High Prevalence of Sexually Transmitted Infections Among Female Sex Workers in the Eastern Highlands Province of Papua New Guinea: Correlates and Recommendations

Background: More than 200 female sex workers (FSWs) participating in commercial sex along the Highlands Highway of Papua New Guinea were identified in a previous survey. This has implications for the spread of sexually transmitted infections (STIs) and human immunodeficiency virus (HIV) to areas and population groups serviced by the road. Goal: The goal of this study was to estimate the prevalence of gonorrhea, chlamydia, syphilis, trichomoniasis, and HIV among FSWs in Goroka and Kainantu in the Eastern Highlands Province (EHP) and to identify correlates that could be considered in intervention and control. Study: Self-identified FSWs recruited through the Goroka Sex Workers Peer-Mediated Programme were invited to participate. All consenting FSWs underwent pretest counseling and provided sociodemographic and behavioral data using a structured questionnaire. The women were also asked to self-collect vaginal specimens and to provide peripheral blood to detect the respective STIs and HIV. Results: Results were available for 211 FSWs. None of the women were positive for HIV. The overall estimated rates for gonorrhea, chlamydia, syphilis, and trichomoniasis were 21%, 19%, 24%, and 51%, respectively. Seventy-four percent were positive for at least 1 STI and 43% had multiple STI infections. High-risk sexual behaviors were found to be common among the women, including low and inconsistent use of condoms, with most of them attributing this to unavailability, dislike by or familiarity with clients, and being drunk and/or high on marijuana. Conclusions: STIs are prevalent among FSWs in Goroka and Kainantu in the EHP and are maintained by widespread high-risk sexual behaviors, including low use of condoms. Implications for their spread through the highway warrants increased efforts in intervention. Apart from a need to promote condom acceptance, distribution, and use, other high-risk sexual behavior and correlates identified in this study provide important considerations for intervention and control in this population.

[1]  K. Holmes,et al.  Prevention of Sexually Transmitted Diseases (STDs) in Female Sex Workers: Prospective Evaluation of Condom Promotion and Strengthened STD Services , 2003, Sexually transmitted diseases.

[2]  M. Schechter,et al.  Surviving the sex trade: A comparison of HIV risk behaviours among street-involved women in two Canadian cities who inject drugs , 2003, AIDS care.

[3]  G. Dallabetta,et al.  Evidence‐based treatment guidelines for sexually transmitted infections developed with and for female sex workers , 2003, Tropical medicine & international health : TM & IH.

[4]  C. Mgone,et al.  High Prevalence of Neisseria gonorrhoeae and Multiple Sexually Transmitted Diseases Among Rural Women in the Eastern Highlands Province of Papua New Guinea, Detected by Polymerase Chain Reaction , 2002, Sexually transmitted diseases.

[5]  J. Caldwell,et al.  AIDS in Papua New Guinea: situation in the Pacific. , 2002, Journal of health, population, and nutrition.

[6]  A. Sharma,et al.  Sexual behavior of drug-users: is it different? , 2002, Preventive medicine.

[7]  M. Alpers,et al.  Human Immunodeficiency Virus and Other Sexually Transmitted Infections Among Female Sex Workers in Two Major Cities in Papua New Guinea , 2002, Sexually transmitted diseases.

[8]  M. Alary,et al.  Role of core and bridging groups in the transmission dynamics of HIV and STIs in Cotonou, Benin, West Africa , 2002, Sexually transmitted infections.

[9]  M. Alary,et al.  Decline in the prevalence of HIV and sexually transmitted diseases among female sex workers in Cotonou, Benin, 1993–1999 , 2002, AIDS.

[10]  S. Bhattacharya,et al.  Interface between drug use and sex work in Manipur. , 2001, The National medical journal of India.

[11]  P. Ghys,et al.  HIV surveillance among female sex workers. , 2001, AIDS.

[12]  G. Koczberski.  The sociocultural and economic context of HIV / AIDS in Papua New Guinea. , 2000, Development bulletin.

[13]  T. Duke,et al.  Congenital syphilis at Goroka Base Hospital: incidence, clinical features and risk factors for mortality. , 2000, Papua and New Guinea medical journal.

[14]  M. Albert,et al.  Etiology of Sexually Transmitted Infections among Street-Based Female Sex Workers in Dhaka, Bangladesh , 2000, Journal of Clinical Microbiology.

[15]  M. Alpers,et al.  Community based study of sexually transmitted diseases in rural women in the highlands of Papua New Guinea: prevalence and risk factors. , 1998, Sexually transmitted infections.

[16]  M. Alpers,et al.  Screening for sexually transmitted diseases in rural women in Papua New Guinea: are WHO therapeutic algorithms appropriate for case detection? , 1998, Bulletin of the World Health Organization.

[17]  M. Alpers,et al.  Urbanization, youth and sexuality: insights for an AIDS campaign for youth in Papua New Guinea. , 1996, Papua and New Guinea medical journal.

[18]  M. Passey,et al.  High prevalence of trichomonal vaginitis and chlamydial cervicitis among a rural population in the highlands of Papua New Guinea. , 1996, Papua and New Guinea medical journal.

[19]  R. Brookmeyer,et al.  Incidence and predictors of human immunodeficiency virus type 1 seroconversion in patients attending sexually transmitted disease clinics in India. , 1995, The Journal of infectious diseases.

[20]  W. I. van der Meijden,et al.  Prevalence of Chlamydia trachomatis in women attending a family planning clinic in Papua New Guinea. , 1995, Genitourinary medicine.

[21]  W. I. van der Meijden,et al.  A survey of sexually transmitted diseases in five STD clinics in Papua New Guinea. , 1994, Papua and New Guinea medical journal.

[22]  P. Piot,et al.  Condom promotion, sexually transmitted diseases treatment, and declining incidence of HIV-1 infection in female Zairian sex workers , 1994, The Lancet.

[23]  R. Nájera,et al.  HIV and female sex workers. , 1993, Bulletin of the World Health Organization.

[24]  K. Pataki-Schweizer,et al.  Knowledge of AIDS in Papua New Guinea. , 1993, Papua and New Guinea medical journal.

[25]  M. A. Pickett,et al.  Genotyping of Chlamydia trachomatis from a trachoma-endemic village in the Gambia by a nested polymerase chain reaction: identification of strain variants. , 1992, The Journal of infectious diseases.

[26]  G. Kariwiga,et al.  Endocervical Chlamydia Trachomatis Infection in Pregnancy: Direct Test and Clinico‐Sociodemographic Survey of Pregnant Patients at the Port Moresby General Hospital Antenatal Clinic to Determine Prevalence and Risk Markers , 1992, The Australian & New Zealand journal of obstetrics & gynaecology.

[27]  F. Plummer,et al.  Condom Use Prevents Genital Ulcers in Women Working as Prostitutes: Influence of Human Immunodeficiency Virus Infection , 1991, Sexually transmitted diseases.

[28]  N. Nagelkerke,et al.  The importance of core groups in the epidemiology and control of HIV-1 infection. , 1991, AIDS.

[29]  Joy Gillett.  The Health of Women in Papua New Guinea , 1990 .

[30]  D. Wesche.  Chlamydia trachomatis infections: therapeutic implications. , 1989, Papua and New Guinea medical journal.

[31]  P. Piot,et al.  Prostitutes Are a Major Reservoir of Sexually Transmitted Diseases in Nairobi, Kenya , 1985, Sexually transmitted diseases.

[32]  V. Zigas.  An evaluation of trichomoniasis in two ethnic groups in Papua New Guinea. , 1977, Sexually transmitted diseases.