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Women's Beliefs about Male Circumcision, HIV Prevention, and Sexual Behaviors in Kisumu, Kenya  [PDF]
Thomas H. Riess, Maryline M. Achieng', Robert C. Bailey
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0097748
Abstract: It is important to understand how women's sexual practices may be influenced by male circumcision (MC) as an HIV prevention effort. Women's beliefs about MC and sexual behaviour will likely influence the scale-up and uptake of medical MC. We conducted qualitative interviews with 30 sexually active women in Kisumu, Kenya. Women discussed MC related to perceived health benefits, condom use, sexual behaviour, knowledge of susceptibility to HIV and sexually transmitted infections (STIs), circumcision preference, and influence on circumcision uptake. Respondents had a good understanding of the partial protection of MC for acquisition of HIV for men. Women perceived circumcised men as cleaner, carrying fewer diseases, and taking more time to reach ejaculation. Male's circumcision status is a salient factor for women's sexual decision making, including partner choice, and condom use. It will be important that educational information affirms that MC provides only partial protection against female to male transmission of HIV and some STIs; that other HIV and STI prevention methods such as condoms need to be used in conjunction with MC; that MC does not preclude a man from having HIV; and that couples should develop plans for not having sex while the man is healing.
Association of Attitudes and Beliefs towards Antiretroviral Therapy with HIV-Seroprevalence in the General Population of Kisumu, Kenya  [PDF]
Craig R. Cohen, Michele Montandon, Adam W. Carrico, Stephen Shiboski, Alan Bostrom, Alfredo Obure, Zachary Kwena, Robert C. Bailey, Rosemary Nguti, Elizabeth A. Bukusi
PLOS ONE , 2009, DOI: 10.1371/journal.pone.0004573
Abstract: Background Since antiretroviral therapy (ART) became available in the developed world, the prevalence of unprotected sex and the incidence of sexually transmitted infections (STIs) and HIV have increased. We hypothesized that a similar phenomenon may be occurring in sub-Saharan Africa concomitant with the scale-up of HIV treatment. Methods We conducted a general population-based survey in Kisumu, Kenya. Participants completed an interview that included demographics as well as ART-related attitudes and beliefs (AB) and then underwent HIV serological testing. Exploratory and confirmatory factor analyses of AB about ART indicated two factors: 1) ART-related risk compensation (increased sexual risk taking now that ART is available); and 2) a perception that HIV is more controllable now that ART is available. Logistic regression was used to determine associations of these factors with HIV-seroprevalence after controlling for age. Findings 1,655 (90%) of 1,844 people aged 15–49 contacted, including 749 men and 906 women, consented to participate in the study. Most participants (n = 1164; 71%) had heard of ART. Of those who had heard of ART, 23% believed ART was a cure for HIV. ART-related risk compensation (Adjusted (A)OR = 1.45, 95% CI 1.16–1.81), and a belief that ART cures HIV (AOR = 2.14, 95% CI 1.22–3.76) were associated with an increased HIV seroprevalence in men but not women after controlling for age. In particular, ART-related risk compensation was associated with an increased HIV-seroprevalence in young (aged 15–24 years) men (OR = 1.56; 95% CI 1.12–2.19). Conclusions ART-related risk compensation and a belief that ART cures HIV were associated with an increased HIV seroprevalence among men but not women. HIV prevention programs in sub-Saharan Africa that target the general population should include educational messages about ART and address the changing beliefs about HIV in the era of greater ART availability.
Microbial Diversity of Genital Ulcer Disease in Men Enrolled in a Randomized Trial of Male Circumcision in Kisumu, Kenya  [PDF]
Supriya D. Mehta, Stefan J. Green, Ian Maclean, Hong Hu, Robert C. Bailey, Patrick M. Gillevet, Greg T. Spear
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0038991
Abstract: Background Medical male circumcision (MMC) reduces the risk of genital ulcer disease (GUD) in men by 50%. In Ugandan and Kenyan trials, a sexually transmissible agent was not identified in 50–60% of GUD specimens by polymerase chain reaction (PCR) assay. We sought to better define the etiology of GUD in men participating in the Kenyan trial and examine how MMC affects GUD etiology. Methods We defined GUD of unknown etiology as negative for HSV (type 1 and type 2), T. pallidum, and H. ducreyi by PCR, and negative for HSV-2 and T. pallidum by serology. We identified bacterial microbiota in a subset of 59 GUD specimens using multitag pyrosequencing of the 16S rRNA gene, and compared results by unknown vs. STI-associated etiology. Statistical analysis employed Bray-Curtis similarity measure of bacterial community by etiology, hierarchical clustering and logistic regression. Results In 59 GUD specimens from 59 men, 23 (39%) had unknown etiology. Bacterial diversity was greater in GUD of unknown than STI etiology (p = 0.01). Fusobacteria (Fusobacterium spp. and Sneathia spp.) were more commonly detected in men with GUD of unknown etiology [adjusted OR = 5.67; 95% CI: 1.63–19.8] as were Oxobacter spp. and Anaerovorax spp. [adjusted OR = 3.12; 95% CI: 0.83–11.7]. Sequences from these four anaerobic bacterial taxa were more often detected in uncircumcised men than circumcised men (p<0.05). Conclusions Anaerobic bacteria are more common in genital ulcers of uncircumcised men. The specific anaerobic bacteria associated with GUD of unknown etiology have cytotoxic properties that can exacerbate epithelial disruptions leading to ulcer-like appearance. MMC may reduce GUD through a reduction in these anaerobic bacteria.
Risk Compensation Is Not Associated with Male Circumcision in Kisumu, Kenya: A Multi-Faceted?Assessment?of Men Enrolled in a Randomized Controlled Trial  [PDF]
Christine L. Mattson, Richard T. Campbell, Robert C. Bailey, Kawango Agot, J. O. Ndinya-Achola, Stephen Moses
PLOS ONE , 2008, DOI: 10.1371/journal.pone.0002443
Abstract: Background Three randomized controlled trials (RCTs) have confirmed that male circumcision (MC) significantly reduces acquisition of HIV-1 infection among men. The objective of this study was to perform a comprehensive, prospective evaluation of risk compensation, comparing circumcised versus uncircumcised controls in a sample of RCT participants. Methods and Findings Between March 2004 and September 2005, we systematically recruited men enrolled in a RCT of MC in Kenya. Detailed sexual histories were taken using a modified Timeline Followback approach at baseline, 6, and 12 months. Participants provided permission to obtain circumcision status and laboratory results from the RCT. We evaluated circumcised and uncircumcised men's sexual behavior using an 18-item risk propensity score and acquisition of incident infections of gonorrhea, chlamydia, and trichomoniasis. Of 1780 eligible RCT participants, 1319 enrolled (response rate = 74%). At the baseline RCT visit, men who enrolled in the sub-study reported the same sexual behaviors as men who did not. We found a significant reduction in sexual risk behavior among both circumcised and uncircumcised men from baseline to 6 (p<0.01) and 12 (p = 0.05) months post-enrollment. Longitudinal analyses indicated no statistically significant differences between sexual risk propensity scores or in incident infections of gonorrhea, chlamydia, and trichomoniasis between circumcised and uncircumcised men. These results are based on the most comprehensive analysis of risk compensation yet done. Conclusion In the context of a RCT, circumcision did not result in increased HIV risk behavior. Continued monitoring and evaluation of risk compensation associated with circumcision is needed as evidence supporting its' efficacy is disseminated and MC is widely promoted for HIV prevention.
Time to Complete Wound Healing in HIV-Positive and HIV-Negative Men following Medical Male Circumcision in Kisumu, Kenya: A Prospective Cohort Study  [PDF]
John H. Rogers, Elijah Odoyo-June, Walter Jaoko, Robert C. Bailey
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0061725
Abstract: Background While voluntary medical male circumcision (VMMC) has been shown to be protective against HIV-acquisition, the procedure may place men and their partners at risk of HIV infection in the period following circumcision if sex is resumed before the wound is healed. This prospective cohort study evaluates post-circumcision wound healing to determine whether the 42-day post-circumcision abstinence period, recommended by the World Health Organization and adopted by VMMC programs, is optimal. Methods and Findings Men were circumcised by forceps-guided method and their post-circumcision wounds examined weekly for seven weeks and at 12 weeks. Time to complete healing was recorded in completed weeks since circumcision, and its associations with baseline covariates were assessed by Kaplan-Meier methods and Cox Proportional Hazard Models. A total of 215 HIV-negative and 108 HIV-positive men aged 18–35 years (median 26, IQR 23–30) were enrolled. 97.1% of scheduled follow-up visits were completed. At week 4, 59.3% of HIV-positive men and 70.4% of age-matched HIV-negative men were healed. At week 6, these percentages rose to 93.4% in HIV-positive men and 92.6% in age-matched HIV-negative men. There was no difference in the hazard of healing between 108 HIV-positive and 108 age-matched HIV-negative men (HR 0.91 95% CI 0.70–1.20). Early post-operative infection was associated with delayed healing in both HIV-positive and HIV-negative men (HR 0.48 95% CI 0.23–1.00). Conclusions Our results indicate that the WHO recommendation for 42-days post-circumcision sexual abstinence should be maintained for both HIV-positive and HIV-negative men. It is important to stress condom use upon resumption of sex in all men undergoing circumcision.
Spatial distribution and cluster analysis of sexual risk behaviors reported by young men in Kisumu, Kenya
Nelli Westercamp, Stephen Moses, Kawango Agot, Jeckoniah O Ndinya-Achola, Corette Parker, Kevine O Amolloh, Robert C Bailey
International Journal of Health Geographics , 2010, DOI: 10.1186/1476-072x-9-24
Abstract: To investigate the geospatial distribution of prevalent sexually transmitted infections and sexual behaviors in a sample of 18-24 year-old sexually active men in urban and rural areas of Kisumu, Kenya, we mapped the residences of 649 men and conducted spatial cluster analysis. Spatial distribution of the study participants was assessed in terms of the demographic, behavioral, and sexual dysfunction variables, as well as laboratory diagnosed STIs. To test for the presence and location of clusters we used Kulldorff's spatial scan statistic as implemented in the Satscan program.The results of this study suggest that sexual risk behaviors and STIs are evenly distributed in our sample throughout the Kisumu district. No behavioral or STI clusters were detected, except for condom use. Neither urban nor rural residence significantly impacted risk behavior or STI prevalence.We found no association between place of residence and sexual risk behaviors in our sample. While our results can not be generalized to other populations, the study shows that geospatial analysis can be an important tool for investigating study sample characteristics; for evaluating HIV/STI risk factors; and for development and implementation of targeted HIV and STI control programs in specifically defined populations and in areas where the underlying population dynamic is poorly understood.The well-established connection between HIV risk behavior and place of residence points to the importance of geographic clustering in the potential transmission of HIV and other sexually transmitted infections (STIs) [1-3]. Rothenberg et al. hypothesized that one of the elements that plays an important role in maintaining endemicity of HIV in high prevalence settings is the geographic range of persons in a social network [1,2]. The correlation between the geographical proximity of persons connected within a network, but not necessarily known to each other [2], was found to be an important factor in maintenance of HIV e
Drug abuse in Kisumu town western Kenya
AO Otieno, AVO Ofulla
African Journal of Food, Agriculture, Nutrition and Development , 2009,
Abstract: This was a cross sectional study designed to determine the factors associated with drug abuse among secondary school students in nine schools in Kisumu town, western Kenya. The objective of this study was to determine the effect of age, gender and peer influence on drug abuse and to establish the reasons why students abuse drugs. Nine schools were randomly selected for the study. A total of 458 students (243 males and 215 females) were interviewed using a closed ended questionnaire. The data were then categorized into non-abusers and abusers and the degree of association between the variables was tested using Chi-square test. A total of 458 students (243 males and 215 females), were interviewed using a close-ended questionnaire. The results showed that 265 (57.9%) of the respondents had consumed alcohol at least once in their lives, 159 (34.7%) had abused tobacco, 84 (18.3%) had abused cannabis, 106 (23.1%) had abused khat and 24 (5.2%) had used inhalants and/or cocaine. The age group most at risk was 16-18 years, the age at which most students are in secondary school. The reasons given for the abuse of the drugs were: experimentation 92 (38.2%), enjoyment of the feeling they experience 114 (47.3%), influence from friends 21 (8.7%), influence from relatives 5 (2.1%) and for treating stomach ailments 7 (2.9%). More boys were found to be abusing drugs (36.9%, n = 169) compared to girls (27.3%, p = 0.007). Also, drug abuse was found to be higher in students living in low socioeconomic class areas of the town (30%, n = 122) compared to high-class areas (21.6%, n = 94, p =0.004) and peer influence had no effect on drug abuse (p = 0.249). From this study it was concluded that drug abuse was widespread in secondary schools in Kisumu and although it affected both sexes boys were more involved in the practice than girls. The study therefore recommends that early intervention should target school attendees at early age with the aim of preventing drug abuse in secondary schools in Kisumu town, western Kenya.
Contraception and sexuality among the youth in Kisumu, Kenya
Missie L. Oindo
African Health Sciences , 2002,
Abstract: Background: A significant proportion of youth is infected by HIV and other sexually transmitted infections mainly through sexual intercourse, while the prevalence of unwanted pregnancies is rising. Objective: To describe knowledge, attitude and practice and factors influencing sexual relationships and contraceptive practice among the youth in Kisumu town in western Kenya. Methods: A descriptive cross-sectional study using a semi-structured questionnaire, key informant interviews, focus group discussions and informal conversations was carried out. The sample population of 388 youth aged 15 24 years was determined by simple random cluster sampling. Quantitative data were analysed using SPSS computer package. Results: The majority of the youth are sexually experienced (73.5%) with most of the first sexual experiences occurring within the 15-19 years age group. There is a high level of knowledge (99.2%) of contraceptive methods and a positive attitude towards contraception. However, the level of contraceptive use is relatively lower (57.5%) even for the sexually active. Factors influencing this practice are associated with the individuals background as well as health delivery systems and policy. Conclusion: There is a wide disparity between contraceptive knowledge and practice, which needs to be bridged. There is need to review policies and practices regarding reproductive health, sexuality and family life education. African Health Sciences 2002; 2(1): 33-39
Prevalence of Forced Sex and Associated Factors among Women and Men in Kisumu, Kenya
MK Adudans, M Montandon, Z Kwena, EA Bukusi, CR Cohen
African Journal of Reproductive Health , 2011,
Abstract: Sexual violence is a well-recognized global health problem, albeit with limited population-based data available from sub-Saharan Africa. We sought to measure the prevalence of forced sex in Kisumu, Kenya, and identify its associated factors. The data were drawn from a population-based cross-sectional survey. A two-stage sampling design was used: 40 clusters within Kisumu municipality were enumerated and households within each cluster selected by systematic random sampling. Demographic and sexual histories, including questions on forced sex, were collected privately using a structured questionnaire. The prevalence of forced sex was 13% (women) and 4.5% (men). After adjusting for age and cluster, forced sex among women was associated with transactional sex (OR 2.33; 95%CI 1.38-3.95), having more than two lifetime partners (OR 1.9; 95%CI 1.20-3.30), having postprimary education (OR 1.49; 95%CI 1.04-2.14) and a high economic status (OR 1.87; 95%CI 1.2-2.9). No factors were significantly associated with forced sex among the male respondents. Intimate partners were the most common perpetrators of forced sex among both women (50%) and men (62.1%). Forced sex prevention programs need to target the identified associated factors, and educate the public on the high rate of forced sex perpetrated by intimate partners.
THE ROLE OF URBAN PARKS AND SOCIO-ECONOMIC DEVELOPMENT: CASE STUDY OF KISUMU KENYA
Rose Susan RABARE,Roselyne OKECH,George Mark ONYANGO
Theoretical and Empirical Researches in Urban Management , 2009,
Abstract: Urban parks are now viewed as an important part of the broader structure of urban and neighborhood development rather than just recreation and leisure facilities. While most of the world has recognized the multifunctional use of urban parks for development; the parks in Kenya and Kisumu Township in particular are suffering from lack of attention, poor maintenance, lack of development and underutilization. Also evident in most parks of Kisumu Township is lack of activities and basic utilities like public toilets, litterbins, benches and notice boards. The stakeholders of Kisumu Town do not seem to realize that parks can contribute to enormous social, cultural and economic development of the poverty stricken region. The aim of the study was to assess the utilization, investigate the benefits and analyze the factors influencing use of urban parks in Kisumu. Descriptive, cross-section research design was used where multistage cluster sampling technique was applied in sampling households and park users within seven wards of Kisumu Township and seven urban parks respectively. The study indicates that the poor maintenance and lack of adequate facilities had hindered optimal social, economical, environmental and educational benefits of the parks.
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