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2.
Int J STD AIDS ; 25(4): 280-8, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-24216036

RESUMO

Female sex workers are at high risk for HIV infection. Sexually transmitted infections are known to be co-factors for HIV infection. Our aims were (1) to assess the prevalence of HIV and other sexually transmitted infections in this population; (2) to determine the association between sociodemographic characteristics, behavioural variables, and variables related to HIV prevention and HIV infection. A cross-sectional study was conducted in Conakry, Guinea, among a convenience sample of 223 female sex workers. A questionnaire on sociodemographic characteristics, risk factors, and exposure to prevention was administered. Screening for HIV, herpes simplex virus type 2, human papillomavirus type 16, Neisseria gonorrhoeae, and Chlamydia trachomatis was performed. Prevalences of HIV, herpes simplex virus type 2, human papillomavirus type 16, N. gonorrhoeae, and C. trachomatis were 35.3%, 84.1%, 12.2%, 9.0%, and 13.6%, respectively. Having a child, lubricant use, and human papillomavirus type 16 infection were associated with HIV infection. Interventions that promote screening and treatment of sexually transmitted infections are needed in order to achieve successful interventions to prevent HIV among female sex workers in resource-limited settings.


Assuntos
Infecções por HIV/epidemiologia , Herpes Genital/epidemiologia , Infecções por Papillomavirus/epidemiologia , Trabalho Sexual , Profissionais do Sexo , Neoplasias do Colo do Útero/epidemiologia , Adulto , Criança , Intervalos de Confiança , Estudos Transversais , Feminino , Guiné/epidemiologia , Infecções por HIV/prevenção & controle , Herpesvirus Humano 2/isolamento & purificação , Papillomavirus Humano 16/isolamento & purificação , Humanos , Entrevistas como Assunto , Prevalência , Fatores de Risco , Comportamento Sexual , Fatores Socioeconômicos , Inquéritos e Questionários
3.
Pediatrics ; 132(6): e1570-6, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24218464

RESUMO

OBJECTIVES: To determine if a standardized global child health (GCH) modular course for pediatric residents leads to satisfaction, learning, and behavior change. METHODS: Four 1-hour interactive GCH modules were developed addressing priority GCH topics. "Site champions" from 4 Canadian institutions delivered modules to pediatric residents from their respective programs during academic half-days. A pre-post, mixed methods evaluation incorporated satisfaction surveys, multiple-choice knowledge tests, and focus group discussions involving residents and satisfaction surveys from program directors. RESULTS: A total of 125 trainees participated in ≥1 module. Satisfaction levels were high. Focus group participants reported high satisfaction with the concepts taught and the dynamic, participatory approach used, which incorporated multimedia resources. Mean scores on knowledge tests increased significantly postintervention for 3 of the 4 modules (P < .001), and residents cited increases in their practical knowledge, global health awareness, and motivation to learn about global health. Program directors unanimously agreed that the modules were relevant, interesting, and could be integrated within existing formal training time. CONCLUSIONS: A relatively short, participatory, foundational GCH modular curriculum facilitated knowledge acquisition and attitude change. It could be scaled up and serve as a model for other standardized North American curricula.


Assuntos
Instrução por Computador/métodos , Saúde Global/educação , Internato e Residência/métodos , Pediatria/educação , Desenvolvimento de Programas , Atitude do Pessoal de Saúde , Canadá , Competência Clínica , Grupos Focais , Humanos , Avaliação de Programas e Projetos de Saúde
4.
World Health Popul ; 14(3): 5-13, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23803490

RESUMO

BACKGROUND: Interventions for condom use promotion have been undertaken for HIV prevention among female sex workers (FSWs). Our aims are to (1) assess the frequency of inconsistent condom use with clients and with the main regular non-client sex partner (RNCP); and (2) investigate factors associated with inconsistent condom use with the RNCP, particularly the desire to have children and links of the RNCP with commercial sex work. METHODS: A cross-sectional study was conducted in Conakry, Guinea, among 223 FSWs. A questionnaire on socio-demographic characteristics, behaviours and desire for children was administered. Descriptive statistics and logistic regression were performed. RESULTS: Inconsistent condom use was frequent with the RNCP but rare with the clients (80.4% vs. 1.3%). FSWs' desire for children was strongly associated with inconsistent condom use with the RNCP. CONCLUSION: Interventions that take into account reproductive health are needed to prevent HIV among FSWs and their children.


Assuntos
Preservativos/estatística & dados numéricos , Infecções por HIV/prevenção & controle , Serviços de Saúde Reprodutiva/organização & administração , Profissionais do Sexo/psicologia , Profissionais do Sexo/estatística & dados numéricos , Adulto , Estudos Transversais , Feminino , Guiné/epidemiologia , Comportamentos Relacionados com a Saúde , Conhecimentos, Atitudes e Prática em Saúde , Humanos , História Reprodutiva , Fatores Socioeconômicos
5.
AIDS Behav ; 14(6): 1287-93, 2010 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-19680799

RESUMO

Self-reported condom use may be prone to social desirability bias. Our aim was to assess the validity of self-reported condom use in a population of female sex workers using prostate specific antigen (PSA) as a gold standard biomarker of recent unprotected vaginal intercourse. We collected data on 223 sex-workers in Conakry, Guinea in order to assess the sensitivity and specificity of self-reported condom use as well as to examine the predictors of discordance between self-report and PSA presence. PSA was detected in 38.4% of samples. Sensitivity of self-reported condom use was 14.6% and its specificity was 94.7%. Self-perceived high risk of HIV infection was the only significant independent predictor of misreported condom use. PSA could be useful to validate self-reported condom use in surveys and to allow a better understanding of factors associated with social desirability in sexual behaviour reporting.


Assuntos
Preservativos/estatística & dados numéricos , Antígeno Prostático Específico/análise , Autorrelato , Sêmen/metabolismo , Trabalho Sexual , Sexo sem Proteção , Adolescente , Adulto , Feminino , Guiné , Infecções por HIV/prevenção & controle , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Infecções Sexualmente Transmissíveis/prevenção & controle , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto Jovem
6.
AIDS Care ; 21(8): 1014-24, 2009 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-20024758

RESUMO

We developed gender-specific explanatory models for unsafe sexual behavior among unmarried young people living in urban West Africa using a culturally adapted instrument which addresses personal, relational and socio-cognitive factors. Data were collected on condom use and number of sexual partners, and on their potential determinants, using in-person interviews on a heterogeneous sample of in-school and out-of-school young women (n=185) and (n=214) men who reported ever having had sexual intercourse. Recruitment was done at various sites in 21 randomly selected neighborhoods in Bamako. Bivariate analysis and multivariate logistic regressions were conducted to identify determinants of lack of condom at last sex and having more than one partner in the last six months and to test for interactions with gender. Similar percentages of men (40%) and women (46%) reported not using a condom at last sex. However, more men (64%) reported multiple partnering in the last six months than women (32%). Our findings suggest that the context of sexual debut, social status, relation to peers and family as well as attitudinal, normative and behavioral control constructs may influence young men and women's sexual behavior, but that pathways leading to unsafe sex are different across genders. Our findings also show that factors associated with condom use and sexual partnering are distinct. Earlier sexual debut seems to be risk-inducing in women while risk-reducing in men. Poor communication with peers and receiving money from sexual partner were associated with lack of condom use in women. High behavioral control was associated with fewer sexual partners in men. Determinants of unsafe sexual behavior were found at the social, interpersonal and individual levels for both men and women, but notable gender differentials existed. These findings underscore the importance of addressing gender as a crucial factor shaping HIV-risk profiles.


Assuntos
Sexo sem Proteção/psicologia , Adolescente , Atitude Frente a Saúde , Coito , Preservativos/estatística & dados numéricos , Métodos Epidemiológicos , Feminino , Humanos , Masculino , Mali , Fatores Sexuais , Parceiros Sexuais , Sexo sem Proteção/estatística & dados numéricos , Saúde da População Urbana , Adulto Jovem
7.
J Acquir Immune Defic Syndr ; 48(4): 476-84, 2008 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-18614917

RESUMO

BACKGROUND: Sub-Saharan Africa has seen dramatic increases in the numbers of people treated with antiretroviral therapy (ART). Although standard ART regimens are now universally applied, viral load measurement is not currently part of standard monitoring protocols in sub-Saharan Africa. METHODS: We describe the prevalence of inadequate virological response (IVR) to ART (viral load >or= 500 copies/mL) and identify factors associated with this outcome in 606 HIV-positive patients treated for at least 6 months. Recruitment took place in 7 hospitals and community-based sites in Bamako and Ouagadougou, and information was collected using medical charts and interviews. RESULTS: The overall prevalence of IVR in treatment-naive patients was 12.3% and 24.4% for pretreated patients. There were no differences in rates of IVR according to ART delivery sites and time on treatment. Patients living farther away [odds ratio (OR) = 2.48; 95% confidence interval (CI) 1.40 to 4.39], those on protease inhibitor or nucleoside reverse transcriptase inhibitor regimens (OR = 3.23; 95% CI 1.79 to 5.82) and those reporting treatment interruptions (OR = 2.36; 95% CI 1.35 to 4.15), had increased odds of IVR. Immune suppression (OR = 3.32, 95% CI 1.94 to 5.70) and poor self-rated health (OR = 2.00; 95% CI 1.17 to 3.41) were also associated with IVR. CONCLUSIONS: Sufficient expertise and dedication exist in public hospital and community-based programs to achieve rates of treatment success comparable to better-resourced settings.


Assuntos
Infecções por HIV/prevenção & controle , HIV-1 , Adulto , Terapia Antirretroviral de Alta Atividade , Burkina Faso/epidemiologia , Contagem de Linfócito CD4 , Centros Comunitários de Saúde , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/imunologia , Infecções por HIV/virologia , HIV-1/genética , HIV-1/isolamento & purificação , Hospitais Municipais , Humanos , Masculino , Mali/epidemiologia , Razão de Chances , Cooperação do Paciente , Projetos Piloto , Fatores de Risco , Resultado do Tratamento , Carga Viral
8.
AIDS Educ Prev ; 20(3): 203-19, 2008 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-18558818

RESUMO

We developed an instrument for HIV/AIDS behavioral surveillance applicable to youth living in urban West Africa. The instrument includes a comprehensive set of constructs borrowed from the sociocognitive theory of planned behavior as well as measures of parental and peer communication An exploratory (n=189) and validation sample (n=342) of young men and women living in Bamako were interviewed. Scale construct validity was assessed via factor analysis and multiple linear regressions and internal consistency was assessed using Cronbach's coefficient. All constructs had high internal consistency, scales' structure was relatively stable, and associations between different components of the questionnaire were in the predicted directions. Gender, sexual experience and education were significantly associated with attitudes and perception of control. Furthermore, attitudes, perceived behavioral control, perceived norms, and peer communication significantly predicted condom use. This questionnaire offers a valid and reliable tool for assessing young people's sexual behavior in an urban West African setting.


Assuntos
Infecções por HIV/epidemiologia , Conhecimentos, Atitudes e Prática em Saúde , Comportamento Sexual , Adolescente , Adulto , Comunicação , Preservativos/estatística & dados numéricos , Escolaridade , Feminino , Infecções por HIV/prevenção & controle , Humanos , Entrevistas como Assunto , Masculino , Mali/epidemiologia , Pais , Reprodutibilidade dos Testes , Medição de Risco/métodos , Assunção de Riscos , Vigilância de Evento Sentinela , Saúde da População Urbana
9.
Antivir Ther ; 13(1): 141-8, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-18389909

RESUMO

BACKGROUND: In a multicentred cohort of patients on antiretroviral therapy (ART) in Burkina Faso and Mali, we analysed the prevalence of HIV drug resistance mutations in patients failing a modified directly observed therapy (mDOT) protocol. METHODS: Patients on ART >6 months and with viral load (VL) >500 copies/ml were enrolled in a mDOT protocol. Genotypic resistance testing was performed on pre- and post-mDOT plasma samples of patients who still had VL >500 copies/ml after mDOT. RESULTS: Eight hundred and one patients from seven sites participated in the study. One hundred and thirteen patients (14.1%) had VL >500 copies/ml. Most patients were treated with lamivudine along with zidovudine or stavudine and efavirenz or nevirapine. Genotypes were available for 46 patients. The predominant HIV-1 subtypes were CRFO2_AG in 26 (56.5%) and AGK/K/AK in 12 (26.1%) patients. The prevalence of drug resistance mutations by class were as follows for nucleoside reverse transcriptase inhibitors: 1841/V (82.6%), 215Y/F (32.6%), 219E/Q (19.6%), 70R (19.6%), 67N (21.7%), 41L (15.2%) and 151M(2.2%). For non-nucleoside reverse transcriptase inhibitors the prevalence was: 103N (50%) and 181C/I (19.6%). Phylogenetic analysis showed that, although the genetic distances were small among isolates, there was no clustering of a particular subtype in a specific region and that the high prevalence of AGK subtype in our drug-resistant population was not due to a circulating resistant strain. CONCLUSION: Although CRFO2_AG is the dominant clade in the Burkina Faso/Mali region, isolates with subtype K reverse transcriptase were frequent in our cohort. Drug resistance mutation pathways in subtype K reverse transcriptase need to be further evaluated in a larger cohort of non-B HIV-infected individuals.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Farmacorresistência Viral , Infecções por HIV/tratamento farmacológico , HIV-1/genética , Adulto , Burkina Faso/epidemiologia , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/virologia , Humanos , Masculino , Mali/epidemiologia , Mutação , Filogenia
10.
Sante Ment Que ; 31(2): 57-71, 2006.
Artigo em Francês | MEDLINE | ID: mdl-18253645

RESUMO

The Paediatric Transcultural Clinic of the Maisonneuve-Rosemont Hospital is unique in the fact that it is part of a General Paediatric Unit. Therefore, the child's symptoms are often the result of a larger problem affecting the whole family. This clinic aims to provide a complete care by addressing physical, emotional and cultural issues. The clinic's professionals among the most often use the concepts of filiation and affiliation and the authors attempt to explain and illustrate them with two clinical cases. Their analysis raises an important question: how resilient can children be in an immigration context when dealing with issues of filiation and affiliation?


Assuntos
Instituições de Assistência Ambulatorial , Características Culturais , Departamentos Hospitalares , Transtornos Mentais , Pediatria , Migrantes , Criança , Humanos , Transtornos Mentais/terapia
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