**2. Materials and methods**

#### **2.1. Study area**

force can be hampered by several pathologies such as cancer, lung diseases, malaria, gastritis, tuberculosis, HIV/AIDS and others, but since many rural African communities rely on oxen for traction services in agriculture, a pathology such as African Animal Trypanosomosis (AAT) has also contributed in hindering agricultural production [3]. Agriculture remains the backbone of Cameroon's economy, employing 70% of its work force while providing 42% of its gross domestic product (GDP) and 30% of its export revenue. Such agro-activities take place in villages where they still exist enough surface area for it like the case of our study area. From the report of Manu et al. [4], 53.1 and 19.5% among other causes of food shortages have been caused by sickness and drought, respectively. Fondonera is a poor rural community found in the west region of Cameroon with a greater fraction of its population relying on agriculture as a source of livelihood. It was noticed that about 12.2% of patients coming for HIV test were farmers, and 79.2% were pregnant women advised to carry out the test through Antenatal Clinic (ANC) checkups. This indicates the capability of this disease in reducing agricultural output in this community as reported by Saliu and Adejoh [5] that the quantity and quality of labor input is strongly determined by state of health of individuals of that

118 Current Topics in Tropical Emerging Diseases and Travel Medicine

It has been estimated that most vulnerable and affected groups to HIV in Cameroon include sex workers, truck drivers, mobile populations and military personnel; young people (15– 29 years old) are also highly affected. Urbanization is associated with higher levels of HIV infection than rural residents [6], many engage in risky business (prostitution) to meet up with their needs as well as those of their children [7] living with their parents in the village or

Protected sex is a critical element in a comprehensive, effective and sustainable approach to HIV and other sexually transmitted diseases (STDs) prevention and treatment. It was confirmed in Uganda that the use of condom coupled with increase delay in the age of first sexual intercourse and the reduction of sexual partners was an important factor in the decline of HIV

Rural women especially in village settings still live in a world where they are expected to be submissive to men and where it is unacceptable for a woman to say no to unwanted and unprotected sex [9], and this makes it difficult for women to have a say when it comes to negotiating safer sex. Certain religions as well as social norms in many SSA contexts permit (and even encourage) men to get several wives, engage in sex with multiple partners, favor

In Africa, marriage is a social obligation and a woman's status in society is judged based on it [11]. Sex is considered as a marital duty to which no woman should withdraw herself from the moment when her husband wishes and even when she has doubts about her husband's sexual life [12]. Against the backdrop of such expectations, women often feel powerless to protect themselves against HIV infection and unintended pregnancies. Economic realities enable men to monopolize the sources of income. In addition, in certain village communities in Cameroon, men have the possibility of opening plantations and getting married to several women who are expected to give birth to several children who

sex with younger partners, and dominate sexual decision-making [10].

community.

with them in town.

prevalence in the 1990s [8].

Fondonera was our study area; it is situated 30 km from the town of Dschang, to the extreme south east of Menoua Division, west region of Cameroon. This area is bordered to the North by Fongodeng, southwards by Foguetafou Village in the Sanzo community, eastwards by Fossong Wentcheng community and westwards by Fontem in the Lebialem Division. The name of this area is colloquially known as Ndoung'lah following the Bamileke tradition (meaning summit of villages). This area suspends on a mountain at altitude between 800 and 1700 m asl with surface area of 120 km<sup>2</sup> with an estimated population of about 21,000 inhabitants. The climate here is equatorial type, characterized by a long rainy season and short dry season and vegetation here is forest. Agriculture is the main activity of the natives of this community, with cash crops such as coffee, cocoa, cassava, cocoyam, plantain, banana and pepper and others. This community is made up of 24 villages and they all seek for health services in the lone Nguiango health center.

#### **2.2. Study design**

A retrospective study was carried out by studying hospital consultation and laboratory registers from November 27, 2008 to November 20, 2015, a prospective study commenced in December 1, 2015 to February 27, 2016. A prospective study was carried out in collaboration with consulting/counseling senior nurse and laboratory technician. In addition, questionnaires were administered and group discussions were organized. Home visits were also made to know the conditions of individuals living with the disease while collecting vital information. All patients coming to carry out the test were considered, but note was taken when studying past data to ensure that the same kit previously used for diagnosis was the same with that presently used for diagnosis. Diagnosis was supervised by a senior researcher to ensure that protocol for testing using the test kit was in accordance with manufacturer's instructions. Confidentiality of test results following the test was confidential, and only a code was designated for each test and not the patient's identity.

## **2.3. HIV testing**

Rapid diagnostic tests using standard commercially sourced 'Determine' and Uni-Gold test kits were used to determine the HIV status of individuals who come for the test. 'Determine 'HIV rapid test kit (www.who.int/diagnostics laboratory) used with whole blood, serum or plasma) as pre-test. Uni-Gold test kits (The trinity Biotech Uni-Gold™ HIV test) are kits that pick or react only with HIV in blood sample and was used for confirmation. The protocol for the usage of the above kits was as outlined by Olusi and Abe [14]. Storage conditions and protocols according to manufacturers of kits were strictly followed.

#### **2.4. Ethical consideration**

An authorization was given by the Chief medical officer at the Dschang health district. Based on the fact that we were working on hospital registers in collaboration with laboratory technicians and nurses following instructions of the head of health unit on patients showing up for the test, ethical clearance was not required since we were not recruiting individuals for HIV screening. All clinical investigations were conducted according to the Declaration of Helsinki principles.

Prevalence with sex revealed that male (14.3%) were more infected than female (4.0%) with a statistical significant difference (*χ*<sup>2</sup> = 4.251, *df* = 1, P = 0.039) (**Table 1**). Prevalence recorded with respect to age showed that the highest cases were signaled in individuals of ages ≥36, followed by 14–24 and lastly by 25–35 years, even though such discrepancies in prevalence existed with age, there was no significant difference (*χ*<sup>2</sup> = 3.096, *df* = 3, P = 0.377), recorded with

N = number sampled, I = number infected, P = prevalence, *χ2* = Chi-square, df = degree of freedom, P-value is level of

**Sex N I P (I/N × 100)%** *χ2 df* **P-value**

Female 200 8 4.0 4.251 1 0.039

**Age N I P (I/N × 100)%** *χ2 df* **P-value**

˃36 44 1 11.1 3.096 3 0.377

N = number sampled, I = number infected, P = prevalence, *χ2* = Chi-square, df = degree of freedom, P-value is level of

HIV/AIDS in a Community of Western Cameroon http://dx.doi.org/10.5772/intechopen.77086 121

Evolution of the disease in this area since 2008 till date was monitored. Prevalence based on the year of screening showed that the years between 2014 and 2016 (30.0%), recorded highest infected and 2012–2013 (4.1%) presented the least number of cases. Statistically, there was a significant difference (*χ*<sup>2</sup> = 27.373, *df* = 8, P = 0.002) in HIV prevalence with years of testing

Prevalence based on profession showed that traders (20.0%) presented the highest prevalence, followed by farmers (14.8%) while students and teachers had zero prevalence, despite the difference in HIV prevalence registered in various occupations, there still existed no statistical significant difference (*χ*<sup>2</sup> = 9.531, *df* = 6, P = 0.146) (**Table 4**). The high HIV prevalence recorded by farmers in this community is an indicator of a possible decrease in agricultural work force in this agriculture-dependent community if serious measures are not taken to prevent spread of the disease among farmers. Traders recorded the highest infection rate among others, and this is due to their high mobility rates exposing them to high risks of

age cohorts (**Table 2**).

Male 21 3 14.3

Total 221 11 18.3

14–24 73 5 6.8 25–35 104 5 4.8

Total 221 11 22.7

**Table 2.** Prevalence with age cohorts.

significance (P < 0.05).

significance (P < 0.05).

**Table 1.** HIV prevalence with sex.

contracting the disease.

(**Table 3**).

#### **2.5. Data analysis**

Data were analyzed using the SPSS statistical software of version 22.0, graphs and pie chart were constructed using MS excel software of version 2010. Chi-square test was used to compare HIV prevalence with, sex, age cohort, years of screening, marital status, motif of test and profession.
