Risk factors for sexually transmitted diseases among sexually active individuals in Mbarara District, Uganda.
Ojera, Jackson Abusu
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BACKGROUND: STDs and HIV/AIDS prevalence has persistently remained high at 14.3% and 11.9% respectively in Mbarara district. HIV (80-85% transmission by sexual intercourse in Uganda), was ranking eighth (1997) among the top ten leading causes of mortality in Mbarara. This prompted research that was conducted in 10 randomly selected health units in April, 2001. OBJECTIVES: To identify socio-demographic characteristic, sexual habits, risky social-cultural practices, and how knowledge of signs/symptoms and complications of STDs were associated with STDs. STUDY DESIGN: Unmatched case-control study of study subjects (156 cases: 151 controls) aged 15 to 65. Fifty community leaders and twenty health workers were key informants. Cases were patients with any one of the STD syndromes (GUD, UD, AVD, genital warts) at the time of the study, while control were patients that did not have any of the STD syndromes at that point in time and had not had any STD during the 12 months preceding the study. RESULTS: The following factors showed significant association with the risk of STDs on both univariate and multivariate analyses: Female constituted 64.7% of cases compared to 47.7% of controls (OR 2.6, CI: 1.50-4.60); about twice the proportion of cases (44.9%) compared to controls (24.5%) had one/more casual partners (OR1.90, CI: 1.24-3.68); more cases (36.5%) than controls (22.5%) had never used a condom with casual partners (OR 1.3,CI: 1.06-1.63); almost four times the percentage of cases (32.1%) compared to controls (8.7%) had unprotected sex because of partner(s)’ refusal to use a condom (OR 3.37, CI: 1.59-7.16); while 51% of cases compared to 22.3% of controls had history of their partners complained of STD signs/symptoms yet they were asymptomatic (OR 8.44, CI: 1.64-43.45). The factors that showed significant association with STDs after adjustment include: being a peasant [56.4% of cases and 55.6% of controls (OR 1.98, CI: 1.06-3.74)] and having no knowledge that STDs have association with HIV [37.2% of cases and 29.8% of controls (OR 2.22, CI: 1.07-4.61)]. The following factors ceased to be significant after adjustment but were significantly associated with, or protective against, STD, on univariate analysis: having had sex with casual partners when drunk or whenever there was feeling for sex [43.3% of cases and 21.8% of controls (OR 0.46, CI: 0.27-0.76)] and accepting condom use if one of the partners has STDs [88% controls and 77.6% cases of 0.47, CI: 0.27-0.92). These findings are complemented by the key informants‘ views that cases were more likely to have casual sex, less likely to use condoms, and less likely to seek medical attention if asymptomatic despite partner(s) having STDs. CONCLUSIONS AND RECOMMENDATIONS: Associations with STDs were strongest with non-use of condom, having casual partners, being asymptomatic despite partner(s) with STDs, being a female, being a peasant and ignorance about STD-HIV association. Interventions by health workers should focus advocacy on the importance of condom use, routine condom prescription to all patients in sexually active age group, campaign against casual multiple sex partners, health education on STD “silent epidemic” and ignorance about STD-HIV association. Further public awareness should be raised through distribution of self-appealing health education messages about the danger of “casual sex and STDs” and STD “silent epidemic”. CI: all at 95%