Issuu on Google+

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

2


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

4


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

6


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 •

• •

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

Non regular partner (NRP)- sexual partner the

Sex worker: MSW/FSW- sexual partner to whom

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

9


Key Findings

10


Age

Mean-34.0 SD-11.407 N-983 Range-15-84

11


Education

12


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

15


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

16


Further Questioning were done on among males who admitted having sexual exposures with partners other than the marital partner

17


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

21


Coitarche

22


Other related risks

23


Drug Users- 5.9% of total

According to the BSS 2006-2007 5.5% drug use among factory workers 24


Safer Sex

25


Reasons for Non use of condoms

26


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

27


• Only STI with a short incubation period Gonorrhoea, Genital Herpes and Non gonococcal urethritis were considered.

28


Relationship/Partner/STI

29


MSM/STI

30


31


Contribution of each category

32


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

38


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


40


To understand the risk behaviours for HIV among male STD clinic attendees