By Kudakwashe Pembere
Zimbabwean individuals divorced, separated or widowed had high chances of contracting active syphilis unlike the married or cohabiting couples, a study found.
In a study published in The Lancet journal, it emerged the trend was not only common among Zimbabweans but Zambians and Ugandans as well.
The study sought to ascertain the prevalence of syphilis in HIV positive and HIV negative persons in Ethiopia, Tanzania, Uganda, Zambia, and Zimbabwe from 2015 to 2018.
Divorced, separated, or widowed individuals had significantly higher odds of active syphilis in Uganda, Zambia, and Zimbabwe than those married or cohabiting, but this was not the case in Tanzania,” read the study.
Multiple sexual partners also increased the odds of contracting the disease, according to the researchers. The researchers included Mansoor Farahani alongside Rose Killian as the lead.Giles A Reid, Godfrey Musuka, Owen Mugurungi, Wilford Kirungi, Harriet Nuwagaba-Biribonwoha, Wafaa M El-Sadr and Jessica Justma were part of the peer reviewed study.
“Additionally, the odds of active syphilis were higher among those reporting two or more sexual partners compared with those reporting one sexual partner in the previous 12 months in Tanzania, Zambia, and Zimbabwe, but not in Uganda,” the researchers said.
The researchers added that the prevalence of active syphilis was significantly higher in Zimbabwe among sexually active participants reporting two or more sexual partners in the previous 12 months compared with those reporting one partners.
“Wealth index and marital status also showed no significant association with syphilis prevalence among HIV-positive individuals. In people living with HIV, active syphilis prevalence varied with condom use only in Zimbabwe, being higher among those who reported not using condoms,” the study said.
Given the high prevalence of HIV and syphilis in sub-saharan Africa, the researchers were using data gathered in Population-based HIV Impact Assessment surveys. In Africa, the prevalence rate for syphilis is 1.6 percent whereas globally it stands 0.6 percent as 8 million people according to the World Health Organization have syphilis.
In Zimbabwe, the researchers found the prevalence rate at 0.9 percent amongst HIV negative persons with those that are HIV positive
“In Zimbabwe, people living with HIV who used condoms had a markedly lower prevalence of syphilis compared with those who did not. .
“The prevalence of active syphilis was 0·9% in both Tanzania and Zimbabwe, 2·1% in Uganda, and 3·0% in Zambia.
“In Zimbabwe, people living with HIV had nearly six times the odds of having active syphilis compared with those who were HIV negative.
“The lowest odds for active syphilis among people living with HIV across these five countries were still more than double those of HIV-negative individuals.
“These findings support existing research indicating a notable issue of syphilis co-infection among people living with HIV in Africa, particularly among groups such as men who have sex with men and sex workers, who are also at increased risk for HIV infection.
“The estimated number of participants with active syphilis was 9869 (95% CI 3967–15 770) in Ethiopia (only among people living with HIV), 298 830 (251 365–346 294) in Tanzania, 401 477 (348 522–454 431) in Uganda, 241 730 (213 904–269 555) in Zambia, and 75 709 (63 452–87 966) in Zimbabwe.
“In each country, the proportion of missing or invalid results for syphilis testing was less than 1%. Based on these estimates, there were a total of 1 017 746 (95% CI 877 243–1 158 246) participants with active syphilis (266 383 [204 120–328 645] among people living with HIV and 761 232 [634 106–888 358] among HIV negative participants) in the five countries,” the study said.
To address the threat of syphilis in Africa, the researchers recommended there be a multipronged approach.
“Integrating HIV and syphilis screening using dual testing kits is necessary. Targeted strategies are also needed to ensure that groups at risk, such as pregnant women and those facing socioeconomic challenges, are reached,” the researchers noted.
Added the researchers, “Early screening and treatment for pregnant women, partner management, and promotion of prevention measures such as consistent condom use and medical male circumcision are also needed to safeguard maternal and neonatal health.”
Access to syphilis screening services in rural areas should be scaled up as suggested by the researchers.
“Addressing issues of access, particularly in rural areas, is crucial. Tailored testing, prevention, and treatment interventions for groups at high risk, such as people living with HIV, female sex workers, and men who have sex with men, regular updates to screening guidelines based on evolving trends, and community awareness campaigns to reduce stigma are all essential.
“This holistic approach, addressing both the medical and socioeconomic dimensions of syphilis, could substantially reduce its burden in participants and prevent its harmful clinical consequences, including congenital syphilis infection,” the researchers said.
