ABBREVIATIONS
AIDS Acquired Immunodeficiency Syndrome
AIDSCAP AIDS Control and Prevention
FHI Family Health International
HIV Human Immunodeficiency Virus
IMPACT Implementing HIV/AIDS Prevention and Control
MSM Men who have Sex with Men
NCHADS National Center of HIV AIDS Dermatology and STD
NGO Non-Governmental Organizations
PCR Polymerase Chain Reaction RPR Rapid Plasma Reagin STD Sexually Transmitted Diseases
TPHA Treponema pallidum Hemaggultination Assay
USAID United States Agency for International Development
I BACKGROUND
Cambodia has the highest HIV prevalence in Asia. The 1999 national estimates suggest that 3.8 percent of the sexually active population is infected with HIV. The HIV epidemic in Cambodia is largely due to sexual transmission and most attention to date has been focused on heterosexual transmission of HIV. The existence of men who have sex with men in Cambodia, the extent of the practice and its impact on the STD/HIV epidemic in Cambodia have been largely ignored.
Cambodia currently has a concentrated HIV epidemic where the prevalence of HIV is over 5 percent in high-risk groups but still under 1 percent in the general population. The FHI/IMPACT project is implementing an HIV prevention program that targets STD treatment provision, condom distribution and behavior change interventions at the high-risk groups of commercial sex workers and their clients. MSM is potentially another key target group for HIV prevention programs. Formative research needs to be done to understand whether and how to design prevention programs for this group.
A recent mapping exercise in Phnom Penh has identified various locations where MSM meet/gather in Phnom Penh such as parks, karaoke bars, brothels, discotheques, massage parlors, cinema and streets. The venues most frequented by MSM are the parks throughout the city. A key informant interview assessment will be done in order to learn more about the sexual behavior of MSM in Cambodia for the purpose of designing targeted HIV/STD prevention interventions.
There are little data on STDs in Cambodia and none in MSM. A study conducted in 1996 by Family Health International's AIDSCAP project with the University of Washington in Seattle documented prevalence rates in selected populations, determine gonococcal antibiotic susceptibility, assessed the validity of the proposed World Health Organization's treatment algorithms for Cambodia and documented high risk sexual behaviors in these populations. The STD prevalence rates found in this cross sectional study are in Table 1.
Table 1: STD prevalence in three groups in Cambodia in 1996
The main purpose of the proposed study is to determine STD and HIV prevalence in MSM in Phnom Penh. This study will provide data to serve as data to determine the potential risk of this population for STDs and HIV and, should interventions be designed and implemented for this group, as baseline data to monitor the planned FHI/IMPACT interventions.
II. OBJECTIVES
- To determine the prevalence of Neisseria gonorrhoeae, Chlamydia trachomatis, syphilis, and HIV among MSM in Phnom Penh, Cambodia.
- To measure the frequency of and the associations between risk behaviors and exposures to STD/HIV among MSM.
- To determine the antimicrobial resistance patterns of N. gonorrhoeae in MSM in Phnom Penh.
- To determine the etiology of genital ulcers.
III. METHODS
A) Study Population: The study population for the cross-sectional STD prevalence survey will be the MSM populations of Phnom Penh. A total of 200 MSM over the age of 18 years will be recruited.
B) Recruitment of Study Participants:
Two teams of four-person male study team will be organized for this survey consisting of the following:
- A physician/medical assistant will perform the examination, collect specimens, and give treatment.
- A male interviewer for completion of the questionnaire and registration
- A field worker to recruit participants at the different location and to bring them at the center.
- A count worker present all the time at the site to count the number of MSM present at the site during the survey. These informations will be used to weight the data during the analysis.
In addition, there will be an overall study coordinator who will coordinate the logistics and activities of the team. This study coordinator will have the overall responsibility to ensure the quality of the study and training of providers in STD.
The study population will be MSM approached by field workers in the various locations identified in Phnom Penh. These field workers are already employed with FHI/IMPACT and they have participated to the MSM mapping in Phnom Penh. Two male interviewers and two medical assistants will be recruited as short-term consultant for this study. The medical staff will attend a one-week STD clinical practice at one of the STD clinic managed by MDM (Mdecins du Monde) in Phnom Penh. All the staff participating to the study will be also trained on interview skills and FHI/IMPACT staff will supervise them.
The FHI/IMPACT Cambodia office already has professional contacts with MSM through various HIV/AIDS prevention meetings in Phnom Penh.
A time location cluster sampling was designed (equal probability with sub-sample fixed) for the study. Towards the 27 locations identified during the mapping exercise, 158-time location clusters were defined. We obtained 40 sample cluster with a sub-sample fixed to 5 persons to control the over sample size. Data will be weighted during the analysis.
