KAIS 2007 1 - Kenya National AIDS & STI Control Programme ...

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DATA IN CONTEXTHSV-2 AND HIV IN THE LITERATUREMultiple studies from sub-Saharan Africa indicate that HSV-2 infection can increase aperson’s risk of acquiring and transmitting HIV:• HSV-2 is the most common cause of genital ulcer disease.• In 40-60% of new HIV cases in sub-Saharan Africa, HSV-2 is a contributingfactor. 1• Among HIV-uninfected heterosexual women and men, HSV-2 is associated withan estimated three-fold increased risk of acquiring HIV. 2• Among HIV-infected women and men, HSV-2 is associated with an estimatedfive-fold increased risk of transmitting HIV per sexual contact and has also beenlinked to more rapid HIV/AIDS disease progression. 3,4• Suppressing HSV-2 with antiviral drugs among HIV-infected persons reducesHIV viral load in the blood and genital secretions. 5,6• HSV-2 suppression is thought to reduce sexual transmission of HSV-2 by up to50%. 7 To date, however, there is no evidence for reduced HIV acquisition at thepopulation level by suppressing HSV-2. 8,918 19 20 21 22 23 24 25 26Figure 12.3b HSV-2 prevalence among women and men aged 15-64 yearsby marital status, Kenya 2007.18Freeman EE, Weiss HA, Glynn JR, et al. Herpes simplex virus 2 infection increases HIV acquisition in men andwomen: Systematic review and meta‐analysis of longitudinal studies. AIDS 2006; 20:73‐83.19Freeman EE, Orroth KK, White RG, et al. Proportion of new HIV infections attributable to herpes simplex 2 increasesover time: simulations of the changing role of sexually transmitted infections in sub‐Saharan African HIV epidemics.Sex Transm Infect 2007; 83 (suppl 1):i17‐24.20Gray RH, Wawer MJ, Brookmeyer R, et al. Probability of HIV‐1 transmission per coital act in monogamous,heterosexual, HIV‐1‐discordant couples in Rakai, Uganda. Lancet 2001; 357:1149‐1153.21Corey L. Synergistic copathogens: HIV‐1 and HSV‐2. N Engl J Med 2007; 356:854‐856.22Baeten JM, Strick LB, Lucchetti A, et al. Herpes simplex virus suppressive treatment decreases plasma HIV‐1 viralload in HSV‐2/HIV‐1 co‐infected women: a randomized, placebo‐controlled, crossover trial. J Infect Dis 2008; 198:1804‐1808.23Nagot N, Ouedraogo A, Foulongne V, et al. Reduction of HIV‐1 RNA levels with therapy to suppress herpes simplexvirus. N Engl J Med 2007; 356:790–799.24Corey L, Ashley R, Valaciclovir HSV Transmission Study Group. Prevention of herpes simplex virus type 2transmission with antiviral therapy. Herpes 2004; 11(suppl 3):170a‐174a.25Celum C, Wald A, Hughes J, et al. 2008.26Watson‐Jones D, Weiss HA, Ruizoka M, et al. Effect of herpes simplex suppression on incidence of HIV amongwomen in Tanzania. N Engl J Med 2008; 358:1560‐1571.KAIS 2007 216
807071.0WomenMen64.3HSV-2 Prevalence (Weighted %)6050403041.935.856.257.929.852.341.726.312.3b HSV-2prevalence waslowest amongwomen and menwho had nevermarried orcohabited.2017.3107.40Nevermarried/cohabitedCurrentlymonogamousCurrently polygamous Separated/divorced Widowed TotalMarital StatusThe term “currently monogamous” refers to respondents that are married or cohabiting in a union with only one wife or onefemale partner.HSV‐2 prevalence varied significantly by marital status among women and men. Among women whowere currently married or cohabiting or had ever married or cohabited, HSV‐2 prevalence rangedfrom 41.9% to 71.0%. Among men who were currently married or cohabiting or had ever married orcohabited, HSV‐2 prevalence ranged from 29.8% to 56.2%. HSV‐2 prevalence among women and menwho had never married or cohabited was 17.3% and 7.4%, respectively.KAIS 2007 217
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KAIS 2007 1
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P.O. Box: 9361 Code: 00202 Nairobi,
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KEMRIKNASPKNBSKshLLITNMCHmlμLMOMSM
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KEY FINDINGS: HIV PREVENTION• Amo
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Among HIV‐uninfected women, 71.2%
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Men 5.4 26.3 1.9Total 7.1 35.1 1.8O
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Kenya is also committed to the “T
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Table 1.4 Distribution of sampled c
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1.7 SURVEY IMPLEMENTATIONTrainingIn
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Data processing included a number o
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Characteristic 2003 KDHS 2007 KAISQ
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Figure 1.11 Sampled clusters and el
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Table 1.11c Survey response rates b
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Population estimates reported in th
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2.4 HIV PREVALENCE AMONG YOUTHFigur
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Figure 2.6b HIV prevalence among ru
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2.7 HIV PREVALENCE BY PROVINCEFigur
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Figure 2.7c Estimated number of HIV
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2.9 HIV PREVALENCE BY EDUCATION LEV
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Figure 2.10b HIV prevalence among r
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2.11 HIV PREVALENCE BY TIME AWAY FR
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2.13 MALE CIRCUMCISION AND ASSOCIAT
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Figure 2.13c HIV prevalence among c
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Comparison of HIV Prevalence in the
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3.3 SEXFigure 3.3a HIV prevalence a
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Figure 3.4b. HIV prevalence among m
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3.7 PROVINCEFigure 3.7a HIV prevale
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2003 KDHS 1 2007 KAIS 2Marital stat
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3.10 WEALTH INDEXFigure 3.10a HIV p
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DATA IN CONTEXT: APPROACHES TO HIV
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Figure 4.3c Ever been tested for HI
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Figure 4.3e Ever been tested for HI
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Figure 4.3g Women aged 15-49 years
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Figure 4.4a Time since last HIV tes
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Figure 4.5a Reasons for not testing
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Increasing access to HIV testing wi
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4.7. Gaps and unmet needs• Two‐
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Figure 5.3b Self-reported HIV statu
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This section examines participants
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Figure 5.5a Knowledge of HIV status
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Figure 5.5c Percent of partnerships
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uninfected. A couple was considered
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Figure 5.6c Women and men aged 15-6
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Sexual Partners, Sexual DebutCircum
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Figure 6.3b. HIV prevalence among w
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Figure 6.3d. HIV prevalence among w
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Figure 6.3f. Men aged 15-64 years r
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In this section, “consistent cond
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Figure 6.4c. Marital or cohabiting
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Figure 6.5b. Young women and men ag
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Figure 6.5d. Young women and men ag
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Figure 6.6a. Male circumcision amon
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Figure 6.6d. HIV prevalence among m
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Knowledge, Attitudes and Beliefs ch
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Figure 7.3b. Most common source of
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Figure 7.3c Women and men aged 15-6
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Figure 7.3e Overall scores for 12 q
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Figure 7.3g Women and men aged 15-6
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Figure 7.3i Correct responses to se
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• If a female teacher has the AID
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7.5. Perceived risk of HIV infectio
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Figure 7.5c Reasons given for havin
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7.6. Attitudes toward women’s rol
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who had never been tested for HIV o
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8.2 INTRODUCTIONIn the absence of i
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8.3 ANTENATAL CLINIC ATTENDANCE, 20
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8.4 KNOWLEDGE OF MOTHER-TO-CHILD TR
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The analysis in this section consid
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Figure 8.5b Women aged 15-49 years
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• Incorrect communication or unde
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8.8 CURRENTLY PREGNANT WOMEN: HIV T
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Among currently pregnant women, 7.1
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Among pregnant, HIV‐uninfected wo
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Figure 8.11b Desire for a child in
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8.12 CONTRACEPTIVE USEThe next figu
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Figure 8.12c Contraceptive use* amo
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Blood and Injection Safety chapter
Page 165 and 166: D ATA IN C ONTEXT: N ATIONAL B LOOD
Page 167 and 168: Figure 9.3a Source of blood donatio
Page 169 and 170: Figure 9.3b Source of blood donatio
Page 171 and 172: Figure 9.3d Source of blood donatio
Page 173 and 174: 9.4 Blood transfusionsAlthough the
Page 175 and 176: 10080Injec tionsPillsNo preferenceW
Page 177 and 178: HIV prevalence among adults who rep
Page 179 and 180: 9.6 Gaps and unmet needs• HIV pre
Page 181 and 182: The Ministry of Medical Services re
Page 183 and 184: 10.3 COTRIMOXAZOLE PROPHYLAXIS FOR
Page 185 and 186: Coverage also varied significantly
Page 187 and 188: 10.4 ARV ELIGIBILITY, COVERAGE AND
Page 189 and 190: ARV coverage was estimated by takin
Page 191 and 192: Figure 10.4b ARV coverage among HIV
Page 193 and 194: DATA IN CONTEXTEstimates of HIV-inf
Page 195 and 196: 10.5 GAPS AND UNMET NEEDS• The es
Page 197 and 198: debilitating illness leading to hos
Page 199 and 200: Among HIV‐infected adults (83.6%
Page 201 and 202: Figure 11.3d HIV-infected adults ag
Page 203 and 204: Figure 11.4b HIV-infected adults ag
Page 205 and 206: Figure 11.4d HIV-infected adults ag
Page 207 and 208: DATA IN CONTEXTHIV Basic Care Packa
Page 209 and 210: Figure 11.5b HIV-infected adults ag
Page 211 and 212: Figure 11.6b Percent of HIV-infecte
Page 213 and 214: 11.8 GAPS AND UNMET NEEDS• Counse
Page 215: 12.3 HSV-2 prevalenceHSV‐2 preval
Page 219 and 220: Figure 12.3d HSV-2 prevalence among
Page 221 and 222: Figure 12.4b HSV-2 prevalence among
Page 223 and 224: Figure 12.5a HIV prevalence by HSV-
Page 225 and 226: Figure 12.6b Condom use during last
Page 227 and 228: 12.7 Gaps and unmet needs• Increa
Page 229 and 230: also at substantially elevated risk
Page 231 and 232: Figure 13.3b Prevalence of syphilis
Page 233 and 234: Figure 13.3d Prevalence of syphilis
Page 235 and 236: Figure 13.3f Prevalence of syphilis
Page 237 and 238: Figure 13.4b Prevalence of syphilis
Page 239 and 240: 13.6 GAPS AND UNMET NEEDS• Patien
Page 241 and 242: Household Characteristics andImpact
Page 243 and 244: Figure 14.3a Sex of head of househo
Page 245 and 246: Figure 14.3d Household population,
Page 247 and 248: 14.5 PREVALENCE OF HIV-AFFECTED HOU
Page 249 and 250: Figure 14.5c HIV-affected household
Page 251 and 252: social and economic conditions of h
Page 253 and 254: households used chemical disinfecta
Page 255 and 256: 14.7 HOUSEHOLD OWNERSHIP OF MOSQUIT
Page 257 and 258: Figure 14.7b HIV-affected and HIV-u
Page 259 and 260: Table 14.7b Source of bednets among
Page 261 and 262: Overall, 52.3% percent of children
Page 263 and 264: 14.9 CARE AND SUPPORT FOR ORPHANS A
Page 265 and 266: For consistency with other populati
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Returning Test Results15.1 KEY FIND
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Figure 15.3b. Participants aged 15-
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Figure 15.3d. Participants aged 15-
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Figure 15.3f. Participants aged 15-
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15.4 RETURNING TO RECEIVE TEST RESU
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Figure 15.5 Women aged 15-64 years
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Methods of the 2007 KAISThis Append
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ClustersHouseholdsProvince Rural Ur
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and treatment services and other he
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The KEMRI Ethical Review Committee
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Red top (5 ml)Whole blood collected
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algorithm using two HIV EIAs (Viron
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Figure A5.a. Structure and flow of
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Recruitment and training of results
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observe confidentiality of particip
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Documentation. Results counsellors
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Normalisation of weightsNormalised
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This report presents the results of
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