Bedømmelseskomité
1. opponent: professor MD MPH PhD Marleen Temmerman, Avdeling for obstetri, Universitetet i Ghent
2. opponent: overlege MD PhD Olav Øktedalen, Infeksjonsmedisinsk avdeling, Ullevål universitetssykehus
3. medlem av komiteen: professor MD PhD Borghild Roald, Patologisk anatomisk avdeling, Fakultetsdivisjon Ullevål universitetssykehus, Universitetet i Oslo
Leder av disputas: professor Øivind Larsen, Institutt for allmenn- og samfunnsmedisin
Sammendrag
Background: Sexual and reproductive health problems account for 18% of the total global burden of disease and 32% of the burden among women of reproductive age. The emergence of human immunodeficiency virus has contributed to the disproportionately high disease burden from reproductive ill health experienced by women. In the worst affected countries the impact of HIV threatens to hinder social, economic and human development and also the achievement the Millennium Development Goal: “to combat HIV/AIDS malaria and other infections” and “to reduce maternal and child mortality. In Zimbabwe, like the rest of the sub-Saharan African countries, HIV is a primarily sexually transmitted . Cofactors particularly sexually transmitted infections, facilitate the spread of HIV. The fundamental challenges in reversing the epidemic therefore, depend on identifying and preventing the factors that may be associated with the infection. Hence, the knowledge of individuals about the disease, and the individual perception of risk of infection are important to examine.
Objective: To determine the prevalence of HIV and to identify cofactors associated with its spread among women of reproductive age attending urban primary healthcare clinics in Harare, Zimbabwe.
Methods: In a cross-sectional study, 393 women attending primary healthcare clinics were recruited, counselled for HIV, interviewed privately, physically examined and screened for sexually transmitted infections, HIV and cervical cancer. Different laboratory techniques were used to detect infections. Socio-demographic risk factors including intra-vaginal practices were studied.
Results: This study revealed a very high HIV prevalence of 29.3%, genital herpes simplex type 2 seropositivity; 42.2%, bacterial vaginosis; 30.3%, and trichomonas vaginalis; 15.4%. Syphilis, chlamydia trachomatis and gonorrhoea were generally low. The prevalence of cervical abnormality (dyskaryosis) was high, 30% among HIV infected women compared to 13% among seronegative women. The cervical dyskaryosis was associated with HIV and intravaginal practices which included use of intravaginal herbs and intravaginal cleansing using a variety of substances. The women`s knowledge of specific STIs and their perception of personal risk of infection was very low. Although 50% had at least one ongoing reproductive tract infection, they did not volunteer the information during routine consultation and only revealed this to the researchers on proactive inquiry.
Conclusion: The high prevalence of both reproductive tract infection and HIV and the fact the opportunity for diagnosis and treatment was not seazed upon while the women were being attended to means the infection continues to quietly remain among the population. It was also apparent that those who were HIV seropositive were more likely to be co-infected with other reproductive tract infections. Intravaginal practices were common and were associated with HIV seropositivity, bacterial vaginosis and cervical dyskaryosis. These findings underscore the urgent need for HIV and STI prevention, diagnosis and treatment especially now that the global effort to make antiretroviral treatment accessible in low resource countries is on the increase. Equally important is the promotion of women’s awareness of urogenital symptoms, their seriousness and the potential consequences of intravaginal practices.
Kontaktperson
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