Clinics aren't Meant for Men': Sexual Health Care Access and Seeking Behaviours Among Men in Gauteng Province; South Africa

Men may be key players in the transmission of sexually transmitted infections (STI); and it is important that STI/HIV health services reach men. The objective of this study was to explore sexual health care access and seeking behaviours in men. This study used focus groups to examine sexual health care access and seeking behaviours in men 5 years after implementation of free antiretroviral therapy (ART) in the South African public sector. Six focus groups (N=58) were conducted with men ?18 years in an urban area of Gauteng province. Men were recruited from various locations throughout the community. Men reported several barriers and facilitators to the use of public and private clinics for sexual health services including HIV testing; and many men reported seeking care from traditional healers. Men often viewed public clinics as a place for women and reported experiences with some female nurses who were rude or judgmental of the men. Additionally; some men reported that they sought sexual health care services at public clinics; however; they were not given physical examinations by health care providers to diagnose their STI syndrome. Most men lacked knowledge about ART and avoided HIV testing because of fear of death or being abandoned by their families or friends. Study findings suggest that men still require better access to high-quality; non-judgmental sexual health care services. Future research is needed to determine the most effective method to increase men's access to sexual health care services

Revision of the National Guideline for First-Line Comprehensive Management and Control of Sexually Transmitted Infections:What's New and Why?

A revised national guideline for the management and control of sexually transmitted infections (STIs) has recently been published by the national Department of Health according to the Essential Drugs List. Since 2004; there has been a marked rise in resistance to ciprofloxacin among Neisseria gonorrhoeae isolates in several South African cities; requiring a change from quinolones to cephalosporins to treat presumptive gonorrhoea. In keeping with WHO recommendations; acyclovir has been added as part of first-line therapy for the management of genital ulceration. The national guideline has been revised accordingly in order to improve management of several key STI syndromes

A descriptive study of HIV-infected long-term surviving children in Barbados--a preliminary report / Estudio Descriptivo de Niños Infectados por el VIH Sobrevivientes a Largo Plazo en Barbados Un Informe Preliminar

OBJECTIVES: To describe the clinical and immunologic characteristics of human immunodeficiency virus type-1 (HIV-1)-infected children surviving to more than eight-years of age (long-survivors) before the introduction of antiretroviral therapy. METHODS: This report is based on all the long-term survivors from a prospective cohort of HIV-infected children born to HIV-positive women in Barbados during 1986-1995. Infants born to HIV-infected women were enrolled into this cohort at birth or at the time of diagnosis of HIV exposure in the postnatal period and followed-up at regular intervals. RESULTS: From a cohort of 44 HIV-infected children, 17 (38.6%) children survived to the age of eight years and beyond and were classified as long-term survivors. Median age of the sixteen long-term surviving children alive at the time of this report was 12 years (age range 8 - 16.7 years). At the age of 8 years, 17.6% of these children remained asymptomatic. Nine (52.9%) children had no immunodeficiency (CD4 counts >500 cells x 10(6)/L). Of the 16 long-term surviving children who were alive and had a median follow-up of 4.1 years (range 0.1 year to 8.5 years) after their eighth birthday, 37.5% had a CD4 cell count greater than 500 cells x 10(6)/L and had either no symptoms or only mild symptoms of HIV infection and were therefore categorized as the long-term non-progressors. CONCLUSIONS: In a small cohort of HIV-infected children, in the absence of antiretroviral therapy, only about one-third survived beyond eight years of age. On further follow-up of these long-term surviving children, over one-third had a slow rate of disease progression

OBJETIVOS: Describir las características clínicas e inmunológicas de niños infectados por el VIH-1, que lograron sobrevivir hasta más de ocho años de edad (sobrevivientes a lago plazo) antes de la introducción de terapia antiretroviral. MÉTODOS: Este informe se basa en todos los sobrevivientes a largo plazo de una cohorte prospectiva de niños infectados por el VIH nacidos de mujeres VIH positivas en Barbados, durante los años 1986-1995. Los niños nacidos de mujeres infectadas por el VIH fueron enrolados en esta cohorte al nacer o en el momento de diagnóstico de exposición al VIH en el periodo postnatal, y seguidos a intervalos regulares. RESULTADOS: De una cohorte de 44 niños infectados por el VIH, 17 niños (38.6%) sobrevivieron hasta los ocho años de edad y más, clasificándoseles por ende como sobrevivientes a largo plazo. La edad media de los 16 niños sobrevivientes a largo plazo, aún vivos en el momento en que se hace este informe, fue de 12 años (rango de edad 8 ­ 16.7 años). A la edad de 8 años, el 17.6% de estos niños permanecían asintomáticos. Nueve de los niños (52.9%) no tenían inmunodeficiencia (conteos CD4 >500 células x 106/L). De los 16 niños sobrevivientes a largo plazo que estaban vivos y tuvieron un seguimiento de 4.1 años (en un rango de 0.1 año a 8.5 años) después de su octavo cumpleaños, 37.5% tuvo un conteo CD4 mayor de 500 células x 106/L, y bien no presentaban síntoma alguno de infección de VIH o se trataba sólo de síntomas leves, por lo cual fueron categorizados como no progresores de largo plazo. CONCLUSIONES: En una pequeña cohorte de niños infectados por el VIH, en ausencia de la terapia del antiretroviral, sólo aproximadamente un tercio logró sobrevivir más allá de ocho años de edad. Un seguimiento posterior de estos últimos niños sobrevivientes a largo plazo, mostró que más de un tercio presentaba un ritmo lento de progresión de la enfermedad

Gastrointestinal immune responses in HIV infected subjects

The gut associated lymphoid tissue is responsible for specific responses to intestinal antigens. During HIV infection, mucosal immune deficiency may account for the gastrointestinal infections. In this review we describe the humoral and cellular mucosal immune responses in normal and HIV-infected subjects.

Factors influencing medical interns trained at U.W.I. to work subsequently in a rural area in Jamaica

Recognising the present paucity of doctors trained at the University of the West Indies who are working in rural government health facilities in Jamaica, and its impact on the health services, this study was done to determine the factors influencing the decision of UWI-trained interns to work in these facilities post-internship. A questionnaire was administered to 57 UWI-trained medical graduates presently doing their internship in Jamaica. The results showed that there was no significant difference in the choice of placement with respect to sex, or residential background of the intern, though the latter seemed to indicate a trend. Of those who thought they would work in a rural government health facility, two-thirds would do so immediately post-internship but 50%did not plan to work there for more than five years. Opportunities for postgraduate training and lack of equipment were the most important deterrents to working in a rural government health facility.

Childhood gastroenteritis in Barbados: occurrence of Campylobacter and Rotavirus

Four hundred children with diarrhoea whose ages rangedfrom 3 months to 6 years were investigated to determine the aetiology of childhood gastroenteritis in Barbados. Rotavirus (11%) was the most frequently identified pathogen, followed by Shigella (7%). enteropathogenic E. coli (4%), Salmonella (3%) and C. jejuni (1.3%) with 2% of patients having multiple pathogens. No pathogens were identified in the remaining cases studied. The ages of the patients with C. jejuni enteritis ranged between 4 months and 2 years (mean 1.3 years). tje male/female ratio was 2:1. The most frequent synptoms were fever (66%) and blood diarrhoea (66%). The duration of stool excretion ranged between 1 and 7 weeks. The organisms were unifromly sensitive to antibiotic tests aginst erythromycin, tetracycline, chloramphenicol, gentamicin an nitrofuratoin. In contrast, the ages of patients with rotavirus enteritis ranged between 3 months and 4 years (mean 1.3 years) with a male/female ratio of 1:1, and the most frequent symptoms were diarrhoea (80%), vomiting (70%) and upper respiratory infections. In 60% of patients, hospitalisation was necessary. All patients had an uneventful recovery