Women and AIDS in Zimbabwe : the making of an epidemic

As the aids epidemic in Africa assumes major proportions; the need to understand the social context in which heterosexual transmission occurs takes onurgent importance. In this article we explore how the intersection of traditional culture with the colonial legacy and present-day political economy has influenced family structure and sexual relations; and particulary the social position of women. Drawing on Zimbabwe's historical experience; we show how land expropriation; rural impoverishment; and the forcible introduction of male migrant labor fostered new patterns of sexual relations; characterized by multiple partners.Traditional patriarchal values reninterpreted in European law resulted in further subjugation of women as even limited right to ownership were withdrawn. For many women; sexual relations with men; either within marriage (for the majority) or outside; become inextricably linked to economic and social survival. In this setting; all sexually transmitted diseases became rampant; including genital ulcer which facilitates transmission of the human immunodeficiency virus (HIV.) Intervention programs to halt the spread of AIDS need to take into account the epidemic's historical roots and social nature. [abstract terminated]

Women and aids in Zimbabwe : the making of an epidemic

As the AIDS epidemic in Africa assumes major proportions; the need to understand the social context in which heterosexual transmission occurs takes on urgent importance. In this article we explore how the intersection of traditional culture with the colonial legacy and present-day political economy has influenced family structure and sexual relations; and particularly the social position of women. Drawing on Zimbabwe's historical experience; we show how land expropriation; rural improverishement; and the forcible introduction of male migrant labor fostered new patterns of sexual relation; characterized by multiple partners. Traditional patriarchal values reinterpreted in European law resulted in further subjugation of women as even limited rights to ownership were withdrawn. For many women; sexual relations with men; either within marriage (for the majority) or outside; become inextricably linked to economic and social survival. [abstract terminated]

Clinical diagnosis of malaria : can we improve?

Most cases of malaria in Zimbabwe are diagnosed on the basis of clinical suspicion; without laboratory tests. Of patience treated; between 10 and 30 have malaria parasites on blood slide examination. Can diagnosis be improved by a systematic history? We examined this question in 287 patients treated for malaria in an area of year-round transmission in Zimbabwe. The most common complaints were 'headache' (85.7); 'bodily weakness' (79.0) and 'fever/feeling hot' (73.2). Eighty patients (28) had malaria parasites on blood smear. Using the blood slide as the standard; we calculated the sensitivity; specificity and positive predictive value of a variety of clinical symptoms and signs. None had a positive predictive value substantially higher than the unknown diagnostic criteria used by health workers (28). Multi-variate analysis showed that 15 different demographic and clinical variables did not significantly predict a positive blood slide result. We conclude that; in this setting; clinical history alone will not improve the diagnosis of malaria

Sexual behaviour and risk factors for HIV infection in a group of male factory workers who donated blood in Harare; Zimbabwe

Zimbabwe has experienced a rapid rise in HIV seroprevalence in recent years. As many as 1 million people (10 of the population) are predicted to become seropositive by 2000. We examined social and behavioral factors associated with HIV infection in a case-control study among male factory workers who donated blood before the launching of the AIDS Awareness Campaign. There were 188 subjects: 69 were HIV-positive and 118 were HIV-negative. High risk behaviour was common in both groups. Among seronegative men; 73.1 reported a sexually transmitted disease (STD); 55.5 reported cash payment for sex; and 73.1; and 73.1 had outside girlfriends. Nonetheless; HIV-positive men were more likely to report a hisotry of STD (OR = 3.9; 95 CI = 1.5-11.9); particulary genital ulcers (OR= 2.4; 95 CI = 1.2-4.8) and extramarital partners (OR = 2.8;95 CI = 1.1-7.1). HIV-positive men reported more lifetime partners (16.5 vs. 12;p less then 0.05 and were less likely to live with their wives. (OR = 0.51;95 CI = 0.23-1.15). [abstract terminated]

Relationship between bladder cancer incidence; schistosoma haematobium infection; and geographical region in Zimbabwe

Bladder cancer is common in Zimbabwe; possibly due to the high prevalence of Schistosoma haematobium infection in some areas. We undertook a correlational study based on retrospective medical record review to see whether the number of bladder cancers could be related to geographical region and prevalence of S. haematobium infection. We also determined patient demographic characteristics and tumour histology. Of 483 patients indentified (1984-1987); 69 with available histology had squamous cell carcinomas. The remainder had transitional cell carcinomas. Patients with squamous cell carcinoma were younger than patients with transitional cell carcinomas (50 vs 20 under 50 years old; P less than 0.05) and had a sex ration of one. [abstract terminated]

Clinical and laboratory characteristics of HIV-1 infection in Zimbabwe

To define the impact of human immunolodeficiency virus (HIV) infection in Africa; clinical and laboratory investigations were conducted on 265 HIV-seropositive outpatients in Zimbabwe. Twenty-four of the study subjects were asymptomatic (ASX); 124 had persistent generalized lympademopathy (PGL); and 117 had AIDS-related complex (ARC). HIV infection was assessed by commercial ELISA; Western blots; synthetic peptide ELISA; and measurement of p24 antigen. Serum immunoglobulins; lympocyte mitogen responses; and CD4+ cell numbers were obrtained in 54 sequential patients. Compared to seronegative subjects meab CD4+ cell numbers were decreased and serum immunoglobulins; particularly IgM and IgG; were increased in all groups of seropositive subjects. [abstract terminated]

Risk of hepatitis B infection among medical and paramedical workers in a general hospital in Zimbabwe

To evaluate the addition of hepatits vaccine to health schemes for hospital workers in Zimbabwe we undertook a cross sectional study of viral markers in 226 hospital workers and compared the results with 97 volunteer blood controls. One hundred and thirty one (58) hospital workers had hepatitis markers compared with 45 (46) of the donor group. Racial group was the strongest risk factor. Blacks were 70 more likely to have markers than whites. This racial difference was not explained by job status or patient contact. Our data suggest that work in a district general hospital does not constitute a clinically important hazard for hepatitis B infection. Because of the high cost of the vaccine; additional studies to assess the risk of hospital work in other settings in Zimbabwe are required before health policy regarding routine hepatitis B vaccination is determined

User Acceptability of the female condom in Zimbabwe

Zimbabwe has experienced a rapid rise in HIV seroprevalence in the past five years. Current estimates of infection rates among urban adults arebetween 10-15 percent. The male condom; currently the mainstay of prevention strategies; is limited by the fact that it is not widely used and depends on male initiative as well as consent. The female condom offers an alternative method that may provide women with more options to reduce their risk of infection. The proposed project will examine the acceptability of the female condom among female volunteers form four different groups: urban outpatient clinicic attendets; urbannurses; rural hospital attenders and commercial sex workers. Where possible; male partners will also be interviewed. Eligible women in these settings who meet inclusion criteria (principally that they be currently sexually active and free of sexually transmitted disease) and following a supervised fitting of the condom will be invited ot participate in a two week trial of the female condom. At completion; they will be interviewed to determine the acceptability of the condom to themselves and their partners. Group discussions will aim to determine the beliefs; feelings and knowledge of women experienced in female condom use. The discussions will determine informational needs as well as messages which may be usedin future promotional materials. The study will not examine effectiveness of thefemale condom