University of Zambia Medical Library

HIV and Interaction with Sexually Transmitted Diseases (Aids in Zambia Bibliography #19-32)

(#19) "Oral Ciprofloxacin Versus Ceftriaxone for the treatment of Urethritis from Resistant Neisseria Gonorrhoea in Zambia ."
Bryan, J.P. (1990) Antimicrobial Agents and Chemotherapy; Vol.34(5);1990; pp 819-22.
Geographical area: Lusaka; Keywords: Gonorrhoea; Location: UNZA Medical Library

Neisseria gonorrhoea strains resistant to treatment with penicillin, tetracycline, and/or spectinomycin are increasing in prevalence in many parts of the world. In Zambia, 52 of N. gonorrhoea isolates produced beta-lactamase in 1986. Few oral regimens have proven effective for treatment of resistant N. gonorrhoea. The researchers conducted a prospective, double-blind, randomised clinical trial of 250 mg of ceftriaxone given orally versus 250 mg of ceftriaxone given intramuscularly for treatment of uncomplicated gonococcal urethritis in adult males.

Two hundred men were enrolled and treated. The two groups were comparable in age (27.5 years), prevalence of latent syphilis (14 per cent and 10 per cent) and human immunodeficiency virus infection (32 per cent and 38 per cent). Both treatment regimens were well tolerated. Chlamydia trachomatous in urethral exudate was found by direct fluorescent-antibody microscopic examination or by culture in penicillinase-producing N. gonorrhoea (PPNG) and 21 with N. gonorrhoea with chromosomally mediated resistance to multiple antibiotics (CMRNG), and ceftriaxone cure 81 of 82 (98.7 per cent), including 30 with PPNG and 19 with CMRNG. All N. gonorrhoea isolates were inhibited by ceftriaxone at 0.06 micrograms/ml, except one which was inhibited at 0.125 micrograms/ml, while ciprofloxacin inhibited all isolates at 0.03 micrograms/ml. Ciprofloxacin is a safe and effective therapy for uncomplicated gonococcal urethritis, including that caused by PPNG and CMRNG in human immunodeficiency virus-infected men.

(#20) "Genital Ulcers and Male Circumcision as Risk Factors for Acquiring HIV-1 in Zambia."
Hira, S.K., Kamanga, J., Macuacua, R., Mwansa, N., Cruess, D.F., et al. (1990) Journal of Infectious Diseases, 161 (March) pp 584-585
Geographical Area: National; Keywords: GUD, circumcision; Location: UNZA Medical Library

Objective:
To determine whether genital ulcerative diseases and an intact foreskin independently increase the risk of acquiring HIV-1 (male circumcision in Zambia is practised only in the northwestern part of the country by a group that comprises about 2 per cent of the total population of Zambia).

Methods:
We have determined the 2-year incidence of HIV-1 in 45 men with intact foreskins and in 28 women who tested negative for HIV-1 antibodies by ELISA. All were first examined in August 1985 and were part of a cohort of patients who were treated for acute genital ulceration (n = 228) or nonulcerative genital lesions (n = 200). 34 patients were diagnosed in 1985 as having nonulcerative STDs (urethritis, cervicitis, balinitis, vaginosis, or genital warts) and 39 as having ulcerative STDs (chancroid, syphilis, herpes, nonspecific disease).

Results:

• The 2-year incidence of Western blot-confirmed HIV-1 infection in those without genital ulcers was 17.6 per cent (6/34) compared to 12.8 per cent (5/39) of those with documented genital ulcerations at the time of admission to the study. The incidence of HIV infection in these two groups was not significantly different (P = 0.56; CI - 0.117, 0.214); to show that our observed difference of 0.047 is significant with a power of 80 per cent, sample sizes of 800 in each group would be required.
• Of the six cases of HIV in nonulcerative STD group, 3 of the 4 HIV-infected men had acquired another STD (one case each of chancroid, herpes genitalis, and gonococcal urethritis) and 1 of the 2 HIV-infected women also had acquired gonorrhea. Removal of those in both groups who had incident genital ulcers from the analysis did not change the non-significance of difference between them (ulcer group = 2 (5.6 per cent) of 36 vs. 4 [12.5 per cent] of 32, nonulcerative group, x = 0.34, P = 0.56). The incidence of another STD in those who became infected with HIV during the study, 7 (63.6 per cent) of 11, is significantly greater than those who remained seronegative for HIV, 4 (7.1 per cent) of 56; P<.01.
• The number of lifetime sexual partners of patients with and without genital ulcers was not significantly different; average of 20.4 in men and 5.5 in women. The average number of new sexual partners (acknowledged by patients at follow-up) was 0.8 [range (0-6)] and did not differ significantly between the ulcerative and nonulcerative STD groups or between the incident and non-incident cases of HIV.

Conclusion:
The people at greatest risk of acquiring HIV in Zambia appear to be uncircumcised men and men and women who are frequently infected by STD pathogens. Genital ulcers are of no greater risk for HIV than are nonulcerative STDs.

(#21) "Syphilis Intervention in Pregnancy: Zambian Demonstration Project"
Hira, S.K., Bhat, G.J., Chikamata, D.M., Nkowane, B., Tembo, G., et al. (1990) Genito-urinary Medicine Vol.66(3);1990; pp 159-64
Geographical area: Lusaka; Keywords: Pregnancy, syphilis, health education; Location: UNZA Medical Library

Despite availability of simpler serologic tests for syphilis and near cure with penicillin, unacceptably high prevalence of infectious maternal syphilis exist in many developing countries including Zambia. It is the foremost risk factor for mid-trimester abortions, still births, prematurity and morbidity and mortality among infants born with congenital syphilis in Zambia. An intervention project was conducted in Lusaka aimed at demonstrating the effectiveness of new health education methods and prenatal screening for syphilis in reducing the adverse outcomes during pregnancy. During the pre-intervention phase, approximately 150 consecutive pregnant women from each of the three study and the three control centres were recruited when they presented in labour at the University Teaching Hospital. The intervention phase lasted for one year at the three study centres during which new methods of health education were introduced to improve early attendances during pregnancy. Also, on-site syphilis screening was performed twice during pregnancy and seroreactive women, and in many cases their sexual partners, were treated by the existing prenatal clinic staff.

During the post-interventions phase the steps of the pre-interventions phase were repeated to evaluate the impact of intervention. Overall, 8.0 per cent of women were confirmed seroreactive for syphilis; there was no difference between the study and the control centres (p>0.05). Fifty seven per cent (132/230) of syphilitic pregnancies ended with an adverse outcome, that is, abortion (RR 2-6) stillbirth (RR 3.6 per cent) and low birth weight (RR 7.8). The overall risk of adverse outcomes due to syphilis was 8.29 (95 per cent confidence interval 6.53, 10.53). The new methods of health education were effective and the percentage of women who had their first prenatal visit under 16 weeks of gestation improved from 9.4 to 42.5. Although screening and treatment during the intervention was suboptimal, the adverse outcomes attributable to syphilis were reduced to 28.3 per cent; this is almost a two-third reduction when compared with 72.4 per cent of adverse outcomes at the control centres (P<0.001). The intervention is culturally and politically acceptable in Zambia. The cost of each prenatal screening is US$0.60 and of averting each adverse outcome US$12. In countries with high rates of syphilis there is an urgent need for STD control and Maternal and Child Health (MCH) programmes to pool their resources to revitalise the prenatal care.

(#22) "Tuberculin insensitivity and HIV status among patients attending a Sexually Transmitted Disease clinic in Lusaka, Zambia."
Duncan, L., Elliot, A., Ebrahim, H., Hira, S., Mumba, G., et al. (1991) Paper presented to the VIIth International Conference on AIDS, Florence, 1991.
Geographical area: Lusaka; Key words: TB, BCG; Location: UNZA Medical Library

Objectives:
To estimate the prevalence of latent tuberculosis in a group at risk of HIV infection and to examine the effect of HIV on tuberculin responses. Methods: A systematic sample of 268 adult patients attending a sexually transmitted clinic in Lusaka were examined for HIV antibody (HIV-Chek and Recombigen-HIV EIA) and given a Mantoux test (2TU RT-23). Data were analysed by Chi-square, F-tests and 95 per cent confidence intervals.

Results:
194 participants (73 per cent) returned to have their Mantoux read. A positive Mantoux was found in 60 per cent of HIV-negatives but only 30 per cent of HIV-positives. There was no interaction with age, sex, or presence of BCG scar. The distribution of Mantoux size showed striking differences between HIV-negative participants: 68 per cent of HIV-positive, compared with 34 per cent of HIV-negative, participants were energetic; the remaining responses in HIV-negatives followed a normal distribution in the 5.0-29,5 mm range, HIV-positives showed a flat distribution, skewed to the left, with a further peak of reactions 30 mm or more in diameter.

Conclusions:
The results indicate a prevalence of latent tuberculosis in the study group of 60 per cent and suggest that HIV infection may lead to both false negative and hyper-reactive responses of tuberculin.

(#23)"Control strategies in STD/HIV clinics in Zambia: A demonstration project."
Hira, S., Kamanga, J., Tembo, G., Perine, P., (1991) Paper presented to the VIIth International Conference on AIDS, Florence, 1991.
Geographical area: National; Key words: Cndoms, counselling, genital ulcer disease; Location: UNZA Medical Library

Objectives:
To test the hypothesis that prompt management of conventional STDs, partner notification, preventive counselling and condom promotion have measurable impact on the incidence of STD (and HIV).

Methods:
The national STD control programme of Zambia launched in the 1980 has a network of 47 STD/HIV clinics located at central, general and district hospitals. Since March 1990 diagnostic, clinical management and prevention capabilities at designated STD/HIV clinics have been improved through training, diagnostic equipment and supplies. These clinics are participating in research which recruits two randomly selected first time STD attenders daily and follows them and their sexual partner(s) at intervals for three years.

Results:
Data available from STD/HIV clinics show that genital ulcer diseases (GUD) constitutes 51.8 per cent of all STD. The HIV prevalence for 1990 in male attenders is 504/1185 (42.5 per cent) and that for female attenders is 293/538 (54.5 per cent). The STD rates are:

Year	Number of Clinics Participating	Average adult out-patient attenders/month	Average new STD attenders/month	STD rate (%)
1987	9	48,944	5,547	11.3
1988	13	72,605	6,140	8.5
1989	13	59,710	4,518	7.6
1990	12	47,459	2,707	5.7

Conclusions:
An apparently declining STD rate may be attributed to the model STD Control Programme and effective anti-AIDS campaigns. Confounding factors, including STD care in private sector and declining STD reservoir due to HIV mortality are under study.

(#24) "Syphilis intervention in pregnancy : Zambian model suitable for other developing countries"
Hira, S., Phiri, J., Perine, P. (1992) Paper presented at the VIIIth International Conference on AIDS, Amsterdam, 1992.
Geographical area: Lusaka; Key words: Syphilis, pregnancy; Location: UNZA Medical Library

Objectives:
The programme for syphilis intervention was launched in 1983 by the Zambian STD control programme aimed at:

• Reducing adverse pregnancy outcomes due to syphilis;
The long term objective was to reduce prevalence of syphilis in pregnant women.

Project Description:
Intervention was implemented as follows:

• Provincial STD seminars were held annually starting in 1983 to present epidemiologic data on maternal and congenital syphilis and to emphasise need for rapid plasma reagin (RPR) screening for all pregnant women;
• On-sight training for midwives at all maternity centres during 1983 in performance, interpretation of RPR testes, and immediate treatment of seropositive women;
• Seropositive women were motivated to act as contact traces for their partners;
• Uninterrupted distribution of RPR tests through UNICEF funding.

Results:
The amortised costs of each RPR screening was US$ 0.60 and that of averting each adverse outcome was US$ 12 at a prevalence of 10 per cent.

Year	Urban coverage (% institutions)	District/rural (% institutions) covered	Number RPR tests distributed annually ('000)	Prenatal syphilis prevalence in Lusaka (%)	Prenatal syphilis prevalence in Chililabombwe district (%)
1983	40	20	152	13.2	6.1
1987	70	30	475	8.0	4.8
1991	100	40	503	6.0	3.4

Lessons learned:
There has been a reduction in clinical cases of congenital syphilis at health institutions. The seroprevalence of syphilis in pregnant women was reduced by one-half in urban and semi-urban centres. The model programme is culturally and politically acceptable in Zambia and could be duplicated in other developing countries.

(#25) "Efficacy of spermicide use and condom use by HIV-discordant couples in Zambia."
Hira, S., Godwin, S., Kamanga, J., Mukelabai, G., Feldblum, P., (1992) paper presented to the VIIIth International Conference on AIDS, Amsterdam, 1992.
Geographical area: Lusaka; Key words: Spermicide, condoms; Location: UNZA Medical Library

Objectives:
To measure the association between consistent spermicide use and HIV incidence, and consistent condom use and HIV incidence among HIV-discordant couples.

Methods:
HIV-discordant couples visit the University Teaching Hospital in Lusaka quarterly. After informed consent, they are counselled on HIV risk reduction and the use of condoms and spermicides (barrier methods). They record data on sexual activity and barrier use on a pictorial coital log. Counselling, blood testing, physical exams and barrier method supply are done at each clinic visit, coital log data are summarised, and other risk behaviours are queried. Follow-up data are available for 105 couples.

Results:
Mean follow-up is 16.6 months per couple. One or both barrier methods are reported used for most coital acts (78 per cent of coital acts are protected by condoms, 86 per cent by spermicides, 5 per cent of acts unprotected). Genital ulcers have been rare during follow-up. Twelve seroconversions have occurred (8.3 per 100 couple years [c-y]). The incidence rate is 4.5/100 c-y among initially seronegative women and 21.2/100 c-y among initially seronegative men. Comparing couples using spermicides at every intercourse with less consistent users, the RR is 0.9 (95 per cent CI: 0.2, 3.3). Comparing couples using condoms at every intercourse with less consistent users, the RR is 0.3 (0.0,2.1). Among initially seronegative women, both consistent spermicide use (RR=0.6) and consistent condom use (RR=0.0) protect against HIV infection. No protection is noted for initially seronegative men, who may be having unreported and unprotected extramarital sexual contact.

Conclusions:
Consistent spermicide use may substantially reduce the rate of HIV infection in women, as may consistent condom use.

(#26) "STD and HIV infection."
Kamanga, J. (1992) Paper presented at the SWAAZ/PANOS International Conference on AIDS for Anglophone African Media, Lusaka, 1992.
Geographical area: NA; Key words: Genital ulcer disease, gonorrhoea; Location: unknown

Sexually transmitted diseases are a major problem in a developing country like Zambia. They contribute up to 10 per cent of out-patient adult attendees. Some of the STDs have serious sequelae and adverse outcomes on pregnancy. The presence of STDs facilitates the acquisition and transmission of HIV by over 50 per cent. The disrupted mucosae in the genital ulcer diseases or STDs and the inflammation in the genital discharges create an easy entry point for the HIV virus. In an already infected individual a load of HIV will present on the ulcers or the inflamed mucosae. The presence of HIV delays the healing of STDs and ultimately results in complications. The delay in healing means prolonged exposure and infectious stages in a sexually active individual.

Mode of transmission:
STDs including HIV are spread through the already known routes: sexual intercourse (hetero- or homosexual route); blood transfusion; perinatal routes: mother to baby - in the womb or during birth. Breastmilk transmission, though possible, is not an efficient or the most important mode of transmission. HIV is not transmitted through inert objects or through mosquitoes. STD/HIV has been very low in the age groups 4-14 years but this group has had a high incidence of malaria in any given year.

Common STDs:
Gonorrhoea adds up to 30 per cent of STDs' attendees; Chancroid, 20 per cent; syphilis, 15 per cent of STDs; herpes genitalis is now a common, recurrent problem; Trichomonas vaginalis and Candida vaginalis are common; Condylomata acuminatum, a viral infection, has become a problem in immuno-suppressive individuals; HIV: between 35 per cent and 51 per cent of patients with previous history of STDs are infected with the virus.

Conclusions:

• Early detection and management of STDs is a sure way of controlling HIV. The measures available for STD control are at the same time ideal measures for HIV control.
• Women usually have unnoticed STDs, they therefore need to be educated and, since condoms for females and other protective devices for women are difficult to obtain, females need to be more sensitised about the dangers posed by STDs.
• STD surveillance systems need support from organisations like SWAAZ. STDs are ideal markers of monitoring the incidence of new HIV infection in a given community. A decline in STDs may be a pointer to a hopeful decline of a new episodes of HIV disease.

(#27) "Evaluation of the guidelines for case management of genital ulcer disease and genital discharge."
Hanson, S., Sunkutu, R.M., Sandstrom, E., Hojer, B., Hira, S., (1993), Paper presented at the IXth International Conference on AIDS, Berlin, 1993.
Geographical area: Lusaka; Key words: Evaluation, policy, Genital ulcer disease: Location: UNZA Medical Library

Objectives:

• To determine the cure rate for the STD syndromes, genital ulcer disease (GUD) and genital discharge (GD), treated according to defined guidelines (based on modified WHO recommendations).
• To identify the cause of treatment failures.

Methods:
421 previously untreated patients with one of the syndromes (158 men and 100 women with GUD; 100 men and 63 women with GD) after a brief history, underwent physical examination and specimen collection according to the guidelines. At the following two revisits patients were examined clinically and new specimen taken. They were further asked about compliance with medication and abstention from sex, and given treatment according to the guidelines.

Results:
Preliminary results indicate cure rate of 49 per cent and 69 per cent for male and female patients with GUD and 96 per cent for male and 87 per cent for females with GD.

Conclusions:
The reason for treatment successes and failures are discussed and changes of existing guidelines presented.

(#28) "Sexual and Reproductive Health in Zambia."
Osborne, M.C. (1993) unpublished
Geographical area: National; Keywords: SRH, perinatal transmission of HIV; Location: UNZA Medical Library

A documentary report based on consultations and research on sexual and reproductive health in Zambia conducted in November 1993. The main objective of this study was to identify the institutions and individuals engaged in sexual and reproductive Health (SRH) activities in the country. An analysis of the documents revealed that in the current aftermath of the adoption of a national population policy and the safe motherhood initiative, a lot of information, education and communication (IEC) messages on population have been propagated widely. Unfortunately, there has been a tendency to target the messages to women only, thereby marginalising the SRH needs of men and adolescents. Men's and adolescents' SRH needs have not been effectively met. The poor knowledge on sexually transmitted diseases (STDs) by this population is still evident. Results of focus group discussions have shown that most women have poor safer sex negotiating skills and although 90 per cent of men know that condoms can prevent STDs, at the most, 50 per cent use them. Research has also shown that the men who use condoms tend to use them with casual partners rather than with their wives and/or steady partners.

The major causes of maternal mortality in Zambia do include human unchecked deficiency (HIV) and tuberculosis. Syphilis continues to be an important public health problem in Zambia and maternal syphilis is the commonest risk factor for mid trimester abortions (20.0 per cent), still births (30.0 per cent), prematurity (12.5 per cent) and infant morbidity and mortality account for 37.8 per cent (UNICEF, 1993). The perinatal transmission rate of syphilis is estimated to be 75 per cent with congenital syphilis accounting for 25 per cent of outcomes in sero-positive pregnant women. To date, human immunodeficiency virus (HIV) seroprevalence rates in women of child bearing age in Zambia are higher than syphilis seroprevalence rates (12-25 per cent for HIV versus 10 per cent for syphilis). The HIV vertical transmission rate appears to be lower than that of syphilis (30-40 per cent versus 75 per cent) but it should be noted that the estimated HIV transmission rate does not include transmission outcomes such as abortions and stillbirths. The risk of maternal death in a recent study involving Zambia was 25 times greater among women with HIV infection. Furthermore 58 per cent of children with perinatally acquired HIV infection are dead by 2 years and 80 per cent by 5 years.

(#29) "STD in Lusaka, Zambia - A review of trends from 1984 to 1991."
Sunkutu, R., Hira, S., (1993) Paper presented at the IXth International Conference on AIDS, Berlin, 1993.
Geographical area: Lusaka; Key words: Surveillance; Location: UNZA Medical Library

Objectives:
To review trend of STD cases presenting at the University Teaching Hospital (UTH) in Lusaka.

Methods:
STD reporting was introduced in Zambia in 1980 with the launching of the national STD control programme. The annual STD morbidity reports for STD outpatient and referral clinics at UTH were reviewed from 1983 (when peak utilisation of services was achieved) to 1991.

Results:
A 72 per cent decline in number of new cases of STD was reported (18,238 in 1985 to 5,127 in 1991). No major changes in clinical practices and policy occurred at UTH during the period. Male to female ratio of 2:1 remained unchanged. The profile of common STD is presented here:

Syndromic diagnosis	Genital Ulcers	Genital Discharges	Aetiologic Diseases	Clinical Syphilis	Syphilis seroprevalence	Gonococcal infection	ChancroidGenital Herpes
1983 (%)	44.2	55	14.4	18.6	20.7	5.1	1.8
1991(%)	51.8	37.8	9.5	16.1	10.5	7.5	6.5
Change (%)	+15.5	-32.2	-34.0	-13.5	-50.0	+47.0	+261.0

Conclusions:
A 72 per cent decline in STD cases may be due to improved management and anti-AIDS activities. While most bacterial STD showed decline, there was disproportionate increase of herpes and chancroid, possibly due to failure to treat those STD in patients with HIV infection.

(#30) "STD control in Central Province, Zambia - would an integrated approach change the situation?"
Hanson, S., Sunkutu, R.M., Hojer, B., (1993) Paper presented at the VIIIth International Conference on AIDS in Africa, Marrakech, 1993.
Geographical area: Central Province; Key words: Health care delivery; Location: UNZA Medical Library

Introduction:
The STD programme in Zambia has trained clinical officers to be responsible for STD control activities at district hospitals and some major health centres. The objectives of this programme include screening of pregnant women for syphilis and prophylaxis of ophthalmia neonatorum. Treatment guidelines for STDs according to a so called syndromic approach have been distributed to all health centres.

Objectives:
To find out to what extent the objectives of the programme are being met and what problems face STD control in the context of health care in general. Method: A questionnaire was sent out to all health institutions and private practitioners in Central Province. Private practitioners were also approached personally by one of the investigators and asked to fill a reporting form for two three-week periods during the year.

Results:
Answers were received from 62 per cent of the health institutions. Results show that although specula and examination tables were available they were rarely used. Microscopes were available in 46 per cent of the institutions but laboratory material was rarely there and the microscope therefore hardly ever used in STD diagnostics. The flowcharts of STD treatment were available at 66 per cent of the health centres but not used e.g., for treatment of gonorrhoea since the first line drug is not part of the of the essential drug kit. About 10 per cent of all patients with STDs seek care at private practitioners. Discussion: Results of the study indicate the need for better coordination between vertical programmes. Decentralisation is likely to increase the interest in more integrated approaches to solving the health problems of the community. A closer coordination between training, the supply of equipment, diagnostic and treatment material will be necessary to increase efficiency.

(#31) "Patients' experience of STD care in Sweden and Zambia."
Fusillade, E., (1994) Thesis for Lic Med. Sc. Department of International Health and Social Medicine, Unit of International Health Care Research (IHCAR), Karolinska Institute, Sweden, 1994.
Geographical area: Zambia and Sweden; Key words: Heath care workers, health care delivery, partner notification: Location: UNICEF

Objectives:

• To explore the number and type of sexual relationships among STD patients in Sweden and Zambia.
• To explore factors which have implications for partner notification under urban health care settings in Sweden and Zambia.
• To explore Swedish and Zambian STD patients reactions about having STD.
• To explore patient-provider interaction in STD health care in Sweden and Zambia.

Methods:
The number of sexual partners, emotional reactions when having an STD, partner notification, and experiences of the patient-provider interaction were investigated through structured interviews with STD patients. In Sweden 50 patients with verified chlamydial infection were interviewed during 1990 whereas in Zambia, 100 patients without a specified STD were interviewed during 1991. Both studies were carried out in urban settings.

Results:
There seem to be gender differences in sexual behaviours and emotional reactions to STD. Men, both in Sweden and Zambia, had more partners than the women had. Zambian men continued having sex during their symptomatic period and they had more people with whom they could discuss STDs than the women. The Swedish women reacted more negatively about having an STD than the men. In Sweden approximately 70 per cent of the partners were to be traced compared to less than 30 per cent of the partners in the Zambian study.

Conclusions:
The results indicate that partner notification could function better in Zambia since the patients know the majority of their partners and also stated a willingness to bring more of their partners than were told to. Furthermore, the results show that the patients with an STD are important target groups for information both in Sweden and Zambia. The communication between the patients and the health care providers needs to be improved in both countries and especially women need more personal support.

(#32) "Spermicide Acceptability among Patients at a Sexually Transmitted Disease Clinic in Zambia."
Hira, S.K., Spruyt, A.B., Feldblum, P.J., Sunkutu, M.R., Glover, M.P.H. et al., (1995) American Journal of Public Health, August 1995, Vol. 85, No. 8, pp 1098-1103.
Geographical area: Lusaka; Key words: Spermicide; Location: UNZA Medical Library

Objective:
This study assessed the acceptability of three nonoxynol-9 spermicides among persons attending a STD clinic in Lusaka.

Methods:
Spermicidal foam, suppositories, and foaming tablets were evaluated. Women (n = 11) and men (n = 150) attending an STD clinic were enrolled. After each participant used two products, each for two weeks, consistency of use and acceptability were evaluated.

Results:
At admission, most women (74 per cent) and men (58 per cent) were not using any family planning method. Moreover, most women (85 per cent) and men (98 per cent) had at least one STD or genital infection. During the study, the proportion of coital episodes protected by spermicide use was high, yet loss to follow-up and discontinuation was also substantial. Discontinuation was frequently unrelated to acceptability. Women and men rated all three products positively along several acceptability parameters. Foam was the least desirable delivery system due to excess messiness.

Conclusions:
The results of this study suggest that it is feasible to distribute spermicides to women and men at increased risk for sexually transmitted disease and that the products will be used. Further research should be done among different populations and include other spermicidal delivery systems.

Last updated February 4, 1999

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