Women’s health in prisons in Africa: prevalence and challenges to address HIV among women in prison in Africa

In Africa around 3.2% of the prison population is represented by women. People in prison are 5 times more likely to be living with HIV than adults in the general population. Moreover, women in prison have a higher HIV prevalence than men. The factors that lead to women becoming incarcerated are often also those that lead to their increased risk of acquiring HIV infection.

Their situation in prison is exacerbated by stigma and discrimination, gender-based violence and inequality. Women have limited access to health care in prison settings and are less likely to receive treatment than men. This is even more the case in Africa, where the precarious and sometimes inhuman prison conditions, render the health-related interventions addressing women health particularly challenging. Their specific health care needs, such as sexual and reproductive health care, treatment of infectious diseases including STIs, as well as nutrition and hygiene requirements, are often neglected. The limited access for women (and their children) to ante- and postnatal care, labour and delivery services and antiretroviral therapy also leads to infants born in prisons being at high risk of contracting HIV. Women in prison should be able to access gender-responsive health care services which are equivalent and of the same quality as those available in the community.

The presentation will present the latest available data on health status and HIV in particular among women in prison in Africa and will present the international standards in health interventions of women in prison.

Pulmonary metastatectomy for soft tissue sarcomas: is it valuable?

BACKGROUND

A retrospective study and analysis was performed to determine the value and benefit of pulmonary metastatectomy for soft tissue sarcomas, and which factors predict prognosis following resection.

METHODS

Twenty-three patients underwent resections for pulmonary metastases from a soft tissue sarcoma (STS) at King Faisal Specialist Hospital and Research Center (KFSH&RC), between January 1985 and December 1998. There were 11 male and 12 female patients. Thirteen of 23 patients (57%) had one to three metastases, and 10 (43%) had four or more metastases. A total of 41 thoracic explorations was performed for the 23 evaluable patients. Median sternotomy was used only for three patients and lateral thoracotomy was used for 20 patients as an initial surgical approach. Pulmonary resections performed included one or more wedge resections (n=16), segmentectomy (n=5), and lobectomy (n=2). No one in this series underwent pneumonectomy. The number of resected metastatic nodules ranged from one-six with average three. Eight patients (35%) received various kinds of postoperative adjuvant chemotherapy.

RESULTS

The overall and disease-free survival rate post-metastatectomy at five years was 24% and 21%, respectively. Various prognostic indicators were examined to evaluate their association with improved survival. Age, sex localization of the primary site and histologic type, tumor grade, size of the resected nodules, laterality (unilateral or bilateral), types of resection, adjuvant chemotherapy, and local recurrence did not significantly affect survival. However, patient with disease free interval >6 months, and those with three or fewer metastases showed a trend toward a higher five-year overall survival (p=0.06, 0.07, respectively).

CONCLUSIONS

Surgical excision of lung metastases from soft tissue sarcomas is well accepted and should be considered as a first line of treatment if preoperative evaluation indicated that complete resection of the metastases is possible. Further investigation is needed before chemotherapy can be recommended as additional therapy.