Sexual Risk Behaviors and Sexually Transmitted Infections among Persons Attending HIV Care in Bamrasnaradura Infectious Diseases Institute
Keywords:
HIV/AIDS patients, Sexually transmitted diseases, Bamrasnadarura Infectious Diseases InstituteAbstract
The objectives of this study were to assess sexual behaviors, factors associated with unprotected sex, and prevalence of STIs among PLHA receiving services at the HIV clinic, Bamrasnaradura Infectious Diseases Institute. PLHA who agreed to participate were interviewed about sexual behavior, condom use, STI related symptoms, examined for genital ulcers and tested for STIs (Neisseria gonorrhoeae and Chlamydial trachomatis infection by polymerase chain reaction, syphilis by serology, VDRL and TPHA positive defined as syphilis). Wet smear for Trichomonas vaginalis was performed in women only. PLHA with signs or symptoms received standard care according to the hospital treatment guidelines. Proportions were compared using chi-square tests, multivariate models of factors associated with unprotected sex were done. From July 2005-February 2006, 894 PLHA participated in the project of which 395 (44%) were men and 499 (56%) were women. Median age was 36 years. Sexual intercourse in the last 3 months was reported by 61%. Among the 546 sexually active persons in the last 3 months, 90/138 (65%) of men and 166/203 (82%) of women reported using condoms with last sex with a steady partner (p-value < 0.01), 90/225 (40%) of men and 37/259 (14%) of women reported having sex with casual partners (p-value <0.01) and 51/98 (52%) reported using a condom with last sex with a casual partner. Forty-four (25%) of 178 men reported having sex with men, 20/33 (61%) had unprotected anal intercourse with last sex. Forty-three (19%) of 223 men bought sex in the last 3 months, 7/26 (27%) used a condom during last sex with a sex worker. Disclosure of HIV status to partners was reported by 266/331 (80%) of women and 89/143 (62%) of men (p-value<0.01). Of 401 steady partners, 44% had unknown HIV status, 34% were HIVpositive, and 22% were HIV-negative. Unprotected sexual intercourse with a steady partner was associated with undisclosed HIV status to the partner (OR =2.5 [95%CI 1.2-5.2]). Unprotected sex with a partner with unknown or discordant HIV status was associated with PLHA not receiving antiretroviral (ARV) treatment (OR = 2.2 [95%CI1.2-4.2]). HIV disclosure to a steady partner was associated with female sex (OR=2.6 [95%CI1.4-4.6]) and ARV treatment (OR=2.2 [95%CI 1.2-4.2]). Prevalence of any STIs including chlamydia, gonorrhea, syphilis and Trichomonas was 10% in men and 6% in women (p-value = 0.06). Prevalence of syphilis was higher in men compared to women, 8% and 2% respectively (p-value <0.01). Factors associated with any STIs were STI-related symptoms in men (OR=31.2 [95%CI7.0-139.7]) and STI-related signs by physical/internal examination in women (OR=4.0 [95%CI1.2-12.9]). In conclusions PLHA receiving care at this HIV clinic had high-risk sexual behavior but low STI prevalence. Persons who did not received ARVs or who did not disclose their HIV status to their partners had a higher risk of unprotected sex. Unprotected sex was high among steady partners with unknown or negative HIV status. Men with STI-related symptoms and women with STI-related signs had a higher risk for STIs compared to other groups.
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