ABSTRACT
OBJECTIVE: To determine the absolute and proportional prevalence of dual seroreactivity to HIV-1 and HIV-2 in female sex workers in Abidjan, to determine risk determinants for this serologic profile, and to describe the associated clinical and immunological characteristics. DESIGN: Cross-sectional study. SETTING: Confidential clinic for female sex workers in Abidjan. PARTICIPANTS: Female sex workers. MAIN OUTCOME MEASURES: HIV serostatus, CD4+ counts, women with AIDS, behavioural and sociodemographic characteristics. RESULTS: Among 1209 women tested, the overall HIV seroprevalence was 80%, while the prevalence of dual seroreactivity was 30%. Dual seroreactivity accounted for 38% of all HIV infections. Compared with women reacting to HIV-1 only, dually seroreactive women were significantly more likely to have been in sex work for a longer period, to be aged > or = 20 years, and to charge less money for intercourse. No difference in mean CD4+ count was noted between women with dual seroreactivity (561 x 10(6)/l) and HIV-1-seropositive women (558 x 10(6)/l). CONCLUSIONS: Female sex workers in Abidjan had the highest absolute (30%) and proportional rate (38%) of dual seroreactivity yet described in any population. Increased sexual exposure is associated with an increased risk of dual seroreactivity. Although better molecular diagnostic techniques are required, a substantial proportion of female sex workers in Abidjan is likely to be infected with both HIV-1 and HIV-2.
Subject(s)
HIV Infections/epidemiology , HIV Seroprevalence , HIV-1 , HIV-2 , Sex Work , Adult , Cote d'Ivoire/epidemiology , Cross-Sectional Studies , Female , Humans , Risk FactorsABSTRACT
In the acquired immunodeficiency syndrome (AIDS) era, adequate management of sexually transmitted diseases (STDs) is a primary concern in Africa. Assessed in this study is the clinical efficacy and feasibility of WHO-recommended therapeutic algorithms for genital discharges and ulcers, diagnosed without laboratory tests, for use at the primary health care level. Drugs were sold on a cost-recovery basis and included intramuscular ceftriaxone and oral ciprofloxacin for single-dose therapy of gonorrhoea and chancroid. During April 1993 in 10 peripheral health care centres in Abidjan, Côte d'Ivoire, a total of 207 patients were followed up, including 89 cases of male urethritis, 92 cases of vaginal discharges and 26 cases of genital ulcers; clinical success, assessed 7 days after the onset of therapy, was, respectively, 92%, 87%, and 100%. Less than 10% of the 207 patients were referred to the next care level, an acceptable rate from a public health point of view. Medical adherence to the algorithms was excellent for urethral discharges and genital ulcers but poor for vaginal discharges, partly because of intentional therapeutic modifications, without detriment to success. For drugs, the average cost per cure was 1546 francs CFA (US$ 5.60) (maximum, 2980 francs CFA (US$ 10.70). Effective and affordable treatments for STDs are necessary for their realistic case management in Africa.
Subject(s)
Algorithms , Anti-Bacterial Agents/therapeutic use , Sexually Transmitted Diseases/drug therapy , Adolescent , Adult , Anti-Bacterial Agents/economics , Costs and Cost Analysis , Cote d'Ivoire , Female , Follow-Up Studies , Humans , Male , Middle AgedABSTRACT
A cross-sectional study among female sex workers in Abidjan was conducted to study the association between sexually transmitted diseases and human immunodeficiency virus (HIV) infection and HIV-related immunosuppression. Among 1209 women tested for HIV, 962 (80%) were seropositive. HIV infection was independently associated with a longer duration of sex work, a lower price for intercourse, being an immigrant, and having a positive Treponema pallidum hemagglutination test (P < .05). Genital ulcers (25% vs. 5%), genital warts (14% vs. 4%), Neisseria gonorrhoeae (32% vs. 16%), Trichomonas vaginalis (27% vs. 17%), and syphilis (27% vs. 17%) were more frequent (P < .05) in HIV-infected than -uninfected women. Among HIV-infected women, the proportions with a genital ulcer were 17%, 25%, and 36% for those with > 28%, 14%-28%, and < 14% CD4 cells, respectively (P < .001). This study suggests that genital ulcers are an opportunistic disease in female sex workers in Abidjan.