Imtyaz Ahmed-Jushuf

Delay in symptom presentation among a sample of older GUM clinic attenders.

Prior research undertaken with predominantly youthful populations has established that delay between symptom recognition and health-care presentation is a common feature of sexually transmitted infection (STI) related illness behaviour1-4. However, it is not known whether similar behaviours are exhibited by older populations with genitourinary symptoms. The present analyses therefore aim to clarify this issue by focusing upon (1) extent of delay behaviour, (2) reasons for delay behaviour and (3) variables predicting delay behaviour among a sample of genitourinary medicine (GUM) clinic attenders aged over 50 years. A self-administered questionnaire study linked to patient note data was undertaken within 3 GUM clinics in the Trent region between January 1997 and March 1998 (Sheffield, Nottingham and Leicester). Of 121 symptomatic older attenders with suspected STI, 43.8% (n=53) waited over 2 weeks between symptom recognition and clinic attendance. Reasons given for delay included wanting to ‘wait and see’ if symptoms improved and being embarrassed or afraid to attend clinic. A logistic regression analysis identified that delay behaviour was predicted by history of HIV testing. Comparisons with previous research undertaken in this field indicate that levels of delay behaviour reported by this older sample are higher than those exhibited by youthful populations with genitourinary symptoms. This finding has significant implications for health-care professionals working both within a GUM setting, and with older people, especially when viewed in the context of an ageing population.

Knowledge of HIV Transmission and Risk Behaviour in Kenyan Health Care Workers

In order to determine knowledge of HIV transmission, sexual risk behaviour and perception of risk in African health care workers, 200 employees at the Aga Khan Hospital, Nairobi, Kenya, were asked to complete an anonymous self-administered questionnaire. There was a 75% response rate. Twenty-five per cent believed that condoms were not protective against HIV transmission. Eighty-nine per cent believed oral sex to be a risk factor, as did 70% for kissing, 41% for masturbation of a partner and 43% for nursing an AIDS patient. Younger people were more likely to think condoms were ineffective (P = 0.007) and that insect bites were a significant risk factor (P = 0.004). Twenty-seven per cent had changed their sexual behaviour as a result of the AIDS epidemic, but 48% did not use condoms with non-regular partners. Four had current or previous homosexual relationships. Seventy per cent believed they were at risk of being HIV positive but only 12% had been tested. We have shown that even in the educated group, misconceptions regarding HIV transmission were high and many continue to be at risk for their sexual behaviour. In addition, in-service training regarding HIV transmission should be considered for health care workers in Africa.

HIV disease in Africans of high social class.

Few studies have examined the clinical signs and symptoms of HIV infection in a high-income population in Africa or their epidemiologic features. A retrospective analysis of data on 98 and 18 HIV seropositive men and women respectively (12% of all medical admissions) being discharged from Aga Khan Hospital in Nairobi Kenya between September 1990 and February 1991 aimed to reduce the information gap on HIV infection in the upper middle class in Africa. The hospital only called for HIV testing when indicated. 74% of the cases did not know that they were HIV seropositive before admission to the hospital. Neuropsychiatric conditions were acute schizophrenia depression neuropathy dementia seizure cerebral abscess attempted suicide confusion and coma. 13 patients died. The causes of death included pulmonary tuberculosis (4) gastroenteritis (2) coma (2) Hodgkins lymphoma (1) histoplasmosis (1) Salmonella paratyphi (1) and unknown causes (2). Epidemiological analysis was limited to 13 men and 10 women. 48% of these adults had had a previous chancroid. 3 men had had syphilis. Men were more likely to have had gonorrhea (p < .01) and to have had more than 1 lifetime sexual partner than women (p = .0052). Men were also more likely to have had more sexual partners in the last year than were women (2.9 vs. 0.6). 2 of the women who had regular sexual partners engaged in unprotected sexual intercourse with an at-risk sexual partner because they feared communicating their HIV status. Only 2 of the men who had engaged in casual sex in the last year always used condoms. Women were more likely to have had only 1 lifetime sexual partner (30% vs. 0). 54% of the men had visited prostitutes. 38% of the men had been circumcised. 6 adults (26%) had scarification. 3 women had had blood transfusions.