Sexually transmitted disease among street dwellers in southern Ethiopia: a mixed methods study design

Abstract

Background: Lack of knowledge about sexual violence, its consequences, substance use and homelessness are major problems that make street dwellers susceptible to sexually transmitted diseases. Hence, this study assessed knowledge, attitudes and treatment-seeking behaviors related to sexually transmitted diseases among street dwellers in southern Ethiopia. Methods: An explanatory sequential mixed-methods study design was conducted among 842 respondents. A simple random sampling technique was used to select seven cities among fourteen major cities of the region. The sample was allocated proportionally to each selected city. In order to identify and fill in the required sample size, a snowball sampling technique was used. A pre-tested and structured interviewer-administered questionnaire was used to collect quantitative data. The collected data were entered using Epidata and exported to SPSS version 23.0 for further analysis. Unstructured questionnaires were also used to collect 21 in-depth interviews and 10 key informants' interviews. Respondents for in-depth interviews were selected purposively during quantitative data collection. Results: Most street dwellers were aware of (86.7%) and had a favourable attitude towards (84.4%) prevention and management of sexually transmitted diseases. A portion of respondents experienced bad-smelling genital discharge (13.8%), genital ulcers (11.2%) and a burning sensation (14.5%) during urination, in the previous year. Among those who experienced symptoms of sexually transmitted disease, only 15.3% of them received treatment from a health care provider. Fear of questions raised by providers was one of the reasons for not seeking care according to our qualitative findings. Conclusions: In this study, a significant number of street dwellers reported experiencing symptoms of a sexually transmitted disease. Despite having awareness about sexually transmitted diseases, seeking treatment from a health center was found to be low based on both quantitative and qualitative findings. We recommend that health care providers should undergo special training to address the sexual and reproductive health problems of street dwellers.

Validação de instrumento: HIV e outras infecções sexualmente transmissíveis em pessoas em situação de rua

“…Estudo com PSR revelou que 39,5% apresentaram sintomas de ISTs, sendo 13,8% corrimento genital de mau cheiro, 11,2% úlceras genitais e 14,5% sensação de queimação durante a micção. Entretanto, a procura por atendimento e seguimento do tratamento foi baixa, demonstrando também a necessidade de os profissionais de saúde se capacitarem para abordar e entender o contexto das PSR (22) .…”

Instrument validity: HIV and other sexually transmitted infections in homeless people

“…A study with HP revealed that 39.5% presented symptoms of STIs, with 13.8% genital discharge of bad smell, 11.2% genital ulcers and 14.5% burning sensation during urination. However, the demand for care and treatment follow-up was low, also demonstrating the need for health professionals to train themselves to address and understand the context of HP ( 22 ) .…”

Substance Use among Homeless Reproductive Age People in Southern Ethiopia

“…By using an individual who assigned by an authorized person, the first study respondent was identified. Then, the snowball sampling technique was used to recruit the representative sample [34].…”

“…The written and verbal consent was obtained from each study subject prior to the data collection process proceeded. For those who were less than 18 years, written informed consent was obtained from their parent or guardian prior to the data collection process which was also approved by ethical review board [34].…”