HIV prevalence in genital fistula patient

HIV prevalence in genital fistula patients presenting to a surgical center in Eastern Democratic Republic of Congo

C. Kimona1, N. Benfield2, R. Soheranda3, M.K. Rogatien3, M. Salmon4
Institute(s):

HEAL Africa, General Surgery, Goma, Congo, the Democratic Republic of the, 2University of California San Francisco (UCSF), Obstetrics and Gynecology, San Francisco, United States, 3HEAL Africa, Obstetrics and Gynecology, Goma, Congo, the Democratic Republic of the, 4University of California San Francisco (UCSF) / San Francisco General Hospital (SFGH), Emergency Medicine, San Francisco, United States

Background:
WHO estimates that 3-5 million women suffer from genital fistula (GF) worldwide, the majority living in poor countries. GF causes urinary/fecal incontinence, vaginal stenosis, pain, and infections that lead to marginalization within their communities, divorce, isolation, malnutrition, and emotional effects like depression and post-traumatic stress. While GFs commonly result from lack of access to medical care during childbirth, they are also caused by violent trauma like rape.

The eastern Democratic Republic of Congo (eDRC) has experienced protracted civil war, internal population displacement, and poverty - all factors that have contributed to an epidemic of rape and made access to healthcare difficult. Indeed, in 2008 the HEALAfrica Surgical Center (HA) in eDRC found the incidence of sexual violence/rape to be 70.6% (n=68) among fistula patients. Yet because of this conflict there had been little study on the relationship between fistula and HIV.

Methods:
204 women from rural North Kivu were seen at HA for fistula care over 12 consecutive months 2008-9. Most patients were identified through outreach and transported to Goma for care. Patients underwent pre-operative HIV antibody testing (Determine HIV-1/2 Abbott Laboratory).

Results:
10 HIV cases were identified (5.0 % HIV seropositivity n=204). This prevalence is almost 5 times higher than the 1.1% seropositivity in prenatal patients from the same rural regions found in other HA testing.

Conclusions:
The exact cause of increased prevalence in fistula patients is unclear at this time, but is likely multi-factorial. It is possible that the destruction of tissue integrity increases risk of transmission and/or high rates of sexual violence increase potential exposure. Indeed, 35% of fistulas (2008 HA study) were directly or indirectly (via a resultant pregnancy) caused by rape with a significant proportion perpetrated by combatants. However, combatant prevalence is unknown. Given the high numbers of HIV in countries in conflict, further study is required.

• Keywords:
• 1. DRC
• 2. Fistula
• 3. Rape
• 4. HIV
• 5. HEAL Africa

Country of research:
Congo, the Democratic Republic
Related to women and girls?
Yes
Related to children?
No
Ethical research declaration:
Yes
Applied for scholarship?
Yes