consequences). The social and symbolic context of drinking suggests why effective HIV prevention around alcohol should not be limited to drinking environments alone.