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Behavioral and Biologic Surveillance Survey Zambia: Female Sex Workers

Results C

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Results, Behavioural Data and Tables (continued)

STD Behaviour
About one-third of the women (35.7%) reported having either a genital discharge (24.4%) or genital ulcers or sores (27.8%) in the past 12 months. Three-quarters (76.1%) of these sought advice at a health facility, be it a government (68.2%), private (27.3%), workplace (14.6%) or church-run (11.4%) health facility. Almost half (46.5%) sought advice from a traditional healer, 25.8% from a pharmacist, 23.5% bought capsules on the street and 27.3% took medicines at home. Less than half (43.1%) said that they told their partner, 32.9% stopped having sex and 23.1% used condoms while symptomatic. The women interviewed in Chipata reported fewer symptoms than in the other sites (26.9% vs. 39.2% and 41.3% in Chirundu and Livingstone respectively). Those women who had symptoms more often reported seeking care at health facilities, pharmacies and drug vendors. They also reported more frequently that they informed their partner, stopped having sex and/or always used condoms while symptomatic.

Table 5.2: Behaviour related to STD

Characteristic

Livingstone

Chirundu

Chipata

Total

History of STD symptoms in the past 12 months

n

%

n

%

n

%

n

%

Genital discharge

70

27.0

37

26.1

44

20.1

151

24.4

Genital ulcer sores

87

33.7

41

29.1

44

20.1

172

27.8

Genital discharge or ulcers/sores

107

41.3

56

39.2

59

26.9

222

35.7

Total

259

 

143

 

219

 

621

 

Behaviour the last time had STD symptoms1

n

%

n

%

n

%

n

%

Seek advice from a government health facility

67

63.2

41

74.5

38

71.7

146

68.2

Seek advice from a workplace health facility

11

10.5

6

10.9

14

26.4

31

14.6

Seek advice from a church or charity run health facility

9

8.7

4

7.3

11

21.6

24

11.4

Seek advice from a private health facility

22

21.4

13

24.1

22

42.3

57

27.3

Seek advice at any of the 4 above

77

72.6

43

78.2

42

80.8

162

76.1

Seek advice from a pharmacist

23

21.9

8

14.5

24

45.3

55

25.8

Seek advice from a traditional healer

54

51.4

22

40.0

23

43.4

99

46.5

Bought capsules on the street

24

22.9

9

16.4

17

32.1

50

23.5

Took medicine at home

32

30.8

9

17.0

16

30.8

57

27.3

Tell partner about the symptoms

42

40.0

17

32.1

32

60.4

91

43.1

Stop having sex while symptomatic

31

29.5

14

25.5

25

47.2

70

32.9

Always use condom while symptomatic

25

24.0

8

14.5

16

30.2

49

23.1

Total

104

 

55

 

53

 

212

 

1 Only those who reported STD symptoms are included

6. Family planning practices

Table 6 presents family planning practices by study population.

Less than half (45.2%) of the women reported using any family planning method. Of those who reported using a family planning method, only 58.5% used a method considered effective for family planning. The most common methods were oral contraception (47.5%) and injectable contraception (13.7%). None of the women had an intrauterine device (IUD) inserted. About half of the women who were using a method (49.5) said they used condoms for family planning. Other methods were rare. About one-third of the women (31.7%) reported losing a pregnancy. The reported use of family planning was significantly higher in Chipata (55.3%), followed by Livingstone (43.2%) and Chirundu (33.6%). When limited to effective methods however, the use of family planning was similar in Chipata and Livingstone (both 29.2% of the total), but lower in Chirundu (16.1%).

 

Table 6: Family planning practices

Characteristic

Livingstone

Chirundu

Chipata

Total

Currently using a family planning method

n

%

n

%

n

%

n

%

Yes

111

43.2

48

33.6

121

55.3

280

45.2

Total

257

 

143

 

219

 

619

 

Method using1

n

%

n

%

n

%

n

%

Oral contraception

53

49.1

19

39.6

59

49.2

131

47.5

Injection

24

22.2

4

8.3

10

8.3

38

13.7

NEO plant

3

2.

0

0.0

0

0.0

3

1.1

IUD

0

0.0

0

0.0

0

0.0

0

0.0

Any of the 4 methods above

75

69.4

23

47.9

64

52.9

162

58.5

Male condom

33

30.6

22

45.8

82

67.8

137

49.5

Spermicides

0

0.0

0

0.0

1

0.8

1

0.4

Diaphragm

0

0.0

1

2.1

3

2.5

4

1.4

Traditional method

4

3.7

3

6.3

10

8.3

17

6.2

Natural

0

0.0

2

4.2

6

5.0

8

2.9

Other

2

1.9

0

0.0

1

0.8

3

1.1

Total

108

 

48

 

121

 

277

 

Ever lost a pregnancy

n

%

n

%

n

%

n

%

Yes

69

26.7

52

36.6

75

34.4

196

31.7

Total

258

 

142

 

218

 

618

 

1.Only those currently using a family planning method are included

7. Knowledge, opinions and attitudes related to HIV

Table 7 presents the data on knowledge, opinions and attitudes related to HIV.

Almost all women, with the exception of two, had heard of HIV/AIDS. Three-quarters (74.7%) also knew someone living with HIV/AIDS. For 89.3% of these women, this person was a close relative (42.7%), a close friend (44.0%) or both (2.7%). The women generally knew that HIV could be transmitted by infected needles (91.8%) or from mother to child during pregnancy (90.6%). The fact that HIV could also be transmitted through breastfeeding was a little less known (81.9%). Still 22.2% of the women thought mosquito bites could transmit HIV, and 8.6% believed it could be transmitted by sharing meals. Most women (93.4%) were aware that a healthy looking person could be infected with HIV. About fourth-fifths of the women knew that HIV infection can be prevented by using condoms (80.7%), by faithfulness (80.1%) or abstinence (84.0%). Only 17.3% of those who knew that HIV can be transmitted from mother to child also knew that treating pregnant infected women could prevent this infection in the child. Again, knowledge overall was better in Chipata than in the other sites.

 

Table 7: Knowledge, opinions and attitudes related to HIV

Characteristic

Livingstone

Chirundu

Chipata

Total

Ever heard of HIV

n

%

n

%

n

%

n

%

Yes

256

99.2

143

100.0

219

100.0

618

99.7

Total

258

 

143

 

219

 

620

 

Knows someone living with HIV/AIDS1

n

%

n

%

n

%

n

%

Yes

188

73.7

100

70.4

169

78.6

457

74.7

Total

255

 

142

 

215

 

612

 

Has close relative or friend living with HIV/AIDS2

n

%

n

%

n

%

n

%

Close relative

66

36.1

37

37.8

89

52.7

192

42.7

Close friend

88

48.1

43

43.9

67

39.6

198

44.0

Both

7

3.8

5

5.1

0

0.0

12

2.7

No

22

12.0

13

13.3

13

7.7

48

10.7

Total

183

 

98

 

169

 

450

 

Thinks that a person can get HIV from1:

n

%

n

%

n

%

n

%

Mosquito bites

48

18.8

42

29.6

47

21.5

137

22.2

Sharing meals

26

10.1

19

13.5

8

3.7

53

8.6

Infected needles

231

89.9

127

88.8

210

95.9

568

91.8

Mother to child during pregnancy

226

87.9

129

90.2

205

94.0

560

90.6

Breast feeding

195

75.9

113

79.0

199

90.9

507

81.9

Total

257

 

143

 

219

 

619

 

Knows that people can prevent HIV by1:

n

%

n

%

n

%

n

%

Condom use

198

77.3

104

72.7

197

90.0

499

80.7

Faithfulness

200

78.1

111

77.6

184

84.0

495

80.1

Abstinence

210

81.7

117

81.8

193

88.1

520

84.0

Treating pregnant infected women

30

12.4

25

18.4

48

22.2

103

17.3

Total

257

 

143

 

219

 

619

 

Characteristic

Livingstone

Chirundu

Chipata

Total

Knows that a healthy looking person can be infected1

n

%

n

%

n

%

n

%

Yes

241

93.8

131

92.3

205

93.6

577

93.4

No

12

4.7

8

5.6

10

4.6

30

4.9

Don't know

4

1.6

3

2.1

4

1.8

11

1.8

Total

257

41.6

142

23.0

219

35.4

618

 

1.Those who never heard of HIV are excluded.
2.Only those who know someone with HIV/AIDS are included

8. HIV Voluntary counselling and testing

Table 8 presents the data on HIV voluntary testing and counselling.

About two-thirds of the women (66.4%) said they had access to a voluntary counselling and testing facility. Twelve percent said they had been tested. Of these, about half (46.6%) said it was not on a voluntary basis, and one-quarter (25.4%) never found out the test result.

 

Table 8: HIV Voluntary counselling and testing

Characteristic

Livingstone

Chirundu

Chipata

Total

Access to confidential testing for HIV1

n

%

n

%

n

%

n

%

Yes

174

67.7

95

66.4

142

64.8

411

66.4

No

56

21.8

29

20.3

43

19.6

128

20.7

Don't know

27

10.5

19

13.3

34

15.5

80

12.9

Total

257

 

143

 

219

 

619

 

Ever been tested1

n

%

n

%

n

%

n

%

Yes

32

12.5

23

16.2

19

8.7

74

12.0

Total

256

 

142

 

219

 

617

 

Voluntary tested2

n

%

n

%

n

%

n

%

Yes

16

50.0

13

56.5

10

55.6

39

53.4

No

16

50.0

10

43.5

8

44.4

34

46.6

Total

32

 

23

 

18

 

73

 

Found out the result2

n

%

n

%

n

%

n

%

Yes

25

83.3

13

56.5

15

83.3

53

74.6

No

5

16.7

10

43.5

3

16.7

18

25.4

Total

30

 

23

 

18

 

71

 

1. Those who never heard of HIV are excluded.
2.Only those who were tested are included

9. Project indicators

The study serves as a baseline for the project implemented by World Vision International. Five behavioural indicators were identified. Table 9 presents the results of the indicators.

 

One of the indicators measures knowledge of STD symptoms; 61.4 percent of the women could cite at least two major STD symptoms in women. The following were considered as major STD symptoms: lower abdominal pain, genital discharge (foul smelling or not), genital ulcers or sores, and swelling in the groin area. The second indicator measures knowledge of HIV prevention; 84.8 percent could mention at least two HIV prevention strategies. The following were considered as prevention strategies: condom use, faithfulness, abstinence and treating pregnant women.

 

The third indicator measures condom availability; 96.1% reported easy access to condoms. The ability to obtain a condom in less than one hour was considered "easy access." The women who did not know the delay period were excluded. The fourth indicator measures condom use with clients; 53.9% of the women reported that they used a condom in the last commercial sex act. The fifth indicator measures condom use with regular partners; 44.0% of the women reported that they used a condom in the last sex act with a non-paying partner. The difference in results on the indicators in the three sites was statistically significant (p<0.05). The women in Chipata performed consistently better than in the two other sites.

Table 9: Project indicators

Characteristic

Livingstone

Chirundu

Chipata

Total

% who can correctly cite two major STD symptoms

n

%

n

%

n

%

n

%

95% CI

1

138

55.4

77

55.0

150

73.2

365

61.4

57.5-65.3

2

111

44.6

63

45.0

55

26.8

229

38.6

34.7-42.5

Total

249

 

140

 

205

 

594

 

 

% who can correctly cite two HIV prevention strategies

n

%

n

%

n

%

n

%

95% CI

1

210

81.7

117

81.8

198

90.4

525

84.8

81.8-87.5

2

47

18.3

26

18.2

21

9.6

94

15.2

12.5-18.2

Total

257

 

143

 

219

 

619

 

 

% who reported easy access to condoms

n

%

n

%

n

%

n

%

95% CI

1

233

95.9

127

92.7

200

98.5

560

96.1

94.2-97.4

2

10

4.1

10

7.3

3

1.5

23

3.9

2.6-5.8

Total

243

 

137

 

203

 

583

 

 

% who reported condom use in last commercial sex act

n

%

n

%

n

%

n

%

95% CI

1

127

48.8

73

51.0

136

61.8

336

53.9

50.0-57.8

2

133

51.2

70

49.0

84

38.2

287

46.1

42.2-50.0

Total

260

 

143

 

220

 

623

 

 

% who reported condom use in last sex act with non-paying partner

n

%

n

%

n

%

n

%

95% CI

1

48

32.7

24

43.6

67

58.8

139

44.0

38.6-49.5

2

99

67.3

31

56.4

47

41.2

177

56.0

50.5-61.4

Total

147

 

55

 

114

 

316

 

 

 

Biological data

At least one biological sample was obtained from 576 of the 630 women (91%) for which questionnaire data are available. In addition, for three women who had no questionnaire data, biological specimens were available. Therefore, biological specimens were obtained from a total of 579 women. Blood samples were available for all of these women, although in two women there was not enough serum to perform the analyses. Vaginal swabs for Trichomonas vaginalis culture were available for 571 women and vaginal swabs for DNA amplification for 568 women.

 

The results of the biological tests are presented in Table 10. The prevalence of gonorrhoea, genital chlamydial infection, syphilis and trichomoniasis was 19.9%, 6.7%, 29.3% and 48.9% respectively. The prevalence of gonorrhoea and syphilis was clearly higher in Livingstone than in the other sites. In Livingstone 23.2% of the women were infected with gonorrhoea and 36.5% with syphilis, while in Chirundu and Chipata these percentages were 19.8% and 16.0% respectively for gonorrhoea and 28.7% and 20.9% respectively for syphilis.

 

Table 10: STI prevalence

Characteristic

Livingstone

Chirundu

Chipata

Total

STI

n

%

n

%

n

%

n

%

95% CI

Gonorrhoea

57

23.2

23

19.8

33

16.0

113

19.9

16.8-23.3

Chlamydia

15

6.1

8

6.9

15

7.3

38

6.7

4.8-9.0

Gonorrhoea and/or chlamydia

65

26.4

27

23.3

44

21.4

136

23.9

20.6-27.6

Total

246

 

116

 

206

 

568

 

 

Syphilis

91

36.5

35

28.7

43

20.9

169

29.3

25.7-33.1

Total

249

 

122

 

206

 

577

 

 

Trichomoniasis

125

50.6

58

49.2

96

46.6

279

48.9

44.8-53.0

Total

247

 

118

 

206

 

571