Demographics, Sexual Risk Behaviours and Uptake of Screening for Sexually Transmitted Infections among Attendees of a Weekly Women-only Community Clinic Program
Tóm tắt
Vancouver’s DTES represents a high-risk neighbourhood, in which there exist a number of community clinics and outreach programs. The purpose of this study was twofold: 1) to describe the population of women attending a weekly women’s program with respect to demographics, risk behaviours and prevalence of STI, and 2) to assess the uptake of STI screening in this setting. A cross-sectional survey was undertaken during a weekly community clinic-based women’s program from October to December, 2004. Women were recruited at the start of the program each week and were invited to provide urine samples for chlamydia and gonorrhea screening. Among 126 respondents, the median age was 42 (36–49), more than half (52%) self-identified as White and 40% as Aboriginal ethnicity. Forty percent were currently involved in the sex trade. Two thirds reported a Pap smear in the past year, while 14% had not accessed sexual health care (Pap smear, STI or HIV testing). Among the 92/126 (74%) women providing a urine sample, the prevalence of chlamydia and gonorrhea was 2.2% and 0.0%, respectively. The majority of women accessing this program were over 35 years of age, and while nearly half were currently involved in the sex trade, cross-sectional screening did not reveal a substantial prevalence of STIs. Women who were not regular program attendees reported less sexual health care, and represented the only two cases of chlamydia found. Innovative programs that better serve the needs of populations that remain unable or unwilling to seek sexual health care in its current formats are needed.
Tài liệu tham khảo
Dallabetta G, Kamenga MC, Field ML. Infections of the female pelvis including septic abortion. In: Cohen J, Powderly WG (Eds.), Infectious Diseases, 2nd ed. London, UK: Mosby, Inc., 2004;693–95.
Fleming DT, Wasserheit JN. From epidemiologi-cal synergy to public health policy and practice: The contribution of other sexually transmitted diseases to sexual transmission of HIV infection. Sex Transm Infect 1999;75(1):3–17.
Sobel JD. Vaginitis, vulvitis, cervicitis and cutaneous vulval lesions. In: Cohen J, Powderly WG (Eds.), Infectious Diseases, 2nd ed. London: Mosby, Inc., 2004;683–92.
Health Canada. Proceedings of the National STD Consensus Meeting and National Goals for the Prevention and Control of Sexually Transmitted Diseases in Canada. Can Commun Dis Rep 1997;23:S6.
Hansen L, Wong T, Perrin M. Gonorrhoeae resurgence in Canada. Int J STD AIDS 2003;14(11):727–31.
Institute of Medicine. The Hidden Epidemic: Confronting Sexually Transmitted Diseases. Washington, DC: National Academy Press, 1996.
Gupta GR, Weiss E. Women’s lives and sex: Implications for AIDS prevention. Cult Med Psychiatry 1993;17(4):399-12.
Ghys PD, Jenkins C, Pisani E. HIV surveillance among female sex workers. AIDS 2001;15(Suppl 3):S33–S40.
Jeal N, Salisbury C. Self-reported experiences of health services among female street-based prostitutes: A cross-sectional survey. Br J Gen Pract 2004;54(504):515–19.
Kohl KS, Markowitz LE, Koumans EH. Developments in the screening for Chlamydia trachomatis: A review. Obstet Gynecol Clin N Am 2003;30:637–58.
Auerswald CL, Sugano E, Ellen JM, Klausner JD. Street-based STD testing and treatment of homeless youth are feasible, acceptable and effective. J Adolesc Health 2006;38(3):208–12.
Pimenta JM, Catchpole M, Rogers PA, Perkins E, Jackson N, Carlisle C, et al. Opportunistic screening for genital chlamydial infection. I: Acceptability of urine testing in primary and secondary healthcare settings. Sex Transm Infect 2003;79(1):16–21.
Steen R, Dallabetta G. Sexually transmitted infection control with sex workers: Regular screening and presumptive treatment augment efforts to reduce risk and vulnerability. Reproductive Health Matters 2003;11(22):74–90.
Bradshaw CS, Pierce LI, Tabrizi SN, Fairley CK, Garland SM. Screening injecting drug users for sexually transmitted infections and blood borne viruses using street outreach and self collected sampling. Sex Transm Infect 2005;81(1):53–58.
Wilson J. Outreach programmes for female commercial sex workers. Int J STD AIDS 1999; 10(11):697–98.
Rekart ML, Patrick DM, Chakraborty B, Maginley JJ, Jones HD, Bajdik CD, et al. Targeted mass treatment for syphilis with oral azithromycin. Lancet 2003;361(9354):313–14.
Steen R, Dallabetta G. The use of epidemiologic mass treatment and syndrome management for sexually transmitted disease control. Sex Transm Dis 1999;26(Supplement 4):S12–S20.
Turner CF, Rogers SM, Miller HG, Miller WC, Gribble JN, Chromy JR, et al. Untreated gono-coccal and chlamydial infection in a probability sample of adults. JAMA 2002;287(6):726–33.
Friedman SR, Flom PL, Kottiri BJ, Zenilman J, Curtis R, Neaigus A, et al. Drug use patterns and infection with sexually transmissible agents among young adults in a high-risk neighbourhood in New York City. Addiction 2003;98(2):159–69.
Ruiz JD, Molitor F, McFarland W, Klausner J, Lemp G, Page-Shafer K, et al. Prevalence of HIV infection, sexually transmitted diseases, and hepatitis and related risk behavior in young women living in low-income neighborhoods of northern California. West J Med 2000;172(6):368–73.
Strathdee S, Sherman SG. The role of sexual transmission of HIV infection among injection and non-injection drug users. J Urban Health 2003;80(4 Suppl 3):iii7–iii14.
Rosengard C, Anderson B, Stein MD. Intravenous drug users’ HIV-risk behaviors with primary/other partners. Am J Drug Alcohol Abuse 2004;30(2):225–36.
Shannon K, Kerr T, Lai C, Ishida T, Wood E, Montaner JSG, et al. Nonadherence to antiretro-viral therapy among a community with endemic rates of injection drug use. J Int Assoc Phys AIDS Care 2005;4(3):66–72.
BC Centre for Disease Control LS. Laboratory Services Annual Report 2002. Vancouver, BC, BCCDC, 2002.
BC Centre for Disease Control. STD/AIDS Control: Annual Report. Vancouver, BC, Provincial Health Services Authority, 2005.
Miller CL, Spittal PM, Frankish JC, Li K, Schechter MT, Wood E. HIV and hepatitis C outbreaks among high-risk youth in Vancouver demands a public health response. Can J Public Health 2005;96(2):107–8.
Mehrabadi A, Craib KJ, Patterson K, Adam W, Moniruzzaman A, Ward-Burkitt B, et al. The Cedar Project: A comparison of HIV-related vulnerabilities amongst young Aboriginal women surviving drug use and sex work in two Canadian cities. Int J Drug Policy 2008;19(2):159–68.
Sherman SG, Latkin CA. Intimate relationship characteristics associated with condom use among drug users and their sex partners: A multilevel analysis. Drug and Alcohol Dependence 2001;64(1):97–104.
Williams M, Ross MW, Bowen AM, Timpson SC, McCoy HV, Perkins K, et al. An investigation of condom use by frequency of sex. Sex Transm Infect 2001;77(6):433–35.
Margolis KL, Lurie N, McGovern PG, Tyrrell M, Slater JS. Increasing breast and cervical cancer screening in low-income women. J Gen Intern Med 1998;13(8):515–21.
Sirovich BE, Welch HG. The frequency of Pap smear screening in the United States. J Gen Intern Med 2004;19(3):243–50.
Yu CK, Rymer J. Women’s attitudes to and awareness of smear testing and cervical cancer. Br J Fam Plann 1998;23(4):127–33.
Hislop TG, Clarke HF, Deschamps M, Joseph R, Band PR, Smith J, et al. Cervical cytology screening. How can we improve rates among First Nations women in urban British Columbia Can Fam Phys 1996;42:1701–8.
Plitt SS, Garfein RS, Gaydos CA, Strathdee SA, Sherman SG, Taha TE. Prevalence and correlates of chlamydia trachomatis, neisseria gonorrhoeae, trichomonas vaginalis infections, and bacterial vaginosis among a cohort of young injection drug users in Baltimore, Maryland. Sex Transm Dis 2005;32(7):446–53.
Poulin C, Graham L. The association between substance use, unplanned sexual intercourse and other sexual behaviours among adolescent students. Addiction 2001;96(4):607–21.
BC Centre for Disease Control. STD/AIDS Control: Annual Report. Vancouver, BC, Provincial Health Services Authority, 2004.
Day S, Ward H. Sex workers and the control of sexually transmitted disease. Genitourinary Med 1997;73(6):161–68.