Association Between Behaviors and STI Risk

have a 0.3 times higher risk of HIV infection than those who do not use condoms.

frequently (OR=0.3; 95% CI: 0.1 – 0.9).

3.1.3.7. Association between behaviors and STI risk

Because the rate of gonorrhea and syphilis infection in the female sex worker group was investigated very

low so we only analyzed the risk of genital Chlamydia infection

Table 3.18. Association between some characteristics of PNBD and Chlamydia infection (n=499)

Chlamydia (+)		Chlamydia (-)		OR	95% CI	p
SL	%	SL	%
Target group
BDDP	48	17.5	227	82.5	2.3	1.3 – 4.0	0.003
BDNH	19	8.5	205	91.5	1
Age group
≤ 20	6	12.8	41	87.2	1.29	0.5 – 3.5	0.62
21-30	45	15.3	250	84.7	1.58	0.9 – 2.9	0.13
≥ 31	16	10.2	141	89.8	1
Education level
Elementary	14	12.5	98	87.5	1
Secondary School	33	13.1	218	86.9	1.1	0.5 – 2.1	0.86
High School	20	14.7	116	85.3	1.2	0.6 – 2.5	0.62
Marital status
Never ended	30	14.4	179	85.6	1.3	0.6 – 2.6	0.49
kiss
Married	12	11.5	92	88.5	1
Had a husband	25	13.4	161	86.6	1.2	0.6 – 2.5	0.64

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Analysis in Table 3.18 shows that PNBD in the BDDP group have a risk of Chlamydia infection 2.3 times higher than the BDNH group (OR=2.3; 95% CI: 1.3 - 4.0). Other factors such as age group, education level, marital status are not related to Chlamydia infection (95% CI contains value 1).

Table 3.19. Age, amount of money earned from prostitution, number of customers and

Chlamydia infection risk of female sex workers in Hanoi in 2005-2006

Infection status
Chlamydia (+)	Chlamydia (-)	p
Age (average)	27.6	28.4	0.37
Age of first sexual intercourse	19.2	19.4	0.60
Average age of initiation of prostitution	24.4	24.2	0.81
Average practice time	3.3	4.2	0.06
Amount received for 1 sexual intercourse	135,000	130,000	0.74
Amount received for 1 overnight stay	314,000	359,000	0.10
Average number of customers	25.6	21.2	0.11

According to table 3.19, there is no relationship between age, age at first sexual intercourse, age at starting prostitution, duration of prostitution, amount of money earned from prostitution and number of customers with Chlamydia infection status (p>0.05, T test).

Table 3.20 shows that history of STI infection and visits to public health facilities, private health facilities, and self-treatment at home when showing signs of STI infection are not related to Chlamydia infection.

Table 3.20. Knowledge of STIs, history of STIs, attitudes towards STI infection and risk of Chlamydia infection

Feature

Chlamydia (+)		Chlamydia (-)		OR	95% CI	P
SL	%	SL	%
Know ≥ 2 STI symptoms Yes No	30 37	18.5 11.0	132 300	81.5 89.0	1.8 1	1.1 – 3.1	0.02
History of STIs
Have	32	13.1	213	86.9	0.9	0.6 – 1.8	0.8
Are not	35	13.8	219	86.2	1
How to deal with STIs
Treatment in public health
Have	2	10.0	18	90.0	0.7	0.2 – 3.3	0.49
Are not	22	13.6	140	86.4	1
Treatment in private health care
Have	7	14.0	43	86.0	1.1	0.4 – 2.8	0.84
Are not	17	12.9	115	87.1	1
Treatment at the pharmacy
Have	21	17.5	99	82.5	4.2	1.2 – 14.6	0.02
Are not	3	4.8	59	95.2	1
Self-treatment at home
Have	4	7.5	49	92.5	0.5	0.1 – 1.4	0.15
Are not	20	15.5	109	84.5	1

According to table 3.20, it shows that people who know 2 or more STI symptoms have a higher risk of Chlamydia (OR=1.8; 95%CI: 1.1 – 3.1).

Buying medicine at the pharmacy to treat yourself has a 4.2 times higher risk of Chlamydia infection.

times (OR= 4.2; 95% CI: 1.2 – 14.6).

Table 3.21. Condom use behavior and Chlamydia infection risk of female sex workers in Hanoi in 2005-2006 (n=499)

Feature

Chlamydia (+)		Chlamydia (-)		OR	95% CI	p
SL	%	SL	%
Use condom with strangers Regularly Not regularly	50 11	15.3 10.6	277 92	84.7 89.4	1 0.7	0.3 – 1.3	0.24
Use condoms with regular customers Not often	39 23	16.5 12.6	198 159	83.5 87.4	1 0.73	0.42 – 1.28	0.27
Use condom with husband/friend male Regularly Not regularly	5 29	12.2 15.0	36 164	87.8 85.0	1 1.27	0.46 – 3.51	0.64

Table 3.21 shows that condom use with strangers, regular customers in the past month and with husband/boyfriend in the past year is not associated with Chlamydia infection status (p>0.05; 95% CI contains value 1).

Table 3.22. Multivariate analysis of risk of Chlamydia infection

Risk factors

OR	95% CI	p
Target group (BDDP vs. BDNH)	2.3	0.9 – 5.7	0.08
Know 2 or more STI symptoms	0.9	0.3 – 2.2	0.74
Going to the pharmacy to buy medicine when infected with an STI	3.6	1 – 12.7	0.05

According to Table 3.22, after including factors including the subject group, awareness of 2 or more STI symptoms and self-medication when infected with STI into the multivariate logistic regression model, only the behavior of self-medication at the pharmacy was a factor independently associated with Chlamydia infection. Those who self-medicated at the pharmacy had a 3.6 times higher risk of Chlamydia infection (OR= 3.6; 95% CI: 1 – 12.7).

3.2. The effectiveness of the intervention model on risk behavior and infection rates

HIV/STI among female sex workers in Hanoi in 2005-2010

3.2.1. Percentage of PNBD accessing intervention programs

Table 3.23. Rate of access to the BDDP intervention program

Access to the following activities

within the last 6 months

Before CT n=275		After CT n=300		p	CSHQ (%)
SL	%	SL	%
Get free/cheap condoms	123	44.7	173	57.7	0.002	29
Heard about safe sex	93	33.8	216	72.0	0.0001	113
Heard about safe TCMT	54	19.6	90	30.0	0.004	53
Get free clean BKT	17	6.2	53	17.7	0.0001	185

According to Table 3.23, the rate of PWID accessing harm reduction activities such as receiving free/cheap condoms, hearing about safe sex, hearing about safe IDU, and receiving free clean needles increased significantly compared to before the intervention (p<0.05).

Table 3.24. Rate of access to BDNH intervention program

Access to the following activities

within the last 6 months

Before CT n=224		After CT n=300		p	CSHQ (%)
SL	%	SL	%
Get free/cheap condoms	135	60.3	184	61.3	0.8	2
Heard about safe sex	103	46.0	219	73.0	0.0001	59
Heard about safe injections	34	15.2	90	30.0	0.0001	97
Get free clean BKT	8	3.6	27	9.0	0.014	150

According to Table 3.24, the rate of BDNH accessing harm reduction activities such as hearing about safe sex, hearing about safe TCMT and receiving free clean needles and syringes increased significantly compared to before the intervention (p<0.05), but the rate of receiving free/cheap condoms was not different (before the intervention was 60.3%, after the intervention was 61.3%, p=0.8).

3.2.2. Changes in basic understanding of HIV/STI

Table 3.25. Changes in basic knowledge about HIV/STI among the BDDP group

Understanding HIV/STI

Before CT (n=275)		After CT (n=300)		p	CSHQ (%)
N	%	N	%
Ever heard of HIV?	235	85.5	293	97.7	0.0001	14
Know where to get tested for HIV	95	34.5	184	61.3	0.0001	78
Have complete basic understanding	93	33.8	200	66.7	0.0001	97
about HIV
Know 2 or more STI symptoms	102	37.1	192	64.0	0.0001	73

Table 3.25 shows that the intervention significantly increased the proportion of BDDP who had heard about HIV, knew where to get tested for HIV, had basic knowledge about HIV, and knew 2 basic signs of STIs (p<0.05).

Table 3.26. Changes in basic knowledge about HIV/STI of the BDNH group

Understanding HIV/STI

Before CT (n=224)		After CT (n=300)		p	CSHQ (%)
n	%	n	%
Ever heard of HIV?	200	89.3	294	98.0	0.0001	10
Know where to get tested for HIV	57	25.4	195	65.0	0.0001	156
Have complete basic understanding	111	49.6	213	71.0	0.0001	43
about HIV
Know 2 or more STI symptoms	60	26.8	225	75.0	0.0001	180

Table 3.26 shows that the intervention significantly increased the proportion of BDNH who had heard about HIV, knew where to get tested for HIV, had basic knowledge about HIV, and knew 2 basic signs of STIs (p<0.05).

In 2009-2010, female sex workers had good knowledge about the role of condoms in disease prevention. 92.4% of female sex workers who used condoms with strangers and 91.2% of female sex workers who used condoms with regular clients said that the reason for using condoms was to prevent disease.

3.2.3. Changes in attitudes towards STI infection Table 3.27. Attitudes towards STI infection of BDDP

Characteristic

Before CT n=68		After CT n=164		p	CSHQ %
SL	%	SL	%
Go to medical facility for examination and treatment	8	11.8	71	43.3	0.0001	267%
state economy
Go to medical facility for examination and treatment	23	33.8	40	24.4	0.14
private health
Go to the pharmacy to buy medicine	54	79.4	59	36.0	0.0001	55
Use condoms during intercourse	11	16.2	29	17.7	0.78
symptom

Table 3.27 shows that for BDDP with STI symptoms, the rate of going to state health facilities increased significantly (from 11.8% to 43.3%, p=0.0001, CSHQ =267%), the rate of self-medication at pharmacies decreased significantly (from 79.4% to 36.0%, p=0.0001, CSHQ =55%).

Table 3.28. Attitudes towards STI infection treatment of BDNH

Characteristic

Before CT n=114		After CT n=178		p	CSHQ %
SL	%	SL	%
Go to medical facility for examination and treatment	12	10.5	79	44.4	0.0001	323
state economy
Go to medical facility for examination and treatment	27	23.7	59	33.1	0.08
private health
Go to the pharmacy to buy medicine	66	57.9	46	25.8	0.0001	55
Use condoms during intercourse	13	11.4	39	21.9	0.02	92
symptom

According to table 3.28, for BDNH when there are STI symptoms, the rate of going to state health facilities for examination increased significantly (from 10.5% to 44.4%; p=0.0001) and the rate of buying medicine at pharmacies decreased (from 57.9% to 25.8%, p=0.0001). The rate of condom use during illness increased (from 11.4% to 21.9%, p=0.02).