Trading HIV for sheep: Risky sexual behavior and the response of female sex workers to Tabaski in Senegal.

We use a cohort of female sex workers (FSWs) in Senegal to show how large anticipated economic shocks lead to increased risky sexual behavior. Exploiting the exogenous timing of interviews, we study the effect of Tabaski, the most important Islamic festival celebrated in Senegal, in which most households purchase an expensive animal for sacrifice. Condom use, measured robustly via the list experiment, falls by between 27.3 percentage points (pp) (65.5%) and 43.1 pp (22.7%) in the 9 days before Tabaski, or a maximum of 49.5 pp (76%) in the 7 day period preceding Tabaski. The evidence suggests the economic pressures from Tabaski are key to driving the behavior change observed through the price premium for condomless sex. Those most exposed to the economic pressure from Tabaski were unlikely to be using condoms at all in the week before the festival. Our findings show that Tabaski leads to increased risky behaviors for FSWs, a key population at high risk of HIV infection, for at least 1 week every year and has implications for FSWs in all countries celebrating Tabaski or similar festivals. Because of the scale, frequency, and size of the behavioral response to shocks of this type, policy should be carefully designed to protect vulnerable women against anticipated shocks.

[Low Body Mass Index and impact of antiretroviral therapy on nephrotoxicity, chronic renal disease among HIV-infected patients in Brazzaville, Congo]. / Faible indice de masse corporelle et impact des antirétroviraux sur la néphrotoxicité, la maladie rénale chronique chez les patients infectés par le VIH à Brazzaville, Congo.

OBJECTIVE: To describe the incidence and risks factors of ART induced nephrotoxicity and chronic kidney disease in HIV-1-infected adults with low body mass index (<18.5kg/m2). METHODS: A retrospective cohort study at the Ambulatory Treatment Center in Brazzaville, Congo. Patients with estimated glomerular filtration rate decrease by 25% compared to baseline or a 0.5mg/dL increase in serum creatinine above baseline were classified as having nephrotoxicity, and chronic kidney disease was defined as a value less than 60mL/min/1.73m2. We used Cox proportional hazards regression models to determine factors associated with nephrotoxicity and chronic kidney disease. RESULTS: Of 325 patients, 73.23% were women. Median values were an age 37.55 years (IQR: 33.51-44.96), weight 45kg (IQR: 41-49), CD4 count 137.5 cells/µL (42-245). In the first 24-months, follow-up on ART incidence rate of nephrotoxicity and chronic kidney disease was 27.95 and 7.44 per 100 persons-year respectively. Multivariate analysis identified as a risk factor of nephrotoxicity, baseline haemoglobin below or equal 8g/dL (aHR=2.25; 95%CI 1.28-3.98; P=0.005) and the use of tenofovir (aHR=1.51; 95%CI 1.01-2.27; P=0.04). DFG between 60-80 mL/min/1.73 m2 (aHR=0.35; 95%CI 0.21-0.59; P<0.001) and 45-59mL/min/1.73 m2 (aHR=0.10; 95%CI 0.01-0.72; P=0.02) was not a contraindication for initiating antiretroviral therapy. Each 10-year older age was associated with an increased risk of developing chronic kidney disease (aHR=1.95; 95%CI 1.2-3.17; P=0.007). CONCLUSION: Incidence of nephrotoxicity and chronic kidney disease were high. African HIV-positive patient with low body mass index at baseline need close monitoring of their renal function when treated with tenofovir.

Experience on the management of the first imported Ebola virus disease case in Senegal.

The Ebola virus disease, as a first epidemic in West Africa, stands as the most deadly one throughout history. Guinea, the source of the epidemic, Sierra Leone and Liberia remain the most strongly affected. That epidemic thoroughly destabilized the health system of those countries. Following Nigeria, Senegal received its first imported case from the neighboring Republic of Guinea. In that sub regional psychotic context, such a situation has been handled and managed starting from the potential of a health system that is already suitably structured. The organization of the response, the management of the communication system and the rigorous monitoring of contacts have been decisive in the control of the epidemic. Our countries have to be prepared in order to face health threats, and that is the reason why the need to empower our health systems is important.