To understand the risk behaviours for HIV among male STD clinic attendees
Dr.Dilmini Mendis, Senior registrar NSACP Dr.P.S.K.Gunathunga, Medical Officer NSACP Dr. M. Jayalath, Medical Officer NSACP Dr.R.C. Fernando Medical Officer NSACP Dr.L.I. Rajapaksa, Consultant Venereologist,NSACP
28/09/2013 1
• According to the data available at the National STD AIDS Control Programme, Sri Lanka – More males seek services at STD clinics (During year 2011-8511 males-gov STD Clinics – male attendance to STD clinics are increasing. – Increasing STI among MSM – Increasing injecting drug use
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Few similar studies on male population in STD Clinics, Sri Lanka 1973 –Arulananthan T STD Clinic, Jaffna, 70% (236)Syphilis 71.7% (2532) gonorrhoea due to FSW. 1977 – STD Clinic, Anuradapura 70% STI due to FSW 1999 – Rajapaksa L STD Clinic, Katugasthota, 30-34% STI due to FSW 2006- Rajapaksa L STD Clinic Kalubowila,40% STI due to CSW 3
Study Objectives • General objective To determine the sexual partners responsible for transmitting STI/HIV and practices of safer sex among males attending Central STD Clinic Colombo
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Specific objectives To determine the sexual partners responsible for transmitting STI/HIV among males attending Central STD Clinic Colombo To understand other related risk behaviour of the same population
To determine the safer sex practices in this population
To identify the relationship between the type of partner and STI 5
Methodology • Study design Clinic based prospective study Study setting Central STD Clinic Colombo
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Study sample • Newly registered males – 1623 • Excluded – – Needle stick injuries – Denied sexual exposure – Less than 15 years old – Prisoners /court referrals – Those who refuse to give consent – Study sample
- 983 7
Study instrument •
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Interviewer administered questionnaire Data collected by medical officers having experience. for >1 year Data collected for a 1 year period from 1st August 2012 to 31st July 2013 Included socio demographic characteristics and details about the last sexual exposure, type of partner, safer sex practices, other related risk behaviours Diagnosis through case records 8
Definitions • •
Marital partner: spouse
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Non regular partner (NRP)- sexual partner the
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Sex worker: MSW/FSW- sexual partner to whom
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According to PIMS
Regular partner: live-in sexual partner/ cohabiting partner
respondent is not living with; had sex rarely or only once with whom money is not involved respondent paid money/ material in exchange for sex
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Key Findings
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Age
Mean-34.0 SD-11.407 N-983 Range-15-84
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Education
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Occupation
40% of the comprised Skilled labourers/Drivers and Forces 13 50% with unskilled labourers
Marital Status
52.5% married 11% denied sex exposures Other than the MP 14
Reason for attendance
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Last Sexual Partner/other than MP
50% sample admitted LSE with a NRP 13.6% FSW/ 13.4% MSM MSW exposures were minimal
N=875
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Further Questioning were done on among males who admitted having sexual exposures with partners other than the marital partner
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Partners according to the age group
Younger males- more contacts with males & Older males with FSW 18
Type of sexual Activity
N=875 19
Males with MSM exposures
N=127 20
Relationship with marital status and partner
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Coitarche
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Other related risks
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Drug Users- 5.9% of total
According to the BSS 2006-2007 5.5% drug use among factory workers 24
Safer Sex
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Reasons for Non use of condoms
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Information/ Condoms Friends
Internet, 8.10%
TV School NGO, 1.30%
Friends, 29.30%
Newspaper Relative
Forces, 9.20%
Doctor
Doctor, 21.60%
Teacher Newspaper 9.60%
NGO
Forces Internet
Missing NA
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• Only STI with a short incubation period Gonorrhoea, Genital Herpes and Non gonococcal urethritis were considered.
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Relationship/Partner/STI
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MSM/STI
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Contribution of each category
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Conclusions • • • • • • • • •
Male population in the sample had satisfactory education More males had contacts with Non regular partners Availability of NRP for unsafe sex MSM / FSW /NRP are equally important sources of infection Other related risk behaviours were similar to the findings of BSS done in 2006-2007 among factory workers Early Syphilis and GC were more seen among MSM However unsafe sex contacts are common Low condom use was not due to unavailability, but for other reasons – satisfaction/faith Apart from doctors and friends Newspapers /Forces/ Internet were more important sources of information on condoms 36
Suggestions • The strategies used for prevention interventions need to be revisited in the context • Current programmes organized by NGO’s aim at MSM &FSW • There are no programmes to reach the general populationwhich is priority since most of the clients and NRP are representing the general population • Increase the awareness among males and females through mass media,primary health care teams and multisectoral involvement may be important • Changing attitudes regarding condoms should be an ongoing activity in prevention programmes 37
Limitations • Study was done at Central STD Clinic Colombo- Sri Lanka • Findings cannot be generalized to the general population as this is a convenient sample • Non condom users may seek more STD services • Low condom use among STD clinic attendees can be also interprited as non condom users seek more STD services • Only last sexual exposure was considered • Increase of injecting drug user population may be due to referral of IDU by the National Dangerous Drug control Board during the study period
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Acknowledgement • Director and Staff at NSACP SLCOV Dr.P.S.K.Gunathunga, Medical Officer NSACP Dr. M. Jayalath, Medical Officer NSACP Dr.R.C. Fernando Medical Officer NSACP Dr.L.I. Rajapaksa, Consultant Venereologist,NSACP 39
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