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

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28/09/2013

• 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

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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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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

Specific objectives

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

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Study instrument

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

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Definitions

• Marital partner: spouse

• Regular partner: live-in sexual partner/ cohabiting partner

• Non regular partner (NRP)- sexual partner the respondent is not living with; had sex rarely or only once with whom money is not involved

• Sex worker: MSW/FSW- sexual partner to whom respondent paid money/ material in exchange for sex

• According to PIMS

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Key Findings

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Age

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Mean-34.0

SD-11.407

N-983

Range-15-84

Education

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Occupation

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40% of the comprised

Skilled labourers/Drivers

and Forces

50% with unskilled labourers

Marital Status

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52.5% married

11% denied sex exposures

Other than the MP

Reason for attendance

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Last Sexual Partner/other than MP

16 N=875

50% sample admitted

LSE with a NRP

13.6% FSW/ 13.4% MSM

MSW exposures were

minimal

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Further Questioning were done on

among males who admitted having

sexual exposures with partners

other than the marital partner

Partners according to the age group

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Younger males- more contacts with males & Older males with FSW

Type of sexual Activity

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N=875

Males with MSM exposures

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N=127

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

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According to the BSS 2006-2007 5.5% drug use among factory workers

Safer Sex

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Reasons for Non use of condoms

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Information/ Condoms

Friends, 29.30%

Newspaper 9.60%

Doctor, 21.60%

NGO, 1.30%

Forces, 9.20%

Internet, 8.10% Friends

TV

School

Newspaper

Relative

Doctor

Teacher

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

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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 population- which 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

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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

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