Analysis of HIV Among Pregnant Women in Moshi Tanzania Article by Sia E. Msuya - Essay Example

AIDS RESEARCH AND THERAPY HIV AMONG PREGNANT WOMEN IN MOSHI TANZANIA: THE ROLE OF SEXUAL BEHAVIOR, MALE PARTNER CHARACTERISTICS AND SEXUALLY TRANSMITTED INFECTIONS INTRODUCTION: In sub-Saharan Africa, the epidemic of Human Immunodeficiency Virus (HIV) continues to take its greatest toll. Among the worst affected is Tanzania , population: 34.5 million, where 7% of the adults are infected with HIV (Msuya et al, 2006: pp.1-2). In Africa, there is a diversity in the prevalence of HIV, some geographical locations showing a decrease in incidence, and other areas showing continued spread of the disease. As compared to men, women have higher rates of prevalence and incidence of HIV: 58% of the infected people in the whole country are women, especially those in the reproductive age. The assigned primary journal article with the title HIV Among Pregnant Women in Moshi Tanzania: the Role of Sexual Behavior, Male Partner Characteristics and Sexually Transmitted Infections, was written by Sia E. Msuya, Elizabeth Mbizvo, Akhtar Hussain, Jacqueline Uriyo, Noel E. Sam and Babill Stray-Pederson, based on research studies on pregnant women in Moshi Tanzania. It was published in the journal: AIDS Research and Therapy 2006, 3: 27. A Synopsis and Critique of the article are presented below. SYNOPSIS: The purpose of this research undertaken by Msuya et al, is to identify the social, biological and behavioral risk factors which underlie the continued HIV epidemic among pregnant women in Moshi urban Tanzania. In the duration 2002 – 2004, consenting women: 2654 in number attending primary health clinics for routine antenatal care are the sample group for the study. The women are interviewed and examined. Also, biological samples are collected for diagnosis of HIV and other sexually transmitted or reproductive tract infections. Results of the studies show that the prevalence of HIV was 6.9% among the women in the research sample. The risk for the infection is higher among women whose male partner has other sexual partners, travels frequently, or consumes alcohol daily. Other significant factors are: age, number of sex partners, recent migration, and presence of sexually transmitted infections such as bacterial vaginosis, genital ulcer, siphylis, and herpes simplex virus type 2. The authors conclude that, to reduce the transmission of HIV in women of reproductive age, it is important to develop programs that actively involve men in HIV prevention. Other important interventions would be: control of sexually transmitted infections (STI) and sexually transmitted diseases (STDs), mobile population, sexual risk behavior, and alcohol use. CRITIQUE The specific topic of the article: The topic of the article dealt with the prevalence and incidence of HIV among pregnant women in Moshi urban Tanzania. Research on the causes for the high rates of transmission among the women of reproductive age were conducted. These included the significance of sexual behavior shown by the male partners of these women, their particular characteristics which were related to high risk of the disease, and the relationship between sexually transmitted infections and the transmission of HIV. The overall purpose of the study: This research study conducted by Msuya et al, had a specific purpose: to reduce the transmission of HIV among pregnant women and women of reproductive age in Moshi Tanzania, since they showed a high incidence of the disease. The study was part of a prospective cohort study that aimed to describe the acceptability of HIV perinatal interventions at the primary health care level; and also to determine factors associated with incident HIV, and STIs in the postpartum period. The readership for whom the article is written: The scientific community, who may be interested in conducting future research on the same topic: for further improving the quality of life of the population that has been studied. The readership will also include health care professionals, sociologists and anthropologists for whom the details of the study will be of significance. The information from this article can be used by other researchers for comparative studies on other populations showing incidence of HIV at a high level among pregnant women and those in the reproductive age. The theoretical assumptions, and whether they are discussed explicitly: Theoretical assumptions regarding the underlying factors were verified by interviewing the women in the study sample. For the women under study, male partners who had other sexual partners, who traveled frequently or consumed alcohol daily were found to be exhibiting high risk behavior. Women with such male partners were infected with HIV. Other theoretical assumptions for risk factors such as age, number of sex partners and recent migration, were also verified by interviewing the women, and by conducting physical examinations and biological tests for STIs and HIV. A direct corelation was seen between the risk factors and the infected women. Contribution of the work to the overall topic of the course: The information in this research article contributes greatly to the overall topic of the course on the Biology of AIDS and STDs. The causes for the high rates of transmission of HIV in pregnant women and those of reproductive age are confirmed, and the importance of actively involving men in HIV prevention for reducing transmission of HIV in this population is emphasized. This contributes research information and statistical data for future comparative studies, and improves current knowledge on the prevalence, and causes for the spread of AIDS and STDs. The general problems and concepts in the Discipline and Course that this work engages with are: The geographical area of maximum prevalence of AIDS, the group that is most affected, the underlying causes, research on the factors causing the high incidence of the disease, developing solutions to decrease the transmission of the disease to women from male partners showing high risk behavior, and whether the presence of sexually transmitted infections increases risk for transmission of HIV. Concrete research studies such as this, provide the data and information on which programs for control of the disease and treatment can be devised. The kinds of material presented by the work: Primary data from personal observation and interviews conducted on the women chosen for the study sample, quantitative data obtained from research of the sample group, and information about the presence of sexually transmitted diseases obtained from physical examination of the women in the sample. Mostly primary information and data were collected, generating significant materials for the study. Usage of the research material for discussion of the work and its potential benefits: Results and discussion: In the research sample of 2664 women, the age range was 14 to 43 years. Most had completed 7 years of formal education, were married or cohabiting, and were not formally employed. The duration of residence in Moshi ranged from less than a year to 42 years. Condom use was low; 75% reported that they had never used a condom, and only 13% reported consistent use. Of the 2654 participating women, 184 women were seropositive, giving a prevalence of 6.9 %, the highest incidence of HIV was among the women aged 25-29 years. In the univariate analysis, women who were single, divorced or separated, women who consumed alcohol either occassionally or daily, and recent migrants had a higher HIV prevalence. Other factors that significantly increased HIV risk in the univariate analysis were sexual debut at or below 15 years, and a higher number of lifetime sexual partners. No association was found between HIV and religion, education level, income, or frequent traveling by the women. Univariate data is that which contains only one dependent variable, and multivariate data is that which has more than one variable. In relation to male partner characteristics, the risk for HIV in women increased as the partner’s age increased. This factor is supported by research done by Kapiga, et al, (2006: p.385), which was also in Moshi urban district, Tanzania. They state that women with a partner who is 12 years or more than 12 years older than themselves, had the highest risk irrespective of their own age. They observe that older men are more likely to transmit the infection because of being exposed to the risk of HIV-1 for many years. Those women with partners who had other women outside the relationship, had the greatest risk for HIV; so also if they had partners who consumed alcohol, verbally or physically abused the women, traveled frequently, or were in the tourism or mining industry. Neither the partner’s education nor circumcision was associated with HIV. A history of treatment for STIs, or the presence of genital ulcers, bacterial vaginosis, gonorrhoea, active syhilis, and herpes simplex type 2, increased the risk for HIV in the univariate analysis. The authors argue that in the multivariate analyses, the most important factor was: having a partner with women outside the realtionship, also: age over 20 years, sexual debut at 15 years, more than two lifetime sexual partners, residing in Moshi less than two years, male partner who consumed alcohol daily, partner who was away more than four times a month, the presence of untreated STIs which magnify the biological susceptibility to HIV. Whether the findings were consistent with previous research: The prevalence of 6.9% in Moshi’s urban women of reproductive age, is similar in prevalence to 7.3% among women aged 15-49 years in Kilimanjaro region in the recent 2003-2004 Tanzania HIV/AIDS Indicator survey. Another correlation cited in the survey is between urban wealth and incidence of HIV being higher, which is surprising, since poverty and HIV are considered to go together. In both Tanzania and Kenya, the positive relationship between HIV and wealth is stronger for women (Shelton, et al, 2005:p.1058). But, in the current study, it is seen that almost all the women in the sample are of low economic status. This finding is inconsistent with the previous research. Another research study had been conducted by the same team of Sia Msuya, which was Mbizvo, et al, (2005: p.96) with an additional member Chirenje in the team: on consenting women from two cities in Africa: Harare and Moshi, between July and December, 1999. In this cross-sectional study it was observed that with increase in age, HIV prevalence doubled among women aged 20 to 29 years, and trebled among those aged 30 years and above in Harare (Zimbabwe) as compared to Moshi (Tanzania). One of the reasons for Zimbabwean women’s higher susceptibility was that a greater number of them were siphylis seropositive. This supports the association between siphylis and HIV infection, as found in the current study. Whether the research was adequate and methods were appropriate: The research was conducted taking all precautions to obtain valid results: Pregnant women in their third trimester were invited to participate in the study, between June 2002 and March 2004. Trained research nurses conducted pretest counseling of every woman. Then an interview, and a general and gynaecological examination were conducted. Biological tests were conducted for identifying STIs and the presence of HIV. The researchers completed the study with a comprehensive analysis of data, using SPSS statistical software of the latest model. The methods used appear to be appropriate for the study. Whether the conclusions were valid and justified by the data: On interviewing the women, sensitive information regarding the male partner’s behavior characteristics were obtained. Lack of openness in sexual matters among the partners, and guesswork regarding casual partners, reduce the accuracy of the information. Also, since infected women are more susceptible to reduced fertility and pelvic inflammatory disease, they may not be represented in the study sample of pregnant women. Hence the data may present an under estimation of the true association between HIV and behavior characteristics. Whether the work raises issues for further research: Preventive and therapeutic interventions can be further developed. Methods of overcoming limitations of the research and ways to raise public awareness can be planned and implemented to successfully curb the spread of HIV. CONCLUSION: The authors conclude that in order to prevent HIV in women and in the community at large, the most important factor would be to involve men in HIV prevention, and in all aspects of reproductive health programs. Empowering women to negotiate in sexual matters is also crucial. Improved counseling, raising awareness of the disease and its implications, promoting correct and consistent use of condoms for safety from STIs and STDs, controlling STIs, targeting mobile people, teaching the benefits of a single partner and the risks of overconsumption of alcohol and casual sex partners. Major advances can thus be made in decreasing the prevalence of HIV among women in the reproductive age in Tanzania. REFERENCES Kapiga, S.H; Sam, N.E; Mlay, J; Aboud, S; Ballard, R.C; Shao, J.F; Larsen, U. “The Epidemiology of HIV-1 Infection in Northern Tanzania: Results from a Community-based Study. Journal: AIDS Care, 2006, Vol.18, No.4, pp.379-387. Mbizvo, Elizabeth Mukuze; Msuya, Sia; Hussain, Akhtar; Chirenje, Mike; Mbizvo, Michael; Sam, Noel; Stray-Pederson, Babill. “HIV and Sexually Transmitted Infections Among Women Presenting at Urban Primary Health Care Clinics in Two Cities of Sub-Saharan Africa”. Journal: African Journal of Reproductive Health, 2005, Vol.9, No.1, pp.88-98. Msuya, Sia E; Mbizvo, Elizabeth; Hussain, Akhtar; Uriyo, Jacqueline; Sam, Noel E; Stray-Pederson, Babill. “HIV Among Pregnant Women in Moshi Tanzania: The Role of Sexual Behavior, Male Partner Characteristics and Sexually Transmitted Infections”. Journal: Aids Research and Therapy, Vol.3:27, 2006, pp.1-10. Shelton, James D; Cassell, Michael, M; Adetunji, Jacob. “Is Poverty or Wealth at the Root of HIV?” Journal: The Lancet, Vol.366, September 24, 2005, pp.1057-1058. Tanzania Commission for AIDS (TACAIDS), National Bureau of Statistics, and ORC Macro: Tanzania HIV/ AIDS Indicator Survey 2003-2004. Calverton, Maryland, USA: TACAIDS, NBS, AND ORC Macro; 2005. Web site: http://tanzania.usaid.gov/documents/HIVAIDSIndicatorSurvey20032004.pdf Read More