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anal sex and hiv transmission in adolescent women in rural south africa

Why Young Women. High rates of HIV infectionHIV epidemic being fuelled by new infections in young women <20 years oldSocial and cultural factorsAge of sexual debutAge difference between partnersTeenage pregnancyAnal sex . Anal Sex and HIV Infection. Misconception that it is an exclusively homosexual male practiceSeveral surveys between 1994 -2000 demonstrate that 10%-30% heterosexual practice anal sexWomen who practice anal sex are:Less likely to use condomsMore likely to engage in r9444

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anal sex and hiv transmission in adolescent women in rural south africa

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    1. Anal Sex and HIV Transmission in Adolescent Women in Rural South Africa Quarraisha Abdool Karim, PhD CAPRISA & Southern African Fogarty AIDS Training Programme

    3. Anal Sex and HIV Infection Misconception that it is an exclusively homosexual male practice Several surveys between 1994 -2000 demonstrate that 10%-30% heterosexual practice anal sex Women who practice anal sex are: Less likely to use condoms More likely to engage in risky behaviours

    4. Anal sex (2) Pregnancy prevention Female circumcision – experimentation prior to vaginal sex Virginity testing Virginity preservation Rape 1 survey of adolescents in US, 39% of adolescents who engaged in anal sex report having been sexually molested

    5. Purpose of proposed study Ascertain the role of anal sex in HIV acquisition in the rural community of Vulindlela, KwaZulu-Natal Assist in design of behavioural and biomedical strategies to reduce HIV incidence rates and risk in young women

    6. Specific Aims Assess the association of anal sex and HIV incidence rates in a cohort of sexually active adolescent women Describe HIV risk behaviours in this cohort Determine incidence rates of gonorrhoea, syphilis, trichomonas and chlamydia in genital tract + ano-rectal gonorrhoea

    7. Vulindlela KwaZulu-Natal Midlands, 150 km west of Durban Rural District with about 400 000 residents 7 Primary Health Care Clinics + 150 000 visits per annum Referrals – Edendale, Northdale and Grey’s CAPRISA Research Facility

    8. Age-specific prevalence of HIV infection in ANC attendees - 2002

    9. Age-specific HIV prevalence among select FPC attendees - 2002

    10. Study Design Prospective Cohort Study 12 month accrual; 24 months follow-up Study Population: 714 sexually active women <19 years old attending ANC or FP in one of three groups (238 each) No Anal Sex (NAS) Practice Anal Sex sometimes (IAS) Regularly Practice Anal Sex (RAS)

    11. Exposure levels Defined at entry Never = NAS Sometimes (IAS) – at least once in past 12 months but no more than twice in past 4 months Regularly (RAS) – > twice in past 4 months

    12. Measurement of Exposure Combination of face-to-face interviews + self-administered questionnaires Open response – minimise bias and measurement error Memory cues - Timeframes and dates Baseline and 4 monthly Follow-up

    13. Measurement of Primary Outcome All HIV testing in context of pre- and post-test counselling Baseline: ANC and FP – Determine + Rapidmed Instant Screen; Discordant results -- 2 EIAs (Virology) Incident HIV infections – 2 rapid confirmed with EIA

    14. Measurement of secondary outcome STIs measured at baseline and follow-up visits T vaginalis – Diamond medium N gonorrhoea – NYC C trachomatis – Microtrak (direct immunofluorescence) Ulcers – HSV-2; H ducreyi, T pallidum Proctoscopic visualisation if indicated

    15. Potential confounder – Violence and age of sexual partner Conflict-tactic scale – measure sexual and physical violence – 6 measures Schema – violence and age of partner Older partner -----? increased risk of HIV OP --? IRAS ---? IRHIV Sexual violence --? IRHIV SV --? IRAS ---? IRHIV OP -? IRSV ---? IRAS ---? IRHIV

    16. Potential Confounder – Sexual behaviour Method as for Anal Sex Age Frequency of coitus Rate of partner change Sex Work Douching practices Condom use

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