Bio

Publications


2015

  2015.  Having Their Say: Sex Workers Discuss Their Needs and Resources. Health Care for Women International. 41.89.93.217download.pdf

2014

  2014.  Male Spouse Perpetrated Psychological and Sexual Abuse among Pregnant Women in Nairobi, Kenya. International Journal of Medicine and Medical Sciences (ISSN: 2315-9844). Vol. 1(11)((ISSN: 2315-9844)):pp.178-184.publication.pdf
Ngugi, E.  2014.  A Reasoned Action Model of Male Client Involvement in Commercial Sex Work in Kibera, A Large Informal Settlement in Nairobi, Kenya. Human Organization. Vol. 73(No. 2, 2014):174-182. Abstract

A Reasoned Action Model of Male Client
Involvement in Commercial Sex Work in Kibera,
A Large Informal Settlement in Nairobi, Kenya
Eric Abella Roth, Elizabeth Ngugi, Cecilia Benoit,
Mikael Jansson, and Helga Hallgrimsdottir
Male clients of female sex workers (FSWs) are epidemiologically important because they can form bridge groups linking high- and
low-risk subpopulations. However, because male clients are hard to locate, they are not frequently studied. Recent research emphasizes
searching for high-risk behavior groups in locales where new sexual partnerships form and the threat of HIV transmission is high. Sub-
Saharan Africa public drinking venues satisfy these criteria. Accordingly, this study developed and implemented a rapid assessment
methodology to survey men in bars throughout the large informal settlement of Kibera, Nairobi, Kenya, with the goal of delineating
cultural and economic rationales associated with male participation in commercial sex. The study sample consisted of 220 male patrons
of 110 bars located throughout Kibera’s 11 communities. Logistic regression analysis incorporating a modified Reasoned Action Model
indicated that a social norm condoning commercial sex among male peers and the cultural belief that men should practice sex before
marriage support commercial sex involvement. Conversely, lacking money to drink and/or pay for sexual services were barriers to male
commercial sex involvement. Results are interpreted in light of possible harm reduction programs focusing on FSWs’ male clients.
Key words: commercial sex work, rapid assessment methodology, Reasoned Action Model, Kenya

2013

Ngugi, EN, Pinkham S, Malinowska-Sempruch K.  2013.  Women, harm reduction and HIV.. Abstract

This paper compares and contrasts number of partners and condom use behaviour for female sex workers and a sample of women working in other economic activities, with both samples drawn from the large informal settlement of Kibera, Nairobi. As expected, univariate analysis revealed much higher numbers of overall sexual partners and higher levels of condom use among female sex workers compared to Kibera women in other occupations. An unexpected finding, however, was that female sex workers with a romantic partner had significantly fewer sexual partners per unit time than female sex workers without such a partner. This finding held for multivariate analysis, with negative binomial regression analyses showing that having a romantic partner was significantly associated with reductions in total number of both sexual partners overall and with sexual partners who did not use condoms. In contrast, HIV status, education, number of immediate family members and levels of alcohol consumption were non-significant factors for both regression analyses. Results suggest that female sex workers' romantic partners act as more than sources of possible HIV infection; rather, romantic partners appear to have an important positive impact on health. We discuss this finding in light of possible harm-reduction programmes focusing on female sex workers and their romantic partners.

E.N., PN.  2013.  HLA class I associations with rates of HIV-1 seroconversion and disease progression in the Pumwani Sex Worker Cohort.. Abstract

Tissue Antigens. 2013 Feb;81(2):93-107. doi: 10.1111/tan.12051.
HLA class I associations with rates of HIV-1 seroconversion and disease progression in the Pumwani Sex Worker Cohort.
Peterson TA, Kimani J, Wachihi C, Bielawny T, Mendoza L, Thavaneswaran S, Narayansingh MJ, Kariri T, Liang B, Ball TB, Ngugi EN, Plummer FA, Luo M.
Source
HIV and Human Genetics, National Microbiology Laboratory, Winnipeg, MB, Canada.
Abstract
Class I human leukocyte antigens (HLA) play an important role in the adaptive immune response by presenting antigens to CD8+ T cells. Studies have reported that several HLA class I alleles are associated with differential disease progression in human immunodeficiency virus (HIV)-infected individuals, however, few class I associations with resistance or susceptibility to HIV-1 infection have been reported. We typed HLA-A, -B and -C of >1000 women enrolled in the Pumwani Sex Worker Cohort using a sequence-based typing method. Kaplan-Meier analysis was used to identify alleles influencing seroconversion and disease progression to acquired immune deficiency syndrome (CD4 < 200/mm³). A*01 (P = 0.020), C*06:02 (P = 0.042) and C*07:01 (P = 0.050) are independently associated with protection from seroconversion. Women with any of these alleles are less likely to seroconvert [P = 0.00001, odds ratio (OR): 0.503, 95% confidence interval (CI): 0.320-0.790]. Conversely, A*23:01 (P = 0.004), B*07:02 (P = 0.003) and B*42:01 (P = 0.025) are independently associated with rapid seroconversion. Women with any of these alleles are twice as likely to seroconvert (P = 0.002, OR: 2.059, 95% CI: 1.290-3.285). The beneficial alleles confer threefold protection from seroconversion when compared with the susceptible alleles (P = 0.000001, OR: 0.268, 95% CI: 0.132-0.544). B*07:02 is the contributing allele, within the B7 supertype, to the rapid seroconversion. A*74:01 (P = 0.04/P = 0.006), B*14 (P = 0.003/P = 0.003) and B*57:03 (P = 0.012/P = 0.038) are independently associated with slower CD4+ decline and LTNP phenotype, while B*07:02 (P = 0.020), B*15:10 (P = 0.022) and B*53:01 (P = 0.007) are independently associated with rapid CD4+ T-cell decline. B7 supertype (P = 0.00006), B*35*-Py (P = 0.028) and B*35-Px (P = 0.001) were also significantly associated with rapid CD4+ T-cell decline. Understanding why these HLA class I alleles are associated with protection/susceptibility to HIV-1 acquisition and disease progression could contribute to the development of effective prophylactic and therapeutic vaccines for HIV-1.
© 2013 John Wiley & Sons A/S.
PMID:
23330720
[PubMed - in process]

2012

E.N., PN.  2012.  Family Kinship Patterns and Female Sex Work in the Informal . . Urban Settlement of Kibera, Nairobi, Kenya. Abstract

Hum Ecol (2012) 40:397-403
DOl 10.1007/s10745-012-9478-3
Family Kinship Patterns and Female Sex Work in the Informal . .
Urban Settlement of Kibera, Nairobi, Kenya
Elizabeth N. Ngugi . Cecilia Benoit-
Helga Hallgrimsdottir· Mikael Jansson- Eric A. Roth
Published online: 4 April 2012
(~) Springer Science+Business Media. LLC 2012
Abstract A basic ecological and epidemiological question
is why some women enter into commercial sex work while
other women in the same socio-economic environment never
do. To address this question respondent driven sampling
principles were adopted to recruit and collect data for 161
female sex workers and 159 same aged women who never
engaged in commercial sex in Kibera, a large informal
settlement in Nairobi, Kenya. Univariate analysis indicated
that basic kinship measures, including number of family
members seen during adolescence and at present, not having
a male guardian while growing up, and earlier times of
ending relationships with both male and female guardians
were associated with commercial sex work in Kibera.
Multivariate analysis via logistic regression modeling
showed that not having a male guardian during childhood,
low education attainment and a small number of family
members seen at adolescence were all significant predictors
of entering sex work. By far the most important predictor of
entering sex work was not having any male guardian, e.g.,
father, uncle, older brother, etc. during childhood. Results
are interpreted in light of the historic pattem of sub-Saharan
African child fostering and their relevance for young women
in Kibcra today.
Keywords Urban ecology- Female sex work HIV/AIDS .
Nairobi Kenya
E. N. Ngugi . C. Benoit· H. Hallgrimsdortir: M. Jansson'
E. A. Roth ([81)
University of Victoria,
Victoria, BC, Canada
e-mail: ericroth@uvic.ca
Introduction
Epidemiologists, medical personnel and public health officials
have long recognized the importance of female sex
workers (FSWs) in the sub-Saharan African AIDS pandemic
(D'Costa et al. J 985; Ngugi et al. 1988; Moses et at. 1991)
where they can serve as core groups, i.e., sub-populations
whose high rates of partner change sustain sexual infections
at epidemic levels. Today female commercial sex work
remains an important source of HIV infection within sub-
Saharan Africa's generalized AIDS epidemic because of
FSWs' high HIV prevalence rates (Steen and Dallabctta
2003; Cote et al. 2004; Gouws et al. 2006; Talbott 2007;
Morris et al. 2009). Yet, despite extensive epidemiological
research on the biological parameters of Hl'V transmission
between African FSWs and their commercial clients, there
remain important knowledge gaps in the basic social epidemiology,
defined as the study of the distributions of health
outcomes and their social determinants of African commercial
sex work (Berkman and Kawachi 2000; Poundstone et
al. 2004). For example, while commercial sex work is a high
risk occupation both in tcnns of STI/HIV infection and
violence (Rekart 2005), few studies consider why or how
African women become FSWs, even though "effective prevention
programs cannot be established until there is a better
understanding of why women enter into commercial sex
exchanges" (Kalipeni et al. 2004:66).
At face value the question of why women enter sex work
appears overly simplistic, with economic need combined with
a lack of opportunities the apparently overwhelming answer.
However, in a study of rural Ugandan sex workers, Gysels et
al. (2002) noted that not all disadvantaged women turn to sex
work, while an analysis of Thai child labor (Taylor 2005)
found that wealth and education were positively associated
with high risk behavior, including commercial sex.
.g) Springer

E.N., PN.  2012.  Partners and clients of female sex workers in an informal urban settlement in Nairobi, Kenya.. Abstract

Cult Health Sex. 2012;14(1):17-30. doi: 10.1080/13691058.2011.608436. Epub 2011 Sep 21.
Partners and clients of female sex workers in an informal urban settlement in Nairobi, Kenya.
Ngugi E, Benoit C, Hallgrimsdottir H, Jansson M, Roth EA.
Source
Centre for HIV Prevention and Research, University of Nairobi, Nairobi, Kenya.
Abstract
This paper compares and contrasts number of partners and condom use behaviour for female sex workers and a sample of women working in other economic activities, with both samples drawn from the large informal settlement of Kibera, Nairobi. As expected, univariate analysis revealed much higher numbers of overall sexual partners and higher levels of condom use among female sex workers compared to Kibera women in other occupations. An unexpected finding, however, was that female sex workers with a romantic partner had significantly fewer sexual partners per unit time than female sex workers without such a partner. This finding held for multivariate analysis, with negative binomial regression analyses showing that having a romantic partner was significantly associated with reductions in total number of both sexual partners overall and with sexual partners who did not use condoms. In contrast, HIV status, education, number of immediate family members and levels of alcohol consumption were non-significant factors for both regression analyses. Results suggest that female sex workers' romantic partners act as more than sources of possible HIV infection; rather, romantic partners appear to have an important positive impact on health. We discuss this finding in light of possible harm-reduction programmes focusing on female sex workers and their romantic partners.
PMID:
21936649

E.N., PN.  2012.  Identifying at-risk populations in Kenya and South Africa HIV incidence in cohorts of men who report sex with men, sex workers, and youth.. Abstract

J Acquir Immune Defic Syndr. 2012 Feb 1;59(2):185-93. doi: 10.1097/QAI.0b013e31823d8693.
Identifying at-risk populations in Kenya and South Africa: HIV incidence in cohorts of men who report sex with men, sex workers, and youth.
Price MA, Rida W, Mwangome M, Mutua G, Middelkoop K, Roux S, Okuku HS, Bekker LG, Anzala O, Ngugi E, Stevens G, Chetty P, Amornkul PN, Sanders EJ.
Source
Department of Medical Affairs, International AIDS Vaccine Initiative, New York, NY, USA. mprice@iavi.org
Abstract
OBJECTIVE:
To identify and describe populations at risk for HIV in 3 clinical research centers in Kenya and South Africa.
DESIGN:
Prospective cohort study.
METHODS:
Volunteers reporting recent sexual activity, multiple partners, transactional sex, sex with an HIV-positive partner, or, if male, sex with men (MSM; in Kenya only) were enrolled. Sexually active minors were enrolled in South Africa only. Risk behavior, HIV testing, and clinical data were obtained at follow-up visits.
RESULTS:
From 2005 to 2008, 3023 volunteers were screened, 2113 enrolled, and 1834 contributed data on HIV incidence. MSM had the highest HIV incidence rate of 6.8 cases per 100 person-years [95% confidence interval (CI): 4.9 to 9.2] followed by women in Kilifi and Cape Town (2.7 cases per 100 person-years, 95% CI: 1.7 to 4.2). No seroconversions were observed in Nairobi women or men in Nairobi or Cape Town who were not MSM. In 327 MSM, predictors of HIV acquisition included report of genital ulcer (Hazard Ratio: 4.5, 95% CI: 1.7 to 11.6), not completing secondary school education (HR: 3.4, 95% CI: 1.6 to 7.2) and reporting receptive anal
intercourse (HR: 8.2, 95% CI: 2.7 to 25.0). Paying for sex was inversely associated with HIV infection (HR: 0.2, 95% CI: 0.04 to 0.8). 279 (13.0%) volunteers did not return after the first visit; subsequent attrition rates ranged from 10.4 to 21.8 volunteers per 100 person-years across clinical research centers.
CONCLUSIONS:
Finding, enrolling, and retaining risk populations for HIV prevention trials is challenging in Africa. African MSM are not frequently engaged for research, have high HIV incidence, need urgent risk reduction counseling, and may represent a suitable population for future HIV prevention trials.

2011

Plummer, FA, Moses S, Willbond B, Rao PJVR, Ngugi EN, Nagelkerke NJD, Jha P.  2011.  Reducing HIV Transmission in Developing Countries. Abstract

Although the global response to the HIV/AIDS epidemic in the developing world has, in general, been inadequate, there are key interventions which have been proven to be effective in reducing the incidence of HIV and relevant risky behaviors. We review and analyze these interventions according to three criteria: importance to HIV transmission, amenability to change, and cost-effectiveness.

Chiao, C, Morisky DE, Rosenberg R, Ksobiech K, Malow R, Ngugi EN.  2011.  The relationship between HIV/Sexuaily Transmitted Infection risk and alcohol use during commercial sex episodes: results from the study of female commercial sex workers in the Philippines. Abstract

The results of this study will be particularly important in designing more responsive interventions for alcohol-related behaviour towards better control of HIV and sexually transmitted infections. This interesting finding involved a large sample size (1114 female commercial sex workers). geographical distribution (four provinces in the Philippines) and duration which were large enough for generalization. The authors re-demonstrate the association between alcohol use amongst female sex-workers and clients and HIV/sexually transmitted disease risk.

  2011.  Utilisation of sexual health services by female sex workers in Nepal.. Abstract

The Nepal Demographic Health Survey (NDHS) in 2006 showed that more than half (56%) of the women with sexually transmitted infections (STIs), including HIV, in Nepal sought sexual health services. There is no such data for female sex workers (FSWs) and the limited studies on this group suggest they do not even use routine health services. This study explores FSWs use of sexual health services and the factors associated with their use and non-use of services. METHODS: This study aimed to explore the factors associated with utilisation of sexual health services by FSWs in the Kathmandu Valley of Nepal, and it used a mixed-method approach consisting of an interviewer administered questionnaire-based survey and in-depth interviews. RESULTS: The questionnaire survey, completed with 425 FSWs, showed that 90% FSWs self-reported sickness, and (30.8%) reported symptoms of STIs. A quarter (25%) of those reporting STIs had never visited any health facilities especially for sexual health services preferring to use non-governmental clinics (72%), private clinics (50%), hospital (27%) and health centres (13%). Multiple regression analysis showed that separated, married and street- based FSWs were more likely to seek health services from the clinics or hospitals. In- depth interviews with 15 FSWs revealed that FSWs perceived that personal, structural and socio-cultural barriers, such as inappropriate clinic opening hours, discrimination, the judgemental attitude of the service providers, lack of confidentiality, fear of public exposure, and higher fees for the services as barriers to their access and utilisation of sexual health services. CONCLUSION: FSWs have limited access to information and to health services, and operate under personal, structural and socio-cultural constraints. The 'education' to change individual behaviour, health worker and community perceptions, as well as the training of the health workers, is necessary.

E.N., PN.  2011.  Determinants of condom use among female sex workers in Kenya: a case-crossover analysis.. Abstract

J Womens Health (Larchmt). 2011 May;20(5):733-8. doi: 10.1089/jwh.2010.2436. Epub 2011 Mar 25.
Determinants of condom use among female sex workers in Kenya: a case-crossover analysis.
Gallo MF, Warner L, Bell AJ, Bukusi EA, Sharma A, Njoroge B, Ngugi E, Jamieson DJ, Eschenbach DA.
Source

Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA 30341-3724, USA. mgallo@cdc.gov
Abstract
BACKGROUND:

We evaluated predictors of consistent condom use among female sex workers (FSWs), a core group for controlling the spread of HIV.
METHODS:

In an analysis of data collected in 2004-2005 from 140 Kenyan FSWs who completed questionnaires administered during a baseline study visit and three bimonthly follow-up visits, we used a case-crossover design to identify predictors of consistent condom use during all coital acts in the preceding 2 weeks, overall and by partner type.
RESULTS:

Participants (n=140) completed the baseline visit and 390 bimonthly follow-up visits. Alcohol use during sex was negatively associated with consistent condom use with helping partners (defined as regular sex partners to whom the woman could go for help or support if needed) (adjusted odds ratio [AOR], 2.6, 95% confidence interval [CI] 1.0-6.5) but not associated with condom use with other partners. Coital frequency was associated with condom use with other partners only. Women who reported 1-5 (AOR 11.0, 95% CI 4.3-28.3) or 6-9 recent coital acts (AOR 3.8, 95% CI 1.7-8.8) with other partners were more likely to report consistent condom use with those partners than were women who reported ≥10 acts. Having a recent partner delay payment was inversely associated with consistent condom use with helping, other, or all partners.
CONCLUSIONS:

Correlates of consistent condom use differed by partner type. By using a case-crossover design, we were able to identify potentially modifiable factors associated with consistent condom use by FSWs who used condoms consistently with a given partner type during some periods but not others.

PMID:
21438697
[PubMed - indexed for MEDLINE]

2010

Ngugi, EN, Bonell C, Rhodes T, Jolley E, Sorhaindo A, Fletcher A, Grenfell P, Platt L.  2010.  Systematic review examining differences in HIV, sexually transmitted infections and health-related harms between migrant and non-migrant female sex workers. Abstract

I have picked this evaluation because it focuses on the special needs of migrant female sex workers (FSWs), in particular those in Sub-Saharan Africa, where the prevalence of sexually transmitted infections (STls) and HIV is high and the health infrastructure is insufficient to respond to these problems. In addition, migrant FSWs might initially be too afraid to immediately seek medical help in the 'new country' due to the fear of being apprehended for real or perceived reasons. By the same token, they might not have access to male or female condoms, but may have a high incidence of partner change and unprotected sex. Fear of stigma and discrimination might also keep them away from appropriate services.

E.N., PN.  2010.  Assessment of changes in condom use among female sex workers in a prospective cohort study introducing diaphragm use for disease prevention.. Abstract

Am J Epidemiol. 2010 Sep 1;172(5):606-12. doi: 10.1093/aje/kwq158. Epub 2010 Jul 26.
Assessment of changes in condom use among female sex workers in a prospective cohort study introducing diaphragm use for disease prevention.
Gallo MF, Warner L, Bell AJ, Wiener J, Eschenbach DA, Bukusi EA, Sharma A, Njoroge B, Ngugi E, Jamieson DJ.
Source

Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia 30341-3724, USA. mgallo@cdc.gov
Abstract

Changes in the rates of condom use and number of sexual partners were evaluated among 140 female sex workers in Kibera, Kenya, participating in a 6-month study of diaphragm safety and acceptability for prevention of sexually transmitted infections conducted in 2004-2005. Analyses were stratified by partner type. Multivariable Tobit regression modeling was used to assess the association between study visit and proportion of acts protected. Participants completed 140 baseline visits and 390 bimonthly follow-up visits. The mean percentage of coital acts reported as protected by a condom increased from 56% at baseline to 68% at the 6-month visit (P < 0.01). Similar increases were observed for condom use by all partner types. Additionally, the mean number of sexual partners decreased over the study. Furthermore, consistent (i.e., 100%) diaphragm use during follow-up was associated with a higher proportion of coital acts protected by a condom in analyses adjusted for study visit and coital frequency. These findings suggest that, despite concerns that introduction of the diaphragm would result in more risky sexual behaviors, reported condom use increased and number of partners decreased.

PMID:
20660519
[PubMed - indexed for MEDLINE]

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E.N., PN.  2010.  Effects of a mobile phone short message service on antiretroviral treatment adherence in Kenya (WelTel Kenya1) a randomised trial.. Abstract

Lancet. 2010 Nov 27;376(9755):1838-45. doi: 10.1016/S0140-6736(10)61997-6. Epub 2010 Nov 9.
Effects of a mobile phone short message service on antiretroviral treatment adherence in Kenya (WelTel Kenya1): a randomised trial.
Lester RT, Ritvo P, Mills EJ, Kariri A, Karanja S, Chung MH, Jack W, Habyarimana J, Sadatsafavi M, Najafzadeh M, Marra CA, Estambale B, Ngugi E, Ball TB, Thabane L, Gelmon LJ, Kimani J, Ackers M, Plummer FA.
Source
Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya. rlester.id@gmail.com
Abstract
BACKGROUND:
Mobile (cell) phone communication has been suggested as a method to improve delivery of health services. However, data on the effects of mobile health technology on patient outcomes in resource-limited settings are limited. We aimed to assess whether mobile phone communication between health-care workers and patients starting antiretroviral therapy in Kenya improved drug adherence and suppression of plasma HIV-1 RNA load.
METHODS:
WelTel Kenya1 was a multisite randomised clinical trial of HIV-infected adults initiating antiretroviral therapy (ART) in three clinics in Kenya. Patients were randomised (1:1) by simple randomisation with a random number generating program to a mobile phone short message service (SMS) intervention or standard care. Patients in the intervention group received weekly SMS messages from a clinic nurse and were required to respond within 48 h. Randomisation, laboratory assays, and analyses were done by investigators masked to treatment allocation; however, study participants and clinic staff were not masked to treatment. Primary outcomes were self-reported ART adherence (>95% of prescribed doses in the past 30 days at both 6 and 12 month follow-up visits) and plasma HIV-1 viral RNA load suppression (<400 copies per mL) at 12 months. The primary analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, NCT00830622.
FINDINGS:
Between May, 2007, and October, 2008, we randomly assigned 538 participants to the SMS intervention (n=273) or to standard care (n=265). Adherence to ART was reported in 168 of 273 patients receiving the SMS intervention compared with 132 of 265 in the control group (relative risk [RR] for non-adherence 0·81, 95% CI 0·69-0·94; p=0·006). Suppressed viral loads were reported in 156 of 273 patients in the SMS group and 128 of 265 in the control group, (RR for virologic failure 0·84, 95% CI 0·71-0·99; p=0·04). The number needed to treat (NNT) to achieve greater than 95% adherence was nine (95% CI 5·0-29·5) and the NNT to achieve viral load suppression was 11 (5·8-227·3).
INTERPRETATION:
Patients who received SMS support had significantly improved ART adherence and rates of viral suppression compared with the control individuals. Mobile phones might be effective tools to improve patient outcome in resource-limited settings.
FUNDING:
US President's Emergency Plan for AIDS Relief.
Copyright © 2010 Elsevier Ltd. All rights reserved.

E.N., PN.  2010.  Antiretroviral therapy in a core transmission group of Kenyan female sex workers is not associated with increased sexual risk taking.. Future Medicinal Chemistry. : African Wildlife Foundation. Nairobi Abstract

Although antiretroviral therapy (ART) prolongs life and reduces infectiousness, in some contexts it has been associated with increased sexual risk taking. We compared self-reported condom use, client numbers, and STI incidence in HIV-infected Kenyan female sex workers (FSW) before and after starting ART (n=62), as well in control FSWs not starting ART (n=40). Sexual behaviour with casual clients did not change after ART initiation; condom use increased and STI incidence decreased in both cases and controls, likely due to successful cohort-wide HIV prevention efforts. ART provision was not associated with increases in unsafe sex in this core transmission group.

N., PROFNGUGIELIZABETH.  2010.  Reproductive Health of Female Sex Workers in the Urban Informal Settlement of Kibera, Nairobi, Kenya. Future Medicinal Chemistry. : African Wildlife Foundation. Nairobi Abstract
Female sex workers (FSWs) have long been recognized as important factors in the sub-Saharan HIV/AIDS epidemic. Because of their large number of sexual partners and high rate of partner change they may act as core groups that keep incidence rates high and as bridge populations, linking high-risk with low-risk sub-populations. What is far less recognized and researched are the roles that African FSWs fulfill as lovers and mothers. In these roles they are epidemiologically important due to mother-child HIV transmission while socially FSWs must provide childcare when they work outside the home. Building upon recently analyzed data for FSWs in the urban informal settlement of Kibera, Nairobi, Kenya, this proposal outlines a pilot study employing a social epidemiological perspective to: 1) delineate and analyze FSWs reproductive histories, future fertility plans, and knowledge, access and usage of contraception methods and, 2) explore possible family-based intervention programs to provide child care for FSWs.
E.N., PN.  2010.  ENTERING SEX WORK IN THE INFORMAL URBAN SETTLEMENT OF KIBERA, NAIROBI, KENYA. Future Medicinal Chemistry. : African Wildlife Foundation. Nairobi Abstract

Female sex work has long been recognized as an important factor in the urban sub-Saharan Africa HIV/AIDS pandemic, and in some cities remains a driving force for HIV transmission. However, despite a long history of epidemiological studies, there are still gaps in our knowledge of the social epidemiology of African female sex work. For example, the basic question of why some women enter into sex work, while others in the same socio-economic environment never do, remains under researched. We investigated this question for two samples of same-aged women, one of whom is currently practicing commercial sex, and another who has never done so. Both come from the informal urban settlement of Kibera, located in Nairobi, Kenya. Inclusion of another sample of women who can serve as comparisons to female sex workers is a notable feature of our research design, and one missing from many ecological and intervention studies. Using respondent driven sampling, we collected socio-economic and sexual behavioural data for a total for 320 women, evenly divided between female sex workers and Kibera women working in other occupations (e.g. hair-dressing, tailoring, hotel workers and food servers) from all ten Kibera communities to test the hypothesis that past and present family ties and structure are important predictors of entry into sex work. Results of univariate and multivariate analyses testing this hypothesis are discussed with respect to the African cultural practice of child fostering and future interventions.

2009

Fujita, M;, Ngugi EN;, Rotha EA.  2009.  HIV/AIDS risk and worry in Northern Kenya HIV/AIDS risk and worry in Northern Kenya. Abstract

Data from a 2003 survey of sexual behaviour (n = 400) conducted in the Ariaal community of Karare, Marsabit District, northern Kenya, were used to delineate patterns of risk and worry about contracting HIV/AIDS. Despite widespread reporting of high-risk sexual behaviours (including multiple partners, concurrency, sexual mixing and not using condoms) by survey participants, logistic regression analysis found only one statistically significant positive association between these behaviours and self-assessment of being at high risk of contracting HIV/AIDS. In contrast, log-linear analysis of worry patterns found highly significant relationships between self-assessment of high risk of HIV/AIDS and worry about one's partner's sexual behaviour. These findings indicate that in relation to contracting HIV/AIDS currently Ariaal are more concerned about the sexual behaviour of others, rather than their own behaviour. More generally, results point to the potential for combining concepts of worry with risk assessment in HIV/AIDS research to generate insights into how both concepts are linked to individual, dyadic and population-level factors within specific cultural settings.

Harper, GW, Ngugi EN, Lemos D, Gikuni A, Riplinger AJ, Hooks K, Hooks K.  2009.  Sources of resillience among kenyan youth newly diagnosed with HIV/AIDS in the nairobi slum of kibera: Implications for intervetion. Abstract

Adolescents and young adults who are living with HIV in Kenya comprise a growing percentage of the population. Currently, youth (ages 15-35) represent 38% of the Kenyan population, yet over 60% of new HIV infections occur among this group. In 2008, adolescents and young adults living with HIV accounted for an estimated 6 % of the adolescent population between the ages of 15 and 24 (KDHS, 2009). Of these, the prevalence rates are nearly 6 times higher among young women (2.7% for 15 to 24 year old females; 6.4% for 20 to 24 year old females) as compared to young men (0.7% for 15 to 19 year old males; 1.5% for 20 to 24 year old males) (KDHS, 2009). The difference in prevalence rates among age groups suggests that many youth are becoming infected during adolescence (NASCOP, 2009). Geographic disparities also exist with regards to HIV infection. HIV is more prevalent in urban areas (7.2%) than in rural areas (6.2%). The vast majority ofthe infections are attributed to heterosexual contact in regular partnerships, men who have sex with men, and prisoners (HIV Prevention, Response and Modes of Transmission Analysis, 2009). A study on HIV seroprevalence study found this disparity is even greater in young women aged 15-24 who are four times more likely to become infected with HIV than men of the same age (KDHS, 2009). While having multiple sex partners is seen as a risk factor for HIV transmission, it has also been reported that married persons (6.4%) have higher HIV prevalence rates than nonmarried persons (4.2%) in Kenya, suggesting the need for tailored messages for married partners. Additionally, despite the urgent need for focus on HIV in Kenya, with limited resources there is a need also to focus on urban slum settlements in Kenya as they have higher rates of HIV prevalence than urban regions in general (12% versus 7.1%).

E.N., PN.  2009.  Levels of innate immune factors in genital fluids: association of alpha defensins and LL-37 with genital infections and increased HIV acquisition.. Abstract

AIDS. 2009 Jan 28;23(3):309-17. doi: 10.1097/QAD.0b013e328321809c.
Levels of innate immune factors in genital fluids: association of alpha defensins and LL-37 with genital infections and increased HIV acquisition.
Levinson P, Kaul R, Kimani J, Ngugi E, Moses S, MacDonald KS, Broliden K, Hirbod T; Kibera HIV Study Group.

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Department of Medicine, Center for Molecular Medicine, Karolinska Institutet, Solna, Stockholm, Sweden.
Abstract
BACKGROUND:

Several mucosal innate immune proteins exhibit HIV inhibitory activity and their analogues are potential microbicide candidates. However, their clinical associations and in-vivo role in cervicovaginal host defense against HIV acquisition are poorly defined.
METHODS:

Cervicovaginal secretions (CVSs) were collected from HIV uninfected Kenyan sex workers at enrolment into an HIV prevention trial. After trial completion, CVS from participants acquiring HIV (cases) and matched controls were assessed for levels of innate immune factors and HIV neutralizing capacity, by blinded investigators. Cross-sectional and prospective associations of innate immune factors were examined.
RESULTS:

CVS contained high levels of defensins (human neutrophil peptide-1-3 and human beta defensin-2-3), LL-37 and secretory leukocyte protease inhibitor. Regulated upon activation normal T-cell expressed and secreted levels were lower, and IFNalpha was undetectable. CVS from 20% of participants neutralized a clade A primary HIV isolate, and 12% neutralized both clade A and C isolates. HIV neutralization was correlated with human neutrophil peptide-1-3 (alpha-defensins) and LL-37 levels. However, alpha-defensin and LL-37 levels were increased in participants with bacterial sexually transmitted infections and were independently associated with increased HIV acquisition in multivariate analysis.
CONCLUSIONS:

Despite significant HIV inhibitory activity, cervicovaginal levels of alpha-defensins and LL-37 were associated with increased HIV acquisition, perhaps due to their association with bacterial sexually transmitted infections.

PMID:
19114868
[PubMed - indexed for MEDLINE]

E.N., PN.  2009.  The HAART cell phone adherence trial (WelTel Kenya1) a randomized controlled trial protocol. Abstract

Background The objectives are to compare the effectiveness of cell phone-supported SMS messaging to standard care on adherence, quality of life, retention, and mortality in a population receiving antiretroviral therapy (ART) in Nairobi, Kenya. Methods and Design A multi-site randomized controlled open-label trial. A central randomization centre provided opaque envelopes to allocate treatments. Patients initiating ART at three comprehensive care clinics in Kenya will be randomized to receive either a structured weekly SMS ('short message system' or text message) slogan (the intervention) or current standard of care support mechanisms alone (the control). Our hypothesis is that using a structured mobile phone protocol to keep in touch with patients will improve adherence to ART and other patient outcomes. Participants are evaluated at baseline, and then at six and twelve months after initiating ART. The care providers keep a weekly study log of all phone based communications with study participants. Primary outcomes are self-reported adherence to ART and suppression of HIV viral load at twelve months scheduled follow-up. Secondary outcomes are improvements in health, quality of life, social and economic factors, and retention on ART. Primary analysis is by 'intention-to-treat'. Sensitivity analysis will be used to assess per-protocol effects. Analysis of covariates will be undertaken to determine factors that contribute or deter from expected and determined outcomes. Discussion This study protocol tests whether a novel structured mobile phone intervention can positively contribute to ART management in a resource-limited setting.

E.N., PN.  2009.  Effects of micro-enterprise services on HIV risk behaviour among female sex workers in Kenya urban slums. Abstract

AIDS Behav. 2009 Jun;13(3):449-61. doi: 10.1007/s10461-008-9485-y. Epub 2008 Nov 8.
Effects of micro-enterprise services on HIV risk behaviour among female sex workers in Kenya's urban slums.
Odek WO, Busza J, Morris CN, Cleland J, Ngugi EN, Ferguson AG.
Source
Department of Community Health, University of Nairobi, P.O. Box 1086, City Square 00200, Nairobi, Kenya. odekw@yahoo.co.uk
Abstract
This study assessed individual-level effects of adding micro-enterprise services to a peer-mediated HIV/AIDS intervention among 227 female sex workers (FSWs) in Kenya. Survey data were collected in May-July 2003 and July-August 2005. Two-thirds of participants had operational businesses by end-line survey. Nearly half reported to have stopped sex work. Self-reported weekly mean number of all sexual partners changed from 3.26 (SD 2.45) at baseline to 1.84 (SD 2.15) at end-line survey (P < 0.001). Weekly mean number of casual partners did not change significantly. Weekly mean number of regular partners changed from 1.96 (SD 1.86) to 0.73 (SD 0.98) over the follow-up period (P < 0.001). Consistent condom use with regular partners increased by 18.5% and remained above 90% with casual partners. Micro-enterprise services may empower FSWs by giving them an alternative livelihood when they wish to exit or reduce reliance on sex work. Determinants of successful business operation by FSWs deserve further research.
PMID:
18998204
[PubMed - indexed for MEDLINE]

2008

E.N., PN.  2008.  Reduced rates of HIV acquisition during unprotected sex by Kenyan female sex workers predating population declines in HIV prevalence.. Abstract

AIDS. 2008 Jan 2;22(1):131-7.
Reduced rates of HIV acquisition during unprotected sex by Kenyan female sex workers predating population declines in HIV prevalence.
Kimani J, Kaul R, Nagelkerke NJ, Luo M, MacDonald KS, Ngugi E, Fowke KR, Ball BT, Kariri A, Ndinya-Achola J, Plummer FA.
Source

Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya.
Abstract
OBJECTIVES:

Female sex workers (FSWs) form a core group at high risk of both sexual HIV acquisition and secondary transmission. The magnitude of these risks may vary by sexual risk taking, partner HIV prevalence, host immune factors and genital co-infections. We examined temporal trends in HIV prevalence and per-act incidence, adjusted for behavioral and other variables, in FSWs from Nairobi, Kenya.
METHODS:

An open cohort of FSWs followed since 1985. Behavioral and clinical data were collected six monthly from 1985 to 2005, and sexually transmitted infection (STI) diagnostics and HIV serology performed. A Cox proportional hazards model with time-dependent covariables was used to estimate infection risk as a function of calendar time.
RESULTS:

HIV prevalence in new FSW enrollees peaked at 81% in 1986, and was consistently below 50% after 1997. Initially uninfected FSWs remained at high risk of acquiring HIV throughout the study period, but the rate of HIV acquisition during unprotected sex with a casual client declined by over four-fold. This reduction correlated closely with decreases in gonorrhea prevalence, and predated reductions in the Kenyan HIV population prevalence by over a decade.
CONCLUSIONS:

The per-act rate of HIV acquisition in high-risk Nairobi FSWs fell dramatically between 1985 and 2005. This decline may represent the impact of improved STI prevention/therapy, immunogenetic shifts in at-risk women, or changes in the proportion of HIV exposures occurring with clients who had acute HIV infection. Declining HIV incidence in high-risk cohorts may predict and/or be causally related to future reductions in population prevalence.

PMID:
18090401
[PubMed - indexed for MEDLINE]

E.N., PN.  2008.  HIV-neutralizing immunoglobulin A and HIV-specific proliferation are independently associated with reduced HIV acquisition in Kenyan sex workers.. Abstract

AIDS. 2008 Mar 30;22(6):727-35. doi: 10.1097/QAD.0b013e3282f56b64.
HIV-neutralizing immunoglobulin A and HIV-specific proliferation are independently associated with reduced HIV acquisition in Kenyan sex workers.
Hirbod T, Kaul R, Reichard C, Kimani J, Ngugi E, Bwayo JJ, Nagelkerke N, Hasselrot K, Li B, Moses S; Kibera HIV Study Group, MacDonald KS, Broliden K.

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Infectious Diseases Unit, Department of Medicine, Solna, Center for Molecular Medicine, Karolinska Institutet, Karolinska University Hospital, Solna, Sweden.
Abstract
OBJECTIVES:

HIV-neutralizing immunoglobulin A (IgA) and HIV-specific cellular immunity have been described in highly exposed, persistently seronegative (HEPS) individuals, but well controlled studies have not been performed. We performed a prospective, nested case-control study to examine the association of genital IgA and systemic cellular immune responses with subsequent HIV acquisition in high-risk Kenyan female sex workers (FSWs).
DESIGN AND METHODS:

A randomized trial of monthly antibiotic prophylaxis to prevent sexually transmitted disease/HIV infection was performed from 1998 to 2002 in HIV-uninfected Kenyan FSWs. After the completion of trial, FSWs who had acquired HIV (cases) were matched 1: 4 with persistently uninfected controls based on study arm, duration of HIV-seronegative follow-up, and time of cohort enrolment. Blinded investigators assayed the ability at enrolment of genital IgA to neutralize primary HIV isolates as well as systemic HIV-specific cellular IFNgamma-modified enzyme-linked immunospot and proliferative responses.
RESULTS:

The study cohort comprised 113 FSWs: 24 cases who acquired HIV and 89 matched controls. Genital HIV-neutralizing IgA was associated with reduced HIV acquisition (P = 0.003), as was HIV-specific proliferation (P = 0.002), and these associations were additive. HIV-specific IFNgamma production did not differ between case and control groups. In multivariable analysis, HIV-neutralizing IgA and HIV-specific proliferation each remained independently associated with lack of HIV acquisition. Genital herpes (HSV2) was associated with increased HIV risk and with reduced detection of HIV-neutralizing IgA.
CONCLUSION:

Genital HIV-neutralizing IgA and systemic HIV-specific proliferative responses, assayed by blinded investigators, were prospectively associated with HIV nonacquisition. The induction of these immune responses may be an important goal for HIV vaccines.

E.N., PN.  2008.  Coinfection with herpes simplex virus type 2 is associated with reduced HIV-specific T cell responses and systemic immune activation.. Abstract

Coinfection with herpes simplex virus type 2 is associated with reduced HIV-specific T cell responses and systemic immune activation.
Sheth PM, Sunderji S, Shin LY, Rebbapragada A, Huibner S, Kimani J, Macdonald KS, Ngugi E, Bwayo JJ, Moses S, Kovacs C, Loutfy M, Kaul R.
Source

Department of Medicine, University of Toronto, Toronto, Canada.
Abstract
BACKGROUND:

Chronic coinfection with herpes simplex virus type 2 (HSV-2) and human immunodeficiency virus (HIV) has been associated with an increased HIV viral load and more rapid disease progression, perhaps related to HSV-2-associated alterations in host immunity.
METHODS:

Studies were nested within (1) a cross-sectional study of men coinfected with HIV and HSV-2 and (2) women not infected with HIV, both before and after HSV-2 acquisition. HSV-2 infection status was determined by ELISA. HIV-specific CD8(+) T cell epitopes were mapped, and proliferation of HIV-specific cells was also assessed. Systemic inflammatory and regulatory T cell populations were assayed by flow cytometry.
RESULTS:

The breadth of both the HIV-specific CD8(+) T cell interferon-gamma and proliferative responses was reduced in participants coinfected with HIV and HSV-2, independent of the HIV plasma viral load and CD4(+) T cell count, and the magnitude of the responses was also reduced. HSV-2 infection in this group was associated with increased T cell CD38 expression but not with differences in the proportion of CD4(+) FoxP3(+) regulatory T cells. However, in women not infected with HIV, acquisition of HSV-2 was associated with an increase in the proportion of regulatory T cells.
CONCLUSIONS:

HSV-2 coinfection was associated with reduced HIV-specific T cell responses and systemic inflammation. The immune effects of HSV-2 may underlie the negative impact that this coinfection has on the clinical course of HIV infection.

PMID:
18444797
[PubMed - indexed for MEDLINE]

Free full text

E.N., PN.  2008.  A common human leucocyte antigen-DP genotype is associated with resistance to HIV-1 infection in Kenyan sex workers.. Abstract

AIDS. 2008 Oct 1;22(15):2038-42. doi: 10.1097/QAD.0b013e328311d1a0.
A common human leucocyte antigen-DP genotype is associated with resistance to HIV-1 infection in Kenyan sex workers.
Hardie RA, Knight E, Bruneau B, Semeniuk C, Gill K, Nagelkerke N, Kimani J, Wachihi C, Ngugi E, Luo M, Plummer FA.
Source
Department of Medical Microbiology, University of Manitoba, Canada.
Abstract
Human leucocyte antigen-DP presents peptides to CD4 T cells and plays an important role in parasitic infections and autoimmune diseases, yet its influence on HIV-1 susceptibility has not been well studied. Here, we report several human leucocyte antigen-DP genotypes associated with HIV-1 susceptibility in Kenyan sex workers. Among these, one common genotype stands out. DPA1*010301 (frequency = 60.4%) was associated with HIV-1 resistance (P = 0.033, odds ratio = 1.585, 95% confidence interval = 1.036-2.425) and slower seroconversion (P = 0.001, log rank = 0.595, 95% confidence interval = 0.433-0.817). The discovery of common human leucocyte antigen-DP genotypes contributing to HIV-1 immunity may help overcome difficulties encountered with highly polymorphic human leucocyte antigens.
PMID:
18784467
[PubMed - indexed for MEDLINE]
PMCID:
PMC2683274
Free PMC Article

E.N., PN.  2008.  Human leukocyte antigen-DQ alleles and haplotypes and their associations with resistance and susceptibility to HIV-1 infection.. Abstract

AIDS. 2008 Apr 23;22(7):807-16. doi: 10.1097/QAD.0b013e3282f51b71.
Human leukocyte antigen-DQ alleles and haplotypes and their associations with resistance and susceptibility to HIV-1 infection.
Hardie RA, Luo M, Bruneau B, Knight E, Nagelkerke NJ, Kimani J, Wachihi C, Ngugi EN, Plummer FA.
Source
Department of Medical Microbiology, University of Manitoba, Winnipeg, Manitoba, Canada.
Abstract
OBJECTIVES:
To determine the association of DQ antigens with resistance and susceptibility to HIV-1.
DESIGN:
Despite repeated exposure to HIV-1, a subset of women in the Pumwani Sex Worker cohort established in Nairobi, Kenya in 1985 have remained HIV-1 negative for at least 3 years and are classified as resistant. Differential susceptibility to HIV-1 infection is associated with HIV-1 specific CD4 and CD8 T cell responses. As human leukocyte antigen-DQ antigens present viral peptides to CD4 cells, we genotyped human leukocyte antigen -DQ alleles for 978 women enrolled in the cohort and performed cross-sectional and longitudinal analyses to identify associations of human leukocyte antigen -DQ with resistance/susceptibility to HIV-1.
METHODS:
DQA1 and DQB1 were genotyped using taxonomy-based sequence analysis. SPSS 13.0 was used to determine associations of DQ alleles/haplotypes with HIV-1 resistance, susceptibility, and seroconversion rates.
RESULTS:
Several DQB1 alleles and DQ haplotypes were associated with resistance to HIV-1 infection. These included DQB1*050301 (P = 0.055, Odds Ratio = 12.77, 95% Confidence Interval = 1.44-112), DQB1*0603 and DQB1*0609 (P = 0.037, Odds Ratio = 3.25, 95% Confidence Interval = 1.12-9.47), and DQA1*010201-DQB1*0603 (P = 0.044, Odds Ratio = 17.33, 95% Confidence Interval = 1.79-168). Conversely, DQB1*0602 (P = 0.048, Odds Ratio = 0.68, 95% Confidence Interval = 0.44-1.05) and DQA1*010201-DQB1*0602 (P = 0.039, Odds Ratio = 0.64, 95% Confidence Interval = 0.41-1.03) were overrepresented in the HIV-1 infected population. DQA1*0504-DQB1*0201, DQA1*010201-DQB1*0201, DQA1*0402-DQB1*0402 and DQA1*0402-DQB1*030101 genotypes were only found in HIV-1 positive subjects (Odds Ratio = 0.30-0.31, 95% Confidence Interval = 0.03-3.70), and these women seroconverted rapidly. The
associations of these DQ alleles and haplotypes with resistance and susceptibility to HIV-1 were independent of the previously reported human leukocyte antigen-DRB*01, human leukocyte antigen A2/6802, and human leukocyte antigen-A*2301.
CONCLUSION:
The associations of DQ alleles and haplotypes with resistance and susceptibility to HIV-1 emphasize the importance of human leukocyte antigen-DQ and CD4 in anti-HIV-1 immunity

E.N., PN.  2008.  Associations of human leukocyte antigen DRB with resistance or susceptibility to HIV-1 infection in the Pumwani Sex Worker Cohort.. Abstract

AIDS. 2008 May 31;22(9):1029-38. doi: 10.1097/QAD.0b013e3282ffb3db.
Associations of human leukocyte antigen DRB with resistance or susceptibility to HIV-1 infection in the Pumwani Sex Worker Cohort.
Lacap PA, Huntington JD, Luo M, Nagelkerke NJ, Bielawny T, Kimani J, Wachihi C, Ngugi EN, Plummer FA.
Source
National Microbiology Laboratory, Winnipeg, Canada.
Abstract
OBJECTIVE:
A group of commercial sex workers in the Pumwani Sex Worker Cohort, established in 1985 in Nairobi, Kenya, remain HIV-1 uninfected despite heavy exposure to HIV-1 through active sex work. Previous studies showed that this resistance is associated with a strong CD4+ T-cell response, which suggested that human leukocyte antigen class II antigens are important in resistance/susceptibility to HIV-1 infection. DRB1 is the most polymorphic locus among class II genes and forms haplotypes with DRB3, DRB4 and DRB5. The aim of this study is to investigate the role of DRB alleles/haplotypes on resistance/susceptibility to HIV-1 infection.
DESIGN:
In total, 1090 women enrolled in the Pumwani cohort were genotyped for DRB1, DRB3, DRB4 and DRB5 using a high-resolution sequence-based method. Allele/haplotype frequencies were compared between HIV-positive women and women who have remained HIV negative for more than 3 years despite frequent exposure.
METHODS:
Human leukocyte antigen DRB genes were amplified, sequenced and genotyped using a two-step sequence-based method. Allele/haplotype frequencies were determined using PyPop32-0.6.0. Statistical analysis was conducted using SPSS 11.0 for Windows.
RESULTS:
Three DRB1 alleles were associated with resistance: DRB1*010101 (P = 0.016; odd ratio (OR): 2.55; 95% confidence interval (CI): 1.16-5.61), DRB1*010201 (P = 0.019; OR: 1.86; 95% CI: 1.10-3.15), and DRB1*1102 (P = 0.025; OR: 1.72; 95% CI: 1.07-2.78). DRB1*030201 (P = 0.038; OR: 0.48; 95% CI: 0.23-0.98), DRB1*070101 (P = 0.035; OR: 0.54; 95% CI: 0.30-0.97), DRB1*1503 (P = 0.0004; OR: 0.34; 95% CI: 0.19-0.64), and DRB5*010101 (P = 0.001; OR: 0.37; 95% CI: 0.20-0.67) were associated with susceptibility. The haplotype DRB1*1102-DRB3*020201 was associated with HIV-1 resistance (P = 0.041; OR: 1.68; 95% CI: 1.02-2.78),
whereas the haplotypes DRB1*070101-DRB4*01010101 (P = 0.041; OR: 0.52; 95% CI: 0.28-0.98) and DRB1*1503-DRB5*01010101 (P = 0.0002; OR: 0.30; 95% CI: 0.15-0.58) were associated with susceptibility. These associations with resistance/susceptibility to HIV-1 were independent of previously reported alleles HLA-DRB1*01 and HLA-A*2301.
CONCLUSION:
Our findings indicate that human leukocyte antigen DRB-specific CD4+ T-cell responses are an important factor in resistance/susceptibility to HIV-1 infection.
PMID:
18520346
[PubMed - indexed for MEDLINE]

2007

Plummer, FA, Ngugi EN, Embree J, Fowke K, Ndinya-Achola J, MacDonald K, Ball T, Nagelkerke N, Kimani J, Ma L.  2007.  Rapid selection for HLA alleles that protect against HIV-1 infection correlates significantly to the declining incidence of HIV-1 in an East African sex worker population.
Shahmanesh, M, Wayal S, Cowan F, Mabey D, Copas A, Patel V, Ngugi EN.  2007.  Suicidal behavior among female sex workers in Goa, India: the silent epidemic. Abstract

Given that sex work is stigmatized In more countries Ihan not, it is likely to cause stress and increase sUicidal behaviour. This is significant and Iherefore the interventions should also include psychosocial counselling in order to support the sex workers' coping mechanisms. The findings of this study show that sooro-eccoormc empowerment reduces HIV risks in female sex workers who are from a low socio-economic class. My experience too has shown thai an empathetic attitude from care providers increases the sex-workers' self-worth and therefore the ability to cope. Studies have shown that female sex work in Africa, part of ASia and some inner cities of developed countries is poverty-driven. The majority of women are really practising survival as they also have children to feed, clothe and send to school. My experience in Kenya is that the interaction between poverty and stigma increases stress and therefore SUicidal tendency. The added problem is when the female sex worker would also turn out to be HIV-infected. Holistic and responsive interventions are recommended for quality mental health in female sex workers A major question that still remains IS how can poverty-driven sex work be effectively reduced. A limitation of the study is that the study population size was not sufficiently large to allow generalization. For further reading please see ret (1}. on which I am an author. whose results give female sex workers power to reduce dependency on sex income or exit.

Wamalwa, D, Benki-Nugent S, Langat A, Tapia K, Ngugi E;, Slyker JA, Richardson BA, John-Stewart GC.  2007.  Survival benefit of early infant antiretroviral therapy is compromised when diagnosis is delayed. Abstract

Late presentation is common among African HIV-1-infected infants. Incidence and correlates of mortality were examined in 99 infants with HIV-1 diagnosis by 5 months of age. Twelve-month survival was 66.8% (95% confidence interval: 55.9-75.6%). World Health Organization stage 3 or 4, underweight, wasting, microcephaly, low hemoglobin, pneumonia and gastroenteritis predicted mortality. Early HIV-1 diagnosis with antiretroviral therapy before symptomatic disease is critical for infant survival.

E.N., PN.  2007.  Sustained changes in sexual behavior by female sex workers after completion of a randomized HIV prevention trial.. Abstract

J Acquir Immune Defic Syndr. 2007 Aug 15;45(5):588-94.
Sustained changes in sexual behavior by female sex workers after completion of a randomized HIV prevention trial.
Ngugi EN, Chakkalackal M, Sharma A, Bukusi E, Njoroge B, Kimani J, MacDonald KS, Bwayo JJ, Cohen CR, Moses S, Kaul R; Kibera HIV Study Group.
Source

Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya.
Abstract
INTRODUCTION:

Behavioral interventions in female sex workers (FSWs) are associated with changes in sexual behavior and reduced rates of sexually transmitted infections (STIs) and HIV We examined the sustainability of such interventions.
METHODS:

HIV-uninfected Kenyan FSWs were enrolled in a clinical trial that provided free male condoms, community and clinic-based counseling, and STI management. After trial completion, scaled-back community-based resources remained in place. More than a year later, women were invited to complete a follow-up behavioral questionnaire and to undergo STI/HIV counseling and testing. Individual changes in sexual behavior were assessed by paired analysis.
RESULTS:

One hundred seventy-two women participated in the resurvey 1.2 years after trial termination. Client numbers had risen (paired t test, P < 0.001), but condom use had also increased (P < 0.001); both remained substantially lower than at enrollment. Regular partners accounted for a greater proportion of unprotected FSW sexual encounters (35% vs. 10%; P < 0.001). Only 9 (5.2%) of 172 women had a conventional STI, and the follow-up HIV incidence of 1.6 per 100 person-years (PYs) was similar to that during the trial period (3.7 per 100 PYs). Incident STIs and HIV were associated with the frequency of unprotected sex and younger age.
CONCLUSIONS:

Less intensive community-based risk reduction services after clinical trial termination may support ongoing reductions in STIs and HIV among high-risk FSWs.

PMID:
17589374
[PubMed - indexed for MEDLINE]

E.N., PN.  2007.  Prevalent herpes simplex virus type 2 infection is associated with altered vaginal flora and an increased susceptibility to multiple sexually transmitted infections.. Abstract

J Infect Dis. 2007 Dec 1;196(11):1692-7. Epub 2007 Oct 25.
Prevalent herpes simplex virus type 2 infection is associated with altered vaginal flora and an increased susceptibility to multiple sexually transmitted infections.
Kaul R, Nagelkerke NJ, Kimani J, Ngugi E, Bwayo JJ, Macdonald KS, Rebbaprgada A, Fonck K, Temmerman M, Ronald AR, Moses S; Kibera HIV Study Group.
Source

Department of Medical Microbiology, University of Nairobi, Kenya. rupert.kaul@utoronto.ca
Abstract
BACKGROUND:

Prevalent herpes simplex virus type 2 (HSV-2) infection increases human immunodeficiency virus acquisition. We hypothesized that HSV-2 infection might also predispose individuals to acquire other common sexually transmitted infections (STIs).
METHODS:

We studied the association between prevalent HSV-2 infection and STI incidence in a prospective, randomized trial of periodic STI therapy among Kenyan female sex workers. Participants were screened monthly for infection with Neisseria gonorrhoeae and Chlamydia trachomatis, and at least every 6 months for bacterial vaginosis (BV) and infection with Treponema pallidum, Trichomonas vaginalis, and/or HSV-2.
RESULTS:

Increased prevalence of HSV-2 infection and increased prevalence of BV were each associated with the other; the direction of causality could not be determined. After stratifying for sexual risk-taking, BV status, and antibiotic use, prevalent HSV-2 infection remained associated with an increased incidence of infection with N. gonorrhoeae (incidence rate ratio [IRR], 4.3 [95% confidence interval {CI}, 1.5-12.2]), T. vaginalis (IRR, 2.3 [95% CI, 1.3-4.2]), and syphilis (IRR, 4.7 [95% CI, 1.1-19.9]). BV was associated with increased rates of infection with C. trachomatis (IRR, 2.1 [95% CI, 1.1-3.8]) and T. vaginalis (IRR, 8.0 [95% CI, 3.2-19.8]). CONCLUSION; Increased prevalences of HSV-2 infection and BV were associated with each other and also associated with enhanced susceptibility to an overlapping spectrum of other STIs. Demonstration of causality will require clinical trials that suppress HSV-2 infection, BV, or both.

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