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Kenyon C. Variations in sexual network connectivity may explain dramatic variations in sexually transmitted infection prevalence between populations and over time: a selected four-country analysis. F1000Res 2022; 9:1009. [PMID: 36246487 PMCID: PMC9490289 DOI: 10.12688/f1000research.24968.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/24/2022] [Indexed: 11/20/2022] Open
Abstract
Background: The incidence of sexually transmitted infections (STIs) has been noted to vary dramatically between population groups and over time. Here, the hypothesis that changes in network connectivity underpin these changes is explored. Methods: The incidence/prevalence estimates of HIV, herpes simplex virus-2, syphilis, chlamydia, and gonorrhoea, as well as two markers of sexual network connectivity (partner concurrency and multiple partnering) by ethnic group and sexual orientation in Kenya, South Africa, the United Kingdom (UK) and the United States (USA) were extracted from published studies. Pearson’s correlation was used to test the association between the markers of network connectivity and the incidence/prevalence of these five STIs. A literature review was performed to evaluate the possible causes of the increases and decreases in syphilis incidence over the past 60 years. Results: In each country, the five STIs were found to cluster in particular ethnic groups and sexual orientations and to be positively associated with the two markers of network connectivity. Syphilis incidence in the UK and USA was found to increase dramatically in the 1960s/1970s, decline in the 1980s and again increase in the late 1990s. These changes took place predominantly in men who have sex with men, and were preceded by corresponding changes in network connectivity. The large decline in antenatal syphilis prevalence in Kenya and South Africa in the 1990s were likewise preceded by declines in network connectivity. Conclusions: Although other explanatory variables are not controlled for, the present analysis is compatible with the hypothesis that differential network connectivity is a parsimonious explanation for variations in STI incidence over time and between populations.
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Affiliation(s)
- Chris Kenyon
- HIV/STI Unit, Institute of Tropical Medicine, Antwerp, Antwerp, 2000, Belgium
- Division of Infectious Diseases and HIV Medicine, University of Cape Town, Cape Town, 7700, South Africa
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Kenyon C, Fatti G. Thank Martin Luther that ciprofloxacin could cure your gonorrhoea? Ecological association between Protestantism and antimicrobial consumption in 30 European countries. F1000Res 2022; 9:1200. [PMID: 35615405 PMCID: PMC9114826 DOI: 10.12688/f1000research.26709.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/05/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Higher consumption of antimicrobials plays an important role in driving the higher prevalence of antimicrobial resistance in Southern compared to Northern Europe. Poor controls on corruption (CoC), high uncertainty avoidance (UA) and performance vs. cooperation orientation (POCO) of societies have been found to explain much of this higher consumption in Southern European countries. We hypothesized that these predictors were in turn influenced by the Protestant Reformation in the 16th century onwards. Methods: We used structural equation modelling (SEM) to assess the relationships between country-level proportions being Protestant, CoC, UA, POCO and four markers of antimicrobial consumption in the community (all antibacterials, cephalosporin, macrolides and fluoroquinolones). Results: The proportion of a country that was Protestant was negatively correlated with the consumption of all antibacterials. SEM revealed that UA predicted all antibacterial consumption (direct effect coef. 0.15, 95% Confidence Interval [CI] 0.04-0.26). The proportion Protestant exerted an indirect effect on consumption (coef. -0.13, 95% CI -0.21- -0.05). This effect was mediated predominantly via its effect on UA (direct effect coef. 0.15, 95% CI 0.04-0.26). The model explained 37% of the variation in consumption. Similar results were obtained for each of the other three classes of antimicrobials investigated. Conclusions: Our results are compatible with the theory that contemporary differences in antimicrobial consumption in Europe stem in part from cultural differences that emerged in the Reformation. These findings may explain the differential efficacy of similar antibiotic stewardship campaigns in Northern and Southern European populations.
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Affiliation(s)
- Chris Kenyon
- HIV/STI Unit, Institute of Tropical Medicine, Antwerp, Belgium
- Division of Infectious Diseases and HIV Medicine, University of Cape Town, Cape Town, South Africa
| | - Geoffrey Fatti
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Magadi M, Gazimbi M, Wafula C, Kaseje M. Understanding ethnic variations in HIV prevalence in Kenya: the role of cultural practices. CULTURE, HEALTH & SEXUALITY 2021; 23:822-839. [PMID: 32364024 DOI: 10.1080/13691058.2020.1734661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 02/21/2020] [Indexed: 06/11/2023]
Abstract
Patterns of HIV prevalence in Kenya suggest that areas where various cultural practices are prevalent bear a disproportionate burden of HIV. This paper examines (i) the contextual effects of cultural practices (polygyny, male circumcision) and related sexual behaviour factors on HIV prevalence and (ii) the extent to which specific cultural practices in a community/county might explain existing ethnic variations in HIV prevalence in Kenya. The analysis applies multilevel logistic regression to data from the 2012/13 Kenya AIDS Indicator Survey. The results reveal striking ethnic variations in HIV prevalence in Kenya. The prevalence of polygyny in a community is positively associated with HIV prevalence, while a higher level of male circumcision in a county is protective for both men and women. The effects of these factors are stronger for men than women at both individual and contextual (community/county) levels. These cultural practices and associated risk factors partly explain existing ethnic differences in HIV prevalence in Kenya, but there remain significant ethnic variations that are not explained by these cultural practices or related sexual behaviour factors. These call for stronger empirical evidence to offer stronger theoretical explanations and inform effective policy and practice to address HIV epidemic in adversely affected communities in Kenya and similar settings in sub-Saharan Africa.
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Affiliation(s)
- Monica Magadi
- School of Education and Social Sciences, University of Hull, Hull, UK
| | - Martin Gazimbi
- School of Education and Social Sciences, University of Hull, Hull, UK
| | - Charles Wafula
- Research Department, Tropical Institute of Community Health and Development (TICH), Kisumu, Kenya
| | - Margaret Kaseje
- Research Department, Tropical Institute of Community Health and Development (TICH), Kisumu, Kenya
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Kenyon CR, Wolfs K, Osbak K, Malataliana M, Van Hal G, Zondo S, van Lankveld J. Could differences in implicit attitudes to sexual concurrency play a role in generalized HIV epidemics? F1000Res 2018; 7:608. [PMID: 30450199 PMCID: PMC6221060 DOI: 10.12688/f1000research.14951.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/11/2018] [Indexed: 10/05/2023] Open
Abstract
Background: Sexual partner concurrency has been implicated in the genesis of generalized HIV epidemic in South Africa. Most South Africans, however, disapprove of concurrency in surveys. These surveys test individuals' explicit attitudes which are susceptible to a number of important biases such as the social desirability bias. Assessment of implicit cognitions have been found to be better predictors of behaviour in socially sensitive domains. We hypothesized that South Africans may have implicit attitudes more tolerant of concurrency than lower concurrency prevalence populations. Methods: To test this hypothesis, we developed a concurrency-implicit association test (C-IAT) and compared the C-IATs of samples of South African and Belgian university students. Results: We found a large and statistically significant difference in the C-IAT between the South Africans (D600-score = -0.009, indicating absence of preference for concurrency or monogamy) and Belgians (D600-score = 0.783, indicating a strong preference for monogamy; t-test = 13.3; P < 0.0001). The effect size measure, Cohen's d, was found to be 0.88, which is considered a large effect size in this field. Conclusions: Our results are compatible with the thesis that differences in implicit attitudes to concurrency play a role in the genesis of generalised HIV epidemics.
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Affiliation(s)
- Chris R. Kenyon
- HIV/STI Unit, Institute of Tropical Medicine, Antwerp, 2000, Belgium
| | - Kenny Wolfs
- Faculty of Psychology and Educational Science, Open University of the Netherlands, Heerlen, The Netherlands
| | - Kara Osbak
- HIV/STI Unit, Institute of Tropical Medicine, Antwerp, 2000, Belgium
| | | | - Guido Van Hal
- Medical Sociology and Health Policy, University of Antwerp, Antwerp, Belgium
| | - Sizwe Zondo
- Department of Psychology, Rhodes University, Grahamstown, South Africa
| | - Jacques van Lankveld
- Faculty of Psychology and Educational Science, Open University of the Netherlands, Heerlen, The Netherlands
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Kenyon CR, Wolfs K, Osbak K, Malataliana M, Van Hal G, Zondo S, van Lankveld J. Could differences in implicit attitudes to sexual concurrency play a role in generalized HIV epidemics? F1000Res 2018; 7:608. [PMID: 30450199 PMCID: PMC6221060 DOI: 10.12688/f1000research.14951.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/15/2018] [Indexed: 11/22/2022] Open
Abstract
Background: Sexual partner concurrency has been implicated in the genesis of generalized HIV epidemic in South Africa. Most South Africans, however, disapprove of concurrency in surveys. These surveys test individuals' explicit attitudes which are susceptible to a number of important biases such as the social desirability bias. Assessment of implicit cognitions have been found to be better predictors of behaviour in socially sensitive domains. We hypothesized that South Africans may have implicit attitudes more tolerant of concurrency than lower concurrency prevalence populations. Methods: To test this hypothesis, we developed a concurrency-implicit association test (C-IAT) and compared the C-IATs of samples of South African and Belgian university students. Results: We found a large and statistically significant difference in the C-IAT between the South Africans (D600-score = -0.009, indicating absence of preference for concurrency or monogamy) and Belgians (D600-score = 0.783, indicating a strong preference for monogamy; t-test = 13.3; P < 0.0001). The effect size measure, Cohen's d, was found to be 0.88, which is considered a large effect size in this field. Conclusions: Our results are compatible with the thesis that differences in implicit attitudes to concurrency play a role in the genesis of generalised HIV epidemics.
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Affiliation(s)
- Chris R. Kenyon
- HIV/STI Unit, Institute of Tropical Medicine, Antwerp, 2000, Belgium
| | - Kenny Wolfs
- Faculty of Psychology and Educational Science, Open University of the Netherlands, Heerlen, The Netherlands
| | - Kara Osbak
- HIV/STI Unit, Institute of Tropical Medicine, Antwerp, 2000, Belgium
| | | | - Guido Van Hal
- Medical Sociology and Health Policy, University of Antwerp, Antwerp, Belgium
| | - Sizwe Zondo
- Department of Psychology, Rhodes University, Grahamstown, South Africa
| | - Jacques van Lankveld
- Faculty of Psychology and Educational Science, Open University of the Netherlands, Heerlen, The Netherlands
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Kenyon C. Strong associations between national prevalence of various STIs suggests sexual network connectivity is a common underpinning risk factor. BMC Infect Dis 2017; 17:682. [PMID: 29025419 PMCID: PMC5639489 DOI: 10.1186/s12879-017-2794-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 10/04/2017] [Indexed: 12/13/2022] Open
Abstract
Background If national peak Human Immunodeficiency Virus (HIV) prevalence is positively associated with the prevalence of other sexually transmitted infections (STIs) from before or early on in the HIV epidemics this would suggest common underlying drivers. Methods Pearson’s correlations were calculated between the prevalence of seven STIs at a country-level: chlamydia, gonorrhoea, trichomoniasis, syphilis, bacterial vaginosis, herpes simplex virus-2 (HSV-2) and HIV. Results The prevalence of all the STIs was highest in the sub-Saharan African region excluding chlamydia. The prevalence of all seven STIs were positively correlated excluding chlamydia. The correlations were strongest for HIV-HSV-2 (r = 0.85, P < 0.0001) and HSV-2-trichomoniasis (r = 0.82, P < 0.0001). Conclusion Our results of a generally positive association between the prevalences of a range of STIs suggests that higher prevalences were driven by common underlying determinants. We review different types of evidence which suggest that differential sexual connectivity is a plausible common determinant.
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Affiliation(s)
- Chris Kenyon
- Sexually Transmitted Infections HIV/STI Unit, Institute of Tropical Medicine, Antwerp, Belgium. .,Division of Infectious Diseases and HIV Medicine, University of Cape Town, Anzio Road, Observatory, 7700, South Africa.
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Kenyon CR, Tsoumanis A, Schwartz IS. A population's higher-risk sexual behaviour is associated with its average sexual behaviour-An ecological analysis of subpopulations in Ethiopia, Kenya, South Africa, Uganda and the United States. Epidemics 2016; 15:56-65. [PMID: 27266849 DOI: 10.1016/j.epidem.2016.02.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 02/05/2016] [Accepted: 02/22/2016] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Given the large variation in the prevalence of sexually transmitted infections between populations it is important to characterize how sexual vary between populations. In this paper we assess how the distribution of lifetime sexual partners varies between populations. We ask: do populations with higher mean lifetime sexual partners merely differ by virtue of the presence of a core-group with increased number of partners or do the population distributions move as more coherent wholes? METHODS We defined those in the top decile of lifetime sex partners in each country as constituting the higher-risk behaviour group (HRB). Spearman's correlation was used to evaluate the relationship between mean lifetime partners and prevalence of those in the HRB by ethnic group within Ethiopia, Kenya, South Africa, Uganda and the United States. In each case, data from nationally representative surveys were used. Two-sample Wilcoxon rank-sum were applied to test if there was a difference in the number of lifetime partners between the highest and lowest-risk subpopulations, separately for men and women. To account for autocorrelation, all analyses were conducted using means/medians excluding those in the HRB. A P-value of <0.05 was considered statistically significant. RESULTS In each country, a positive correlation existed between subpopulations' mean lifetime partners and the prevalence of the HRB. Spearman's correlation varied from 0.20 to 0.99 for men and 0.74 to 1.0 for women. This association was statistically significant in 6 out of 10 comparisons. There was a statistically significant difference in the number of lifetime partners between the highest and lowest-risk ethnic groups in all countries except South Africa, where the difference was only significant for women. CONCLUSIONS Our results suggest that sexual behaviours vary coherently between different populations. As such, sexually transmitted infection control efforts would benefit from including both targeted campaigns focusing on the HRB and population-strategies that seek to address factors responsible for high mean risk behaviour.
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Affiliation(s)
- Chris R Kenyon
- HIV/STI Unit, Institute of Tropical Medicine, Antwerp, Belgium.
| | | | - Ilan Steven Schwartz
- Department of Medical Microbiology, Faculty of Health Sciences, College of Medicine, University of Manitoba, Winnipeg, MB, Canada; Department of Epidemiology and Social Medicine, Faculty of Health Sciences, University of Antwerp, Antwerp, Belgium.
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Atteraya M, Kimm H, Song IH. Caste- and ethnicity-based inequalities in HIV/AIDS-related knowledge gap: a case of Nepal. HEALTH & SOCIAL WORK 2015; 40:100-107. [PMID: 26027418 DOI: 10.1093/hsw/hlv010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Caste- and ethnicity-based inequalities are major obstacles to achieving health equity. The authors investigated whether there is any association between caste- and ethnicity-based inequalities and HIV-related knowledge within caste and ethnic populations. They used the 2011 Nepal Demographic and Health Survey, a nationally represented cross-sectional study data set. The study sample consisted of 11,273 women between 15 and 49 years of age. Univariate and logistic regression models were used to examine the relationship between caste- and ethnicity-based inequalities and HIV-related knowledge. The study sample was divided into high Hindu caste (47.9 percent), "untouchable" caste (18.4 percent), and indigenous populations (33.7 percent). Within the study sample, the high-caste population was found to have the greatest knowledge of the means by which HIV is prevented and transmitted. After controlling for socioeconomic and demographic characteristics, untouchables were the least knowledgeable. The odds ratio for incomplete knowledge about transmission among indigenous populations was 1.27 times higher than that for high Hindu castes, but there was no significant difference in knowledge of preventive measures. The findings suggest the existence of a prevailing HIV knowledge gap. This in turn suggests that appropriate steps need to be implemented to convey complete knowledge to underprivileged populations.
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Kenyon CR, Buyze J. Correlation between National Peak HIV Prevalence and Concurrency, STI Treatment Capability, Condom Use and Circumcision: An Ecological Study. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/wja.2014.42030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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