Addressing the high prevalence of gonorrhoea and chlamydia among female sex workers in Indonesia: results of an enhanced, comprehensive intervention

Bollen, Liesbeth J. M.; Anartati, Atiek; Morineau, Guy; Sulami, Siti; Prabawanti, Ciptasari; Silfanus, Fonny J; Esti, Prima Kartika; Nurhayati, .; Mahatmi, Tiara; Sutarman, Leo; Rahadi, Wahyu; Natpratan, Chawalit; Magnani, Robert J.

doi:10.1136/sti.2009.038299

Cited by 15 publications

(5 citation statements)

References 12 publications

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“…HIV/STI prevalences among transactional and commercial sex workers in PNG were high in this review, and broadly comparable to those observed among similar populations in Indonesia[65], [66], [67], [68], the Philippines[69], [70] and other countries in SE Asia[71], [72], [73], [74], [75]. Prevalences among men and women in the general community however appear much higher in PNG (and in several other Pacific Island nations, such Fiji, Samoa and Vanuatu) than in SE Asia [76], [77].…”

Section: Discussionsupporting

confidence: 82%

The Prevalence of Sexually Transmitted Infections in Papua New Guinea: A Systematic Review and Meta-Analysis

et al. 2010

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BackgroundThe potential for an expanded HIV epidemic in Papua New Guinea (PNG) demands an effective, evidence-based and locally-appropriate national response. As sexually transmitted infections (STIs) may be important co-factors in HIV transmission nationally, it is timely to conduct a systematic review of STI prevalences to inform national policy on sexual health and HIV/STI prevention.Methodology/Principal FindingsWe undertook a systematic review and meta-analysis of HIV and STI prevalences in PNG, reported in peer-reviewed and non-peer-reviewed publications for the period 1950–2010. Prevalence estimates were stratified by study site (community or clinic-based), geographic area and socio-demographic characteristics. The search strategy identified 105 reports, of which 25 studies (10 community-based; 10 clinic-based; and 5 among self-identified female sex workers) reported STI prevalences and were included in the systematic review. High prevalences of chlamydia, gonorrhoea, syphilis and trichomonas were reported in all settings, particularly among female sex workers, where pooled estimates of 26.1%, 33.6%, 33.1% and 39.3% respectively were observed. Pooled HIV prevalence in community-based studies was 1.8% (95% CI:1.2–2.4) in men; 2.6% (95% CI:1.7–3.5) in women; and 11.8% (95% CI:5.8–17.7) among female sex workers.Conclusions/SignificanceThe epidemiology of STIs and HIV in PNG shows considerable heterogeneity by geographical setting and sexual risk group. Prevalences from community-based studies in PNG were higher than in many other countries in the Asia-Pacific. A renewed focus on national STI/HIV surveillance priorities and systems for routine and periodic data collection will be essential to building effective culturally-relevant behavioural and biomedical STI/HIV prevention programs in PNG.

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Section: Discussionsupporting

confidence: 82%

The Prevalence of Sexually Transmitted Infections in Papua New Guinea: A Systematic Review and Meta-Analysis

et al. 2010

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“…As previous studies have indicated that these infections may result in increased risk of HIV transmission [8], it seems appropriate to focus on controlling STIs among waria in order to decrease HIV transmission. We have shown previously that periodic presumptive treatment for gonorrhea and chlamydia among female sex workers in Indonesia resulted in a rapid decline in prevalence of gonorrhea and Chlamydia [12]. A similar project has been developed by the Indonesian Ministry of Health for waria and the first round of presumptive treatment for gonorrhea and chlamydia has been provided for 250 waria in Surabaya in December 2009.…”

Section: Discussionmentioning

confidence: 96%

HIV, Sexually Transmitted Infections, and Sexual Risk Behavior Among Transgenders in Indonesia

et al. 2010

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Behavioral surveillance was undertaken among 1,150 male-to-female transgenders (waria) in Java, Indonesia, 2007; samples were collected for HIV and STI testing (n = 748). Almost all waria had ever sold sex (median duration 10 years). Prevalence of HIV was 24.4%, syphilis 26.8% and rectal gonorrhea and/or chlamydia 47.0%. Syphilis and rectal STIs were associated with HIV infection. Consistent condom use during receptive anal sex with clients was reported by 35.9% waria and was higher among those who visited an STI clinic and who knew their HIV status. Efforts should continue to strengthen behavior change and STI care in future HIV prevention programs.

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“…Brothel-based FSWs have experienced the highest increase, from 0.62% in 2000 to 20.16% in 2010 [8]. This high prevalence is accompanied by a high prevalence of gonococcal and chlamydial infections, both important factors in the high risk of HIV infection among brothel-based FSWs and clients [9]. Moreover, behavioural surveys in 2009, 2010 and 2011 show that consistent condom use among brothel-based FSWs remains below 40%, much lower than the national target to achieve a minimum 60% consistent condom use among high risk groups including FSWs [6].…”

Section: Introductionmentioning

confidence: 99%

Newcomers in a hazardous environment: a qualitative inquiry into sex worker vulnerability to HIV in Bali, Indonesia

2014

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BackgroundWomen new to sex work and those with a greater degree of mobility have higher risk of HIV infection. Using social capital as a theoretical framework, we argue that better understanding of the interactions of micro-level structural factors can be valuable in reshaping and restructuring health promotion programmes in Bali to be more responsive to the concerns and needs of newcomer and mobile female sex workers (FSWs).MethodsWe conducted interviews with 11 newcomer FSWs (worked < six months), 9 mobile FSWs (experienced but worked at the current brothel < six months), and 14 senior FSWs (experienced and worked at current brothel > six months). The interviews explored women’s experience of sex work including how and why they came to sex work, relationships with other FSWs and their HIV prevention practices.ResultsA thematic framework analysis revealed newcomer FSWs faced multiple levels of vulnerability that contributed to increased HIV risk. First, a lack of knowledge and self-efficacy about HIV prevention practices was related to their younger age and low exposure to sexual education. Second, on entering sex work, they experienced intensely competitive working environments fuelled by economic competition. This competition reduced opportunities for positive social networks and social learning about HIV prevention. Finally, the lack of social networks and social capital between FSWs undermined peer trust and solidarity, both of which are essential to promote consistent condom use. For example, newcomer FSWs did not trust that if they refused to have sex without a condom, their peers would also refuse; this increased their likelihood of accepting unprotected sex, thereby increasing HIV risk.ConclusionsPublic health and social welfare interventions and programmes need to build social networks, social support and solidarity within FSW communities, and provide health education and HIV prevention resources much earlier in women’s sex work careers.

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Addressing the high prevalence of gonorrhoea and chlamydia among female sex workers in Indonesia: results of an enhanced, comprehensive intervention

Abstract: The STI-control programme was effective in reducing infection prevalence and increasing condom use among sex workers. This intervention has been scaled up and may decrease national STI levels and reduce HIV transmission.

Cited by 15 publications

References 12 publications

The Prevalence of Sexually Transmitted Infections in Papua New Guinea: A Systematic Review and Meta-Analysis

The Prevalence of Sexually Transmitted Infections in Papua New Guinea: A Systematic Review and Meta-Analysis

HIV, Sexually Transmitted Infections, and Sexual Risk Behavior Among Transgenders in Indonesia

Newcomers in a hazardous environment: a qualitative inquiry into sex worker vulnerability to HIV in Bali, Indonesia

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