Chlamydia Prevalence and Associated Behaviours Among Female Sex Workers in Vanuatu: Results from an Integrated Bio-behavioural Survey, 2011

Abstract

There is insufficient data on sexually transmitted infections (STI) and related behaviours among key populations, including female sex workers (FSW), in the Pacific region. Using respondent driven sampling, we conducted an integrated bio-behavioural survey with FSW in Vanuatu (aged ≥18 years) to investigate risk behaviours associations with Chlamydia trachomatis (CT). Weighted population estimates and correlates of CT infection were calculated. Among 149 FSW, prevalence of CT was 36 % (95 % CI 26–48 %). Few FSW reported consistent condom use with recent transactional sex partners (TSP) (8 %; 95 % CI 2–13 %). CT infection was positively associated with increasing number of TSP (adjusted odds ratio [AOR] 1.1; 95 % CI 1.0–1.2) and group sex (AOR 2.9; 95 % CI 1.1–8.2). CT was negatively associated with increasing age of first sex (AOR 0.6; 95 % CI 0.5–0.9) and previous STI treatment (AOR 0.1; 95 % CI 0.0–0.4). A comprehensive public health strategy for prevention and treatment of STI among FSW, incorporating community empowerment strategies, FSW-targeted health services and periodic presumptive treatment, is urgently needed in Vanuatu.

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References

  1. 1.

    STI Regional Working Group. Breaking the silence: responding to the STI epidemic in the Pacific. Secretariat of the Pacific Community. 2010.

  2. 2.

    Cliffe SJ, Tabrizi S, Sullivan EA, Pacific Islands Second Generation HIV Surveillance Group. Chlamydia in the Pacific Region, the Silent Epidemic. Sex Transm Dis. 2008;35(9):801–806.

  3. 3.

    Vanuatu National Statistics Office, Minstry of Finance and Economic Management, Vanuatu Ministry of Health. Census of population and housing 2009: Summary release. 2009.

  4. 4.

    Vanuatu Ministry of Health, Secretariat of the Pacific Community. Second generation surveillance of antenatal women, STI clinic clients and youth, Vanuatu, 2008. Secretariat of the Pacific Community. 2008.

  5. 5.

    World Health Organization. Global incidence and prevalence of selected curable sexually transmitted infections—2008. Geneva: WHO Press; 2012.

    Google Scholar 

  6. 6.

    World Health Organisation. Global Strategy for the prevention and control of sexually transmitted infections: 2006–2015: breaking the chain of transmission, Geneva. 2007.

  7. 7.

    Low N, Broutet N, Adu-Sarkodie Y, Barton P, Hossain M, Hawkes S. Global control of sexually transmitted infections. Lancet. 2006;368(9551):2001–16.

    PubMed  Article  Google Scholar 

  8. 8.

    Gold J, Bulu S, Sladden T. Vanuatu female sex worker survey. 2007.

  9. 9.

    Coghlan B, O’Neill S, Goullou M, Spelman T, van Gemert C, Watson-Jones R, et al. HIV in the Pacific: 1984–2007. Burnet Institute. 2008.

  10. 10.

    Report of the Commission on AIDS in the Pacific. Turning the tide: an OPEN strategy for a response to AIDS in the Pacific. Report of the Commission on AIDS in the Pacific. Suva, Fiji: UNAIDS Pacific Region. 2009.

  11. 11.

    Buchanan-Aruwafu H. An integrated picture: HIV risk and vulnerability in the pacific. Research Gaps, Priorities and Approaches. Secretariat of the Pacific Community. 2007.

  12. 12.

    Mossman E, Roguski M, Ravuidi R, Devi R. Integrated biological behavioural surveillance survey and size estimation of sex workers in Fiji: HIV Prevention Project. Commissioned by UNAIDS Pacific Office and the Ministry of Health with assistance from Fiji National University. 2013.

  13. 13.

    McMillan K, Worth H. Risky business Vanuatu: selling sex in Port Vila. Sydney: International HIV Research Group; 2011.

    Google Scholar 

  14. 14.

    World Health Organization, UNAIDS. Guidelines on surveillance among populations most at risk for HIV. Geneva: World Health Organisation; 2011.

    Google Scholar 

  15. 15.

    Family Health International, Implementing AIDS Prevention and Care Project. Behavioral surveillance surveys BSS: guidelines for repeated behavioral surveys in populations at risk of HIV. Virginia, USA: Family Health International. 2000.

  16. 16.

    Heckathorn D. Respondent driven sampling: a new approach to the study of hidden populations. Soc Prob. 1997;44(2):174–99.

    Article  Google Scholar 

  17. 17.

    Malekinejad M, Johnston LG, Kendall C, Kerr LR, Rifkin MR, Rutherford GW. Using respondent-driven sampling methodology for HIV biological and behavioral surveillance in international settings: a systematic review. AIDS Behav. 2008;12(4 Suppl):S105–30 (PubMed PMID: 18561018).

    PubMed  Article  Google Scholar 

  18. 18.

    Wilson K. Development and validation of an HIV confirmatory testing strategy for use in Pacific Island countries and territories. Melbourne: NRL; 2012.

  19. 19.

    UNAIDS/WHO Working Group on Global HIV/AIDS and STI Surveillance. Guidelines for second generation HIV surveillance: an update: know your epidemic. Geneva: WHO/UNAIDS. 2013.

  20. 20.

    Giles K, Handcock M. Respondent-driven sampling: an assessment of current methodology. Sociol Methodol. 2010;40:285–327.

    Article  Google Scholar 

  21. 21.

    van Gemert C, Kwarteng T, Bulu S, Bergeri I, Malverus J, Tarivonda L, et al. Vanuatu integrated bio-behavioural survey and population size estimation with female sex workers in Vanuatu, 2011. Melbourne: Burnet Institute; 2013.

    Google Scholar 

  22. 22.

    Cwikel JG, Lazer T, Press F, Lazer S. Sexually transmissible infections among female sex workers: an international review with an emphasis on hard-to-access populations. Sex Health. 2008;5(1):9–16.

    PubMed  Article  Google Scholar 

  23. 23.

    Mgone CS, Passey ME, Anang J, Peter W, Lupiwa T, Russell DM, et al. Human immunodeficiency virus and other sexually transmitted infections among female sex workers in two major cities in Papua New Guinea. Sex Transm Dis. 2002;29(5):265–70.

    PubMed  Article  Google Scholar 

  24. 24.

    McMillan K, Worth H. Risky business: sex work and HIV prevention in Fiji. Sydney: International HIV Research Group; 2010.

    Google Scholar 

  25. 25.

    Harcourt C, Donovan B. The many faces of sex work. Sex Transm Infect. 2005;81(3):201–6.

    PubMed  Article  CAS  PubMed Central  Google Scholar 

  26. 26.

    Vandepitte J, Lyerla R, Dallabetta G, Crabbe F, Alary M, Buve A (2006) Estimates of the number of female sex workers in different regions of the world. Sex Transm Infect 82(Suppl 3):iii18–25. PubMed PMID: 16735288. Pubmed Central PMCID: 2576726.

  27. 27.

    Baral S, Beyrer C, Muessig K, Poteat T, Wirtz AL, Decker MR, et al. Burden of HIV among female sex workers in low-income and middle-income countries: a systematic review and meta-analysis. Lancet Infect Dis. 2012;12(7):538–49.

    PubMed  Article  Google Scholar 

  28. 28.

    Kerrigan D, Fonner V, Stromdahl S, Kennedy C. Community empowerment among female sex workers is an effective HIV prevention intervention: a systematic review of the peer-reviewed evidence from low- and middle-income countries. AIDS Behav. 2013;17(6):1926–40 (English).

    PubMed  Article  Google Scholar 

  29. 29.

    World Health Organization. Prevention and treatment of HIV and other sexually transmitted infections for sex workers in low- and middle-income countries: recommendations for a public health approach. Geneva: WHO; 2012.

    Google Scholar 

  30. 30.

    WHO. Periodic presumptive treatment for sexually transmitted infections, experience from the field and recommendations for research. Geneva: WHO Library Cataloguing-in-Publication Data. 2008.

  31. 31.

    Friedman SR, Bolyard M, Khan M, Maslow C, Sandoval M, Mateu-Gelabert P, et al. Group sex events and HIV/STI risk in an urban network. J Acquir Immune Defic Syndr. 2008;1(49):440–6.

    Article  Google Scholar 

  32. 32.

    Baggaley RF, Dimitrov D, Owen BN, Pickles M, Butler AR, Masse B, et al. Heterosexual anal intercourse: a neglected risk factor for HIV? Am J Reprod Immunol. 2013;69:95–105.

    PubMed  Article  PubMed Central  Google Scholar 

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Acknowledgments

We wish to thank the Vanuatu Ministry of Health for their ongoing support and for laboratory testing; NRL (Melbourne, Australia) for laboratory testing; Wan Smolbag for coordinating data collection and entry and management of the field researchers; WHO Western Pacific Regional Office and the Pacific UNAIDS Coordinator for their technical support in project implementation. Caroline van Gemert received a Travel Grant from the Ian Potter Foundation to receive training in Respondent Driven Sampling from Lisa G Johnston of Tulane University and University of California, San Francisco in USA. We thank the Pacific Island HIV and STI Response Fund Grant, a collaborative funding mechanism by the Australia and New Zealand governments and managed by the Secretariat of the Pacific Community for funding this project. Laboratory testing of specimens at the Port Vila Central Hospital was provided by the Global Fund Round 7 Grant through the Vanuatu Ministry of Health. Finally, we thank all participants of the study for their valuable input.

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Correspondence to Caroline van Gemert.

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van Gemert, C., Stoove, M., Kwarteng, T. et al. Chlamydia Prevalence and Associated Behaviours Among Female Sex Workers in Vanuatu: Results from an Integrated Bio-behavioural Survey, 2011. AIDS Behav 18, 2040–2049 (2014). https://doi.org/10.1007/s10461-014-0791-2

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Keywords

  • Integrated bio-behavioural survey
  • Female sex workers
  • Chlamydia
  • Pacific
  • Risk behaviours