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CD4 T cell counts appear to decline much more rapidly among HIV-infected female prostitutes in Kenya than in other HIV-infected women. The median time to AIDS in these prostitutes is less than five years, compared to 10 years in other groups studied. Researchers used a Markov model to study the transition between different stages of CD4 T cell levels in 485 HIV-infected Nairobi prostitutes and 231 infected mothers. The mothers were more likely to move backward to a stage of higher T cell levels than the prostitutes. It took an estimated 37.4 months for the prostitutes to reach T cell counts of 200 or less, compared to 89.5 months in the mothers. Prostitutes may become infected with several strains of HIV or they may contract other sexually transmitted diseases that cause their HIV infection to progress more rapidly.

Counseling programs that encourage patients with sexually transmitted diseases (STDs) to notify their sexual partners may be effective in controlling the spread of STDs in the developing world. Limited transportation and communication services, fear, and cultural barriers restrict STD patients and clinic staff in notifying STD partners in developing nations. Researchers gave 5-10 minutes of additional counseling to 254 STD patients in a developing country. The researchers counseled them on the importance of informing their sexual partners about their condition and encouraging their partners to seek treatment. The researchers asked these patients to return one week later for follow-up. Only 100 patients returned. Sixty-eight percent of these patients claimed to have informed their partners and 58% claimed that their partners received treatment. Without the additional counseling, only 15% of STD partners received treatment. Married patients and women attending family clinics were most likely to inform their potentially infected partners.

Genital ulcer disease (GUD) due to infection or inflammation is known to increase the risk of transmitting human immunodeficiency virus (HIV), which causes AIDS. The problem is particularly relevant for prostitutes, who are important agents of HIV transmission. To evaluate the effectiveness of condoms for preventing genital ulcers, 423 poor Nairobi women working as prostitutes were studied. The subjects were interviewed and examined at six-month intervals between 1986 and 1988. In this population, the organism most commonly associated with GUD is Haemophilus ducreyi; subjects were tested for the presence of this bacterium and for other sexually transmitted diseases (STDs) as well. If genital ulcers were found, the subjects were treated with antibiotics. The women were counseled concerning STDs and STD prevention and were given condoms. Results showed that condom use increased during the two years of the study: in 1986-1987, 41 percent of the women used condoms, compared with 65 percent in 1987-1988. However, the prevalence of GUD did not change during that time (34 percent during the earlier period, and 32 percent during the later period). A greater proportion of women who tested positive for HIV antibodies had GUD (35 percent), compared with those who tested HIV negative (14 percent). The proportion of HIV-positive women with GUD increased as did the disease severity. When HIV status was taken into account, it was found that GUD was more prevalent in prostitutes who did not use condoms. While using condoms prevents the ulcers, HIV infection predisposes women to developing ulcers. Programs to control the spread of HIV infection should include emphasis on the use of condoms and on the control of GUD among prostitutes and their clients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Human immunodeficiency virus (HIV) causes AIDS. HIV infection attacks the immune system and places infected individuals at risk for developing opportunistic infections, which can be life-threatening. HIV infection first appeared as a disease that was transmitted by anal intercourse among homosexual men and by intravenous drug use. However, it is becoming apparent that HIV infection can be transmitted between heterosexual partners. In the United States, heterosexually-transmitted HIV is not very common, and only accounts for 4 percent of all AIDS cases. Infection of regularly exposed female partners of men with HIV type 1 (HIV-1) is thought to be infrequent. However, a recent study predicted that spouses of male AIDS patients have a 42 percent risk of contracting HIV-1 infection. Although HIV-1 is carried in the semen of infected men, all female sexual partners of men with HIV-1 do not become infected. In Africa, however, HIV-1 is a heterosexually transmitted disease. Those at greatest risk for contracting HIV-1 are prostitutes and their customers, and men and women who have several different sex partners. The reason why heterosexually-transmitted HIV-1 is much more prevalent in Africa than in the US is unknown. To identify the risk factors associated with and the rate of occurrence of heterosexually-transmitted HIV-1 infection in Africa, 595 prostitutes from Nairobi were assessed. When blood samples were tested for HIV-1 at the beginning of the study, it was found that 399 women were infected (seropositive) and 196 were not (seronegative). Within 6 months, 83 of the seronegative women became infected with HIV. Within 1 year, 72 more women became seropositive and only 41 women remained seronegative. Risk factors associated with developing HIV-1 infection included genital sores and infection with Chlamydia trachomatis. The use of condoms reduced the risk of getting HIV-1 infection. The reason for the heterosexual HIV-1 epidemic in Africa is unknown, but frequent heterosexual anal intercourse and the presence of other sexually transmitted diseases may be contributing factors. (Consumer Summary produced by Reliance Medical Information, Inc.)