thực trạng nhiễm hiv và các nhiễm trùng lây qua đường tình dục ở phụ nữ bán dâm 4 quận hà nội và hiệu quả một số biện pháp can thiệp bản tóm tắt tiếng anh

1 Ministry of Education and Training Ministry of Health National Institute of Epidemiology and Hygiene PHAM THI MINH PHUONG HIV AND SEXUALLY TRANSMITTED INFECTIONS IN FEMALE SEX WORKERS IN 4 DISTRICTS OF HA NOI AND THE EFFECT OF SOME INTERVENTION ACTIVITIES Specialization: Epidemiology Code: 62 72 01 17 ABSTRACT OF PhD DISERTATION Ha Noi - 2014 2 The work is completed in: National Institute of Epidemiology and Hygiene Thesis advisor: 1. Ass.Prof. TRẦN HẬU KHANG, PhD 2. Ass.Prof. NGUYỄN ANH TUẤN, PhD Opponent 1: Prof. Dao Van Dung, PhD The Central Department of Propaganda and training Opponent 2: Ass. Prof. Ho Ba Do, PhD The Military Medical Insitute Opponent 3: Ass. Prof. Tran Dang Quyet PhD The Military Medical Insitute The thesis will defensed at Institutional commitee in National Institute of Epidemiology and Hygiene at , date month year Full disertation could be found at - National Library - The library of National Institute of Epidemiology and Hygiene 3 Scientific articles published 1. Pham Thi Minh Phuong, Tran Hau Khang, Nguyen Anh Tuan (2012), “HIV prevalence and risk related behaviors in female sex workers in Hanoi, Vietnam 2005-2006”, Journal of Preventive Medicine. 6(133), pp.55-63 2. Pham Thi Minh Phuong, Tran Hau Khang, Nguyen Anh Tuan (2013), “Assessment of intervention to reduce HIV/STI risk among female sex workers in Hanoi 2005- 2010”, Journal of Preventive Medicine. 3(139), pp.66-73 3. Pham Thi Minh Phuong, Tran Hau Khang, Nguyen Anh Tuan (2013), “Chlamydia prevalence and behavioral risk among community female sex workers in Hanoi 2005- 2006”, Journal of Preventive Medicine. 7(143), tr.56-63 4 ABREVIATION INTRODUCTION 1. Justification for the study Sexually transmitted infections (STI) including HIV are big public health issue. Prostitution plays an important role in transmitting HIV/STI, therefore HIV/STI prevention for sex workers is one of the key activities in HIV program. In Vietnam, National strategy on HIV/AIDS prevention and control claims that STI counseling and management for high risk group need to be strengthen. A study on HIV/STI epidemiology and intervention for female sex workers is necessary for making HIV/STI prevention plan. Therefore, the study “HIV/STI situation in Acronym AIDS Acquired Immuno-Deficiency Syndrome FSW Female sex worker HCM City Ho Chi Minh City HIV Human Immunodeficiency Virus PCR Polymerase Chain Reaction RPR Rapid Plasma Reagin STI Sexually Transmitted Infection TPHA Treponema Pallidum Haemagglutination Assay 5 female sex workers in 4 districts of Ha Noi and the effect of some intervention activities” was implemented. 2. Study objectives: − To describe the HIV/STI situation and related factor among FSW in 4 districts of Ha Noi 2005 – 2006. − To evaluate the effectiveness of some HIV/STI control intervention activities in FSW in Ha noi 2005-2010. 3. New findings of the dissertation The dissertation has provided new information about HIV/STI prevalence of FSW in 4 districts in Ha Noi at 2005-2006 and at 2009- 2010 and about HIV/ Chlamydia infection related factors among FSW at 2005-2006. The dissertation has also evaluated some intervention activities aiming to HIV/STI control in FSW group. 4. Scientific and confident issue in the thesis The study used quasi-experimental study with pre and post intervention comparison. The sampling and sample size, data collection instrument including questionnaire and laboratory tests, data analysis were relevant, thus the results are scientifically confident. 5. Outline of the dissertation The dissertation is 123 page length excluding table of content, list of tables, list of figures, appendix and 131 references. The dissertation includes: introduction, literature review, methodology, results, discussion, conclusion and recommendation part, 32 tables and 15 figures. CHPATER ONE: LITERATURE REVIEW 1.1. Prostitution situation in the world and in Viet Nam Commercial sex worker group is stigmatized over the world. Prostitution is considered illegal, therefore it is very difficult to access 6 and trace them. Female sex worker (FSW) group is considered one of the high risk group and they play an important role in HIV epidemic. There are 2 type of FSW: direct and indirect FSW. Direct FSW income comes from selling sex activity only. They sell sex on streets and brothels. Indirect FSW income comes from selling sex and from other jobs such as massage girl, hair dresser and waitress in hotel/restaurant. In Viet Nam, prostitution is illegal and considered as a social evil. Police and local authorities carry out campaign to attack FSW. If arrested, FSW will be brought to rehabilitation center where they get STI/HIV checking/ treating and vocational education. 1.2. HIV/STI situation and related factors in FSW 1.2.1.HIV/STI situation in FSW HIV: Africa is the place having very high HIV prevalence in FSW (19%). In Asia, HIV epidemic is concentrated in some special populations such as intravenous drug user and sex worker. In China, HIV sentinel surveillance reveals that HIV prevalence in sex worker is increasing. In India, HIV prevalence in FSW is 5%. In Viet Nam, HIV prevalence in FSW is higher than 10% in some cities/provinces and tends to increase in some other provinces. In the period of 2003-2011, according to HIV sentinel surveillance, the HIV prevalence in this group was around 3-5%. However, in some place, HIV prevalence was very high such as in Lang Son (17.6%), Can Tho (10.67%) and was low such as in Da nang (0.6%) and Khanh Hoa (1.1%). Gonorrhea: Gonorrhea prevalence in FSW in Yunnan (China) was 37.8%, in Cambodia was 12%, in Indonesia was 28.6%. In Viet Nam, gonorrhea prevalence was 3% in Ha Noi, 0.5% in HCM city, 5.3% in Hai Phong, 20.2% in Lai Chau, 24.8% in Quang Tri, 7.3% in Dong Thap, 5.7% in An Giang, 9.4% in Kien Giang and 14.9% in Soc Trang. 7 Syphilis: Syphilis prevalence in FSW was 8% in Quang Dong, 2.3% in Cambodia. In Viet Nam, the prevalence in street based FSW and in venue based FSW was 9.1% and 7.3% in HCM city, 5.5% and 5.8% in An Giang, 3.0% and 5.4% in Da Nang, 5.6% and 0.3% in Can Tho, 3.2% and 2.2% in Hai Phong. Chlamydia: Chlamydia prevalence in FSW in Yunnan (China) was 58.6%, in Cambodia was 14%. Some studies inViet Nam showed that Chlamydia prevalence in FSW was 48.4% in Soc Trang, 5% in Ha Noi, 3.3% in Hai Phong, 3% in Quang Ninh, 6.5% in HCM city and 3.5% in Da Nang. 1.2.2. The association between some behaviors and HIV/STI A study in Quang Dong (2010) showed that high education level and good STI knowledg were protective factor that could reduce the risk of STI. The behavior of inviting clients on street or in hotel, getting more money for selling sex was associated with higher risk of STI. According to a study in Jamaica, age, using drug, not using condom in the last sex were high risk behaviors of getting HIV in FSW. A study in HCM city, Can Tho, An Giang revealed that the age under 30, genital ucer, inconsistent condom use were associated with higher risk of HIV. A study in Hai Phong showed that good STI knowlegd was a protective factor while having more than 4 clients per week, self STI treatment, poor knowlegd on condom use associated with higher risk of STI. A study in Hue in 2008 also proved that low education level and incorrect condom use were considered high risk behavior. 1.3. Some interventions to reduce HIV/STI in FSW In Thailand, interventions including information education communication activities, strengthening condom use and STI management helped to increase consistent condom use and decreased 8 STI prevalence in FSW, HIV prevalence in community got stable and finally decreased. In 2003, an intervention in India including communication for bahavior change, increasing condom use, regular STI screening, periodical STI check also increased condom use with regular clients, decreased HIV and some STI prevalence. A study in Vinh Long showed that after 2 year intervention, knowlegd on how to prevent HIV got increased, consistent condom use with regular clients and husband/boyfriend got improved. However, HIV prevalence did not decreased after the intervenion. Another intervention for FSW in Ha Tay showed that after intervention, consistent condom use with regular and irregular clients did not change, but with boyfriend got increased. In venue based FSW, consistent condom use with irregular clients and with boy friends got improved, but with regular clients did not. The percentage of people who knew STI symptoms did not improve (p>0.05). After intervention, prevalence of genital discharge, lower abdominal pain and genital ulcer syndrom decreased significantly. 1.4. Some information about Ha Noi HIV prevalence in FSW in Ha Noi is very high in comparison with that of the whole country. According to HIV sentinel surveillance, HIV prevalence in FSW group was around 3-5% during the period of 2003- 2011, but that of Ha Noi was 13-16% during the period of 2003-2005. The cumulative HIV number at the end of each year in this period of Thanh Xuan and Cau Giay were lowest and that of Hai Ba Trung and Dong Da were highest in compare with other districts. In Ha Noi, prostitution situation is complicated. Karaoke bar is one of the places of prostitution activities. A master often hires a place to gather 10-15 FSWs, prints name cards to distribute to entertainment places such as karaoke bars, restaurants, hotels. The heads of these entertainment places will call the master if necessary. Each FSW carries a number for easy 9 and confidential contact. Prostitution brings much profit, therefore many entertainment places get involved in. In addition, the monitoring activities of local authorities do not strong enough; many tourists go to Viet Nam for prostitution leading to complicated prostitution situation. CHAPTER 2 METHODOLIGY 2.1. Study subjects The subjects of the study were FSWs in community of Ha Noi, including 2 groups: street based and venue based FSW. 2.2. Place and time The study was implemented in 4 districts of Ha Noi: Dong Da, Hai Ba Trung, Thanh Xuan, Cau Giay. Study was carried out from 2005 -2010. Pre intervention survey was from 2005-2006 and post intervention survey was from 2009-2010; Intervention was implemented from 2006-2009. 2.3. Study design This is an quasi experimental study with pre/ post intervention comparision. Pre intervention and post intervention survey were cross sectional survey with cluster sampling. 2.3.1. Sample size Formular for sample size calculation: D = 1.3; P 1 = 0.6; P 2 = 0.75; α = 0.05; β = 0.90 The necessary sample size is at least 215 FSWs. 10 2.3.2. Sampling: In pre and post intervention survey, 2 stage cluster sampling was used. Stage 1: Sampling frame development and cluster selection. Mapping technique was use to establish sampling frame which included all places where FSW could be reached. Cluster is a group of at least 10 FSW. The list of all clusters was used as sampling frame and 30 clusters in the list were chosen randomly. Stage 2: Study subject selection. If in a cluster, the number of FSW at the time of selection was larger than 10, the subject has been chosen randomly. If the number was less than 10, all of the FSW at that time have been selected and the investigator had to come back later to select more FSW until geting 10 FSW. 2.4. Study activities Questionnaire development and piloting The questionnaire was developed by experienced expert and tested/ adjusted before being used. Interviewer selection and training All of interviewers were experienced staff and they had been trained on mapping technique and how to implement a survey. Data collection After getting to the interview place, study subjects got registered at reception area, and then were interviewed. After interview, urine and blood samples were collected. The urine samples were used for gonorrhea and Chlamydia detection by PCR at National Institution of Epidemiology and Hygiene (NIHE); Blood sample was used for HIV and syphilis detection test at Hanoi HIV/AIDS Center. 2.5. Intervention [...]... not change significantly (HIV: 16.6% vs 18.7%, p=0.38; Syphilis: 0.8% vs 1.2%, p=0.76) Gonorrhea prevalence decreased from 1.8% to 0.3% (p=0.028) and chlamydia prevalence also decreased from 13 .4% to 3.8% (p=0.0001) CHAPTER 4: DISCUSSION 4. 1 HIV/ STI situation and related factors in FSWs in 4 districts of Ha Noi 2005 -2006 4. 1.1 HIV/ STI prevalence in FSW in Ha Noi 2005 -2006 4. 1.1.1 HIV prevalence The... 79 .4% to 36%, p=0.0001, among venue based FSW: decreased from 57.9% to 25.8%, p=0.0001) The percentage of FSW getting STI checking at government clinic increased (in street based FSW: from 11.8% to 43 .3%, p=0.0001); in venue based FSW: from 10.5% to 44 .4% , p=0.0001) 3.2.3 Changing in drug use bahavior After intervention, drug use proportion did not change significantly among street based FSW ( 24. 4%... survey recruited 49 9 FSW (275 venue based FSW and 2 24 street based FSW) Post intervention survey recruited 600 FSW (300 venue based FSW and 300 street based FSW) 3.1 HIV/ STI situation and related factor in FSW in 4 districts of Ha Noi 2005-2006 3.1.1 HIV/ STI prevalence in FSW Figure 3 .4 HIV prevalence by FSW type and by drug use behavior The survey 2005-2006 showed that 16.6% FSW got HIV infected According... mean of duration of selling sex was 4, 1 year, that of street based was 4, 4 year, longer than of venue based FSW (3.7 years) (p=0, 047 , t test) FSWs had around 21.7 clients monthly including 14. 8 irregular and 5.5 regular clients The number of regular and of irregular clients monthly of street based FSWs did not different with that of venue based FSWs  14 3.1.2.2 HIV/ STI knowledge of FSWs before intervention... studies of Nguyen Manh Cuong (2008), Hoang Duc Hanh (2010), Nguyen Khac Hien (2010), Wariki (2012) However, many studies showed that intervention helped to reduce HIV prevalence such as study in Cambodia, Benin, Zaire, India and China HIV is a life long infection and the survival time of HIV infected person is long (commonly longer than 5 years) Intervention may reduce HIV incidence, but HIV prevalence... 28.3%, 14. 4% and 20.2% of surveyed FSW, accordingly) The percentage of FSW who did not know any common STI signs accounted for 17.8% The proportion of FSW knowing 4 STI signs was 3.6% among street based FSWs and was 0 .4% among venue based FSW 3.1.2.3 STI history of FSW in Ha Noi before intervention Figure 3.8 STI history of FSW in Ha Noi before intervention (n =49 9) According to figure 3.8, 46 .5% of... effective The antibiotic for syphilis treatment is still very sensitive to the bacteria 4. 1.1 .4 Chlamydia prevalence Chlamydia prevalence in the pre intervention survey was 13 .4 %, was similar to the prevalence of FSW in Cambodia, ( 14% ), lower than in Indonesia (43 ,5%), in Kien Giang (17.3%), Lai Chau (16.2%), higher than in Quang Tri (10.9%), Dong Thap (10%), An Giang (7.3%) The difference of chlamydia prevalence... and in risky bahavior of FSW in different location 4. 1.2 HIV/ Chlamydia related factors of FSW of Ha Noi in 2005 2006 4. 1.2.1 Association between bahaviors and HIV This study and some other studies found the behaviors that did not relate to HIV These included condom use with boyfriend, with regular clients and STI history Some studies found out the HIV related bahavior similar to this study These included... and did not get right treatment Therefore they were still STI infected at the time of survey This can lead to the result of noassociation between comdom use and STI 4. 2 Effect of HIV/ STI intervention in FSW in Ha Noi 2005-2010 4. 2.1 Effect on HIV/ STI knowledge The intervention helped to improve sufficient HIV knowledge and STI signs The same effect has been found in other studies in Vinh Long, An Giang,... FSW knew the role of condom in HIV/ STI prevention However, condom availability after intervention was decreased, the percentage of FSW who carried condom at the time 24 of interview was very low The condom use negotiation skill of FSW was not paid attention These could lead to low condom use proportion among FSW 4. 2 .4 Effect of HIV prevalence After our intervention, HIV prevalence did not decreased, . 13 .4% to 3.8% (p=0.0001). CHAPTER 4: DISCUSSION 4. 1. HIV/ STI situation and related factors in FSWs in 4 districts of Ha Noi 2005 -2006 4. 1.1. HIV/ STI prevalence in FSW in Ha Noi 2005 -2006 4. 1.1.1 Hai Phong, 20.2% in Lai Chau, 24. 8% in Quang Tri, 7.3% in Dong Thap, 5.7% in An Giang, 9 .4% in Kien Giang and 14. 9% in Soc Trang. 7 Syphilis: Syphilis prevalence in FSW was 8% in Quang Dong, 2.3% in Cambodia FSW was 48 .4% in Soc Trang, 5% in Ha Noi, 3.3% in Hai Phong, 3% in Quang Ninh, 6.5% in HCM city and 3.5% in Da Nang. 1.2.2. The association between some behaviors and HIV/ STI A study in Quang