Sexually Transmitted Infection Control with Sex Workers: Regular Screening and Presumptive Treatment Augment Efforts to Reduce Risk and Vulnerability

Steen, Richard; Dallabetta, Gina

doi:10.1016/s0968-8080(03)02295-x

Cited by 99 publications

(76 citation statements)

References 48 publications

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“…The nature of commercial sex in the poorest settings with high numbers of partners, high STI prevalence in the clients, limited diagnostic capabilities, little bargaining power among women for condom use, and strong financial incentives for non-use of protection-suggests that sex workers are likely to remain highly vulnerable to STI transmission. Multidimensional control programmes that include outreach to men and perhaps periodic presumptive treatment (PPT) of sex workers 26 seem rational in this context, although the best means of applying PPT is not clear. 27 This study had several limitations.…”

Section: Discussionmentioning

confidence: 99%

Results of a randomised trial of male condom promotion among Madagascar sex workers

Feldblum

Hatzell²,

Damme³

et al. 2005

Sexually Transmitted Infections

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Objectives: To test the effect of supplementing peer promotion of male condom use with clinic based counselling, measured in terms of STI prevalence and reported male condom use. Methods: 1000 female sex workers in Madagascar were randomised to two study arms: peer education supplemented by individual risk reduction counselling by a clinician (peer + clinic) versus condom promotion by peer educators only (peer only). STI testing was conducted at baseline and 6 months. Behavioural interviews were administered at baseline, 2, 4, and 6 months. Results: At baseline, women in the peer only arm had prevalences of 16.0%, 23.6%, and 12.1% for chlamydia, gonorrhoea, and trichomoniasis respectively, with an aggregate prevalence of 38.2%. Baseline STI prevalences for the peer + clinic arm were slightly lower and 34.1% in aggregate. At 6 months, aggregate STI prevalence increased in the peer only arm to 41.4%, whereas the aggregate prevalence diminished slightly to 32.1% in the peer + clinic arm. In logistic regression analyses, the estimated odds ratios (ORs) for chlamydia, gonorrhoea, trichomoniasis, and aggregate STI were 0.7 (95% confidence interval 0.4 to 1.0), 0.7 (0.5 to 1.0), 0.8 (0.6 to 1.2), and 0.7 (0.5 to 0.9) respectively, comparing the peer + clinic arm with the peer only arm. The logistic regression OR for reported condom use with clients in the past 30 days increased from 1.1 at 2 months to 1.8 at 6 months, comparing the peer + clinic arm with the peer only arm, and was 1.4 overall (1.1 to 1.8). Adjustment for baseline factors changed the regression results little. Conclusions: The impact of male condom promotion on behaviour can be heightened through more concentrated counselling on risk reduction. Persistently high STI prevalence despite increases in reported condom use by sex workers supports the need for multidimensional control programmes.

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Section: Discussionmentioning

confidence: 99%

Results of a randomised trial of male condom promotion among Madagascar sex workers

Feldblum

Hatzell²,

Damme³

et al. 2005

Sexually Transmitted Infections

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“…Such interventions emphasize the means of prevention, information and referrals to clinical services. 11,17 There is strong evidence that male latex condoms reduce transmission of HIV by at least 80-85%, are effective against most other STIs and reduce the risk of unintended pregnancy. 18 Other barrier methods, such as the female condom, may have advantages over the male condom in some situations, or as backup methods.…”

Section: Primary Preventionmentioning

confidence: 99%

Control of sexually transmitted infections and prevention of HIV transmission: mending a fractured paradigm

Steen¹,

Wi²,

Kamali³

et al. 2009

Bull World Health Org

Self Cite

116

103

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Control of sexually transmitted infections (STIs) is feasible, leads to improved sexual and reproductive health and contributes to preventing HIV transmission. The most advanced HIV epidemics have developed under conditions of poor STI control, particularly where ulcerative STIs were prevalent. Several countries that have successfully controlled STIs have documented stabilization or reversal of their HIV epidemics.STI control is a public health outcome measured by reduced incidence and prevalence. The means to achieve this include: (i) targeting and outreach to populations at greatest risk; (ii) promoting and providing condoms and other means of prevention; (iii) effective clinical interventions; (iv) an enabling environment; and (v) reliable data.Clinical services include STI case management, screening and management of STIs in sex partners. Syndromic case management is effective for most symptomatic curable STIs and screening strategies exist to detect some asymptomatic infections. Presumptive epidemiologic treatment of sex partners and sex workers complement efforts to interrupt transmission and reduce prevalence. Clinical services alone are insufficient for control since many people with STIs do not attend clinics. Outreach and peer education have been effectively used to reach such populations.STI control requires effective interventions with core populations whose rates of partner change are high enough to sustain transmission. Effective, appropriate targeting is thus necessary and often sufficient to reduce prevalence in the general population. Such efforts are most effective when combined with structural interventions to ensure an enabling environment for prevention. Reliable surveillance and related data are critical for designing and evaluating interventions and for assessing control efforts.Une traduction en français de ce résumé figure à la fin de l'article. Al final del artículo se facilita una traducción al español. ‫املقالة.‬ ‫لهذه‬ ‫الكامل‬ ‫النص‬ ‫نهاية‬ ‫يف‬ ‫الخالصة‬ ‫لهذه‬ ‫العربية‬ ‫الرتجمة‬ a

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“…One approached HIV as an occupational hazard, advocating harm reduction strategies such as empowering SWs to use condoms and removing structural barriers to safety (Rekart 2005). The other examined strategies to provide STI treatment for SWs and concluded that, using presumptive periodic treatment (PPT) with single dose antibiotics, followed by regular algorithm-driven screening, was likely to be the most effective strategy (Steen & Dallabetta 2003). The effectiveness of either -harm reduction or STI treatment as an HIV prevention intervention -for SWs has not been systematically assessed.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of interventions for the prevention of HIV and other sexually transmitted infections in female sex workers in resource poor setting: a systematic review

Shahmanesh

Patel

Mabey

et al. 2008

Tropical Med Int Health

214

156

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Summaryobjective To systematically review the evidence for effectiveness of HIV and sexually transmitted infection (STI) prevention interventions in female sex workers in resource poor settings.method Published and unpublished studies were identified through electronic databases (Cochrane database, Medline, Embase, and Web of Science), hand searching and contacting experts. Randomizedcontrolled-trials and quasi-experimental studies were included if they were conducted in female sex workers from low and middle income settings; if the exposure was described; if the outcome was externally measurable, it was after the discovery of HIV, and if follow-up was longer than 6 months. A priori criteria were used to extract data. Meta-analysis was not performed due to the heterogeneity of studies.results Twenty-eight interventions were included. Despite methodological limitations, the evidence suggested that combining sexual risk reduction, condom promotion and improved access to STI treatment reduces HIV and STI acquisition in sex workers receiving the intervention. Strong evidence that regular STI screening or periodic treatment of STIs confers additional protection against HIV was lacking. It appears that structural interventions, policy change or empowerment of sex workers, reduce the prevalence of STIs and HIV.conclusion Rigorous evaluation of HIV ⁄ STI prevention interventions in sex workers is challenging. There is some evidence for the efficacy of multi-component interventions, and ⁄ or structural interventions. The effect of these interventions on the wider population has rarely been evaluated.

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Sexually Transmitted Infection Control with Sex Workers: Regular Screening and Presumptive Treatment Augment Efforts to Reduce Risk and Vulnerability

Cited by 99 publications

References 48 publications

Results of a randomised trial of male condom promotion among Madagascar sex workers

Results of a randomised trial of male condom promotion among Madagascar sex workers

Control of sexually transmitted infections and prevention of HIV transmission: mending a fractured paradigm

Effectiveness of interventions for the prevention of HIV and other sexually transmitted infections in female sex workers in resource poor setting: a systematic review

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