Prevalence and correlates of syphilis and condom use among male injection drug users in four Afghan cities.

Abstract

BACKGROUND:

: Injecting drug use is increasing in Afghanistan but little is known about sexual risk behaviors and sexually transmitted infection (STI) prevalence among injection drug users (IDU). The purpose of this study is to assess prevalence and correlates of syphilis and condom use with female sex workers (FSWs) among male IDUs in Hirat, Jalalabad, Kabul, and Mazar-i-Sharif, Afghanistan.

METHODS:

: Participants in this cross-sectional study completed an interviewer-administered questionnaire and serologic testing for syphilis between June 2005 and January 2008. Factors associated with syphilis condom use with FSWs were assessed with site-controlled logistic regression analysis.

RESULTS:

: Of 1078 male IDUs, most (90.3%) reported prior sexual experience, of whom 27.6% reported any condom use. Sexual experiences with FSWs (58.1%) and men or boys (25.7%) were common, although prior condom use with FSWs (32.6%) or male partners (10.8%) was relatively rare. Few reported having a lifetime STI diagnosis (6.3%, n = 68) or symptoms (10.4%, n = 110) in the last 6 months. Prevalence of syphilis was 3.72% (95% CI: 2.66%-5.06%) and varied significantly between sites ranging from 0% (Jalalabad) to 13.9% (Mazar-i-Sharif) (P < 0.001)). Syphilis was significantly associated with STI diagnosis (adjusted odds ratio [AOR] = 3.84) or sex with FSWs (AOR = 3.82) in the last 6 months, and with lower (≤6 years) educational level (AOR = 2.20). Prior condom use with FSWs was independently associated with living outside Afghanistan in the last decade (AOR = 5.52, 95% CI: 1.83-16.71), higher income (AOR = 2.03, 95% CI: 1.17-3.51), greater number of lifetime partners (AOR = 1.80, 95% CI: 1.32-2.45), and younger age (AOR = 0.985, 95% CI: 0.973-0.998).

CONCLUSIONS:

: Although prevalence of syphilis and condom use varied significantly by site, high levels of risky sexual behavior were common, and consistent condom use was rare among IDUs in Afghanistan. Harm reduction programming should incorporate sexual risk reduction and condom promotion and distribution in Afghan cities.

• Authors: Catherine S Todd, Abdul Nasir, Mohammad Raza Stanekzai, Abdullah M S Abed, Steffanie A Strathdee, Christian T Bautista, Paul T Scott, Boulos A Botros, Jeffrey Tjaden
• Journal: Sexually transmitted diseases (Sex Transm Dis) Vol. 37 Issue 11 Pg. 719-25 (Nov 2010) ISSN: 1537-4521 [Electronic] United States
• PMID: 20585276 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, U.S. Gov't, Non-P.H.S.)

Topics

• Adult
• Afghanistan (epidemiology)
• Condoms (statistics & numerical data)
• Cross-Sectional Studies
• Humans
• Interviews as Topic
• Male
• Prevalence
• Risk Factors
• Risk-Taking
• Sexual Behavior
• Sexually Transmitted Diseases (complications, diagnosis, epidemiology)
• Substance Abuse, Intravenous (complications, epidemiology)
• Surveys and Questionnaires
• Syphilis (complications, diagnosis, epidemiology)
• Young Adult