STD and HIV Prevalence Survey among Female Sex Workers and Truckers on Highway Routes in the Terai, Nepal

Abstract

EXECUTIVE SUMMARY: Female sex workers (FSW) and truckers in the Terai region have been identified as key core group populations in the HIV/STD control plan for Nepal. In March-July 1999, a cross-sectional study was conducted along the highway routes in the Terai in an effort to determine the HIV/STD prevalence among sex workers and truckers and to determine the demographic, behavioral and biological correlates for infection. Data from this study will also be used as a baseline for evaluating control interventions, and to assist instrategic planning to reduce HIV/STD in the region. Four hundred and ten sex workers from four representative sites in the Terai and 400 truckers from one central location were enrolled in the study. Following informed consent, a questionnaire was administered, blood, urine, and self-administered vaginal swab samples were collected, syndromic STD treatment was provided, and HIV counseling was conducted. Lab analysis included HIV, gonorrhea, chlamydia, trichomonas, bacterial vaginosis, and syphilis. Subjects returnedafter one month for results and possible treatment. The significant findings among the sex workers included: a 70% illiteracy rate; 70% of their clients were truckers; 50% had at least one STD including 20% with syphilis; the HIV prevalence of 4% was 2.5 times the trucker rate and 13 times that of the general public; only 17% of sex workers had worked in India, but 75% of the HIV cases were from this group; only 4% had worked in Mumbai, but 50% of the HIV cases were from this group; sex workers with syphilis had a tenfold higher risk of HIV than those without syphilis. The significant findings among the truckers included: 75% reported having sex with a sex worker; 10% had at least one STD including 5.3% with syphilis; the HIV rate of 1.5% was 5 times higher than found in the general public; truckers with syphilis had a tenfold higher risk of HIV than those without syphilis; and STDs were associated with older, married men with no schooling. The implications of these finding include a continued increase in HIV rates among female sex workers, an increased HIV rate among their clients (i.e., truckers),increased secondary transmission of HIV to their steady sex partners, and because of this dynamic, a general increase in the HIV rate among the general population. The high syphilis rates among the truckers and sex workers will leadto 1/3 of those infected developing tertiary syphilis and its fatal health effects. The high rate of chlamydia will lead to 20% sterility. Recommendations Include: 1. Sex workers and truckers should continue to be targeted for HIV and STD control programs; 2. An active syphilis control program, including rapid diagnostics and treatment should be initiated and should include periodic screening for all STDs; 3. Ongoing outreach and education programs should emphasize: the HIV/STD risk of sex work in India, especially in Mumbai; identification of women returning from India for additional support and services; STD symptom recognition and improved care seeking behavior; and improved condom use, even among married men.