Progress toward the UNAIDS 90–90-90 targets among female sex workers and sexually exploited female adolescents in Juba and Nimule, South Sudan

Background

Little is known about HIV in South Sudan and even less about HIV among female sex workers (FSW). We characterized progress towards UNAIDS 90–90-90 targets among female sex workers (FSW) and sexually exploited female adolescents in Juba and Nimule, South Sudan.

Methods

We conducted a biobehavioral survey of FSW and sexually exploited female adolescents using respondent-driven sampling (RDS) in Juba (November 2015–March 2016) and in Nimule (January–March 2017) to estimate achievements toward the UNAIDS 90–90-90 targets (90% of HIV-positive individuals know their status; of these, 90% are receiving antiretroviral therapy [ART]; and of these, 90% are virally suppressed). Eligibility criteria were girls and women who were aged ≥15 years; spoke English, Juba Arabic, or Kiswahili; received money, goods, or services in exchange for sex in the past 6 months; and resided, worked, or socialized in the survey city for ≥1 month. Data were weighted for RDS methods.

Results

We sampled 838 FSW and sexually exploited female adolescents in Juba (HIV-positive, 333) and 409 in Nimule (HIV-positive, 108). Among HIV-positive FSW and sexually exploited female adolescents living in Juba, 74.8% self-reported being aware of their HIV status; of these, 73.3% self-reported being on ART; and of these, 62.2% were virally suppressed. In Nimule, 79.5% of FSW and sexually exploited female adolescents living with HIV self-reported being aware of their HIV status; of these, 62.9% self-reported being on ART; and of these, 75.7% were virally suppressed.

Conclusions

Although awareness of HIV status is the lowest of the 90–90-90 indicators in many countries, treatment uptake and viral suppression were lowest among FSW and sexually exploited female adolescents in South Sudan. Differentiated service delivery facilitate linkage to and retention on treatment in support of attainment of viral suppression.

High HIV and syphilis prevalence among female sex workers in Juba, South Sudan

HIV prevalence is estimated to be 2.7% in South Sudan; however, little is known about the young country’s epidemic. We conducted a respondent-driven sampling biobehavioral survey in Juba of female sex workers (FSW) aged ≥15 years who sold or exchanged sex in the last 6 months to learn more about this population. We enrolled 838 FSW from November 2015 to March 2016 and estimated HIV prevalence to be 37.8%. Prevalence of active syphilis was 7.3%. FSW were from South Sudan and most neighboring countries. Comprehensive knowledge of HIV was 11.1% and 64.2% of FSW had never spoken with an outreach worker. In multivariable analysis, HIV was associated with being from Uganda (aOR: 3.3, 95% CI: 1.7–6.1) or Kenya (aOR: 4.3, 95% CI: 1.5–13.0) versus from South Sudan. Our survey suggests that FSW may play a critical role in South Sudan’s HIV epidemic and highlights the importance of tailoring services to the unique needs of FSW of all nationalities in Juba.

Embryonic and fetal cells which are not diseased or defective; possible sources of genes for disease prevention or treatment

Cancer and other diseases may be a natural biological event, the activities of which may be dependent on the constitution of the individual. Where fetal and embryonic cells are not diseased or faulty or defective, they may be useful as therapies against cancer and other diseases.

[Value of endoscopic ovarian surgery--critical analysis of 626 pelviscopically operated ovarian cysts at the Kiel University Gynecologic Clinic 1990-1991]

During 1990-1991, 626 cystic ovarian tumours measuring > 3 cm diameter were treated endoscopically at the Department of Obstetrics and Gynaecology at the University of Kiel. In 97 patients, either ovariectomy or adnexectomy, and in 529 cases, an ovarian cyst enucleation was performed. In every case, we considered clinical laboratory, pre-examinations as well as a vaginal ultrasound examination to be of extreme importance for our decision. In 1990, we changed 18 times from pelviscopy to laparotomy and in 1991 7 times under the visual impression of an ovarian malignant tumour. The diagnosis was verified 8 times in 1990 and 3 times in 1991. 10 times in 1990 and 4 times in 1991, the patients were laparotomised with benign ovarian tumours, whose form and motility did not indicate laparotomy at the beginning. No case of ovarian cancer was endoscopically biopsied in 1990-1991. Details on the treatment of patients, their brief hospitalisation period and quick reintegration into family and professional life speak for the applied operation technique.

Oncogenes, antioncogenes, and a hypothesis on cancer therapy, i.e. the origin of cancer, and the prevention of its activity

Existing data indicates there is a set of genes--oncogenes--whose increased or abnormal expression causes cancer. Another set of genes--antioncogenes--control oncogene expression. Implied is that cancer is neither infectious nor contagious, i.e. one cannot catch cancer, and cancers are fundamentally similar. Fetal cells can be used instead of immunosuppressing drugs, regulate antigen-antibody action-reaction, and may be in some instances genetically wholesome. They, therefore may be useful to compensate for the immunological breakdown or deficiency which results in active cancer.

Analysis of the protovirus hypothesis

Cancer may be endogenous to all mankind. Its activity is dependent upon the absence of anti cancer gene agent or agents.

Analysis of the oncogene hypothesis

Cancer may be a natural biological event commencing at birth. Its activity is dependent upon the absence of an anti cancer gene agent or agents which are also present from birth.

Illness after influenza vaccination reported through a nationwide surveillance system, 1976-1977

In 1976, the Center for Disease Control coordinated nationwide surveillance for illnesses after influenza vaccination as part of an effort to vaccinate the nation against influenza A/New Jersey/76. For the 48,161,019 persons vaccinated in 1976, a total of 4733 reports of illness were received which included reports of 223 deaths. When Guillain-Barré syndrome was reported in vaccine recipients, an investigation was begun to examine this possible association. Other than the Guillain-Barré syndrome and rare cases of anaphylaxis, no serious illnesses were causally associated with influenza vaccination by this type of surveillance. Widespread underreporting of illness and death in the passive phase of this surveillance system, however, impaired the ability to draw conclusions about reactions to vaccine from the reports of illness received.