b aseline prevalence and risk factors associated for stis among newly-arrived female sex workers in...
TRANSCRIPT
![Page 1: B aseline prevalence and risk factors associated for STIs among newly-arrived female sex workers in Timika, Indonesia Presented by Nurlan Silitonga ASHM](https://reader036.vdocument.in/reader036/viewer/2022062417/551c1f82550346a84f8b5aa0/html5/thumbnails/1.jpg)
Baseline prevalence and risk factors associated for STIs among newly-arrived female sex workers in Timika, Indonesia
Presented by
Nurlan SilitongaASHM Conference, Cairns, 23 October 2003
Silitonga N, Donegan E, Davies SC, Kaldor J, Wignall FS,
Okoseray M, Schachter J
![Page 2: B aseline prevalence and risk factors associated for STIs among newly-arrived female sex workers in Timika, Indonesia Presented by Nurlan Silitonga ASHM](https://reader036.vdocument.in/reader036/viewer/2022062417/551c1f82550346a84f8b5aa0/html5/thumbnails/2.jpg)
Acknowledgements
• Mimika District Health Office• PT Freeport Indonesia• International SOS• University of California, San Francisco• Naval Medical Research Unit No 2• Sexually Transmitted Infectious
Research Centre – University of Sydney
• University of New South Wales• Ford Foundation
![Page 3: B aseline prevalence and risk factors associated for STIs among newly-arrived female sex workers in Timika, Indonesia Presented by Nurlan Silitonga ASHM](https://reader036.vdocument.in/reader036/viewer/2022062417/551c1f82550346a84f8b5aa0/html5/thumbnails/3.jpg)
IndonesiaIndonesia
• 39 active mining companies (30,000 miners). • The mines are mostly in remote locations,
employ male workers• An increasing number of FSWs has become
available for these men • Most of the women are poor and illiterate.
Little information on STIs and often have little negotiating power for condom use
![Page 4: B aseline prevalence and risk factors associated for STIs among newly-arrived female sex workers in Timika, Indonesia Presented by Nurlan Silitonga ASHM](https://reader036.vdocument.in/reader036/viewer/2022062417/551c1f82550346a84f8b5aa0/html5/thumbnails/4.jpg)
HIV/AIDS and STIs in Indonesia• The HIV/AIDS program
primarily in urban areas and focuses on HIV testing
• Diagnosis and treatment of STIs are rarely available
• Many people do self-treated
• Inadequate STI health care services
• HIV/AIDS program tends to rely on donor agencies
![Page 5: B aseline prevalence and risk factors associated for STIs among newly-arrived female sex workers in Timika, Indonesia Presented by Nurlan Silitonga ASHM](https://reader036.vdocument.in/reader036/viewer/2022062417/551c1f82550346a84f8b5aa0/html5/thumbnails/5.jpg)
Timika• A mining town in Papua
province where a large gold mining company is operating with 12,000 male employees
• Approximately 600 FSWs
• In 1997, a survey among 462 mining employees – Visited brothel complex (14%) and local bars (20%)
– Low level of condom use (3%)
– Not aware of their risk of contracting STI/HIV infection (48%)
![Page 6: B aseline prevalence and risk factors associated for STIs among newly-arrived female sex workers in Timika, Indonesia Presented by Nurlan Silitonga ASHM](https://reader036.vdocument.in/reader036/viewer/2022062417/551c1f82550346a84f8b5aa0/html5/thumbnails/6.jpg)
• 1995 - First HIV cases
• 1997 – A partnership between District Health Office and PTFI in developing HIV Prevention program was established:
– Behavior change
– Provision of STI care
![Page 7: B aseline prevalence and risk factors associated for STIs among newly-arrived female sex workers in Timika, Indonesia Presented by Nurlan Silitonga ASHM](https://reader036.vdocument.in/reader036/viewer/2022062417/551c1f82550346a84f8b5aa0/html5/thumbnails/7.jpg)
Aim of studyAim of study• Prevalence and risk factors associated with STIs
among the FSWs attending the STI clinic for the first time from January 1997 – June 2002
MethodsMethods• We recruited FSWs from the only brothel, local
bars and from the street
![Page 8: B aseline prevalence and risk factors associated for STIs among newly-arrived female sex workers in Timika, Indonesia Presented by Nurlan Silitonga ASHM](https://reader036.vdocument.in/reader036/viewer/2022062417/551c1f82550346a84f8b5aa0/html5/thumbnails/8.jpg)
MethodsMethods• Every month each bar/brothel receives a reminder
of the availability of clinic appointments
• Clinic participation is voluntary
• A clinic administrator – acts as an ombudsman solving problems– organizing clinic visits – maintaining a log of the number of FSWs living in each
bar or house at the brothel
![Page 9: B aseline prevalence and risk factors associated for STIs among newly-arrived female sex workers in Timika, Indonesia Presented by Nurlan Silitonga ASHM](https://reader036.vdocument.in/reader036/viewer/2022062417/551c1f82550346a84f8b5aa0/html5/thumbnails/9.jpg)
VariablesVariables• Sociodemographics
– Type of sex worker (Brothel, Bar, Independence / freelance / street)
– Age and place of origin
• Sexual behavior – Contraceptive use
– Having regular partner and their occupation
– Frequency of sex in the past one week
– Condom use
• Consistent (100% condom use during their sexual acts in the past one week)
• Inconsistent (less than 100% or no condom)
![Page 10: B aseline prevalence and risk factors associated for STIs among newly-arrived female sex workers in Timika, Indonesia Presented by Nurlan Silitonga ASHM](https://reader036.vdocument.in/reader036/viewer/2022062417/551c1f82550346a84f8b5aa0/html5/thumbnails/10.jpg)
Specimens & testsSpecimens & tests
• Posterior fornix vaginalis tested for Trichomonas vaginalis (TV) by wet mount
• Endocervical samples tested for Nesseria gonorrhoeae
(NG) by culture and LCR
• Urine samples tested for Chlamydia trachomatis (CT) by LCR
• Blood samples tested for – RPR and TPHA– HIV tests (Immunoblot, ELISA) confirmed by WB
![Page 11: B aseline prevalence and risk factors associated for STIs among newly-arrived female sex workers in Timika, Indonesia Presented by Nurlan Silitonga ASHM](https://reader036.vdocument.in/reader036/viewer/2022062417/551c1f82550346a84f8b5aa0/html5/thumbnails/11.jpg)
Statistical MethodsStatistical Methods
• Data of FSWs who attended the STI clinic for the first time were selected, almost all of whom are newly arrived in Timika
• Data were analysed by EPIINFO 6.4 and SPSS version 11.5
• To test for trends over time of categorical variables, a logistic regression model was used.
• To adjust for multiple risk factors, multivariate analysis was performed: variables associated with STIs on univariate analysis were included in a backward selection logistic regression model
![Page 12: B aseline prevalence and risk factors associated for STIs among newly-arrived female sex workers in Timika, Indonesia Presented by Nurlan Silitonga ASHM](https://reader036.vdocument.in/reader036/viewer/2022062417/551c1f82550346a84f8b5aa0/html5/thumbnails/12.jpg)
ResultsResults
• Socio-demographic characteristics– Most of the 3086 FSWs recruited
worked in the brothel (63%) or bars (34%) and most originated from Java (70%) or Sulawesi (25%)
– Age mean (median) =25 (26)
![Page 13: B aseline prevalence and risk factors associated for STIs among newly-arrived female sex workers in Timika, Indonesia Presented by Nurlan Silitonga ASHM](https://reader036.vdocument.in/reader036/viewer/2022062417/551c1f82550346a84f8b5aa0/html5/thumbnails/13.jpg)
Table 1. Sexual behaviour characteristics of female sex workers attending STI Clinic in Timika, 1997 to 2002 by type of sex worker
Characteristics Brothel Bar and freelance
95% CI P
Age in years (mean) 27.6 23.4 4.2 (3.82-4.64) 0.0001
Java as place of origin (%) 91.8 18.1 40.4 (30.66-53.29) 0.0002
Use contraceptive use (%) 53.3 25.5 3.3 (2.84-3.91) 0.000
Frequency of sex in the last week (mean)
5.4 2.8 2.6 (2.09-3.04) 0.000
Consistent condom use (%) 14.0 9.7 1.5 (1.09-2.12) 0.014
Regular partner (%) 10.2 29.1 0.3 (0.23-0.34) 0.0001 T-test2 Chi-square testCI, confidence interval
![Page 14: B aseline prevalence and risk factors associated for STIs among newly-arrived female sex workers in Timika, Indonesia Presented by Nurlan Silitonga ASHM](https://reader036.vdocument.in/reader036/viewer/2022062417/551c1f82550346a84f8b5aa0/html5/thumbnails/14.jpg)
Table 2. Trend socio-demographic characteristics of female sex workers attending STI Clinic in Timika by year
Year
1997 1998 1999 2000 2001 2002 P
Number of sex workers 702 584 500 466 495 339
Age >25 (%) 47.7 46.4 52.2 54.5 50.9 53.4 0.014
Place of origin (%)
Java 93.2 69.8 84.2 65.3 59.4 61.4 0.000
Outside Java 6.8 30.2 15.8 34.7 40.6 38.6 0.000
Sex venues (%)
Brothel 61.1 52.2 77.6 64.8 59.8 61.4 0.253
Freelance 1.4 2.4 5.6 5.2 3.4 7.7 0.000
Bar 37.5 45.4 16.8 30.0 36.8 31.0 0.002
Having regular partner (%) 14.2 21.4 20.8 15.9 14.9 16.5 0.597
Consistent condom use (%) NA 8.1 11.6 12.1 15.1 16.3 0.001
Chi-square test for linear trend for categorical variables. NA, not available, as the data on sexual behaviour was not collected in 1997 and 1998. Reported condom use during a week prior their visit to the clinic.
![Page 15: B aseline prevalence and risk factors associated for STIs among newly-arrived female sex workers in Timika, Indonesia Presented by Nurlan Silitonga ASHM](https://reader036.vdocument.in/reader036/viewer/2022062417/551c1f82550346a84f8b5aa0/html5/thumbnails/15.jpg)
Fig. 1. Annual prevalence rates of CT, NG, TV, syphilis, and HIV among female sex workers attending STI Clinic in Timika 1997-2002.
0
5
10
15
20
25
30
35
40
45
1997 1998 1999 2000 2001 2002
% w
ith
se
xu
all
y tr
an
sm
itte
d i
nfe
cti
on
s
Gonorrhoea Trichomonas Syphilis HIV Chlamydia
P=0.005
P=0676
P=0.003
P=0.546
P=0.003
![Page 16: B aseline prevalence and risk factors associated for STIs among newly-arrived female sex workers in Timika, Indonesia Presented by Nurlan Silitonga ASHM](https://reader036.vdocument.in/reader036/viewer/2022062417/551c1f82550346a84f8b5aa0/html5/thumbnails/16.jpg)
Table 3. Risk factors associated with any STIs
Risk factors n infected / n tested (%) Odds ration (95% CI)
Unadjusted P Adjusted P
Type of sex venues
Bar and freelance 432/1158 37.3 1.0
Brothel 615/1928 31.9 0.8 (0.68-0.92) 0.002 NS
Age (years)
≤ 21 ® 260/660 39.4 1.0
21-25 322/872 36.9 0.9 (0.73-1.11) 0.325 1.0 (0.80-1.35) 0.778
26-30 263/858 30.7 0.7 (0.55-0.84) 0.000 0.8 (0.63-1.08) 0.164
31+ 202/696 29.0 0.6 (0.50-0.79) 0.000 0.7 (0.51-0.89) 0.006
Place of Origin
Other region 203/579 35.1 1.0
Jawa 425/1366 31.1 0.8 (0.68-1.03) 0.089
Contraception
No 648/1764 36.7 1.0
Yes 399/1322 30.2 0.7 (0.64-0.87) 0.000 0.8 (0.63-0.93) 0.006
Frequency of sex
No sex 153/542 28.2 1.0
1-4 324/1084 29.9 1.1 (0.86-1.36) 0.488 1.1 (0.87-1.38) 0.433
5-9 115/370 31.1 1.2 (0.86-1.53) 0.353 1.2 (0.88-1.58) 0.259
> 9 76/206 36.9 1.5 (1.06-2.09) 0.022 1.6 (1.11-2.21 0.011
Condom
Consistent 57/210 27.1 1.0
Inconsistent/nil 458/1450 31.6 1.2 (0.90-1.71) 0.194
Having a regular partner
No regular partner 848/2553 33.2 1.0
Mining worker 66/179 36.9 1.2 (0.86-1.61) 0.317
Other 98/257 38.1 1.2 (0.95-1.62) 0.112
![Page 17: B aseline prevalence and risk factors associated for STIs among newly-arrived female sex workers in Timika, Indonesia Presented by Nurlan Silitonga ASHM](https://reader036.vdocument.in/reader036/viewer/2022062417/551c1f82550346a84f8b5aa0/html5/thumbnails/17.jpg)
Table 4. Factors associated with inconsistent condom use
Risk factors n inconsistent / n sex (%) Odds ratio (95% CI)
Unadjusted P Adjusted P
Type of sex venues
Bar and freelance 483/535 90.3 1.5 (1.09-2.12) 0.014 NS
Brothel 967/1125 86.0 1.0
Age (years)
≤ 21 308/332 92.8 2.8 (1.69-4.49) 0.000 1.7 (1.00-3.15) 0.069
21-25 416/458 90.8 2.1 (1.41-3.20) 0.000 1.7 (1.02-2.37) 0.042
26-30 395/468 84.4 1.2 (0.81-1.66) 0.414 1.0 (0.69-1.57) 0.859
31+ 331/402 82.3 1.0
Place of Origin
Other region 362/397 91.2 2.0 (1.34-2.95) 0.000 1.6 (1.02-2.50) 0.042
Jawa 686/818 83.9 1.0
Contraception
No 818/923 88.6 1.3 (0.97-1.73) 0.081
Yes 632/737 85.8 1.0
Frequency of sex
1-4 914/1084 84.3 1.0
5-9 339/370 91.6 2.0 (1.36-3.04) 0.001 2.0 (1.30-3.14) 0.002
> 9 197/206 95.6 4.1 (2.05-8.10) 0.000 5.1 (2.30-11.80) 0.000
Having a regular partner
No regular partner 1116/1307 85.4 0.3 (0.17-0.62) 0.000 0.4 (0.19-0.96) 0.039
Mining worker 108/192 94.7 1.0 (0.35-2.80) 0.989 1.4 (0.40-5.00) 0.599
Other 182/192 94.8 1.0
![Page 18: B aseline prevalence and risk factors associated for STIs among newly-arrived female sex workers in Timika, Indonesia Presented by Nurlan Silitonga ASHM](https://reader036.vdocument.in/reader036/viewer/2022062417/551c1f82550346a84f8b5aa0/html5/thumbnails/18.jpg)
Discussion• First study of its kind in Indonesia
• Suggests a partnership with business corporation in developing HIV/AIDS intervention program is feasible
• Young age, high frequency of sex, having regular partner and place of origin can be predictors in choosing an intervention for behavioural change
![Page 19: B aseline prevalence and risk factors associated for STIs among newly-arrived female sex workers in Timika, Indonesia Presented by Nurlan Silitonga ASHM](https://reader036.vdocument.in/reader036/viewer/2022062417/551c1f82550346a84f8b5aa0/html5/thumbnails/19.jpg)
Discussion• This study revealed an increase in consistent
condom use over time. However, the rate is still very low, which may have little impact on reducing the transmission of STIs.
• Increase in the prevalence of HIV infection is worrying, as the prevalence of other STIs such as CT, NG and syphilis in this group study remains high
![Page 20: B aseline prevalence and risk factors associated for STIs among newly-arrived female sex workers in Timika, Indonesia Presented by Nurlan Silitonga ASHM](https://reader036.vdocument.in/reader036/viewer/2022062417/551c1f82550346a84f8b5aa0/html5/thumbnails/20.jpg)
Discussion (Limitations)• There was low representation of women from the street /
freelance / independence (3,9%)
• There were incidents of closing brothel/bars in year 1998 and 1999 which may dramatically reduce the number of sexual encounters
• The frequency of screening was reduced from every month to every two months in 2001, and so newly-arrived FSWs who came to the clinic in 2001 and thereafter were exposed to more partners
• Accuracy for NG testing - In 1997 and 1998, the NG culture was performed with manual CO2 incubator
![Page 21: B aseline prevalence and risk factors associated for STIs among newly-arrived female sex workers in Timika, Indonesia Presented by Nurlan Silitonga ASHM](https://reader036.vdocument.in/reader036/viewer/2022062417/551c1f82550346a84f8b5aa0/html5/thumbnails/21.jpg)
Conclusions• High prevalence of STIs, low consistent condom
use and increasing HIV prevalence among these FSWs require enhanced interventions
• FSWs in Indonesia are vulnerable to HIV transmission, and a partnership with industry can help in developing an intervention program
• Further study on freelance or street FSWs is required
![Page 22: B aseline prevalence and risk factors associated for STIs among newly-arrived female sex workers in Timika, Indonesia Presented by Nurlan Silitonga ASHM](https://reader036.vdocument.in/reader036/viewer/2022062417/551c1f82550346a84f8b5aa0/html5/thumbnails/22.jpg)
Thank you