Investigating HIV/AIDS prevalence in an antenatal population using sexually transmitted infections (hepatitis B (HBsAg), syphilis (TPHA) and genital herpes (HSV2)) and conflict related influences as risk markers in Sierra Leone

Abstract

Introduction: Armed conflict comes with a baggage envisaged to enhance the spread of HIV. The goal of this researchw as to explore and describe the associations between war-related risk factors and HIV prevalence among women attending antenatal care in the Western Area of Sierra Leone. The war-related influences observed were -: 1) displacement causing disruption of social and sexual networks; 2) exposure to blood and blood products through nosocomial, iatrogenic or war wounds and 3) sexual coercion and violence with rape used as a form of warfare and sex as a commodity in exchange for basic survival (food and money). The prevalences of antibodies for other sexually transmitted infections (STis) (Herpes Simplex Virus Type 2 (HSV2), Hepatitis B Virus (HBV) and Syphilis) were investigated as secondary outcomes affected by the war-related factors and as potential risk factors for HIV infection. Methodology: - The research preparatory stages involved two pilot surveys - Pilot I was to ascertain the feasibility of the research and evaluate the biological survey assays. Pilot 2 was employed to develop, evaluate, and validate the qualitative and quantitative instruments used in the research. The study was conducted in the Western Area of Sierra Leone. This area recorded the highest infrastructural damage as a result of the war and also housed the largest number of internally displaced persons. Given the sensitivity of the research theme and other feasibility considerations, a cross-sectional design was deemed appropriate for the study. A conceptual research framework was developed upon which the questionnaire was sequenced and also on which the analyses were based. Crude and adjusted associations were examined using logistic regression models. Results-:. The study revealed that the three war-related risk factor themes, directly and indirectly affected HIV prevalence, and also a strong positive association was found between HIV and other STIs (HSV2 and HBV). The adjusted odds of HIV infection among women with HSV2 was over twice that of women without HSV2 (adjusted odds ratio (aOR) =2.15,95%Cl 1.14.3, P=0.018). The association with HBV was even stronger (aOR=2.81,950/oCl 1.64.9, P=0.008). There was no association between syphilis and HIV infection. Amongst the war-related factors, there was a strong positive association between having a surgical operation with blood transfusion and a higher prevalence of HIV (aOR=5.48,95%CI 1.9-15.9, P=0.02). For HSV2, all participants exposed to this variable were found to be positive. The displacement variables showed an association between frequency of movements and STIs (HSV2 (aOR=2.44,95%CI 1.6- 3.8, P=<0.001) and also between those who moved primarily because of the war and HBV (aOR=I. 16,95%CI 0.7-1.8, P=O0. 2). Among the sexual coercion variables, women who had a sexual relationship with members of the peacekeeping forces had higher odds of being HSV2 positive (aOR=I 1.67,95%CI 1.5-97.3, P=<0.001), and women raped by family members or other persons in the community were found to have a higher prevalence of syphilis (aOR=1 1.4,95%CI 2.8-45.7, P=0.04). The sociodemographic and economic related variables examined included loss of an infant within the war years, gravidity (pregnancy frequencies), age and marital status. The women, who had lost an infant, were found to have higher HIV infection levels (aOR=2.43,95%CI 1.5-3.9, P=0.01) than others. Increased gravidity and age were found to be associated with HSV2, but HBV was only positively associated with gravidity. Syphilis was higher in women who were in cohabiting relationships than in their counterpart married or single status women. Associations with the antenatal services accessed by the women (which to some extent reflected their financial status) indicated that women who used rural government cost recovery services showed a higher prevalence of HSV2 (aOR=1.34,95%CI 0.7-2.4, P=0.02) than others. Sociocultural practices such as skin and gum tattooing showed a significant association with syphilis infection levels (aOR--2.9,95%CI 1.4-6.2, P--0.03). Conclusion:- Armed conflict affects HIV in a complex multidivisional context. HIV prevalence was seen to be affected directly and indirectly through existing pathways such as endemic STIs. The study concluded that armed conflict does affect I-HV prevalence and could influence existing risk factors such as STIs and depressed social living standard. Therefore, factors which affect STIs and related socio-demographic and socioeconomic factors would ultimately influence HIV prevalence

Date of Award	2005
Original language	English
Awarding Institution	University of Portsmouth
Supervisor	John D. Smart (Supervisor) & Paul Rutter (Supervisor)