Indian J Sex Transm Dis Indian J Sex Transm Dis
Official Publication of the Indian Association for the Study of Sexually Transmitted Diseases
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ORIGINAL ARTICLE
Year : 2007  |  Volume : 28  |  Issue : 1  |  Page : 15-18
 

STI/HIV prevalence in Sakhi Swasthya Abhiyan, Jyotisangh, Ahmedabad: A clinico-epidemiological study


1 Department of Community Medicine, BJ Medical College, Ahmedabad, India
2 Department of Community Medicine, Kesar SAL Medical College, Ahmedabad, India

Correspondence Address:
N J Talsania
Department of Community Medicine, B.J. Medical College, New Civil Hospital Campus, Asarwa, Ahmedabad - 380 016
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0253-7184.35705

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   Abstract 

Sexually transmitted infections (STIs) are becoming a major public health problem in India. The study was undertaken to identify different STIs/ human immunodeficiency virus (HIV) in female sex workers, their co-relation with socio-demographic and behavioral factors; and also to provide treatments for symptoms. The mean age at presentation was 27.5 years for female sex workers (FSWs), and majority (64.5%) of FSWs were below 35 years. A higher proportion (75%) of the women were living with their husbands. About 88.5% of sex workers had less than two partners per day, and only 2.5% of sex workers had more than five partners per day. Forty percent received a monthly income of less than Rs. 1,000, while 6% received more than Rs. 5,000 per month. In half (49.4%) of the women, vaginal discharge was the major complaint, followed by genital ulcer, pain during intercourse, burning micturition and lower abdominal pain. HIV and VDRL reactivity were observed in 3.2% and 3.73% of subjects respectively.


Keywords: Female sex workers, human immunodeficiency virus, sexually transmitted infections


How to cite this article:
Talsania N J, Rathod D, Shah R, Patel Y, Mathur N. STI/HIV prevalence in Sakhi Swasthya Abhiyan, Jyotisangh, Ahmedabad: A clinico-epidemiological study. Indian J Sex Transm Dis 2007;28:15-8

How to cite this URL:
Talsania N J, Rathod D, Shah R, Patel Y, Mathur N. STI/HIV prevalence in Sakhi Swasthya Abhiyan, Jyotisangh, Ahmedabad: A clinico-epidemiological study. Indian J Sex Transm Dis [serial online] 2007 [cited 2020 Aug 13];28:15-8. Available from: http://www.ijstd.org/text.asp?2007/28/1/15/35705



   Introduction Top


Sexually transmitted infections (STIs) are a group of communicable diseases that are predominantly transmitted by sexual contact. They are a global problem of great magnitude. [1] Approximately 5% of the Indian population suffers from one or the other form of STIs other than human immunodeficiency virus (HIV) infection every year. [2] STIs are the major contributors to the morbidity and mortality of population, particularly because their presence increases the risk of HIV transmission between 2- and 20-fold. [3] The major mode of HIV transmission reported in India is heterosexual contact (85%), [4] and female sex workers constitute a core group for transmission of HIV and other sexually transmitted infections. [5],[6],[7] The reported number of HIV-positive female sex workers in India is 71,000. [8]

In many parts of southeast Asia, female sex workers are at increased risk of HIV and hence targeted for HIV prevention activities. [9] Since transmission of HIV/STIs requires the exchange of body fluid between infected and uninfected, only certain behaviors are risky for acquiring HIV/STI. [10],[11] Hence this study was conducted by clinical experts and Community Medicine Department of B.J. Medical College, Ahmedabad, to assess prevalence of STIs/HIV among female sex workers according to various socio-demographic and behavioral factors. A rapid clinical and laboratory surveillance was carried out so that they could be put under treatment, thus reducing the source of infections.


   Materials and Methods Top


A cross-sectional community-based study was conducted among the female sex workers registered under NGO Jyotisangh STD clinic of Ahmedabad, where Gujarat State AIDS Control Society is taking care of them since the year 2000. The female sex workers in this area lived in different ethnic clusters based on place of origin, language spoken, i.e., migrant population from different states of India. The survey was conducted as teamwork from 5 th December to 25 th December 2005. It was decided to study all (almost 3,000) FSWs registered under Jyotisangh. We could study only 1,930 FSWs for all aspects based on socio-demographic and behavioral factors during that period.

Counseling was carried out for the purpose of clinical examination and for voluntary testing. Identification number for clinical and laboratory investigation was given to all (1,930) participants for confidentiality, but 1,527 participants were enrolled for laboratory tests. The rest (403) were not enrolled because of various reasons - like unwillingness, refusal to undergo clinical and laboratory examination and fear of disclosure of clinical condition. Voluntary informed consent was obtained from all the participants; personal privacy and confidentiality were respected at all the levels. The standard pro forma pre-designed, pre-tested earlier by the Department for International Development (DFID), New Delhi, was used. Open-ended questions covering their socio-demographic profile, daily life style, sexual practices and attitude, 'health care'-seeking behavior were asked. 'Health checkup' approach was taken to motivate the participants. All the participants were encouraged by giving them a gift from Jyotisangh.

Clinical examination of 1,527 participants was carried out by resident doctors of obstetric and gynecology and skin department. All volunteers underwent per speculum and per vaginal examination, if necessary, at the obstetric and gynecological examination room and were sent to skin OPD room to rule out relevant dermatological conditions. Laboratory tests were used to confirm the diagnosis of syphilis (by VDRL) and other STIs. Participants were screened for HIV (ELISA), HBV, HCV; and other blood investigations (hemoglobin, blood group and blood sugar) were also carried out.

Data obtained through pro forma were entered into a computer with Epi Info package to establish co-relation. Various socio-demographic and behavioral factors and prevalence of STIs were examined by calculating odds ratio and Chi-square values.


   Results Top


Socio-demographic characteristics of FSWs are shown in [Table - 1]. The mean age was 27.5 years. As many as 79.2% of sex workers belonged to Gujarat state, and the remaining 20.8% were from other states. The majority (95.0%) of FSWs were Hindu, and three-fourths of women were living with their husbands. About 88.5% of sex workers had less than two partners per day, and only 2.5% of sex workers had more than five partners per day.

Symptoms and treatment-seeking behaviors among FSWs [Table - 2] showed that in half of the women, vaginal discharge was the major complaint reported within the last 6 months, followed by genital ulcer (4.9%) and dyspariunia (4.3%). Among all FSWs, 1,303 FSWs reported at least one symptom within the last 6 months, but nearly half of them had not sought any treatment; whereas 20.6% of FSWs went to Jyotisangh as they felt free to talk with the staff at Jyotisangh, along with counseling.

[Table - 3] shows that STI prevalence was higher in the >25 years age group; in those who were married, illiterate; FSWs from other states; those having up to five sex partners per day; and those having income >1,000 per month. There was no significant difference when compared with respect to the age and marital status.

Laboratory findings [Table - 4] showed that 1.11% were HBV (asymptomatic carriers) positive; 1.44%, HVC positive; and 3.73%, VDRL positive. As many as 3.2% were found to be HIV positive.


   Discussion Top


It is unethical to stigmatize or discriminate people who are HIV infected. STI/HIV infection occurs worldwide. It is more common in high-risk segments of the population, e.g., commercial sex workers (CSWs), migrants, intravenous drug users. Among women, the profession of commercial sex confers an extra-high risk of acquisition of HIV. [12]

In the present study, out of the 1,527 FSWs screened, 3.2% were reactive for HIV and 3.7% were VDRL positive. Although Gujarat state has moderate prevalence of HIV/AIDS (>5% prevalence in high-risk group and <1% in low-risk group), [13] in this study all FSWs registered under Jyotisangh (almost 3,000) had not participated; and again, the results are well matched with published data of Gujarat State AIDS Control Society (GSACS), showing that the prevalence of HIV is gradually reducing among STIs due to improved awareness among the sex workers.

In a study conducted by Thakor HG et al . in 2000 [14] on sex workers of Surat city, about two-thirds of sex workers were below the age of 30 years. As many as 51% were married; about 90% of them had more than two sexual partners per day. In this study age group compares well with the finding, but majority of the females had less than two partners per day as three-fourths of them were residing with their husband; hence it might be possible that they had not adopted commercial sex as the primary source of income.

Almost all the socio-demographic parameters of female sex workers match with the studies carried out by Jyotisangh, Ahmedabad, in 2000 and 2004. [15] The prevalence of HIV was 11.7% in 2000 and 13.2% in 2004; whereas in the present study, it was 3.2%. As many as 88.5% of FSWs having less than two partners per day led to less exposure and therefore less chances of infection, with the higher level of awareness regarding preventive measures as compared to the previous studies.

The present study highlights the need for generation of awareness regarding symptoms of STIs and importance of treatment for reducing the risk of getting HIV infection. Behavior change communication and condom promotion should be promoted as they are very effective means for prevention of STIs.

 
   References Top

1.Sharma AK, Chubey D. Risk factors in STI. Indian J Sex Trans Dis 1996;17:8-10.  Back to cited text no. 1    
2.Alder MW. STI control in developing countries. Genito Urin Med 1996;72:85-8.  Back to cited text no. 2    
3.Fleming DT, Wasserhelt JN. From epidemiological synergy to public health policy and practice: The contribution of the STIs to sexual transmission of HIV infection. Sex Transm Infect 1999;75:3-17.  Back to cited text no. 3    
4.National AIDS Control Organization, Monthly updates on AIDS, Facts and figures, September 30, 2004.  Back to cited text no. 4    
5.Weniger BG, Limpakarnjanarat K, Ungchusak K, Thanprasertsuk S, Choopanya K, Vanichseni S, et al . The epidemiology of HIV infection and AIDS in Thialand. AIDS 1991;5:S71-85.  Back to cited text no. 5  [PUBMED]  
6.Rodigues JJ, Mehendale SM, Shepherd ME, Divekar AD, Gangakhedkar RR, Quinn TC, et al . Risk factors for HIV infection in people attending clinics for STIs in India. Br Med J 1995;311:283-6.  Back to cited text no. 6    
7.Thuy NT, Lindan CP, Phong TH, Van Dat, Nhung VT, Barclay J, et al . Predictors of visits to commercial sex workers by male attendees at sexually transmitted disease clinics in southern Vietnam. AIDS 1999;13:719-25.  Back to cited text no. 7    
8.National AIDS Control Organization, HIV estimate 2003. Facts and figures 2003. Available from: http://www.nacoonline.org/facts_overview.  Back to cited text no. 8    
9.Thuong NV, Nhung VT, Nghia KV, Tram LT, O'Farrell N. HIV in female sex workers in five border provinces of Vietnam. Sex Transm Infect 2005;81:477-8.  Back to cited text no. 9  [PUBMED]  [FULLTEXT]
10.Bandra A. Social foundations of thought and action- A social cognitive theory. Englewood Cliffs, NJ: Prentice-Hall; 1986.   Back to cited text no. 10    
11.Clark NM. Social learning theory in current health education practice. Adv Health Education Promot 1987;2:251-75.  Back to cited text no. 11    
12.Bwayo J, Plummer F, Omari M, Mutere A, Moses S, Ndinya-Achola J, et al . Human immunodeficiency virus infection in long-distance truck drivers in east Africa. Arch Intern Med 1994;154:1391-6.  Back to cited text no. 12  [PUBMED]  
13.Park K. Park's Textbook of Preventive and Social Medicine. 19 th ed. Bhanot: Jabalpur; 2007. p. 287.  Back to cited text no. 13    
14.Thakor HG, Kosambiya JK, Desai VK. Prevalence of STI in sex workers of Surat city. Indian J Commun Med 2004;29:104-8.  Back to cited text no. 14    
15.Malodia L. Prevalence and trend of STI and HIV among FSW of Ahmedabad, AMC AIDS Control Society, 2004.  Back to cited text no. 15    



 
 
    Tables

  [Table - 1], [Table - 2], [Table - 3], [Table - 4]


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