Sexual and treatment-seeking behaviour for sexually transmitted infection in long-distance transport workers of East Africa

Estimated economic burden of genital herpes and HIV attributable to herpes simplex virus type 2 infections in 90 low- and middle-income countries: A modeling study

BACKGROUND

Economic losses due to herpes simplex infections in low- and middle-income countries (LMICs) are unknown. We estimated economic and quality-of-life losses due to genital herpes in 2019, in 90 LMICs, and from 2020 to 2030 in 45 countries in the World Health Organization (WHO) Africa. We additionally estimated economic losses due to human immunodeficiency virus (HIV) attributable to herpes simplex virus type 2 (HSV-2) infections.

METHODS AND FINDINGS

We estimated genital herpes-related spending on treatment, wage losses due to absenteeism, and reductions in quality of life, for individuals aged 15 to 49 years, living with genital herpes. Had HSV-2 had contributed to the transmission of HIV, we estimated the share of antiretroviral treatment costs and HIV-related wage losses in 2019 that can be attributed to incident and prevalent HSV-2 infections in 2018. For the former, we used estimates of HSV-2 incidence and prevalence from the global burden of disease (GBD) study. For the latter, we calculated population attributable fractions (PAFs), using the classic (Levin's) epidemiological formula for polytomous exposures, with relative risks (RRs) reported in literature. To extend estimates from 2020 to 2030, we modeled the transmission of HSV-2 in 45 African countries using a deterministic compartmental mathematical model, structured by age, sex, and sexual activity, which was fitted to seroprevalence gathered from a systematic review and meta-regression analysis. In the 90 LMICs, genital herpes contributed to US$813.5 million in treatment and productivity losses in 2019 (range: US$674.4 to US$952.2 million). Given observed care-seeking and absenteeism, losses are in the range of US$29.0 billion (US$25.6 billion to US$34.5 billion). Quality-of-life losses in the amount of 61.7 million quality-adjusted life years (QALYs) are also possible (50.4 million to 74.2 million). The mean annual cost of treatment and wage losses per infection is US$183.00 (95% CI: US$153.60 to US$212.55); the mean annual cost of quality-of-life losses is US$343.27 (95% CI: 272.41 to 414.14). If HSV-2 has fueled the transmission of HIV, then seroprevalent HSV-2 cases in 2018 can account for 33.2% of the incident HIV infections in 2019, with an associated antiretroviral therapy (ART) cost of US$186.3 million (range: US$163.6 to US$209.5 million) and 28.6% of HIV-related wage losses (US$21.9 million; range: US$19.2 to US$27.4 million). In the WHO Africa region, the 3.9 million seroprevalent genital herpes cases from 2020 to 2030 contributed to US$700.2 million in treatment and productivity losses. Additionally, quality-of-life losses in the range of 88 million to 871 million QALYs are also possible. If HSV-2 has contributed to the transmission of HIV, then in 2020, the PAF of HIV due to prevalent HSV-2 will be 32.8% (95% CI: 26.7% to 29.9%) and due to incident infections will be 4.2% (95% CI: 2.6% to 3.4%). The PAF due to prevalent infections will decline to 31.0% by 2030 and incident infections to 3.6%. Though we have accounted for the uncertainty in the epidemiological and economic parameter values via the sensitivity analysis, our estimates still undervalue losses due to limiting to the 15- to 49-year-old population.

CONCLUSIONS

Economic losses due to genital herpes in LMICs can be large, especially when considering the lifelong nature of the disease. Quality-of-life losses outweigh spending on treatment and reductions in productivity. If HSV-2 has contributed to the spread of HIV in LMICs, then nearly one third of antiretroviral costs and HIV-related wage losses can be attributed to HSV-2. Given the magnitude of the combined losses, a vaccine against HSV-2 must be a global priority.

COVID-19 Pandemic as "Curate's Egg" on Human Immunodeficiency Virus Infection: A Commentary

It is a high time not to sideline human immunodeficiency virus (HIV) response during the 2019 coronavirus disease (COVID-19) crisis. COVID-19 will affect the decade’s hard-earned gains from HIV care delivery and response. At the same time, it could be an important time for the COVID-19 containment response to help minimize the occurrence of a new infection. Sexual contact is the main transmission ways in HIV dynamics. However, COVID-19 prevention and control strategies such as movement restrictions, physical and social distancing will reduce exposure to such kinds of risk behaviors. Those containment strategies, including stringent infection prevention and control at health facilities, may minimize transmission of HIV infection and will reduce the incidence of new HIV infection. While recognizing the immense challenges of the COVID-19 pandemic, efforts should be made by governments and international organizations to maintain the response to HIV and to ensure that the progress made against HIV is not lost. In addition, it is very crucial to undertake further researches on the status of new HIV infection during the COVID-19.

Applying a social-ecological lens to opinions about HIV self-testing among Kenyan truckers who declined to test: a qualitative study

HIV prevalence among truckers in Africa is high and testing rates suboptimal. With numerous African countries having approved HIV self-testing kits, more information on how to design acceptable and accessible self-testing programs for high-risk populations is necessary. We explored views about self-testing via in-depth interviews with 24 truckers participating in a randomised controlled trial who refused HIV testing. A social-ecological lens was used to guide data analysis and frame study findings. While most participants said that they would use an HIV self-test, perceived barriers and facilitators were identified at multiple levels. Many participants noted lack of time to test or obtain a self-test kit as a major barrier (intrapersonal) and varied in their views about self-testing with a partner (interpersonal). Participants offered programmatic/policy recommendations, suggesting that they preferred accessing self-test kits in settings where training could be provided. Participants believed they should be able to pick up multiple test kits at the same time and that the test kits should be free or low cost. These study findings will help guide the design of self-testing programs for truckers and other mobile populations.

Diagnosing sexually transmitted infections in resource-constrained settings: challenges and ways forward

INTRODUCTION

Sexually transmitted infections (STIs) remain prevalent and are increasing in several populations. Appropriate STI diagnosis is crucial to prevent the transmission and sequelae of untreated infection. We reviewed the diagnostic accuracy of syndromic case management and existing point-of-care tests (POCTs), including those in the pipeline, to diagnose STIs in resource-constrained settings.

METHODS

We prioritized updating the systematic review and meta-analysis of the diagnostic accuracy of vaginal discharge from 2001 to 2015 to include studies until 2018. We calculated the absolute effects of different vaginal flowcharts and the diagnostic performance of POCTs on important outcomes. We searched the peer-reviewed literature for previously conducted systematic reviews and articles from 1990 to 2018 on the diagnostic accuracy of syndromic management of vaginal and urethral discharge, genital ulcer and anorectal infections. We conducted literature reviews from 2000 to 2018 on the existing POCTs and those in the pipeline.

RESULTS AND DISCUSSIONS

The diagnostic accuracy of urethral discharge and genital ulcer disease syndromes is relatively adequate. Asymptomatic Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections limit the use of vaginal discharge and anorectal syndromes. The pooled diagnostic accuracy of vaginal syndromic case management for CT/NG is low, resulting in high numbers of overtreatment and missed treatment. The absolute effect of POCTs was reduced overtreatment and missed treatment. Findings of the reviews on syndromic case management underscored the need for low-cost and accurate POCTs for the identification, first, of CT/NG, and, second, of Mycoplasma genitalium (MG) and Trichomonas vaginalis (TV) and NG and MG resistance/susceptibility testing. Near-patient POCT molecular assays for CT/NG/TV are commercially available. The prices of these POCTs remain the barrier for uptake in resource-constrained settings. This is driving the development of lower cost solutions.

CONCLUSIONS

The WHO syndromic case management guidelines should be updated to raise the quality of STI management through the integration of laboratory tests. STI screening strategies are needed to address asymptomatic STIs. POCTs that are accurate, rapid, simple and affordable are urgently needed in resource-constrained settings to support the uptake of aetiological diagnosis and treatment.

Depression and sexual risk behavior among long-distance truck drivers at roadside wellness clinics in Kenya

Background

Truck drivers in sub-Saharan Africa are at high risk for both mental health disorders and sexually transmitted infections. We sought to determine the prevalence of depression among a sample of long-distance truck drivers seeking services at roadside wellness clinics in Kenya and explore the relationship between depression and sexual risk behavior.

Methods

We used data from an interviewer-administered questionnaire from 284 truck drivers in Kenya who participated in a randomized controlled trial evaluating whether offering oral HIV self-testing could increase HIV test uptake. Depression was categorized based on the Patient Health Questionnaire-9 score, with a score ≥10 indicative of probable major depressive disorder (MDD). Sexual risk behavior was operationalized as the number of condomless sex partners in the past 6 months.

Results

The mean participant age was 36.9 years, 83.0% were married, and 37.0% had a secondary school education or higher. Overall, 24% of participants had probable MDD, and 58.2% reported having one condomless sex partner in the past 6 months, whereas 27.3% reported having had two or more. In a multivariable Poisson regression model adjusted for demographic and other relevant variables, including number of sex partners, MDD was significantly associated with a greater number of condomless sex partners (adjusted prevalence ratio 1.63, 95% confidence interval [1.25–2.12], p < 0.001). General self-efficacy significantly mediated the association between MDD and number of condomless sex partners.

Conclusions

The high prevalence of depression highlights the need to test the feasibility and acceptability of mental healthcare interventions for this population, possibly integrated with HIV prevention services. Future research is needed to better understand the association between depression and sexual risk behavior, as well as the role of self-efficacy.

Psychosocial characteristics of primary care-seeking long-distance truck drivers in Kenya and associations with HIV testing

The 90-90-90 strategy from the Joint United Nations Programme on HIV/AIDS (UNAIDS) to end the AIDS epidemic by 2020 includes, as its first goal, to have 90% of all people living with HIV to know their status. Achieving this goal will depend on effectively reaching high risk populations, which include mobile populations such as truck drivers. This study aimed to characterise a sample of 305 truck drivers recruited from 2 roadside wellness clinics in Kenya in terms of anticipated HIV stigma, self-efficacy, fatalism, gender equity, sensation seeking, and self-esteem, and then determine the association of these psychosocial characteristics with HIV testing behaviour. Greater general self-efficacy was associated with higher income and more years working as a truck driver. Greater fatalism was associated with non-Christian religion, being married, and having a lower income. Greater gender equity was associated with completing high school, being married, and having higher income. Greater sensation seeking was associated with lower income and fewer years employed as a truck driver. In multivariable logistic regression adjusted for demographic variables, anticipated HIV stigma was negatively associated with having ever tested for HIV (adjusted odds ratio [aOR] = 0.79; 95% confidence interval [CI] = 0.63–0.98; p = 0.034) and self-esteem was positively associated with testing (aOR = 1.06; 95% CI = 1.00–1.12; p = 0.038). Associations with HIV testing behaviour were not significant for self-efficacy, fatalism, gender equity, or sensation seeking. Public health interventions aiming to reduce anticipated stigma and increase self-esteem may potentially increase the uptake of HIV testing among truck drivers. Further research is needed to better understand the influence of these psychosocial characteristics on HIV testing.

Health Risk Behaviour among Adolescents Living with HIV in Sub-Saharan Africa: A Systematic Review and Meta-Analysis

The burden of health risk behaviour (HRB) among adolescents living with HIV (ALWHIV) in sub-Saharan Africa (SSA) is currently unknown. A systematic search for publications on HRB among ALWHIV in SSA was conducted in PubMed, Embase, PsycINFO, and Applied Social Sciences Index and Abstracts databases. Results were summarized following PRISMA guidelines for systematic reviews and meta-analyses. Heterogeneity was assessed by the DerSimonian and Laird method and the pooled estimates were computed. Prevalence of current condom nonuse behaviour was at 59.8% (95% CI: 47.9–71.3%), risky sexual partnerships at 32.9% (95% CI: 15.4–53.2%), transactional sex at 20.1% (95% CI: 9.2–33.8%), and the experience of sexual violence at 21.4% (95% CI: 16.3–27.0%) among ALWHIV. From this meta-analysis, we did not find statistically significant differences in pooled estimates of HRB prevalence between ALWHIV and HIV uninfected adolescents. However, there was mixed evidence on the occurrence of alcohol and drug use behaviour. Overall, we found that research on HRB among ALWHIV tends to focus on behaviour specific to sexual risk. With such a high burden of HRB for the individuals as well as society, these findings highlight an unmet need for age-appropriate interventions to address the behavioural needs of these adolescents.

Uptake of health services among truck drivers in South Africa: analysis of routine data from nine roadside wellness centres

BACKGROUND

Long-distance truck drivers are occupationally susceptible to poor health outcomes. Their patterns of healthcare utilisation and the suitability of healthcare services available to them are not well documented. We report on truck driver healthcare utilisation across South Africa and characterise the client population of the clinics serving them for future service development.

METHODS

We analysed anonymised data routinely collected over a two-year period at nine Roadside Wellness Centres. Associations between services accessed and socio-demographic characteristics were assessed using univariable and multivariable logistic regression models.

RESULTS

We recorded 16,688 visits by 13,252 individual truck drivers (average of 1.26 visits/person) who accessed 17,885 services for an average of 1.07 services/visit and 1.35 services/person. The mean age of truck drivers was 39 years. Sixty-seven percent reported being in stable relationships. The most accessed services were primary healthcare (PHC)(62%) followed by HIV (32%). Low proportions (≤6%) accessed STI,TB and malaria services. Most visits were characterised by only one service being accessed (93%, n = 15,523/16,688). Of the remaining 7% of visits, up to five services were accessed per visit and the combination of TB /HIV services in one visit remained extremely low (<1%, n = 14/16,688). Besides PHC services at the beginning of the reporting period, all service categories displayed similar seasonal utilisation trends(i.e. service utilisation peaked in the immediate few months post clinics opening and substantially decreased before holidays). Across all service categories, younger truck drivers, those with a stable partner currently, and those of South African origin were the main clinic attendees. Older truck drivers (≥40 years) were more likely to access TB and PHC services, yet less likely to access HIV and STI services. Those with stable partners were less likely to access STI and TB services but more likely to access malaria and PHC services. South African attendees were more likely to access PHC, while attendees from other nationalities were more likely to access HIV and malaria services.

CONCLUSIONS

This utilisation analysis shows that tailored services assist in alleviating healthcare access challenges faced by truck drivers, but it underscores the importance of ensuring that service packages and clinics speak to truck drivers' needs in terms of services offered and clinic location.

Social and structural factors related to HIV risk among truck drivers passing through the Iringa region of Tanzania

Truck drivers and their assistants have been identified as groups at higher risk for HIV infection. We sought to identify and describe the social and structural factors that may contribute to HIV risk among truck drivers who visit rest stops in Iringa, Tanzania, a region characterized by high levels of migration and mobility. This analysis was part of a comprehensive strategic assessment to examine HIV risk factors in Iringa. This analysis focuses on 11 in-depth interviews with truck drivers and a transport owner. A semi-structured interview guide was developed to elicit open-ended responses and enable probing. Interviews were conducted in Swahili, transcribed, and translated into English. Data analysis followed thematic analysis procedures that included initial reading of transcripts, development of a codebook and identification of themes through in-depth reading of transcripts. Drivers described structural risk factors for HIV including work conditions, the power imbalance between male drivers and their sexual partners and minimal perceived HIV risk with certain partners (e.g., regular partners and women selling sex). Multiple and inter-related social norms associated with truck stop environments influenced HIV risk, including peer influence and expectations, presence of sex workers, ability to purchase sex throughout their travel and alcohol consumption. These distinct social norms in truck stops and other rest points facilitated behavior that many participants said they would not engage in elsewhere. HIV prevention strategies with truck drivers should address individual, social and structural barriers to HIV prevention through partnerships with the health and transportation sectors, local government and local communities. HIV prevention services should be adapted to drivers' times and places of availability, for example, condom provision where/when drivers make decisions about or have sex. A focus on positive messaging and addressing specific challenges including the continual challenge of re-choosing and reinforcing decisions to engage in safer sexual behaviors is important.

Prevalence of HIV and Associated Risk Factors Among Long Distance Truck Drivers in Inchope, Mozambique, 2012

This is the first integrated biological and behavioral surveillance survey among long-distance truck drivers (LDTD) in Mozambique. Using modified time-location sampling in 2012 at a key transportation junction (Inchope), we enrolled 327 male LDTD. HIV prevalence was 15.4 % (95 % confidence interval : 11.4-19.4 %, n = 318 tested). Among HIV-positive LDTD, 83.7 % did not know their status. One-third of LDTD had never tested for HIV and three-quarters had not received free condoms, lubricants or HIV literature in the past 12 months. In that same period, 61.4 % of LDTD had at least four sexual partners and 27.1 % paid for sex. Among sexually-active LDTD, 76.5 % did not use a condom at last sex. HIV was associated (p < 0.05) with primary education or lower (AOR 2.1), residence in Mozambique (AOR 2.3) and never having tested for HIV (AOR 2.2). Our findings reveal that broader coverage of HIV prevention and comprehensive care services for LDTD are urgently needed.

On the road again: concurrency and condom use among Uganda truck drivers

Long-distance truck drivers have been shown to be a critical population in the spread of HIV in Africa. In 2009, surveys with 385 Ugandan long-distance truck drivers measured concurrency point prevalence with two methods; it ranged from 37.4% (calendar-method) to 50.1% (direct question). The majority (84%) of relationships reported were long-term resulting in a long duration of overlap (average of 58 months) across concurrent partnerships. Only 7% of these men reported using any condoms with their spouses during the past month. Among all non-spousal relationships, duration of relationship was the factor most strongly associated with engaging in unprotected sex in the past month in a multivariable analyses controlling for partner and relationship characteristics. Innovative intervention programs for these men and their partners are needed that address the realities of truck drivers' lifestyles.

Most at-risk populations: contextualising HIV prevention programmes targeting marginalised groups in Zanzibar, Tanzania

According to a 2009 UNAIDS report the HIV/AIDS prevalence rate in Zanzibar, Tanzania, is low in the general population (0.6%), but high among vulnerable groups, specifically sex workers (10.8%), injecting drug users (15.1%), and men who have sex with men (12.3%). In response to this concentrated epidemic, the Government of Zanzibar, international and local non-profit organisations have focused their prevention activities on these marginal populations. Although these efforts are beneficial in terms of disseminating information about HIV/AIDS and referring clients to health clinics, they fail to address how the socio-economic status of these groups places them at a greater risk for contracting and dying from the virus. Furthermore, there is an absence of qualitative research on these populations which is needed to understand the challenges these groups face and to improve the effectiveness of interventions. Through interviews with employees of government agencies and non-profit organisations, medical professionals, vulnerable populations and HIV/AIDS patients, this paper used a political economy of health and syndemic framework to examine how local realities inform and challenge HIV/AIDS programmes in Zanzibar.

HIV prevalence and risk in long-distance truck drivers in South Africa: a national cross-sectional survey

We estimated the prevalence of HIV and assessed correlates of HIV infection in long-distance truck drivers in South Africa. Between October 2003 and July 2004, 1900 long-distance truck drivers aged ≥18 years consented to interview and for testing for HIV. Participants were selected from a 10% stratified random sample of registered truck depots. A proximate-determinants framework was used to assess the hierarchical relationship between risk factors and HIV infection using logistic regression. HIV prevalence was 26% (95% confidence interval 24% to 28%). In multivariate analyses, HIV infection was associated with spending 2–4 weeks on the road (adjusted odds ratio 1.4; 95% confidence interval 1.1 to 1.9). There was modest evidence of a dose-response relationship between time on the road and HIV risk. Mobility increased risk by creating conditions for unsafe sex and reducing access to health services. Targeted HIV interventions for long-distance truck drivers are needed.

Knowledge, attitudes & barriers to condom use among female sex workers and truck drivers in Uganda: a mixed-methods study

BACKGROUND

There is limited documentation on knowledge, attitudes and barriers to condom use among female sex workers (FSWs) and truck drivers (truckers).

OBJECTIVE

To explore knowledge, attitudes and barriers to condom use among FSWs and truckers operating along major transport corridors in Uganda.

METHODS

Structured questionnaires were administered to explore FSWs' and truckers' knowledge of and attitudes towards condom use among 259 FSWs and 261 truckers. Qualitative data were collected on barriers to condom use using focus group discussions. Quantitative data were analyzed using SPSS while qualitative data were audio-recorded, transcribed and thematically analyzed.

RESULTS

Condom knowledge was high with 97% of FSWs and 95% of truckers agreeing with the statement, "using condoms properly and consistently reduces risk of HIV infection". Attitudes towards condom use were generally favorable with 91% of FSWs and 82% of truckers agreeing with the statement, "condom use is the best method of HIV prevention". Qualitative findings show that poverty, refusal to use condoms by male partners, alcohol use before sex and beliefs that condoms 'kill the mood for sex' remain key barriers to consistent condom use.

CONCLUSIONS

Consistent condom use among FSWs and truckers is still hampered by economic and relationship factors.

Sexually transmitted infections among heterosexual male clients of female sex workers in China: a systematic review and meta-analysis

BACKGROUND

Female sex workers have been the target of numerous sexually transmitted infection (STI) prevention strategies in China, but their male clients have attracted considerably less public health attention and resources. We sought to systematically assess the prevalence of HIV, syphilis, gonorrhea, and chlamydia among heterosexual male clients of female sex workers in China.

METHODS/PRINCIPAL FINDINGS

Original research manuscripts were identified by searching Chinese and English language databases, and 37 studies analyzing 26,552 male clients were included in the review. Client STI prevalence across studies was heterogeneous. Pooled prevalence estimates and 95% confidence intervals were 0.68% (0.36-1.28%) for HIV, 2.91% (2.17-3.89%) for syphilis, 2.16% (1.46-3.17%) for gonorrhea, and 8.01% (4.94-12.72%) for chlamydia.

CONCLUSIONS/SIGNIFICANCE

The pooled prevalence estimates of HIV, syphilis, gonorrhea, and chlamydia among clients in this review exceed the prevalences previously reported among population-representative samples and low-risk groups in China. However, heterogeneity across studies and sampling limitations prevent definitive conclusions about how the prevalence of STIs in this population compares to the general population. These findings suggest a need for greater attention to clients' sexual risk and disease prevalence in China's STI research agenda in order to inform effective prevention policies.

Health care seeking among men with genital ulcer disease in South Africa: correlates and relationship to human immunodeficiency virus-1 and herpes simplex virus type 2 detection and shedding

BACKGROUND

Episodic acyclovir therapy has been added to genital ulcer disease (GUD) syndromic management guidelines in several sub-Saharan African countries with human immunodeficiency virus (HIV) epidemics. We examined the correlates of health care seeking in men with GUD and its relationship to HIV-1 and herpes simplex virus type 2 outcomes.

METHODS

Men with GUD (n = 615) were recruited from primary health care clinics in Gauteng province, South Africa for a randomized controlled trial of episodic acyclovir therapy. We used baseline survey and sexually transmitted infection/HIV-testing data to examine delay in health care seeking (defined as time from ulcer recognition to baseline study visit).

RESULTS

Median delay in health care seeking for GUD was 5 days, and one-quarter of men had previously sought care for the current ulcer. Previous care seekers were older, had more episodes of ulceration in the past year, and were more likely to test seropositive for HIV-1 and HSV-2. Delay in health care seeking was significantly associated with age, education level, and sex during the ulceration episode. Delays in care seeking were related to poorer HIV-1 outcomes; these findings were valid after controlling for advanced HIV.

CONCLUSIONS

Interventions to help shorten the duration between ulcer recognition and health care seeking for men with GUD are needed.

North-South Corridor Demonstration Project: Ethical and Logistical Challenges in the Design of a Demonstration Study of Early Antiretroviral Treatment for Long Distance Truck Drivers along a Transport Corridor through South Africa, Zimbabwe, and Zambia

Background. Long-distance truck drivers are at risk of acquiring and transmitting HIV and have suboptimal access to care. New HIV prevention strategies using antiretroviral drugs to reduce transmission risk (early antiretroviral therapy (ART) at CD4 count >350 cells/μL) have shown efficacy in clinical trials. Demonstration projects are needed to evaluate “real world” programme effectiveness. We present the protocol for a demonstration study to evaluate the feasibility, acceptability, and cost of an early ART intervention for HIV-positive truck drivers along a transport corridor across South Africa, Zimbabwe, and Zambia, as part of an enhanced strategy to improve treatment adherence and retention in care. Methods and Analysis. This demonstration study would follow an observational cohort of truck drivers receiving early treatment. Our mixed methods approach includes quantitative, qualitative, and economic analyses. Key ethical and logistical issues are discussed (i.e., choice of drug regimen, recruitment of participants, and monitoring of adherence, behavioural changes, and adverse events). Conclusion. Questions specific to the design of tailored early ART programmes are amenable to operational research approaches but present substantial ethical and logistical challenges. Addressing these in demonstration projects can inform policy decisions regarding strategies to reduce health inequalities in access to HIV prevention and treatment programmes.

Sexual risk behaviours, condom use and sexually transmitted infection treatment-seeking behaviours among female sex workers and truck drivers in Uganda

We assessed sexual risk behaviours, condom use and sexually transmitted infection (STI) treatment-seeking behaviours among truckers and female sex workers (FSWs) operating at 12 hotspots along two major transport corridors in Uganda. Participants were identified through local contact persons: 261 truckers and 259 FSWs were interviewed. FSWs reported a mean number of 28 partners in the past 30 days while truckers reported a mean of seven partners. Ninety-four percent of FSWs and 87% of truckers reported condom use in the past month; however, only 21% of truckers and 45% of FSWs reported using condoms consistently during that time. More than half of truckers (n = 261) and 77% of FSWs (n = 259) reported that they suffered from STIs in the past year, and 93% of FSWs and 92.9% of truckers sought treatment for STIs in the past year. Of these, 78% of truckers and 86% of FSWs sought treatment at least three days following recognition of symptoms. These findings suggest that FSWs and truckers engage in high-risk sexual behaviours characterized by multiple sexual partnerships, low consistent condom use and delayed treatment-seeking behaviours.

Cognizance of sexually transmitted infections among low-income men in western Kenya

Sexually transmitted infections (STIs) pose a worldwide health problem. To improve the efforts of prevention of STIs it is important to gain insight into the awareness of STIs among people in the society.

OBJECTIVE

To describe the cognizance of STIs among low-income men in western Kenya.

METHOD

Data was collected from eight focus groups consisted of 64 men between 15 and 54 years of age. The interviews were audio taped and content analysis was used for the analysis.

FINDINGS

Three categories were derived: Consciousness of STIs, Risk of and prevention of STIs, and Marital relationship and STIs. The results indicate that men had some limited consciousness of STIs but that there were misunderstandings. The treatments the men mentioned were hospital treatment help, from traditional herbalists and self-administration. Condoms were regarded as an effective prevention method, but there were obstacles to using them as well as to talking about STIs within marriage.

CONCLUSION

The study stresses the need to promote cognizance of STIs, including gender aspects, and to reduce the gap between knowing and practising.

Sexual and drug use risk behaviors of long-haul truck drivers and their commercial sex contacts in New Mexico

OBJECTIVES

Long-haul truck drivers and their commercial sex contacts (CCs) have been associated with the spread of sexually transmitted infections (STIs) in the developing world. However, there is a paucity of information about the STI risk behaviors of these populations in the U.S. We conducted a qualitative phase of a two-phase study to gather information about STI-related risk behaviors in drivers and their CCs in New Mexico.

METHODS

Between July and September 2004, we conducted face-to-face unstructured and semistructured qualitative interviews at trucking venues, health department facilities, and a community-based organization to solicit information on sexual behavior and condom and illicit drug use. The interviews were audiotaped, transcribed, reviewed for quality control, and then coded and analyzed for emerging themes using NVivo software.

RESULTS

Thirty-three long-haul truck drivers and 15 CCs completed the interview. The truck drivers were mostly male and non-Hispanic white with a mean age of 41 years. The majority of the CCs were female, the largest percentage was Hispanic, and the mean age was 36 years. Data suggested risky sexual behavior and drug use (i.e., inconsistent condom use, illicit drug use including intravenous drug use, and the exchange of sex for drugs) that could facilitate STI/human immunodeficiency virus (HIV) and hepatitis virus transmission. Results also showed a low knowledge about STIs and lack of access to general health care for both populations.

CONCLUSIONS

Additional studies are needed to further assess risk and inform the development of prevention interventions and methods to provide STI/HIV and other medical services to these populations.