Bacterial genital infections in HIV-positive and HIV-negative African-Caribbean (AC) women in Toronto, Canada
M.R. Loutfy1, R.S. Remis2, W. Tharao3, A. Rebbapragada4, J. Liu5, M. Saunders3, L.-A. Green-Walker3, L. Chieza3, R. Kaul1
1University of Toronto, Department of Medicine, Toronto, Canada, 2University of Toronto, Dalla Lana School of Public Health, Toronto, Canada, 3Women's Health in Women's Hands, Toronto, Canada, 4Public Health Laboratory Toronto, Ontario Agency for Health Protection and Promotion, Etobicoke, Canada, 5University of Toronto, Dalla Lana School of Public Health, Toronto, Canada
Background: Bacterial vaginosis (BV) and sexually transmitted infections (STIs) may increase the risk of HIV acquisition and subsequent transmission. Their prevalence is high in women in sub-Saharan Africa and the Caribbean. We examined the prevalence and correlates of these genital infections among AC women living in Toronto.
Methods: We recruited HIV-positive and HIV-negative AC women from the Women's Health in Women's Hands Community Health Centre in Toronto. Women completed a questionnaire using ACASI. We tested serum for syphilis, urine for chlamydia and gonorrhea by LCR and examined Gram stains of vaginal secretions to diagnose BV. Prevalence was reported as proportions and compared using the chi-square test
Results: We analyzed data from 94 HIV-positive and 229 HIV-negative women with a median age of 40 (IQR35-44) and 31 (IQR24-42) (p< 0.001), respectively. The prevalence of STIs was low in both groups: 1.1% and 0.0% for syphilis (HIV-infected vs. uninfected; p=0.30); 0.0% vs. 4.0% for chlamydia (p=0.04); and no cases of gonorrhea. The prevalence of BV did not vary with HIV status (18.7% vs. 17.7%; p>0.50). Similarly, abnormal vaginal flora did not vary by HIV status (30.8% vs. 28.6%; p>0.50). Among HIV-negative subjects, Caribbean women had higher BV positivity rates than African women (23.7% vs. 10.9%; p=0.03); no difference was observed in HIV-positive women. BV prevalence was higher in younger women: HIV-positive 15-44 years 25.0% versus 45+ years 0.0% (p=0.004) and HIV-negative 15-24 years 31.0% versus 25+ years 13.0% (p=0.004). However, BV prevalence did not differ significantly education, income or marital status for either group.
Conclusions: The prevalence of BV and STIs was relatively low in AC women in Toronto, independent of HIV status. It is difficult to draw conclusions about BV/STI/HIV interactions since the HIV infection may have been acquired in the remote past and/or in the country of origin.
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