Munkolenkole Kamenga

Evidence of marked sexual behavior change associated with low HIV-1 seroconversion in 149 married couples with discordant HIV-1 serostatus: experience at an HIV counselling center in Zaire.

To determine the effect of an HIV-1 counselling program on 149 married Zairian couples with discordant HIV-1 serology, the rates of HIV-1 seroconversion and reported condom utilization have been observed during 382.4 person-years of follow-up (minimum follow-up time per couple of 6 months). Before determination of HIV-1 serostatus and counselling, less than 5% of these couples had ever used a condom. One month after notification of HIV-1 serostatus and counselling, 70.7% of couples reported using condoms during all episodes of sexual intercourse. At 18 months follow-up, 77.4% of the 140 couples still being followed reported continued use of condoms during all episodes of sexual intercourse. At the time of notification of HIV-1 serostatus, 18 couples experienced acute psychological distress. Home-based counselling by trained nurses resolved these difficulties in all but three couples who subsequently divorced. Intensive counselling following notification of HIV-1 serostatus led to low rates of HIV-1 seroconversion (3.1% per 100 person-years of observation) in Zairian married couples with discordant HIV-1 serostatus who voluntarily attended an HIV counselling center.

High HIV-1 incidence in young women masked by stable overall seroprevalence among childbearing women in Kinshasa, Zaïre: estimating incidence from serial seroprevalence data.

ObjectiveTo describe the dynamics of the HIV-1 epidemic in childbearing women in Kinshasa, Zaïre, by estimating incidence from serial seroprevalence studies. MethodsIn 1986 and 1989, 5937 and 4623 pregnant women, respectively, were screened for HIV-1 in Kinshasa. We estimated age-specific incidence from two seroprevalence surveys by using a birth-year cohort analysis and adjusting for differences in mortality and fertility between HIV-1-infected and uninfected women. Mortality and fertility data were measured in a cohort of women recruited from the survey in 1986 and followed until 1989. ResultsWhile the overall HIV-1 seroprevalence changed little (5.8% in 1986 and 6.5% in 1989; P=0.17), the prevalence increased in birth-year cohorts of women under 25 years of age in 1989 from 3.2 to 6.2% (P < 0.001), but decreased for women above 25 years of age from 6.9 to 6.7% (P = 0.7). In addition, new HIV infections between 1986 and 1989 were balanced by a higher mortality and lower fertility observed in HIV-infected women. After adjusting for these effects, we estimated an overall 3-year cumulative HIV-1 incidence of 2.8 per 100 uninfected women [95% confidence interval (Cl), 1.4–4.2]. The highest incidence, 5.7 per 100 (95% Cl, 3.5–8.0), was in women aged 20–24 years in 1989. ConclusionDespite an overall relatively stable HIV-1 prevalence in childbearing women in Kinshasa between 1986 and 1989, approximately 40% of all HIV-1 infections detected in the 1989 survey occurred between 1986 and 1989, and 60% occurred in women under 25 years of age in 1989.

Impact of HIV counseling and testing among child-bearing women in Kinshasa, Zaïre

Objective:To determine the impact of HIV counseling and testing among child-bearing women. Study setting:Mama Yemo Hospital in Kinshasa, Zaïre. Participants and interventions:After informed consent, 187 HIV-seropositive and 177 HIV-seronegative child-bearing women received pre- and post-test counseling for HIV infection. Main outcome measures:Participant knowledge of HIV/AIDS and plans for notifying partners of serologic status and contraceptive use at the time of counseling, and actual partner involvement and contraception use 12 months later. Results:During pre-test counseling, participant knowledge of HIV infection was high, although 30% of women were unaware of perinatal HIV transmission, and 50% did not know that HIV infection could be asymptomatic. At post-test counseling, 70% of mothers (47% of HIV-seropositive, 94% of HIV-seronegative) intended to notify their partners and have joint counseling and testing, although after 12 months, only 2.2% of all women and 7.9% of those who desired assistance to notify their partner returned with their partners for joint counseling and testing. Similarly, 86% planned to use birth control (61% condoms), with HIV-seropositive women more likely to prefer condoms than HIV-seronegative women (71 versus 53%; P<0.001). After 12-months, however, only 20% of HIV-seropositive women reported condom use, and the frequency of pregnancy in both groups was approximately equal. Conclusions:HIV counseling and testing led to higher rates of contraceptive and condom use, although the actual level was lower than the intended use. To further reduce the risk of heterosexual and perinatal HIV transmission in families with an HIV-infected woman, counseling should also include their male partners. AIDS 1993, 7:1633–1637

Heterosexual transmission of HIV-1 among employees and their spouses at two large businesses in Zaire.

To better understand the reasons why up to 80% of all HIV-1 infections in Zaire, but less than 5% in North America and Europe, are acquired through heterosexual transmission, and to assess the impact of HIV-1 infection on a large urban African workforce, we enrolled 7068 male employees, 416 female employees and 4548 female spouses of employees at two large Kinshasa businesses (a textile factory and a commercial bank) in a prospective study of HIV-1 infection. The HIV-1 seroprevalence rate was higher in male employees (5.8%) and their spouses (5.7%) at the bank than among male employees (2.8%) and their spouses (3.3%) at the textile factory. At both businesses HIV-1 seroprevalence was higher among employees in managerial positions (5.0%) than among workers in lower-level positions (3.0%; P less than 0.0001). In a multivariate analysis of male employees, receipt of a transfusion, a history of genital ulcer disease, working at the bank, urethritis, or being divorced or separated were independently associated with HIV-1 infection. During 1987 and 1988, AIDS was the most common cause of death among recently employed workers, accounting for 20 and 24% of all deaths at the textile factory and the commercial bank, respectively. The HIV-1 seroprevalence rate was higher among female workers (7.7%) than among the spouses of male workers (3.9%; P = 0.001). In multivariate analysis of the wives of workers, having an HIV-1-seropositive spouse, receipt of a blood transfusion, or a history of genital ulcer disease were independently associated with HIV-1 infection.(ABSTRACT TRUNCATED AT 250 WORDS)

AIDS orphans in Kinshasa, Zaïre : incidence and socioeconomic consequences

ObjectiveTo determine the incidence, morbidity, mortality, and socioeconomic consequences of becoming an AIDS orphan (a child with an HIV-1-seropositive mother who has died) in Kinshasa, Zaïre. DesignA longitudinal cohort study was undertaken between 1986 and 1990. Within this cohort, a nested case–control study of AIDS orphans was performed. AIDS orphan cases were children with an HIV-1-seropositive mother who had died. Two groups of control children were identified. The first group of control children were age-matched children with HIV-1-seropositive mothers who were alive at the time of death of the AIDS orphan case mother. The second group of control children were children with HIV-1-seronegative mothers who were also alive at the time of death of the AIDS orphan case mother. SettingObstetric ward and follow-up clinic at two large municipal hospitals in Kinshasa, Zaïre. ParticipantsA total of 466 HIV-1-seropositive women, their children, and the fathers of these children; 606 HIV-1-seronegative women, their children, and the fathers of these children. Main outcome measuresAIDS orphan incidence, HIV-1 vertical transmission rate, morbidity, mortality and socioeconomic indicators of the consequences of becoming an AIDS orphan. ResultsThe AIDS orphan incidence rate was 8.2 per 100 HIV-1-seropositive women-years of follow-up. Vertical transmission of HIV-1 was higher in AIDS orphan cases (41%) than in control children with HIV-1-seropositive mothers (26%; P<0.05). Among children without vertically acquired HIV-1 infection, morbidity rates and indices of social and economic well-being were similar in AIDS orphans and control children. Five out of 26 (19%) AIDS orphan cases died during follow-up, compared with three out of 52 (6%) control children (P<0.05). ConclusionDuring a 3-year follow-up period, children with HIV-1-seropositive mothers had a considerable risk of becoming an AIDS orphan. However, the presence of a concerned extended family appeared to minimize any adverse health and socioeconomic effects experienced by orphan children.

Mortality in HIV-1-seropositive women their spouses and their newly born children during 36 months of follow-up in Kinshasa Zaire.

ObjectiveTo calculate 3-year mortality rates in HIV-1-seropositive and HIV-1-seronegative mothers, their newborn children and the fathers of these children. DesignLongitudinal cohort study of HIV-1-seropositive, age and parity-matched HIV-1-seronegative pregnant women, their newborn babies and the fathers of these children. SettingObstetric ward and follow-up clinic at a large municipal hospital in Kinshasa, Zaïre. ParticipantsA total of 335 newborn children and their 327 HIV-1-seropositive mothers and 341 newborn children and their 337 HIV-1-seronegative mothers and the fathers of these children. Main outcome measuresRates of vertical HIV-1 transmission and maternal, paternal and early childhood mortality. ResultsThe lower and upper bounds of vertical transmission were 27 and 50%, respectively. The 3-year mortality rate was 44% in children with vertically acquired HIV-1 infection, 25% in children with HIV-1-seropositive mothers and indeterminant HIV-1 infection status, and 6% in uninfected children with HIV-1-seronegative mothers. HIV-1-seropositive women who transmitted HIV-1 infection to their most recently born child had lost a greater number of previously born children (mean, 1.5 versus 0.5; P< 0.05), were more likely to have had AIDS at delivery (25 versus 12%; P<0.01) and were more likely to die during follow-up (22 versus 9%; P<0.01) than HIV-1-seropositive women who did not transmit HIV-1 infection to their newborn child. Twenty-five out of 239 (10.4%) fathers of children with HIV-1-seropositive mothers, not lost to follow-up, died compared with three out of 310 (1%) fathers of children with HIV-1-seronegative mothers (P<0.01). ConclusionsFamilies in Kinshasa, Zaïre, in which the mother was HIV-1-sero-positive experienced a five to 10-fold higher maternal, paternal and early childhood mortality rate than families in which the mother was HIV-1 -seronegative.

Prevention of perinatal HIV transmission: are there alternatives to pre-pregnancy serological screening in Kinshasa, Zaire?

Complete obstetrical and medical histories were obtained from 6312 women between the ages of 15 and 45 years who had undergone HIV serological tests. Individual factors were examined for sensitivity, specificity and positive predictive value of HIV infection. No individual risk factors for HIV infection were identified which had sensitivities greater than 60%. Combinations of factors were modelled by logistic regression. Only a model which included indicators of present illness with AIDS/HIV-related symptoms (i.e., chronic fever, diarrhea or profound weight loss) was predictive of HIV serostatus. These results suggest that identification of healthy women at high risk of HIV infection using non-serological information is not feasible. Thus, since the yearly cost of universal serological screening is prohibitively expensive in the Zairean context, HIV/AIDS education and prevention campaigns may in fact be a more cost-effective means of preventing perinatal transmission of HIV.

Risk for perinatal HIV-1 transmission according to maternal immunologic, virologic, and placental factors

lower than those seen in normal labor (P < 0.05). The concentration of PGFM in cord blood was signifïcantly higher (P C 0.0001) in the parous women who labored than in women delivered by elective cesarean section. There was no differente in the corresponding concentrations of PGEM (P = 0.9). Conclusions: These data show that spontaneous labor is associated with increased concentrations of prostaglandin metabohtes in the maternal plasma, and are consistent with PGF [2] being an important stimulator of uterine contractility, with a relative deIïciency of PGF [2] being associated with dysfunctional labor.