Newletter December 2012

ICRH Global Newsletter

 19th of December, 2012


ICRH is finally getting social!

ICRH Belgium has expanded its communication reach by joining the Facebook community. You can follow us at!/InternationalCentreforReproductiveHealth

Being social is a very basic part of our work, striving for sexual and reproductive health to be a human right for all. Now we are also discovering another side of being social: on social media.

Since about everybody in the whole world is on Facebook already, we decided to follow them and set up our own Facebook page.

We will use it to spread information on our work, on current projects or events. Keep up to date with what we do and follow us at!/InternationalCentreforReproductiveHealth


INPAC kick off meeting

The kick-off meeting of the ICRH-coordinated INPAC project was held between 3rd and 6th November 2012 in Beijing, China.

INPAC (INtegrating Post-Abortion family planning services into existing abortion services in hospital settings in China) is an EC funded FP7 project that officially started on August 01, 2012 and will run a period of 4 years.

inpac-kick-offinpac-kick-offAround 40 members from the INPAC consortium partners participated actively in the kick-off meeting. At the opening session, Ms. Yu Hua, Deputy Director of National Research Institution for Family Planning (NRIFP), China, welcomed all participants on behalf of the host and expressed best wishes to INPAC project.  Other speeches were given by invited guests: Mr. Wifried Pfeffer, the first Secretary of Belgian Embassy in China; Mr. Yang Min, Deputy Secretary General of Chinese Medical Association and Mr. Domien Proost, Chief Representative of Easter Flanders & UGent China Platform in Beijing. Prof. Dr. Marleen Temmerman, founder and former director of ICRH, presented the history of ICRH and the development of ICRH activities in China.

The meeting was very productive and the successful outcome included a clear work plan and timeline for the first 18 months of the project and several agreements on the scientific, financial and administrative management of the project.  Prof. Wei-Hong Zhang, the scientific coordinator of the project, expressed in her closing remarks her satisfaction with the meeting and announced that the next Programme Management Team meeting will be held in Belgium at the end of June 2013.

INPAC website:

For more information:

Dealing with FGM within the health care sector

ICRH is conducting a study on how to deal with female genital mutilation within the healthcare sector in Belgium.

There are an estimated 22,480 women living in Belgium who come from countries where female genital mutilation is performed. Gynaecologists and midwives are faced with specific care issues related to female genital mutilation. Women with genital mutilation addressing our health system require a specific approach for medical, psychosocial and sexual matters related to FGM, but also in terms of communication.
ICRH is currently conducting a study on how to deal with female genital mutilation within the healthcare sector.

This includes 2 studies.:
-A qualitative study (on the basis of in-depth interviews) will be conducted to identify the role of midwives in the prevention of FGM (from preconception to postpartum), and will equally identify the means of communication that are used - or could be used - by both gynaecologists and midwives, to provide adequate care to women with genital mutilation.

-Secondly, a quantitative study will be performed among midwives, using semi-structured questionnaires sent to all Flemish maternity hospitals to assess the knowledge of FGM and attitudes of midwives regarding FGM. We also want to identify potential bottlenecks in care of patients with FGM. Ultimately, the study will formulate recommendations to improve clinical practice and the quality of care.
The study is being conducted by ICRH in collaboration with four master students Midwifery. The research team consists of: Els Leye (promoter), Inge Tency (co-supervisor), Charlotte L'Ecluse & Sien Cappon for the quantitative part and Jade Strobbe and Habadia El Asjadi for the qualitative component. The study should be completed by mid 2013.

More information:


 Five years post-rape care centre in Mombasa

On August 24, the five year functioning of the ‘Gender Based Violence Recovery Centre’ , a partnership initiative between the Mombasa Coast Province General Hospital and ICRH Kenya, was celebrated.

In its five years existence, the GBVRC has provided over 3,000 victims/survivors of sexual violence with professional medical and psychological care.  In addition, successful follow-up in the legal/forensic area is ensured, leading to prosecution and conviction of the perpetrators. The GBVRC is also active in the field of community outreach for awareness raising and prevention.  80 % of the survivors are minors (<18) and 57 % are even <15, in which subgroup there are 20 % boys and 80 % girls.

The celebration started with a march through the town of Mombasa, starting at the Town Hall and ending in the Hospital.

More information:

 Hélène De Beir Research Fellowship

A generous grant from the Hélène De Beir Foundation to Ghent University allowed ICRH to install a two year ‘Hélène De Beir Research Fellowship’.

Hélène De BeirHélène De BeirHélène De Beir worked for Médecins Sans Frontières in various assignments around the world and was in Afghanistan for the second time to run a hospital for tuberculosis patients, when she was murdered 2004. She was only 29 years old. The Hélène De Beir Foundation was established in her memory, and aims at giving a voice to people who have none, particularly to women in countries where gender equality does not exist. The Hélène De Beir foundation believes in structural solutions to realize human rights, and strives for access to healthcare for everybody. In the beginning of December, a grant agreement was signed between the Hélène De Beir Foundation and Ghent University. This grant will be used by ICRH to establish a ‘Hélène De Beir Research Fellowship’, that will focus on research in the field of (among others) improving access to sexual and reproductive health services and emergency obstetrics care.

More information:

ICRH Mozambique at the Jornadas Cientificas of Mozambique, 17 – 21 September 2012

The annual Jornadas Cientificas of Mozambique is the opportunity for researchers to present the work done in all health related fields. This year’s theme was “Research institutions contributing to better health in Mozambique”

Gilda Gondola, researcher in Maternal and Child Health at ICRH Mozambique, presented the results of the policy analysis undertaken within the framework of the MOMI-project (Missed Opportunities in Maternal and Infant Health), which aims to assess the impact of postpartum interventions tailored to the national setting and conditions to improve maternal and child health.  While the national health policies identify postnatal care services as essential components of sexual and reproductive health, the package of interventions for postnatal care after day 28 is not fully developed. The study results will guide the design of an experimental intervention in Chiúta district, located in Tete province in Central region of Mozambique.

The presentation was well received by the audience. It was recommended to include more districts  for the experimental interventions due to importance of the project for policy improvement or change on post-partum care.

Two other ICRH presentations were made: ‘Integration of maternal and child health issues in the community ART support groups in rural areas of Mozambique’ and ‘Barriers and facilitating factors for the implementation of the WHO model for antenatal consultations’.

More information: Gilda Gondola,

ICRH at the Second Global Symposium on Health Systems Research

The Second Global Symposium on Health Systems Research was held in Beijing between 31st, October and 3rd November 2012 with more than 1,800 participants from all over world attending and sharing their work. 

The plenary presentations and the online Book of Abstracts are available at

Former ICRH director Marleen Temmerman, and ICRH researchers Wei-Hong Zhang and Jinke Li attended the Symposium and presented three research papers, which included the following:

-Duysburgh E, Zhang WH, Decat P,  Kerstens B, De Meyer  S and Temmerman M. Stakeholders' inclusion for translating health systems research into policy and action: experiences in Africa, China and Latin America.

-Li, JK, Temmerman M, Chen QJ,  Xu JL, Hu LN and Zhang WH. A review on contraceptive prevalence and changes in married and unmarried women in China during last three decades.

-Zhang WH,  Duysburgh E,  Cheng Y and Temmerman M . Integrating family planning services into existing abortion services in China: needs and challenges.

Medical school in Mombasa

In August 2012, a memorandum of understanding was signed between Ghent University, ICRH Kenya, Mombasa Polytechnic University College (MPUC) and Coast Provincial General Hospital (CPGH), forging a strategic alliance to establish a Medical School in Mombasa.

Ghent University, ICRH Kenya and the Coast Provincial General Hospital have a long standing cooperation, among others regarding internships in Mombasa by medical students from Ghent University. With the Memorandum of Understanding, the partners want to strengthen their cooperation by joining forces to establish a Medical School within the  Mombasa Polytechnic University College.

The Memorandum was signed on August 27, by MPUC Principal Prof. Dr. J. Mwatelah, MPUC Chairman Prof. A. El-Busaidy, Provincial Director of Medical Services Dr. Maurice Siminyu, Belgian Ambassador Bart Ouvry, Ghent University Rector Prof. Paul Van Cauwenberge, and Prof. Marleen Temmerman.

More information: Peter Gichangi, director of ICRH Kenya,

Give Me Time

Singer-songwriter Marc Terreur launched a most original support action for ICRH projects.

On the same day when his mother was cremated, Marc Terreur learned that his daughter was pregnant. This symbolically charged conjunction of events inspired him to writing a song. In “Geef Me Tijd” (“Give Me Time”), Marc Terreur sings about how people pass on life to future generations, but still continue to long  for extending their own time on earth.  When the song was ready, he wondered what he could do with it. The process of writing had in itself had a beneficial impact on him, but he still wanted to share it with as many people as possible. At the same time he considered how great it would be if the death of his mother could serve, through the revenues of the song, a good cause. He left the choice of the cause to his daughter, who immediately brought forward Marleen Temmerman and her work with ICRH to fight maternal and child mortality in Africa and elsewhere. Marleen was enthusiastic about the idea, and a remarkable support action was born.

“Geef Me Tijd” can be downloaded from iTunes, more information can be found on Facebook. The revenue of downloading “Geef Me Tijd” goes entirely to ICRH projects.

More information:


Ellen Taets leaves ICRH Belgium…

After four years of combining ICRH work with law studies, Ellen moves to new career perspectives.

Ellen started working as office manager for ICRH Belgium in the beginning of 2009. She brought lots of joy and light into the offices and the team, ensured the administrative and logistic functioning of the organisation and for numerous PhD students she was the tower of strength and the ever cheerful guide through the sometimes opaque and complex administrative procedures of admission, registration and thesis defence. In her spare time, Ellen studied at the faculty of law, and she is now in the final stage of obtaining her master’s degree.  We wish her a good graduation and a successful career in law.


…and Cindy De Muynck comes in

Cindy De Muynck joined the finance & administration team of ICRH Belgium in November 2012.

She is responsible for general administrative and logistic support for ICRH activities, projects and secretariat.

In her professional career, Cindy worked first as a youth worker and next at the Free University Brussels, where she did administration for an international and inter-university master program.

Next to her job, she loves to travel, go out, eat and drink in good company of course, play music and she  is a volunteer in a youth organization and neighbourhood work.

More information:

Aurore Guieu is back

Aurore started working at ICRH Belgium, in replacement of Ines Keygnaert during her pregnancy leave.

Aurore is not new to ICRH: she already spent a few months in the Ghent office in the spring of 2012, as a trainee within the framework of her studies at SciencesPo Paris, France, where she obtained a Master Degree in European Studies last June. Her main areas of interest are European policies on SRH, migration, and gender equality, and she is also involved in diverse Central European and feminist associations. In the next few months, she will replace Ines Keygnaert who just gave birth to a son, and work among others on violence and sexual and reproductive health of migrants.

More information:

Kristien Michielsen graduated as Doctor in Social Health Sciences

On November 9th, Kristien Michielsen successfully defended her PhD thesis “HIV prevention for young people in sub-Saharan Africa: effectiveness of interventions and areas for improvement. Evidence from Rwanda”

Given that young people remain at the centre of the HIV epidemic in sub-Saharan Africa, the general objective of this study was to improve the effectiveness of HIV prevention interventions for young people in sub-Saharan Africa.

PhD supervisors were Prof. dr. Marleen Temmerman and Prof. dr. Ronan Van Rossem.

The full thesis can be found at:


Transmission of HPV from mother to child: a meta-analysis of published studies.

Currently, human papillomavirus (HPV) research focuses on HPV infection in adults and sexual transmission. Data on HPV infection in children are only slowly becoming available.

It is a matter of debate whether mother-to-child transmission of HPV is an important infection route and whether children born to HPV-positive mothers are at a higher risk of HPV infection compared with children born to HPV-negative mothers. The objective of this meta-analysis is to summarize the published literature on the extent to which genital HPV infection is vertically transmitted from mother to child. Medline, Web of Science, and CINAHL were searched for eligible reports published before January 2011. Differences in the risk of HPV infection between newborns from HPV-positive and HPV-negative mothers were pooled using a random-effects model. Twenty eligible studies, including 3128 women/children pairs, fulfilled the selection criteria. High heterogeneity could be found (I=96%). The overall estimated risk difference was 33% (95% confidence interval: 22-44%). On restricting to high-risk HPV-positive mothers only (n=4; women=231), the difference in risk was 45% (95% confidence interval: 33-56%). The heterogeneity was found to be low (I=15%). This meta-analysis indicates a significantly higher risk for children born to HPV-positive mothers to become HPV positive themselves. Plausible explanations include vertical transmission of HPV during pregnancy and/or birth or a higher infection rate during early nursing from mother to child. More research is required to gain an insight into the precise mode of transmission and the clinical effects of infection on the child.

Merckx M, Liesbeth WV, Arbyn M, Meys J, Weyers S, Temmerman M, Vanden Broeck D. Transmission of carcinogenic human papillomavirus types from mother to child: a meta-analysis of published studies. Eur J Cancer Prev. 2012 Sep 16. [Epub ahead of print]

Female sex work and international sport events

A cross-sectional study found no major changes in demand or supply of paid sex during the 2010 Soccer World Cup.

Important unanswered questions remain on the impact of international sporting events on the sex industry. Speculation about increased demand and supply of sex work often generates significant attention, but also additional funding for HIV programmes. This study assessed whether changes occurred in the demand and supply of paid sex during the 2010 Soccer World Cup in South Africa.

Trained sex worker interviewers conducted face-to-face semi-structured interviews among consenting female sex workers during May-September 2010. Using bivariate analyses the researchers  compared supply, demand, sexual risk-taking, and police and health services contact pre-World Cup, to levels during the World Cup and after the event.

No increases were detected in indicators of sex work supply, including the proportion of sex workers newly arrived in the city (< 2.5% in each phase) or those recently entering the trade (≤ 1.5%). Similarly, demand for sex work, indicated by median number of clients (around 12 per week) and amount charged per transaction ($13) remained similar in the three study periods. Only a third of participants reported observing any change in the sex industry ascribed to the World Cup. Self-reported condom-use with clients remained high across all samples (> 92.4% in all phases). Health-care utilisation decreased non-significantly from the pre- to during World Cup period (62.4% to 57.0%; P = 0.075). Across all periods, about thirty percent of participants had interacted with police in the preceding month, two thirds of whom had negative interactions.

The authors conclude that contrary to public opinion, no major increases were detected in the demand or supply of paid sex during the World Cup. Although the study design employed was unable to select population-based samples, these findings do not support the public concern and media speculation prior to the event, but rather signal a missed opportunity for public health action. Given the media attention on sex work, future sporting events offer strategic opportunities to implement services for sex workers and their clients, especially as health service utilisation might decrease in this period.

Richter M, Luchters S, Ndlovu D, Temmerman M, Chersich MF. Female sex work and international sport events - no major changes in demand or supply of paid sex during the 2010 Soccer World Cup: a cross-sectional study. BMC Public Health 2012 Sep 11;12(1):763. [Epub ahead of print]

Bacterial vaginosis and cervical cancer

Researchers conducted a systematic review and meta-analysis on the association between bacterial vaginosis and cervical intraepithelial neoplasia

Bacterial vaginosis (BV), the most common vaginal disorder among women of reproductive age, has been suggested as co-factor in the development of cervical cancer. Previous studies examining the relationship between BV and cervical intra-epithelial neoplasia (CIN) provided inconsistent and conflicting results. The aim of this study was to clarify the association between these two conditions.

A systematic review and meta-analysis were conducted to summarize published literature on the association between BV and cervical pre-cancerous lesions. An extensive search of electronic databases Medline (Pubmed) and Web of Science was performed. Eligible studies required a clear description of diagnostic methods used for detecting both BV and cervical pre-cancerous lesions. Publications were included if they either reported odds ratios (OR) and corresponding 95% confidence intervals (CI) representing the magnitude of association between these two conditions, or presented data that allowed calculation of the OR.

Out of 329 articles, 17 cross-sectional and 2 incidence studies were selected. In addition, two studies conducted in The Netherlands, using the national KOPAC system, were retained. After testing for heterogeneity and publication bias, meta-analysis and meta-regression were performed, using a random effects model. Although heterogeneity among studies was high (?(2)?=?164.7, p<0.01, I(2)?=?88.5), a positive association between BV and cervical pre-cancerous lesions was found, with an overall estimated odds ratio of 1.51 (95% CI, 1.24-1.83). Meta-regression analysis could not detect a significant difference between studies based on BV diagnosis, CIN diagnosis or study population.

The authors conclude that, although most studies were cross-sectional and heterogeneity was high, this meta-analysis confirms a connection between BV and CIN.

Evy Gillet, Joris F. A. Meys, Hans Verstraelen, Rita Verhelst, Philippe De Sutter, Marleen Temmerman, Davy Vanden Broeck. Association between Bacterial Vaginosis and Cervical Intraepithelial Neoplasia: Systematic Review and Meta-Analysis. PLoS One. 2012;7(10):e45201. doi: 10.1371/journal.pone.0045201. Epub 2012 Oct 2.

MMP:TIMP balance in preterm labour

A case control study on imbalances between Matrix Metalloproteinases (MMPs) and Tissue Inhibitor of Metalloproteinases (TIMPs) in Maternal Serum during Preterm Labour.

Matrix metalloproteinases (MMPs) are involved in remodelling of the extracellular matrix (ECM) during pregnancy and parturition. Aberrant ECM degradation by MMPs or an imbalance between MMPs and their tissue inhibitors (TIMPs) have been implicated in the pathogenesis of preterm labour, however few studies have investigated MMPs or TIMPs in maternal serum. Therefore, the purpose of this study was to determine serum concentrations of MMP-3, MMP-9 and all four TIMPs as well as MMP:TIMP ratios during term and preterm labour.

A case control study was conducted with 166 singleton pregnancies, divided into four groups: (1) women with preterm birth, delivering before 34 weeks (PTB); (2) gestational age (GA) matched controls, not in preterm labour; (3) women at term in labour and (4) at term not in labour. MMP and TIMP concentrations were measured using Luminex technology.

MMP-9 and TIMP-4 concentrations were higher in women with PTB vs. GA matched controls (resp. p = 0.01 and p,0.001). An increase in MMP-9:TIMP-1 and MMP-9:TIMP-2 ratio was observed in women with PTB compared to GA matched controls (resp. p = 0.02 and p,0.001) as well as compared to women at term in labour (resp. p = 0.006 and p,0.001). Multiple regression results with groups recoded as three key covariates showed significantly higher MMP-9 concentrations, higher MMP-9:TIMP-1 and MMP-9:TIMP-2 ratios and lower TIMP-1 and -2 concentrations for preterm labour. Significantly higher MMP-9 and TIMP-4 concentrations and MMP-9:TIMP-2 ratios were observed for labour.

Conclusions: Serum MMP-9:TIMP-1 and MMP-9:TIMP-2 balances are tilting in favour of gelatinolysis during preterm labour. TIMP-1 and -2 concentrations were lower in preterm gestation, irrespective of labour, while TIMP-4 concentrations were raised in labour. These observations suggest that aberrant serum expression of MMP:TIMP ratios and TIMPs reflect pregnancy and labour status, providing a far less invasive method to determine enzymes essential in ECM remodelling during pregnancy and parturition.

Tency I, Verstraelen H, Kroes I, Holtappels G, Verhasselt B, et al. (2012) Imbalances between Matrix Metalloproteinases (MMPs) and Tissue Inhibitor of Metalloproteinases (TIMPs) in Maternal Serum during Preterm Labor. PLoS ONE 7(11): e49042. doi:10.1371/journal.pone.0049042

Female adolescent sex workers in China

This study assesses social and behavioural predictors for sexual risk taking and sexually transmitted infections (STIs) including HIV among adolescent female sex workers (FSWs) from Kunming, China. Additionally, health services needs and use were assessed.

A cross-sectional survey was conducted in 2010. Using snowball and convenience sampling, self-identified FSWs were recruited from four urban areas in Kunming. Women consenting to participate were administered a semi-structured questionnaire by trained interviewers identified from local peer-support organisations. Following interview, a gynaecological examination and biological sampling to identify potential STIs were undertaken. Descriptive and multivariable logistic regression analyses were performed.

Adolescent FSWs had a mean age of 18.2?years and reported numerous non-paying sexual partners with very low rate of consistent condom use (22.2%). Half (50.3%) the respondents had sex while feeling drunk at least once in the past week, of whom 56.4% did not use condom protection. STI prevalence was high overall (30.4%) among this group. Younger age, early sexual debut, being isolated from schools and family, short duration in sex work, and use of illicit drugs were found to be strong predictors for unprotected sex and presence of an STI. Conversely, having access to condom promotion, free HIV counselling and testing, and peer education were associated with less unprotected sex. The majority reported a need for health knowledge, free condoms and low-cost STI diagnosis and treatment.

The authors conclude that there is an urgent need to improve coverage, accessibility and efficiency of existing interventions targeting adolescent FSWs. Sexually Transmitted

Xu-Dong Zhang, Marleen Temmerman, Yan Li, Wei Luo, Stanley Luchters. Vulnerabilities, health needs and predictors of high-risk sexual behaviour among female adolescent sex workers in Kunming, China  Sex Transm Infect doi:10.1136/sextrans-2012-050690.

The article can be downloaded from

MSM in Sub-Saharan Africa

Current knowledge and future directions after a decade of behavioural research involving men who have sex with men in sub-Saharan Africa.

It has been just over 10 years since the first large behavioural survey of men who have sex with men (MSM) was implemented in Senegal in 2001. Since then, behavioural and/or HIV prevalence surveys have been conducted in over 14 other countries in sub-Saharan Africa.

Current available evidence and review have established that HIV prevalence among MSM in these countries are significantly higher than corresponding general populations, that MSM engage in sexual risk behaviours that place them and sexual partners at higher risk, and that issues of discrimination and stigmatization inhibit HIV interventions for MSM. This paper summarizes the existing knowledge, describes limitations of this evidence, and proposes new and enhanced research approaches to fulfil needed gaps to inform national HIV responses for MSM populations.

Nicholas Muraguri , Marleen Temmerman & Scott Geibel. A decade of research involving men

who have sex with men in sub-Saharan Africa: Current knowledge and future directions. SAHARA-J: Journal of Social Aspects of HIV/AIDS: An Open Access Journal, 9:3, 137-147.

The article can be downloaded at

Prophylactic maternal ARV

The Kesho Bora Study Group assessed 18-24-month postpartum disease progression risk among women in a randomized trial assessing efficacy and safety of prophylactic maternal ARVs.

Antiretroviral (ARV) prophylaxis effectively reduces mother-to-child transmission of human immunodeficiency virus type 1 (HIV). However, it is unclear whether stopping ARVs after breastfeeding cessation affects maternal HIV disease progression.

From 2005 to 2008, HIV-infected pregnant women with CD4(+) counts of 200-500/mm(3) were randomized to receive either triple ARV (zidovudine, lamivudine, and lopinavir/ritonavir during pregnancy and breastfeeding) or AZT/sdNVP (zidovudine until delivery with single-dose nevirapine without postpartum prophylaxis). Maternal disease progression was defined as the combined endpoint of death, World Health Organization clinical stage 4 disease, or CD4(+) counts of <200/mm(3).

Among 824 randomized women, 789 had at least 1 study visit after cessation of ARV prophylaxis. Following delivery, progression risk up to 24 months postpartum in the triple ARV arm was significantly lower than in the AZT/sdNVP arm (15.7% vs 28.3%; P = .001), but the risks of progression after cessation of ARV prophylaxis (rather than after delivery) were not different (15.0% vs 13.8% 18 months after ARV cessation). Among women with CD4(+) counts of 200-349/mm(3) at enrollment, 24.0% (95% confidence interval [CI], 15.7-35.5) progressed with triple ARV, and 23.0% (95% CI, 17.8-29.5) progressed with AZT/sdNVP, whereas few women in either arm (<5%) with initial CD4(+) counts of ≥350/mm(3) progressed.

Interrupting prolonged triple ARV prophylaxis had no effect on HIV progression following cessation (compared with AZT/sdNVP). However, women on triple ARV prophylaxis had lower progression risk during the time on triple ARV. Given the high rate of progression among women with CD4(+) cells of <350/mm(3), ARVs should not be discontinued in this group.

The Kesho Bora Study Group. Maternal HIV-1 Disease Progression 18-24 Months Post-Delivery According to Antiretroviral Prophylaxis Regimen (Triple-Antiretroviral Prophylaxis during Pregnancy and Breastfeeding Versus Zidovudine/Single-Dose Nevirapine Prophylaxis): The Kesho Bora Randomized Controlled Trial. Clinical Infectious Diseases. 2012;55(3):449-60

Sexual behaviour among HIV-infected women

A cohort analysis investigating changes in sexual behaviour among HIV-infected women in West and East Africa in the first 24 months after childbirth.

The cohort analysis was nested within a prevention of mother-to-child transmission trial in Burkina Faso (n = 339) and Kenya (n = 432). Women were followed during pregnancy and until 12-24 months after delivery. At each visit, structured questionnaires were administered about sexual activity and condom use, and risk-reduction counselling and condoms were provided.

At study entry, a median 2 months after HIV testing (interquartile range =1-4), 411/770 (53.4%) of women reported partner disclosure, increasing to 284/392 (71.9%) at the final visit. Although most partners were supportive following disclosure, between 5 and 10% of disclosed women experienced hostile or unsupportive partner responses during follow-up visits. At each visit, about a third of sexually active women reported unsafe sex (unprotected sex with HIV-uninfected or unknown status partner). In multivariable logistic regression, unsafe sex was 1.70-fold more likely in Kenyan than in Burkinabe women [95% confidence interval (95% CI) = 1.14-2.54], and in those with less advanced HIV disease or aged 16-24 years. Compared with women who disclosed their status to partners and others, unsafe sex was over six-fold higher in nondisclosers (95% CI = 3.31-12.11), the effect size reducing with increasing disclosure.

HIV-infected women who recently delivered have a high potential for further HIV transmission, especially as HIV discordance is common in Africa. Longitudinal care for women, including positive-prevention interventions, is needed within new services providing antiretroviral prophylaxis during breastfeeding - this repeated interface with services could focus on reducing unsafe sex. Much remains unknown about how to facilitate beneficial disclosure.

Irungu E, Chersich MF, Sanon C, Chege R, Gaillard P, Temmerman M, Read J, Luchters S for the Kesho Bora Study Group. Changes in sexual behaviour among HIV-infected women in West and East Africa in the first 24 months after childbirth. AIDS. 2012 May 15;26(8):997-1007

Peer education as HIV prevention strategy for male sex workers

Study on the impact of peer outreach on HIV knowledge and prevention behaviours of male sex workers in Mombasa, Kenya.

Targeting most at-risk populations is an essential component of HIV prevention strategies. Peer education programmes have been found to increase HIV knowledge, condom use and safer sex behaviours among female sex workers in Africa and men who have sex with men elsewhere. The authors aimed to evaluate the impact of a peer-driven intervention on male sex workers who sell sex to men in Mombasa, Kenya.

Using time-venue sampling, a baseline survey of 425 male sex workers was conducted in late 2006, after which, 40 peer educators were trained in HIV prevention, basic counselling skills and distribution of condoms and lubricants. A follow-up time-venue survey of 442 male sex workers was conducted in early 2008, and pre- and post-intervention changes were examined. The impact of peer educator exposure on HIV knowledge and condom use was analysed.

Positive changes in HIV prevention behaviours were observed, including increases in consistent use of condoms with both male clients (35.9%-50.2%, p<0.001) and non-paying male partners (27.4%-39.5%, p=0.008). Exposure to peer educators (AOR=1.97, 95% CI 1.29 to 3.02) and ever having been counselled or tested for HIV (AOR=1.71, 95% CI 1.10 to 2.66) were associated with consistent condom use in multivariate analysis. Peer educator contact was also associated with improved HIV knowledge and use of water-based lubricants.

Conclusion: peer outreach programming reached highly stigmatised male sex workers in Mombasa, resulting in significant, but limited, improvements in HIV knowledge and prevention behaviours. Improved peer coverage and additional prevention initiatives are needed to sufficiently mitigate HIV transmission.

Geibel S, King’ola N, Temmerman M, Luchters S. The impact of peer outreach on HIV knowledge and prevention behaviors of male sex workers in Mombasa, Kenya. Sex Transm Infect. 2012 Aug;88(5):357-62.