Awa Gaye

HIV prevalence, previous HIV testing, and condom use with clients and regular partners among Senegalese commercial sex workers

Objectives: To assess HIV prevalence and risk factors for HIV infection, to investigate condom use among registered female commercial sex workers (CSWs) in Senegal, West Africa, and to examine the association between previous HIV testing, knowledge of HIV serostatus and condom use with both regular sex partners and clients within this population. Methods: A cross-sectional study was conducted at three sexually transmitted disease clinics among 1052 Senegalese registered CSWs between 2000 and 2004. Inperson interviews soliciting information concerning demographic characteristics, medical history, sexual behaviour with clients and regular partners, and previous HIV testing history were performed. Blood samples were collected for determination of HIV-1 and/or HIV-2 serostatus. Multivariable, Poisson and log-binomial models were used to calculate prevalence ratios. Results: The overall HIV prevalence was 19.8%. Over 95% of CSWs reported always using a condom with clients, but only 18% reported always using a condom with their regular partners. A history of previous HIV testing was not associated with condom use with clients (adjusted prevalence ratio (APR) = 0.98, 95% confidence intervals, CI: 0.90 to 1.06). However, prior HIV testing was associated with decreased condom use with their regular partners (APR = 0.44, 95% CI: 0.28 to 0.69), especially in women who tested HIV negative (APR = 0.17, 95% CI: 0.08 to 0.36). Conclusions: CSWs in Senegal have a high HIV prevalence; therefore preventing HIV transmission from this population to the general population is important. Condom use with regular partners is low among registered CSWs in Senegal, and a prior HIV negative test is associated with even less condom use with regular partners. Intervention efforts to increase condom use with regular sexual partners are needed.

HIV-1 outcompetes HIV-2 in dually infected Senegalese individuals with low CD4+ cell counts

Objective:Dual infection with HIV-1 and HIV-2, which is not uncommon in West Africa, has implications for transmission, progression, and antiretroviral therapy (ART). Few studies have examined viral dynamics in this setting. Our objective was to directly compare HIV-1 and HIV-2 viral loads and to examine whether this relationship is associated with CD4+ cell count. Study design:This is a retrospective analysis of data from observational cohort studies. Methods:We compared HIV-1 and HIV-2 viral loads from 65 dually infected, ART-naive Senegalese individuals. Participants provided blood, oral fluid, and cervicovaginal lavage (CVL) or semen samples for virologic and immunologic testing. We assessed relationships between HIV-1 and HIV-2 levels using linear regression with generalized estimating equations to account for multiple study visits. Results:After adjusting for CD4+ cell count, age, sex, and commercial sex work, HIV-1 RNA levels were significantly higher than HIV-2 levels in semen, CVL, and oral fluids. Despite similar peripheral blood mononuclear cell DNA levels among individuals with CD4+ cell counts above 500 cells/&mgr;l, individuals with CD4+ cell counts below 500 cells/&mgr;l had higher HIV-1 and lower HIV-2 DNA levels. Individuals with high CD4+ cell counts had higher mean HIV-1 plasma RNA viral loads than HIV-2, with HIV-1 levels significantly higher and HIV-2 levels trending toward lower mean viral loads among individuals with low CD4+ cell counts. Conclusion:Our data are consistent with the hypothesis that with disease progression, HIV-1 outcompetes HIV-2 in dually infected individuals. This finding helps explain differences in prevalence and outcomes between HIV-1, HIV-2, and HIV-dual infection.

HIV shedding in the oral cavity: an assessment of HIV type, immunovirologic, demographic and oral factors

Objective To quantify the prevalence and burden of HIV type 2 (HIV-2) and HIV-1 RNA in the oral cavity of antiretroviral therapy-naive HIV-infected Senegalese individuals and to identify correlates of oral HIV viral loads. Design A cross-sectional study of 163 HIV-1 and 27 HIV-2-infected antiretroviral therapy-naive Senegalese adults. Methods Participants received clinical and oral exams and provided blood and oral wash samples for viral load and plasma CD4 count ascertainment. Logistic and interval regression models were used to identify univariate and multivariable associations between presence and level of oral HIV RNA and various immunovirologic, local and demographic factors. Results Presence of detectable oral HIV RNA was less common in HIV-2-infected compared with HIV-1-infected study participants (33% vs 67%, OR 0.25, 95% CI 0.11 to 0.59). HIV type was no longer associated with oral shedding of HIV when plasma viral load was considered. Detection of oral HIV RNA was associated with increased plasma viral load in both HIV-1-infected and HIV-2-infected individuals (HIV-1, OR 1.89, 95% CI 1.24 to 2.61; HIV-2, OR 1.93, 95% CI 1.1 to 3.39). Oral HIV-1 detection was also associated with periodontal disease (OR 3.02, 95% CI 1.16 to 7.87). Conclusions Oral shedding of HIV-2 RNA is less common than HIV-1 RNA, a likely consequence of lower overall viral burden. Both systemic and local factors may contribute to shedding of HIV in the oral cavity.

Community-Based Maternal and Neonatal Health Services in Kolda and Sedhiou Districts of Senegal

INTRODUCTION : A recent assessment of the Millennium Development Goals has shown significant gaps in most developing countries, particularly with regard to the decline in maternal and infant mortality. Unaccess to health services is a major obstacle to reducing maternal and infant mortality. To support the Ministry of Health and Social Action in the implementation of its Strategic Plan for Reproductive Health (2012-2015), the NGO Micronutriment Initiative has developed a project based on Community-based Maternal and Neonatal Health services (CBMNH), which will be implemented at the level of the Kolda region. The general objective of this study is to carry out a situational analysis of maternal and neonatal health in the health districts of Kolda and Sedhiou to help the implementation and the evaluation of the project. METHOD : It was a descriptive and analytical cross-sectional survey. The study included women who gave birth between February 2013 and January 2014. The sampling was random at two degrees. The sample size was 471 women for each of the two health districts. The data collected during an individual interview focused on prenatal consultation (PNC), delivery, postnatal consultation (PONC) and exclusive breastfeeding (EBF). The quantitative analysis of the data consisted of the estimation of the main indicators, the comparison of the indicators between the health district of Sedhiou and the health intervention district of Kolda. Multivariate analysis identified factors associated with PNC, delivery, and EBF. RESULTS : In total, 965 women were interviewed. The results of the study show that the average duration of PNC1 ranged from 3.41 months in Sedhiou to 3.82 months in Kolda. The proportion of women with full PNC was 38.8% and 54.9% respectively in Kolda and Sedhiou. The proportion of women who took iron-folic acid for at least 90 days ranged from 78.8% (Sedhiou) to 71.7% (Kolda). The delivery was carried out by trained staff in 61.0% and 57.4% respectively in Kolda and Sedhiou. The EBF was initiated in the first hour in 47.0% (Kolda) and 52.6% (Sedhiou). The results of the multivariate analysis showed that the early use of PNC services was related to low household income (0.65 [0.50-0.86]), proximity to the health facility (1.93 [1.34-2.78]) and multiparity (1.4 [1.05-1.87]). Completion of all PNC was associated with household income and early PNC1 (3.65 [2.58-5.18]). With regard to iron-folic acid intake, it was more common in women who achieved early PNC1 (2.19 [1.58-3.04]) and all PNC (3.58 [2.22- 5.77]). The delivery by trained personnel was related to the proximity of the structure (2.43 [1.75-3.37]), but also to the preparation of the delivery. Women who knew the period of the MBF (1.37 [1.04-1.81]) and the protective role of the EBF (1.71 [1.28-2.27]) started their children early at the EBF. CONCLUSION : The results of the study show that the use of reproductive health services was linked to environmental, economic, cultural and structural factors. Improving the accessibility of these services requires joint action by the government, NGOs, community actors and the involvement of the population. This will be done through the construction, equipping and rehabilitation of health facilities, strengthening the knowledge of providers, community actors, women and support groups.

[Sesame Health Programme at Senegal: Limitations of this free healthcare model].

INTRODUCTION Up until now, elderly people have experienced medical management difficulties despite the free care provided by the Sesame Health Programme. The objective of this study was to determine the costs borne by beneficiaries and/or their families and to evaluate these costs in relation to overall management. This comprehensive, cross-sectional, quantitative study was conducted from 21 February to 21 March 2011 in the Ouakam gerontology centre. METHODS Epi Info Version 6 software was used for data analysis. The study population was composed of 203 patients with a mean age of 68 years, with 59% of women and 63% of retired subjects. The most common diseases were hypertension (52%), cataract (16%), and osteoarthritis (12%). RESULTS The beneficiaries healthcare costs were covered by the Sesame Health Programme, apart from most of the drugs used to treat chronic diseases, which remained at the charge of patients and/or their families. The overall mean cost of monthly management of the diseases detected in elderly people was estimated to be CFA 37,700, a large share of which (65%) was supported by the patient and/or the family corresponding to the purchase of these drugs. Other dysfunctions were also observed, particularly the difficulty of targeting beneficiaries, generic stock shortages, absence of generics for the treatment of chronic diseases. CONCLUSION Recommendations are formulated to improve implementation of the Sesame Health Programme.

Vivre le vieillissement au SénégalPerceptions/représentations et stratégies d’adaptation des personnes du troisième âge : résultats d’enquêtes rétrospectives

In Senegal, due to the young age of the population (60%) the concerns of the old tend to be put in the background. And yet, problems related to old age are a reality. These problems come up not in terms of demography (the old represent only 4.7% of the population), but in terms of the breaking-up of the social fabric, urbanization and the dismantling of the solidarity and poverty networks. This work is based on a collection of qualitative data from three studies conducted between 2008 and 2011 with the elderly to assess their real- life experiences, their perception of aging, their challenges and coping strategies. The results showed a transformation in the role and status of the old; this transformation being caused by social and society-related mutations. As a result, the inter-generation solidarity links have much loosened in the urban areas making the old people more vulnerable (in economic, social, health terms), especially those in charge of a family. The situation has been made worse by the unemployment affecting their offspring. In addition, the old people, who are often suffering from chronic diseases, find it hard to take charge of their medical expenses, despite the institution of the National Sesame Health Plan for the old or free health care policy. This has made them even more vulnerable. Yet before this precarious situation, the elderly develop strategies to cope with difficulties. Some recommendations have been made with a view to improving their lives and socioeconomic condition.