Psychiatric disorders and psychosocial correlates of high HIV risk sexual behaviour in war-affected Eastern Uganda.

This article sets out to investigate the psychiatric and psychosocial risk factors for high risk sexual behaviour in a war-affected population in Eastern Uganda. A cross-sectional survey was carried out in four sub-counties in two districts in Eastern Uganda where 1560 randomly selected respondents (15 years and above) were interviewed. The primary outcome was a derived variable "high risk sexual behaviour" defined as reporting at least one of eight sexual practices that have been associated with HIV transmission in Uganda and which were hypothesised could arise as a consequence of psychiatric disorder or psychosocial problems. Multivariable logistic regression was used to assess factors associated with high risk sexual behaviour in this population. Males were more likely to have at least one "high risk sexual behaviour" than females (11.8% vs. 9.1% in the last year). Sex outside marriage was the most commonly reported high risk sexual behaviour. Among males, the factors independently associated with high risk sexual behaviour were: being married, belonging to non-Catholic/non-Protestant religions, poverty, being a victim of intimate partner violence and having a major depressive disorder (MDD). Among females, the factors that were independently associated with high risk sexual behaviour were: being in the reproductive age groups of 25-34 and 35-44 years, not seeing a close relative killed and having experienced war-related sexual torture. Holistic HIV/AIDS prevention programming in conflict and post-conflict settings should address the psychiatric and psychosocial well-being of these communities as a risk factor for HIV acquisition.

HIV/AIDS-related attitudes and practices of hospital-based health workers in Kampala, Uganda.

OBJECTIVE: To assess HIV/AIDS-related attitudes and practices of hospital-based health workers in Kampala, Uganda. METHODS: A cross-sectional study was conducted in Mulago Hospital, the main national referral hospital in Uganda. A total of 155 physicians and nurses completed a brief questionnaire on HIV risk perception, attitudes and practices regarding AIDS prevention education, HIV counseling and testing and care of patients with HIV disease. RESULTS: Twenty-nine per cent of health workers reported never having discussed AIDS prevention with patients, 26% had never referred patients for HIV counseling and 31% had never advised patients suspected of HIV infection to be tested. Frequent explanations for not providing AIDS prevention education included time constraints and/or lack of related knowledge or skills. While 29% perceived recapping needles as involving no risk, activities involving casual contact with patients and condom use for protection against HIV infection were associated with a high perceived risk of HIV transmission, particularly among nurses. Physicians and nurses differed in their HIV/AIDS-related attitudes and practices. The physicians had a more positive attitude towards the care of patients with HIV disease. In addition, 80% of physicians compared to 59% of nurses referred patients for HIV counseling. A similar trend was found for advising patients to obtain HIV testing. CONCLUSIONS: Hospital-based health workers are missing important opportunities for AIDS prevention education with their patients. There are gaps in their knowledge about HIV and related infection control practices. Interventions should address their concerns and barriers to HIV prevention practices.

Epilepsy and retarded growth in a hyperendemic focus of onchocerciasis in rural western Uganda.

An unusually high number of patients with epilepsy was observed in Kyarusozi sub-county, where infection with Onchocerca volvulus is hyperendemic. A preliminary survey was carried out in April 1991, when all patients with epilepsy and growth retardation were invited for medical examination. Two hundred and thirty one patients were screened, of whom, 91% were below the age of 19 years. The infection rate with Onchocerca volvulus in patients with epilepsy (61%) and retarded growth (70%) was significantly higher than in the general population of Kyarusozi sub-county. The prevalence of epilepsy in the study area was estimated to be at least 2%. Psychological impairment was more often observed among patients with a combination of onchocerciasis, epilepsy and/or growth retardation than the patients with onchocerciasis, epilepsy or growth retardation alone.

PIP: A remarkably high number of patients with epilepsy was observed in Kyarusozi subcounty, Uganda, where infection with Onchocerca volvulus is hyperendemic. A survey was conducted from April 22 to May 4, 1991, in Kyarusozi subcounty when all patients with epilepsy and growth retardation were invited for medical examination. A full history was taken and a physical examination as well as a mental state assessment were carried out for all patients. A total of 231 persons were screened, of whom, 91% were below the age of 19 years. The infection rate with Onchocerca volvulus in patients with epilepsy (61%) and retarded growth (70%) was significantly higher than in the general population of Kyarusozi subcounty. The prevalence of epilepsy in the study area was estimated to be at least 2%. The cardinal clinical features were pigeon chest, increased curvature of the dorsum, hyperextended joints, poor oral hygiene, and dental caries with disproportionately large, and displaced maloccluded teeth. Additional features were malnutrition, including dry atrophic scaly skin, skin sores, and golden hair. The thyroid gland was enlarged in 7.4% of the children with physical growth retardation. Secondary sexual characteristics were absent or poorly developed in a further 1.3%. The data seemed to indicate that social adaptation and psychological functioning are more often disturbed in individuals who suffer from the combined effects of epilepsy, onchocerciasis, and growth retardation than in patients with onchocerciasis, epilepsy, or growth retardation along. This investigation suggests that onchocerciasis is associated with epilepsy, psychological impairment, retarded growth, and retarded sexual development. Should further studies confirm a relationship between Onchocerca volvulus infection, epilepsy, and mental development, the public health importance of onchocerciasis would have the be reconsidered to control Onchocerca volvulus infection more vigorously.