1
|
Steen R, Zhao P, Wi TE, Punchihewa N, Abeyewickreme I, Lo YR. Halting and reversing HIV epidemics in Asia by interrupting transmission in sex work: experience and outcomes from ten countries. Expert Rev Anti Infect Ther 2014; 11:999-1015. [PMID: 24124797 DOI: 10.1586/14787210.2013.824717] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
HIV epidemics spread rapidly through Asian sex work networks two decades ago under conditions of high vulnerability, low condom use, intact male foreskins and ulcerative STIs. Experiences implementing interventions to prevent transmission in sex work in ten Asian countries were reviewed. All report increasing condom use trends in sex work. In the seven countries where condom use exceeds 80%, surveillance and other data indicate declining HIV trends or low and stable HIV prevalence with declining STI trends. All four countries with national-level HIV declines among sex workers have also documented significant HIV declines in the general population. While all interventions in sex work included outreach, condom programing and STI services, the largest declines were found in countries that implemented structural interventions on a large scale. Thailand and Cambodia, having controlled transmission early, are closest to providing universal access to HIV care, support and treatment and are exploring HIV elimination strategies.
Collapse
Affiliation(s)
- Richard Steen
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Netherlands
| | | | | | | | | | | |
Collapse
|
2
|
Sexual, Behavioral, and Social Characteristics of Female Sex Workers and Their Risk of Sexually Transmitted Infections: In South Korea. SEXUALITY AND DISABILITY 2012. [DOI: 10.1007/s11195-012-9261-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
3
|
Lee J, Jung SY, Kwon DS, Jung M, Park BJ. Condom Use and Prevalence of Genital Chlamydia trachomatis Among the Korean Female Sex Workers. Epidemiol Health 2010; 32:e2010008. [PMID: 21191461 PMCID: PMC2984866 DOI: 10.4178/epih/e2010008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2010] [Accepted: 07/07/2010] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES Since 2004, availability of resources for preventing sexually transmitted diseases in Korean female sex workers (FSWs) has decreased because of strict application of a law against prostitution. This study is to evaluate the condom use and prevalence of Chlamydia trachomatis among FSWs in Korea. METHODS We performed a cross-sectional study of FSWs from 15 major sex work sites in Korea from June to November 2008, using convenience sampling. Self-administered questionnaires and urine samples were collected after all participants' written informed consent. Urine samples were analyzed with PCR at a single central laboratory. RESULTS Among 1,086 FSWs who consented to study participation, data from 999 FSWs were appropriate for analysis. C. trachomatis prevalence was 12.8% (95% CI: 10.7-14.9%). Younger age increased risk for C. trachomatis. Whereas majority of FSWs (71.0%) answered high self confidence in condom negotiation, the proportion of FSWs who always used condoms last month was only 23.7%. However, practicing regular condom use showed significant protection against chlamydia infection, not self confidence in condom negotiation. CONCLUSION In Korea, FSWs were not practicing enough self-protection at work with a high prevalence of C. trachomatis. Education for constant practice of protection against sexually transmitted diseases is needed, especially for younger FSWs.
Collapse
Affiliation(s)
- Joongyub Lee
- Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Korea
| | | | | | | | | |
Collapse
|
4
|
Nag VL, Dash NR, Pathak A, Agarwal SK. Need for syphilis screening and counselling in HIV counselling and testing centres: a curtain raiser study from north India. Aust J Rural Health 2009; 17:102-6. [PMID: 19335601 DOI: 10.1111/j.1440-1584.2009.01045.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Voluntary counselling and testing centres (VCTC) are important HIV screening points for the population with suspicion or apprehension for HIV, because of high-risk exposures. Theoretically, these are also at the risk of having co-infections, commonest being syphilis. The present short-term study was aimed at knowing the sero-reactivity of syphilis among a study cohort attending the VCTC in King George's Medical University, Lucknow, India. METHOD During a 2.5-month period, 49 HIV-positive and 171 HIV-negative sera were tested for venereal disease research laboratory (VDRL). The positive sera were further tested for treponema pallidum haemagglutination (TPHA). RESULT Eleven (22.4%) HIV-positive sera and 104 (60.8%) HIV-negative sera were VDRL-reactive (>or=1:8 dilutions). Of these, TPHA was reactive in three (27.3%) and four (3.9%), respectively. CONCLUSION The result might suggest the need for routine screening and counselling for syphilis at VCTC. Studies from other centres on larger population are required.
Collapse
Affiliation(s)
- Vijaya Lakshmi Nag
- Department of Microbiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
| | | | | | | |
Collapse
|
5
|
Risk factors for HIV infection in males who have sex with males (MSM) in Bangladesh. BMC Public Health 2007; 7:153. [PMID: 17625020 PMCID: PMC1931591 DOI: 10.1186/1471-2458-7-153] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2006] [Accepted: 07/12/2007] [Indexed: 11/17/2022] Open
Abstract
Background Recent surveillance data from Bangladesh indicate rising HIV infection among intravenous drug users (IDU) in the country. We suggest a likely association between HIV risk factors in this group and other groups, such as males who have sex with males (MSM). Methods Data on MSM in Bangladesh was collected and analyzed from numerous primary and secondary sources, including government ministries, non-profit health organizations, and personal communications. Results The overall prevalence of HIV in Bangladesh is relatively low, but surveillance data indicate that infection has reached significant proportions in certain high-risk groups and may soon spread to other groups, specifically MSM. Conclusion The epidemiology of HIV infection in other countries suggests that increasing rates of HIV in higher-risk populations can precede an epidemic in the general population. We review the data concerning MSM, IDU and HIV in Bangladesh from a variety of sources and propose ways to prevent HIV transmission.
Collapse
|
6
|
Alam N, Rahman M, Gausia K, Yunus MD, Islam N, Chaudhury P, Monira S, Funkhouser E, Vermund SH, Killewo J. Sexually transmitted infections and risk factors among truck stand workers in Dhaka, Bangladesh. Sex Transm Dis 2007; 34:99-103. [PMID: 16837827 PMCID: PMC2730758 DOI: 10.1097/01.olq.0000225325.23340.a3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study was conducted to determine the prevalence of selected sexually transmitted infections (STIs) and their risk factors among workers in and near a truck stand in Dhaka, Bangladesh. STUDY DESIGN A random sample of 696 men and 206 women were recruited into a cross-sectional study using a census that enumerated transport agents, motor mechanics, laborers, and vendors in Tejgaon truck stand. RESULTS The prevalence rates of syphilis (rapid plasma reagin and Treponema pallidum hemagglutination), gonorrhea (polymerase chain reaction [PCR]), and chlamydial infections (PCR) among men were 4.1%, 7.7%, and 2.3%, respectively, and among women were 2.9%, 8.3%, and 5.2%. Multivariable analysis revealed that having >or=2 sex partners in the last month, never using a condom with sex workers, and ever injecting narcotics were significant predictors of STI among men. Being never married, working as a laborer, older age, and living within the truck stand were significant predictors of practicing high-risk behaviors among men, but none predicted infection with STIs. CONCLUSIONS Both behavioral and STI data suggest that truck stand workers should be included in the STI/HIV intervention programs.
Collapse
Affiliation(s)
- Nazmul Alam
- ICDDR,B: Centre for Health and Population Research, Bangladesh.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Nigro L, Larocca L, Celesia BM, Montineri A, Sjoberg J, Caltabiano E, Fatuzzo F. Prevalence of HIV and other sexually transmitted diseases among Colombian and Dominican female sex workers living in Catania, Eastern Sicily. J Immigr Minor Health 2006; 8:319-23. [PMID: 16924411 DOI: 10.1007/s10903-006-9002-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION STDs are a significant cause of illness throughout the world. Female sex workers (FSWs) are commonly perceived as belonging to a social group which may engage in high-risk behaviour for acquiring or transmitting HIV and other STDs. The number of immigrant women engaged in sex work has increased in Catania, Sicily, over the last 10 years. This study aims to estimate the prevalence of HIV, HBV, HCV and syphilis among Colombian and Dominican FSWs. METHODS In total 118 (63.78%) of the FSWs contacted in the course of the project agreed to participate in the study. All women enrolled were counselled on STDs/HIV, safer sex practices and the use of condoms. Blood samples were taken and tested for HIV, HBV, HCV and syphilis. RESULTS Of the 118 FSWs enrolled, all were negative for both HIV and HCV infection. Two women (1.6%) were positive for hepatitis B (HbsAg). Syphilis testing by VDRL showed three positive results (2.5%), which was confirmed by TPHA. DISCUSSION This study showed that HIV, HBV, HCV and syphilis seroprevalence among Colombian and Dominican FSWs remains low or very rare. It also indicates that these women were healthy when they arrived in Italy and that condom use with clients is high.
Collapse
Affiliation(s)
- Luciano Nigro
- Italian League for the Fight Against AIDS-Catania LILA-Catania, via Sanfilippo 10, 95100, Catania, Italy.
| | | | | | | | | | | | | |
Collapse
|
8
|
Abstract
Increasing population mobility and increasing frequency and variety of sexually transmitted infections (STI) are closely linked around the globe. Although all mobile populations are at increased risk for acquiring STIs, international travelers are the focus of this review. Several aspects of travel such as opportunity, isolation, and the desire for unique experiences all enhance the likelihood of casual sexual experiences while abroad. The situational loss of inhibition of travel can be markedly enhanced by alcohol and drugs. Several of the most important elements of the complex interaction between travel and STIs are discussed.
Collapse
Affiliation(s)
- Brian J Ward
- McGill University Tropical Diseases Centre, Montreal General Hospital, 1650 Cedar Avenue, Montreal, Quebec, Canada.
| | | |
Collapse
|
9
|
Hosain GMM, Chatterjee N. Beliefs, sexual behaviours and preventive practices with respect to HIV/AIDS among commercial sex workers in Daulatdia, Bangladesh. Public Health 2005; 119:371-81. [PMID: 15780324 DOI: 10.1016/j.puhe.2004.08.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2003] [Revised: 07/28/2004] [Accepted: 08/16/2004] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Despite the rising prevalence of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) since 1994 in Bangladesh, the World Bank found the epidemic to be preventable provided vigorous and prompt action is taken. High-risk heterosexual contact, especially among commercial sex workers (CSWs), is a major mode of transmission. Formulation of relevant and effective prevention programmes for HIV/AIDS requires better understanding of the knowledge, attitudes, behaviours and practices in the high-risk groups. STUDY DESIGN AND METHODS A cross-sectional survey comprising face-to-face interviews using a structured questionnaire with items on knowledge, beliefs, condom use and other sexually transmitted diseases (STDs). SETTINGS In total, 300 CSWs were interviewed between July and October 2000 in Daulatdia brothel. Daulatdia is one of the largest river ports in Bangladesh. RESULTS Although most CSWs had heard of AIDS, correct knowledge of transmission and symptoms was lacking. HIV/AIDS was viewed as a remote threat, over-ridden by immediate economic and survival concerns. Although the majority of CSWs knew that condoms afforded protection against STDs/AIDS, only one-third of sex acts on the last day of work were protected through condom use. CSWs who were married, had been a CSW for less than 5 years, were with a new client, or had two or more clients in last working day reported significantly higher condom use. Client dissatisfaction was the major reason for not using condoms. Many did not obtain treatment for STDs in a timely fashion, if at all. CONCLUSIONS Bangladesh needs a comprehensive HIV programme that combines clinical and screening measures with behaviour change and communication interventions, along with change in social norms and attention to the rights of CSWs in order to avert a widespread epidemic.
Collapse
|
10
|
Nessa K, Waris SA, Alam A, Huq M, Nahar S, Chawdhury FAH, Monira S, Badal MU, Sultana J, Mahmud KF, Das J, Mitra DK, Sultan Z, Hossain N, Rahman M. Sexually Transmitted Infections Among Brothel-Based Sex Workers in Bangladesh: High Prevalence of Asymptomatic Infection. Sex Transm Dis 2005; 32:13-9. [PMID: 15614116 DOI: 10.1097/01.olq.0000148298.26228.74] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
UNLABELLED OBJECTIVE AND GOAL: The goal of this study was to study the prevalence of sexually transmitted infections (STIs)/reproductive tract infections (RTIs) among brothel-based sex workers (SWs) in Bangladesh. STUDY A cross-sectional study was conducted among SWs in 4 randomly selected brothels. A sociodemographic and behavioral survey and pelvic examination was conducted. Specimens including endocervical swab, high vaginal swab, and blood were collected and were examined for Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, bacterial vaginosis candidiasis, and syphilis. RESULTS A total of 439 SWs were enrolled and 49.6% had genital symptoms. Among all SWs, 17.5% were positive for N. gonorrhoeae; 15.5% for C. trachomatis; 7.5% for T. vaginalis, and 6.6% had active syphilis. A total of 67.4% SWs were positive for at least 1 cervical and/or vaginal infection. CONCLUSION The prevalence of STIs/RTIs among SWs in brothels in Bangladesh is high. An intervention strategy addressing both symptomatic and asymptomatic infections and periodic screening of SWs for RTIs/STIs is essential for successful HIV and STIs prevention programs.
Collapse
Affiliation(s)
- Khairun Nessa
- International Centre for Diarrhoeal Disease Research, Bangladesh
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Nessa K, Waris SA, Sultan Z, Monira S, Hossain M, Nahar S, Rahman H, Alam M, Baatsen P, Rahman M. Epidemiology and etiology of sexually transmitted infection among hotel-based sex workers in Dhaka, Bangladesh. J Clin Microbiol 2004; 42:618-21. [PMID: 14766825 PMCID: PMC344477 DOI: 10.1128/jcm.42.2.618-621.2004] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The prevalence of sexually transmitted infections (STIs) and reproductive tract infections (RTIs) among hotel-based sex workers (HBSWs) in Dhaka, Bangladesh, was studied. A total of 400 HBSWs were enrolled in the study during April to July 2002. Endocervical swabs, high vaginal swabs, and blood samples from 400 HBSWs were examined for Neisseria gonorrhoeae (by culture), Chlamydia trachomatis (by PCR), Trichomonas vaginalis (by microscopy), antibody to Treponema pallidum (by both rapid plasma reagin and Treponema pallidum hemagglutination tests), and antibody to herpes simplex virus type 2 (HSV-2) (by enzyme-linked immunosorbent assay). Sociodemographic information as well as gynecological and obstetric information was collected. Among the HBSWs, 228 women (57%) were symptomatic and 172 (43%) were asymptomatic, 35.8% were positive for N. gonorrhoeae, 43.5% were positive for C. trachomatis, and 4.3% were positive for T. vaginalis. A total of 8.5% had syphilis, 34.5% were positive for HSV-2, and 86.8% were positive for at least one RTI or STI. There was no significant difference between the prevalences of STIs among the symptomatic and asymptomatic HBSWs. These data suggested a high prevalence of STIs, particularly gonorrhea and chlamydia, among HBSWs in Dhaka.
Collapse
Affiliation(s)
- Khairun Nessa
- International Centre for Diarrhoeal Disease Research, Bangladesh. Family Health International SRISTI, Khilgaon, Dhaka, Bangladesh
| | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Steen R, Dallabetta G. Sexually transmitted infection control with sex workers: regular screening and presumptive treatment augment efforts to reduce risk and vulnerability. REPRODUCTIVE HEALTH MATTERS 2004; 11:74-90. [PMID: 14708399 DOI: 10.1016/s0968-8080(03)02295-x] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Sex workers have high rates of sexually transmitted infections (STIs), many of them easily curable with antibiotics. STIs as co-factors and frequent unprotected exposure put sex workers at high risk of acquiring HIV and transmitting STIs and HIV to clients and other partners. Eliminating STIs reduces the efficiency of HIV transmission in the highest-risk commercial sex contacts--those where condoms are not used. This paper reviews two STI treatment strategies that have proven effective with female sex workers and their clients. 1) Clinical services with regular screening have reported increases in condom use and reductions in STI and HIV prevalence. Such services include a strong peer education and empowerment component, emphasize consistent condom use, provide effective treatment for both symptomatic and asymptomatic STIs, and begin to address larger social, economic and human rights issues that increase vulnerability and risk. 2) Presumptive treatment of sex workers, a form of epidemiologic treatment, can be an effective short-term measure to rapidly reduce STI rates. Once prevalence rates are brought down, however, other longer-term strategies are required. Effective preventive and curative STI services for sex workers are key to the control of sexually transmitted infections, including HIV, and are highly synergistic with other HIV prevention efforts.
Collapse
|
13
|
Gibney L, Saquib N, Metzger J. Behavioral risk factors for STD/HIV transmission in Bangladesh's trucking industry. Soc Sci Med 2003; 56:1411-24. [PMID: 12614693 DOI: 10.1016/s0277-9536(02)00138-7] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
To examine behaviors that could influence STD/HIV transmission in Bangladesh's trucking industry, a survey was orally administered to 388 truck drivers/helpers at Tejgaon truck stand in Dhaka. A two-tiered sampling strategy was used: 38 trucking agencies were randomly selected and a mean of 10.2 subjects was recruited from each agency. Focus group and in-depth interviews were also conducted. The focus was on behaviors that affect (i) exposure to STD/HIV infection, (ii) efficiency of transmission of infection and (iii) duration of infectiousness. The findings illustrated that intravenous drug use was not an important risk factor; only 1 subject had used drugs intravenously. Sexual risk behaviors, however, were prevalent: the mean number of sexual partners in the past year was 4.57 (SD=8.70) and in the past 3 months was 1.82 (SD=3.27). Premarital and extramarital sex was common, often with commercial sex workers (CSW); 54% of all subjects had relations with at least 1 CSW in the past year. In a multiple logistic regression analysis, subjects who engaged in other types of socially risky behavior (drinking alcohol, ingesting or smoking recreational drugs, having sex with other men) were significantly (p<0.05) more likely to have had sex with a CSW in the past year. While 7.2% of subjects had a male sex partner in the past year, 21% had ever had one (likely youthful experimentation for most). Condom use was very infrequent: of the 343 subjects who had ever had sexual intercourse only 31% had ever used a condom and most of those subjects had used only once or occasionally. Having sex with CSWs, being married, having heard of AIDS and age were significantly associated (p<0.05) with ever use of condoms. Frequently, subjects who had genital symptoms either did not have those symptoms treated at all or treated in a timely fashion, and over 1/3 did not change their sexual behavior while infected. To reduce the potential for the spread of STD/HIV in this population, appropriate treatment practices for sexually transmitted infections need to be encouraged and condom use promoted, particularly in the context of casual sexual relations.
Collapse
Affiliation(s)
- Laura Gibney
- Department of Epidemiology, University of Alabama at Birmingham, Ryals Building, 1665 University Boulevard, 35294-0022, Birmingham, AL, USA.
| | | | | |
Collapse
|
14
|
Jenkins C, Rahman H. Rapidly changing conditions in the brothels of Bangladesh: impact on HIV/STD. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2002; 14:97-106. [PMID: 12092941 DOI: 10.1521/aeap.14.4.97.23882] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Bangladesh is a low HIV prevalence country with several well-documented at-risk groups, the most prominent of which is brothel-based sex workers. Using two waves of HIV behavioral surveillance data for a national sample of all operating registered brothels supplemented by historical and observational accounts, this article presents a case study of the changing conditions in the brothels. Between the two waves of surveillance, several brothels were forcibly closed; the number of sex workers dropped; the average number of clients per woman rose; and overall safety, both in terms of violence and protected sex, did not improve. Only treatment-seeking behavior for sexually transmitted diseases was positively changed. Continued surveillance of the possible negative impact of HIV prevention programs is under way. Protective policies are needed to facilitate improved HIV prevention and safety of sex workers, a key to controlling the HIV epidemic.
Collapse
Affiliation(s)
- Carol Jenkins
- Family Health International, IMPACT, Bangladesh, Dhaka.
| | | |
Collapse
|
15
|
Gibney L, Macaluso M, Kirk K, Hassan MS, Schwebke J, Vermund SH, Choudhury P. Prevalence of infectious diseases in Bangladeshi women living adjacent to a truck stand: HIV/STD/hepatitis/genital tract infections. Sex Transm Infect 2001; 77:344-50. [PMID: 11588280 PMCID: PMC1744386 DOI: 10.1136/sti.77.5.344] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Little is known about infection rates for human immunodeficiency virus (HIV) and other diseases that can be transmitted sexually in Bangladeshi women who may be at intermediate levels of risk--that is, women who are not commercial sex workers (CSWs) but whose sexual contacts may include men at high risk for STD. This study examines HIV/hepatitis/STD and other genital tract infections in women living near Tejgaon truck stand in Dhaka, Bangladesh. METHODS This population based study was conducted from January to December 1998. A random sample of 384 women provided urine and blood samples and participated in an interview; 261 of them also had a physical examination in which vaginal and cervical specimens were taken. Laboratory tests included PCR on urine and cervical swabs for gonorrhoea and chlamydia, culture for trichomoniasis, serology tests for syphilis, herpes simplex 2, hepatitis B, C, D, HIV1, HIV2, and clinical diagnoses of other genital tract infections. RESULTS None of the participants tested positive for HIV. In the 261 women who had a physical examination, trichomoniasis was detected in 19.5%, chlamydia in 3.4%, gonorrhoea in 5.4%, bacterial vaginosis in 37.2%, and candidiasis in 10%. In the full sample of 384 women, with tests of urine and blood, prevalence of infection with chlamydia, gonorrhoea, syphilis, and herpes simplex 2 was detected in 0%, 6.3%, 5.7%, and 32% respectively. Almost 50% of the subjects had ever been exposed to hepatitis B, 3.6% were currently infective, 1.6% had hepatitis C, and none had hepatitis D. CONCLUSION The high prevalence of certain of these infectious diseases indicates the need to implement prevention interventions with these women and, perhaps more importantly, with their male partners. Qualitative research is needed to provide insights into their sexual behaviour and the contexts in which high risk behaviours occur.
Collapse
Affiliation(s)
- L Gibney
- The University of Alabama at Birmingham, School of Public Health, Department of Epidemiology and International Health, Birmingham, Alabama 35294-0022, USA.
| | | | | | | | | | | | | |
Collapse
|
16
|
Hawkes S. Commentary: Human immunodeficiency virus and hepatitis in Bangladesh: widespread or targeted prevention strategies? Int J Epidemiol 2001; 30:885-6. [PMID: 11511621 DOI: 10.1093/ije/30.4.885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- S Hawkes
- Population Council, India Habitat Centre, New Delhi, India.
| |
Collapse
|
17
|
Abstract
Female sex workers are at high risk for infection with HIV, and their clients may act as a bridging population by spreading HIV to the general population. Comprehensive HIV surveillance among sex workers includes surveillance of HIV infection, of sexually transmitted infections and of risk behavior. Surveillance of HIV infection among sex workers is critical for countries with low-level or concentrated HIV epidemics, and can help in monitoring the response to the HIV epidemic in countries with a generalized epidemic. Sex workers are a vulnerable population, and particular attention needs to be paid to human rights issues including consent, confidentiality and stigma. Collaborations with key players in the local sex work scene--sex workers themselves in the first place--and alliances with salient institutions and groups are key to the success of surveillance among sex workers. Surveillance activities should have a strong link to interventions targeted at sex workers. Surveillance for HIV infection among sex workers can be institution- or community-based. Institutional settings include screening programs for registered sex workers, of sexually transmitted diseases clinics, and re-education camps. Specific sources of bias need to be considered in different settings, and must be measured--through the collection of socio-demographic and behavioral data--to allow a correct interpretation of prevalence data and time trends. Community-based HIV infection surveillance can be conducted in a probability sample of the sex worker population, thereby reducing selection bias. This requires the mapping of sex workers' contact venues, and drawing a random sample from the resulting sampling frame.
Collapse
Affiliation(s)
- P D Ghys
- UNAIDS, 20 Avenue Appia, CH-1211 Geneva 27, Switzerland.
| | | | | |
Collapse
|
18
|
Salimullah M, Tahera Y, Siddiqui MA, Salam MA, Rumi MA, Huq F, Hassan MS. Prevalence of human immunodeficiency virus infection among tuberculosis cases in some clinics in Dhaka, Bangladesh. Trans R Soc Trop Med Hyg 2000; 94:276. [PMID: 10974997 DOI: 10.1016/s0035-9203(00)90319-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- M Salimullah
- Department of Immunology, Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM), Dhaka, Bangladesh
| | | | | | | | | | | | | |
Collapse
|
19
|
Rahman M, Alam A, Nessa K, Hossain A, Nahar S, Datta D, Alam Khan S, Amin Mian R, Albert MJ. Etiology of sexually transmitted infections among street-based female sex workers in Dhaka, Bangladesh. J Clin Microbiol 2000; 38:1244-6. [PMID: 10699032 PMCID: PMC86388 DOI: 10.1128/jcm.38.3.1244-1246.2000] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
An etiological study of sexually transmitted infections (STIs) was conducted among female sex workers (FSWs) in Dhaka, Bangladesh. Endocervical swab and blood samples from 269 street-based FSWs were examined for Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis as well as for antibodies to Treponema pallidum and herpes simplex virus 2 (HSV-2). Sociodemographic data and data regarding behavior were also collected. A total of 226 of the 269 FSWs (84%) were positive for the STI pathogens studied. Among the 269 FSWs, 35.5% were positive for N. gonorrhoeae, 25% were positive for C. trachomatis, 45.5% were positive for T. vaginalis, 32.6% were seropositive for T. pallidum, 62.5% were seropositive for HSV-2, and 51% had infections with two or more pathogens.
Collapse
Affiliation(s)
- M Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka 1000, Bangladesh.
| | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Azim T, Islam MN, Bogaerts J, Mian MA, Sarker MS, Fattah KR, Simmonds P, Jenkins C, Choudhury MR, Mathan VI. Prevalence of HIV and syphilis among high-risk groups in Bangladesh. AIDS 2000; 14:210-1. [PMID: 10708297 DOI: 10.1097/00002030-200001280-00022] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
21
|
Hawkes S, Morison L, Foster S, Gausia K, Chakraborty J, Peeling RW, Mabey D. Reproductive-tract infections in women in low-income, low-prevalence situations: assessment of syndromic management in Matlab, Bangladesh. Lancet 1999; 354:1776-81. [PMID: 10577639 DOI: 10.1016/s0140-6736(99)02463-0] [Citation(s) in RCA: 91] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND In the control of reproductive-tract infections, including sexually transmitted infections (STIs), in low-income and middle-income countries, WHO recommends syndromic management for individuals with symptoms. This intervention was initially developed in areas where prevalence of such infections is high. We investigated the clinical effectiveness and cost of this approach among a group of women with a low prevalence of infection. METHODS During a 5-month period, we investigated all women complaining of abnormal vaginal discharge and seeking care at maternal and child health/family-planning centres in Matlab, Bangladesh, for the presence of laboratory-diagnosed reproductive-tract infections and STIs. Syndromic diagnoses made by trained health-care workers were compared with laboratory diagnosis of infection. We then calculated the costs of treating women by means of the recommended WHO algorithm and an adapted algorithm incorporating use of a speculum and simple diagnostic tests. FINDINGS The prevalence of endogenous infections among 320 women seen was 30%. Cervical infections (Neisseria gonorrhoeae and Chlamydia trachomatis) were found in only three women. The WHO algorithm had a high sensitivity (100%) but a low specificity (zero for bacterial vaginosis, candida, and Trichomonas vaginalis). The speculum-based algorithm had a low sensitivity (between zero and 59%) but a higher specificity (79-97%). Between 36% and 87% of costs would have been spent on uninfected women. INTERPRETATION The high rate of overtreatment in the population studied carries both financial and social costs--the latter in potentially exposing women misdiagnosed as having an STI to threats of domestic disruption or even violence. We make recommendations for management programmes in areas of low STI prevalence and low income.
Collapse
Affiliation(s)
- S Hawkes
- International Centre for Diarrhoeal Disease Research, and Centre for Health and Population Research, Bangladesh.
| | | | | | | | | | | | | |
Collapse
|
22
|
Abstract
Nationwide surveillance of HIV/AIDS from 1989 through 1996 in Bangladesh included several risk groups such as professional blood donors, patients with sexually transmitted diseases (STDs), pregnant women at antenatal clinics, commercial sex workers (CSWs), patients with tuberculosis, long-distance truck drivers, sailors, and non-residents. The population was enrolled by convenience sampling after taking informed consent. Among 70,676 persons tested, 80 (1.13 per 1000) were HIV positive. The prevalence rate was steady until 1994, and then increased rapidly. The rate among male heterosexuals was significantly higher than that in females (3.40 per 1000 versus 0.29 per 1000; odds ratio (OR) 11.60; 95% confidence intervals (CI) 6.45 to 21.16; P < 0.0001). Twelve per cent of patients with STDs had HIV. The HIV cases concentrated in 2 districts, Sylhet (25/72) and Chittagong (20/72), that border India and Myanmar (formerly Burma), respectively. Frequent movement of people of Bangladesh to India, Pakistan, Myanmar and Thailand, where HIV rates are higher, is one of the possible sources of spread of the cases. Bangladesh has the potential to avert epidemic spread of HIV at its early stage.
Collapse
Affiliation(s)
- M Islam
- School of Public Health, University of Alabama at Birmingham, USA
| | | | | | | |
Collapse
|
23
|
Gibney L, Choudhury P, Khawaja Z, Sarker M, Islam N, Vermund SH. HIV/AIDS in Bangladesh: an assessment of biomedical risk factors for transmission. Int J STD AIDS 1999; 10:338-46. [PMID: 10361927 DOI: 10.1258/0956462991914087] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Behavioural risk factors for HIV/AIDS in Bangladesh were reviewed in a preceding article in this journal. Omitted from that review was a discussion of potential biomedical risk factors including: (i) an unregulated blood supply system in which blood used in transfusions is not screened for HIV and is donated primarily by professional donors: (ii) unsterile injections in non-formal and formal health-care settings; and (iii) a high prevalence in high-risk groups of other sexually transmitted diseases (STDs) which may function as co-factors for HIV transmission, particularly if chronically untreated. Studies elsewhere in the world suggest that the unregulated blood supply system, in particular, poses a serious danger in terms of the spread of the HIV epidemic. While certain socio-cultural factors may be contributing to low levels of HIV in Bangladesh, the prevalence of biomedical and behavioural risk factors suggest the importance of implementing targeted cost-effective interventions now.
Collapse
Affiliation(s)
- L Gibney
- Schools of Public Health and Medicine, University of Alabama at Birmingham, 35294-0022, USA.
| | | | | | | | | | | |
Collapse
|
24
|
Gibney L, Choudhury P, Khawaja Z, Sarker M, Vermund SH. Behavioural risk factors for HIV/AIDS in a low-HIV prevalence Muslim nation: Bangladesh. Int J STD AIDS 1999; 10:186-94. [PMID: 10340200 PMCID: PMC2564792 DOI: 10.1258/0956462991913862] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A review of published and unpublished data indicates the prevalence of high-risk behaviours for HIV transmission in segments of the Bangladeshi population. These include casual unprotected sex, heterosexual as well as between males, prior to and after marriage. Intravenous drug use (IVDU) exists though illicit drugs are more commonly inhaled. There is a fear, however, that inhalers may turn to injecting drugs, as is common in neighbouring countries. The lack of public awareness of HIV/AIDS, and misconceptions about the disease, may contribute to continued high-risk behaviours by segments of the population and, thus, to the spread of HIV. Bangladesh's proximity to India and Myanmar (countries with high HIV endemicity and a rapidly growing number of cases) increases fears of an epidemic in Bangladesh. This proximity will only be a risk factor, however, if high-risk contacts occur between nationals of these countries.
Collapse
Affiliation(s)
- L Gibney
- School of Public Health, University of Alabama at Birmingham, USA.
| | | | | | | | | |
Collapse
|