Factors that could influence the spread of AIDS in Ghana, West Africa: knowledge of AIDS, sexual behavior, prostitution, and traditional medical practices.

Ghana is a West African nation in the early stages of the human immunodeficiency virus (HIV) epidemic. In a series of surveys done between 1987 and 1989, we examined factors related to the spread of HIV infection, including knowledge about the acquired immune deficiency syndrome (AIDS), sexual habits, use of prostitutes, traditional healer practices, and skin-piercing customs. Although a polygamous society, three-fourths of married men had only one wife. The number of sexual partners at any one time was generally low. However, the divorce rate was more than 29% and 55% of married men had current sexual partners in addition to their wives. Knowledge about AIDS was widespread, yet 4% of men interviewed had had a sexual encounter with a prostitute within the last month. Use of condoms was very limited and 66% of customers of high-class prostitutes refused to use a condom even after a request to do so by the prostitute. Skin piercing, including scarification, was done by an unsterile instrument by 39% of 74 rural traditional healers, many of whom had more than one patient per day. To combat the spread of AIDS, Ghanaians will have to apply their knowledge of AIDS risk factors to their actual behavior. Many of the social customs are products of poverty and its ensuing social consequences. Funds are needed for specific AIDS prevention programs as well as improved education and health care throughout the country.

The prevalence of antibodies to the human T lymphotropic virus (HTLV) in Ghana, West Africa.

We conducted a population-based serosurvey of urban areas and rural regions of southern Ghana, West Africa. Subjects (3763) of all ages were enrolled from 25 city and village sites and in studies of groups of special interest. "Positive" results were difficult to define because of a high frequency of results that were indeterminate on immunoblotting, the current standard for confirmation of HTLV-I. However, polymerase chain reaction results and HTLV type-specific discriminatory tests proved HTLV-I was present in Ghana. No HTLV-2 positivity was observed. By using strict criteria that considered indeterminate results as negative, the overall prevalence was found to be between 1 and 2% in all areas, with no difference by geographic location. Prevalence rose with age and was higher in adult women than men. However, in substudies of selected populations, we found HTLV prevalence among 124 persons with lymphomas and hematological malignancies was not different from that in the general population. Furthermore, the prevalence in prostitutes was similar to that in the general population and in pregnant women. HTLV-I is present in West Africa, but we were unable to associate HTLV-I seropositivity with malignancy or with prostitution.

HIV-1 and HIV-2 in Ghana, west Africa: community surveys compared to surveys of pregnant women.

We conducted a population-based serosurvey of HIV-1/2 in 2,410 residents of two urban and two rural areas of southern Ghana, West Africa and compared the results to serosurveys of 1,417 pregnant women. Using conservative criteria, we found the prevalence of HIV-1/2 in community survey adults (> 15 years old) to be 1.5% in women and 1.0% in men. Among pregnant women, the prevalence was 9.3% in one rural area but only 1.0% in other areas. Many samples, especially among the pregnant women were HIV-1 and -2 dual reactive on serology. We attribute the disparity between prevalence in the community survey participants and pregnant women to local socio-economic factors. Women in this area have a tradition of working throughout West Africa as trader/ commercial sex workers. When pregnant or ill, they return to their home villages to be with their families. HIV surveillance programs which rely on pregnant women need to be sure that sampled populations are truly typical of the communities they are intended to represent.

PIP: HIV prevalence in urban and rural southern Ghana was investigated in a community-based serosurvey of 2410 people conducted in 1989-90 and an analysis of serum samples collected in 1987 from 1330 pregnant women attending antenatal clinics in the Eastern Region. None of the 906 children in the community-based survey was HIV-positive, including 6 born to HIV-infected women. Among the 1329 adults, 5 men (1.0%) and 12 women (1.5%) were infected. Among pregnant women, 100 (7.1%) were HIV-positive. At the four antenatal centers, HIV prevalence ranged from 0.6% to 10.3%. The high HIV prevalence recorded among pregnant women in the Manya-Krobo District (10.3%), a rural area away from major travel routes, likely reflects the tendency for ill women to return home to be cared for by their families. HIV surveillance programs that focus on pregnant women should be aware of this social phenomenon.

Intrathecal chemoprophylaxis in the prevention of central nervous system relapse in Burkitt's lymphoma.

A retrospective review of patients treated for endemic Burkitt's lymphoma in Ghana was undertaken to evaluate the efficacy of intrathecal (IT) chemoprophylaxis in preventing central nervous system (CNS) relapse. Patients treated before 1974 received no IT chemoprophylaxis and those treated between 1974 and 1979 received IT methotrexate in addition to systemic chemotherapy. In patients presenting with facial disease only (Stages I-II), there was no significant difference in the frequency of CNS relapse between those receiving IT chemoprophylaxis and those not receiving any. CNS relapse was, however, significantly reduced in patients presenting with abdominal disease (Stage III) who received IT chemoprophylaxis in addition to systemic combination therapy. This was associated with an improved survival.

Bone marrow in sickle cell anaemia at time of anaemic crisis.

Samples of bone marrow from 33 Ghanaian children with homozygous sickle cell anaemia who presented with profound anaemia (haemoglobin less than 5 g/dl) were studied. The principal finding was depression of erythropoiesis (aplastic crisis) in 14 children and erythroid hyperplasia in 17. A splenic sequestration crisis was clinically diagnosed in the remaining two children. Stainable iron was absent in the marrow of 14 children and reduced in another five. Megaloblastic changes compatible with folate deficiency were present in 8 children. It is suggested that iron and folate deficiencies may complicate sickle cell anaemia in children living in geographical areas where nutritional deficiencies are prevalent.