The Prevalence of Other Sexually Transmitted Infections in Confirmed HIV Cases at a Referral Clinic in Jamaica

Article excerpt

Abstract

Jamaica has the second highest number of acquired immunodeficiency syndrome (AIDS) cases and deaths in the Caribbean and a significant number of human immunodeficiency virus (HIV) infected individuals have a concomitant sexually transmitted infection (STI). The study determined the prevalence of non-ulcerative and ulcerative STIs and their association with sexual risky behaviour in a sample of HIV seropositive men and women. This study was conducted at the Comprehensive Health Centre in Jamaica, a sexually transmitted infection referral centre. The sample comprised 138 men and 132 women age 15-49 years, of average 29.5 years. The study was retrospective, from 2000 to 2002, and sample collection was randomized. The sexual behaviours of the subjects were assessed from the case records. In the 270 HIV diagnosed cases examined, the prevalence of STIs was 51.1% in men and 48.9% in women, with 85.4% having one or more STIs with an average of four STIs per patient. There was a total occurrence of 744 STIs with non-gonococcal urethritis (19.4%), gonorrhoea (17.2%), candidiasis (13.4%), trichomonas (12.4%), genital ulcer (10.4%) and syphilis (7.3%) the most common in HIV infected men and women. The presence of STI was associated with continued practice of risky sexual behaviour. The age group most implicated was the 30-34 year old, and 73.1 % of the HIV infected patients had multiple sexual partners with only 16.4% reporting frequent condom use. The study demonstrates that there is a high prevalence of non-ulcerative and to a lesser extent ulcerative STIs in HIV infected patients in Jamaica. There are significant associations between STIs and continued high risk sexual practices in HIV infected men and women. The findings support the need for implementation of effective diagnosis and treatment strategies coupled with education about safe-sex practices in HIV prevention and STI control programmes.

Key words

HIV; sexually transmitted infections; prevalence; condoms

INTRODUCTION

HIV/AIDS is presently taking a heavy toll on the Caribbean, with prevalence rates that are second only to those of sub-Saharan Africa.1 In Jamaica, the rate of HIV infection is one to two per cent of the adult population.2 New HIV infections in adolescents have been increasing at an alarming rate since 1995 and adolescent females have a three times higher risk of HIV infection than males of the same age. At the end of 2000, there were 5099 cases of AIDS in Jamaica with a case fatality rate of 61.4% (3131 persons have died)3 and 60.7% of HIV/AIDS cases were attributed to heterosexual transmission.4 Similarly, there were an estimated 50,590 STI cases per 100,000 population in Jamaica (not including HIV infection) among sexually active adults in the year 2000.3 A quarter of these infected persons did not seek medical treatment and a large population of them had multiple sex partners using condoms inconsistently thus increasing the risk of STI and HIV.3

Sexually transmitted infections ranked fourth among the major cause of health centre visits for males and third for females in Jamaica. Infection with gonorrhoea accounted for 20.0% of the STI visits, syphilis 7.4% and herpes 1.7%.5 In a study of male STI clinic attendees, rates of genital ulcer disease had increased from 9.3% to 18.2%, in an eight year period and from 4.2% to 6.8% among females.6 In another Jamaican-based study of female STI clinic attendees, approximately onethird of the women aged 15-24 years tested positive for human papillomavirus (HPV) with increasing age being significantly associated with a lower prevalence of the virus.7 The risk factors reported by HIV infected Jamaicans include a history of STI (38.7%), multiple sex partners (31.8%) and sexual intercourse with a sex worker (23%).* Several STI epidemics are well documented in populations at risk for HIV9,10 suggesting that STIs may also be prevalent in HIV infected people who continue to practise risky sexual behaviours. …