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RESEARCH ARTICLE (Open Access)

Factors associated with HIV and syphilis infection among female sex workers in three cities in Papua New Guinea: findings from Kauntim mi tu, a biobehavioral survey

Angela Kelly-Hanku https://orcid.org/0000-0003-0152-2954 A B E , Damian Weikum C , Steven G. Badman B , Barne Willie A , Ruthy Boli-Neo A , Martha Kupul A , Parker Hou A , Josephine Gabuzzi A , Sophie Ase A , Angeline Amos A , Rebecca Narokobi A , Herick Aeno A , Simon Pekon A , Kelsey Coy C , Johanna Wapling A , Janet Gare A , Nick Dala D , John M. Kaldor B , Andrew J. Vallely A B , Avi J. Hakim C and on behalf of the Kauntim mi tu Study Team
+ Author Affiliations
- Author Affiliations

A Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands Province, Papua New Guinea.

B Public Health Intervention Research Group, Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Sydney, NSW 2052, Australia.

C US Centers for Disease Control and Prevention, Atlanta, GA 30329-4018, United States of America.

D HIV and STI Program, Papua New Guinea National Department of Health, Port Moresby, Papua New Guinea.

E Corresponding author. Email: a.kelly@unsw.edu.au

Sexual Health 17(4) 311-320 https://doi.org/10.1071/SH19218
Submitted: 27 November 2019  Accepted: 8 May 2020   Published: 23 July 2020

Journal Compilation © CSIRO 2020 Open Access CC BY-NC

Abstract

Background: In this paper, factors associated with HIV and syphilis infection in three cities in Papua New Guinea are explored. Methods: Respondent-driven sampling surveys among FSW in Port Moresby, Lae, and Mt. Hagen (2016–17) were conducted. FSW who were aged ≥12 years, who were born female, who spoke English or Tok Pisin and who had sold or exchanged vaginal sex in the past 6 months were eligible to participate. Participants were interviewed face-to-face and offered rapid HIV and syphilis testing. Survey logistic procedures were used to identify factors associated with HIV and syphilis infection, including modern contraception use, physical violence and having a casual male partner. Weighted data analysis was conducted. Results: Overall, 2901 FSW (Port Moresby, 673; Lae, 709; and Mt. Hagen, 709) were enrolled in the study. HIV prevalence was 15.2% in Port Moresby, 11.9% in Lae and 19.6% in Mt. Hagen. Factors associated with HIV varied by city; for example, use of modern contraception in Port Moresby, experiences of physical violence in Lae and ever having tested for HIV in Mt. Hagen. No one variable was associated with HIV in all cities. Prevalence of syphilis infection was 7.1%, 7.0%, and 3.0% in Port Moresby, Lae, and Mt. Hagen, respectively. Factors associated with syphilis infection also varied by city and were only significant in Lae. Conclusion: The different factors associated with HIV and syphilis infection in each city highlight the complex HIV and syphilis epidemics among FSW and the importance of conducting surveys in multiple locations and developing local interventions.

Additional keywords: condoms, key populations, Pacific, sexually transmitted infections, violence.


References

[1]  The Joint United Nations Programme on HIV and AIDS, editor. 2017 Global HIV Statistics. Geneva: UNAIDS; 2018.

[2]  Ngugi EN, Roth E, Mastin T, Nderitu MG, Yasmin S. Female sex workers in Africa: epidemiology overview, data gaps, ways forward. SAHARA J 2012; 9 148–53.
Female sex workers in Africa: epidemiology overview, data gaps, ways forward.Crossref | GoogleScholarGoogle Scholar | 23237069PubMed |

[3]  Kerrigan D, Wirtz A, Baral S, Decker M, Murray L, Poteat T, et al. The global HIV epidemics among sex workers. Washington DC, USA: World Bank; 2013.

[4]  Shannon K, Crago AL, Baral SD, Bekker LG, Kerrigan D, Decker MR, et al The global response and unmet actions for HIV and sex workers. Lancet 2018; 392 698–710.
The global response and unmet actions for HIV and sex workers.Crossref | GoogleScholarGoogle Scholar | 30037733PubMed |

[5]  National AIDS Council Secretariate, editor. National HIV and AIDS Strategy 2011–2015. Port Moresby: National Department of Health; 2010.

[6]  World Health Organization. Country profiles on HIV: Papua New Guinea. 2018. Available online at: http://www.wpro.who.int/hiv/data/countries/png/en/ [verified 13 September 2018] .

[7]  Kelly A, Kupul M, Man WYN, Nosi S, Lote N, Rawstorne P, et al. Askim na Save (Ask and understand): people who sell and/or exchange sex in Port Moresby. Key Quantitative Findings. Sydney, Australia: Papua New Guinea Institute of Medical Research and the University of New South Wales; 2011.

[8]  Maibani G, Ryan C, Lote N, Edward G, Ralai A, Gare J, et al. Papua New Guinea - Australia Sexual Health Improvement Program. Report on the Baseline Survey. Goroka: PNG Institute of Medical Research; 2011.

[9]  World Health Organization, CDC, UNAIDS, FHI 360. Biobehavioral survey guidelines for Populations at Risk for HIV. Geneva: World Health Organization; 2017.

[10]  Kelly-Hanku A. Past. Present. Future. Response(s) to HIV in Papua New Guinea. Australasian HIV/AIDS Conference; 2016 Nov 14–16; Adelaide, Australia, 2016.

[11]  Cohen M. Sexually transmitted diseases enhance HIV transmission: no longer a hypothesis. Lancet 1998; 351 5–7.
Sexually transmitted diseases enhance HIV transmission: no longer a hypothesis.Crossref | GoogleScholarGoogle Scholar | 9652712PubMed |

[12]  Freeman EE, Weiss HA, Glynn JR, Cross PL, Whitworth JA, Hayes RJ. Herpes simplex virus 2 infection increases HIV acquisition in men and women: systematic review and meta-analysis of longitudinal studies. AIDS 2006; 20 73–83.
Herpes simplex virus 2 infection increases HIV acquisition in men and women: systematic review and meta-analysis of longitudinal studies.Crossref | GoogleScholarGoogle Scholar | 16327322PubMed |

[13]  Zetola NM, Klausner JD. Syphilis and HIV infection: an update. Clin Infect Dis 2007; 44 1222–8.
Syphilis and HIV infection: an update.Crossref | GoogleScholarGoogle Scholar | 17407043PubMed |

[14]  Heckathorn DD. Respondent-driven sampling: a new approach to the study of hidden populations. Soc Probl 1997; 44 174–99.
Respondent-driven sampling: a new approach to the study of hidden populations.Crossref | GoogleScholarGoogle Scholar |

[15]  Heckathorn DD. Snowball versus respondent-driven sampling. Sociol Methodol 2011; 41 355–66.
Snowball versus respondent-driven sampling.Crossref | GoogleScholarGoogle Scholar | 22228916PubMed |

[16]  Malekinejad M, Johnston LG, Kendall C, Kerr LR, Rifkin MR, Rutherford GW. Using respondent-driven sampling methodology for HIV biological and behavioral surveillance in international settings: a systematic review. AIDS Behav 2008; 12 S105–30.
Using respondent-driven sampling methodology for HIV biological and behavioral surveillance in international settings: a systematic review.Crossref | GoogleScholarGoogle Scholar | 18561018PubMed |

[17]  Government of Papua New Guinea. The HIV and AIDS Management and Prevention Act. Port Moresby: Government of Papua New Guinea; 2003.

[18]  Heckathorn DD. Respondent-driven sampling: a new approach to the study of hidden populations. Soc Probl 1997; 44 174–99.
Respondent-driven sampling: a new approach to the study of hidden populations.Crossref | GoogleScholarGoogle Scholar |

[19]  Johnston LG, Hakim AJ, D’ittrich S, Burnett J, Kim E, White RG. A systematic review of published respondent-driven sampling surveys collecting behavioral and biologic data. AIDS Behav 2016; 20 1754–76.
A systematic review of published respondent-driven sampling surveys collecting behavioral and biologic data.Crossref | GoogleScholarGoogle Scholar | 26992395PubMed |

[20]  Kroenke K, Williams JB. The Patient Health Questionnaire-2: validity of a two-item depression screener. Med Care 2003; 41 1284–92.
The Patient Health Questionnaire-2: validity of a two-item depression screener.Crossref | GoogleScholarGoogle Scholar | 14583691PubMed |

[21]  The Joint United Nations Programme on HIV and AIDS. Global AIDS response progress reporting 2014: construction of core indicators for monitoring the 2011 United Nations political declaration on HIV and AIDS. Geneva: UNAIDS; 2014.

[22]  Causer LM, Kaldor JM, Conway DP, Leslie DE, Denham I, Karapanagiotidis T, et al An evaluation of a novel dual treponemal/nontreponemal point-of-care test for syphilis as a tool to distinguish active from past treated infection. Clin Infect Dis 2015; 61 184–91.
An evaluation of a novel dual treponemal/nontreponemal point-of-care test for syphilis as a tool to distinguish active from past treated infection.Crossref | GoogleScholarGoogle Scholar | 25810288PubMed |

[23]  National Department of Health PNG. Standard treatment guidelines for adults. Port Moresby: National Department of Health PNG; 2012.

[24]  Gile KJ. Improved inference for respondent-driven sampling data with application to HIV prevalence estimation. J Am Stat Assoc 2011; 106 135–46.
Improved inference for respondent-driven sampling data with application to HIV prevalence estimation.Crossref | GoogleScholarGoogle Scholar |

[25]  Schwartländer B, Stover J, Hallett T, Atun R, Avila C, Gouws E, et al Towards an improved investment approach for an effective response to HIV/AIDS. Lancet 2011; 377 2031–41.
Towards an improved investment approach for an effective response to HIV/AIDS.Crossref | GoogleScholarGoogle Scholar | 21641026PubMed |

[26]  Berkman A, Garcia J, Muñoz-Laboy M, Paiva V, Parker R. A critical analysis of the Brazilian response to HIV/AIDS: lessons learned for controlling and mitigating the epidemic in developing countries. Am J Public Health 2005; 95 1162–72.
A critical analysis of the Brazilian response to HIV/AIDS: lessons learned for controlling and mitigating the epidemic in developing countries.Crossref | GoogleScholarGoogle Scholar | 15933232PubMed |

[27]  Campbell C, Scott K, Nhamo M, Nyamukapa C, Madanhire C, Skovdal M, et al Social capital and HIV Competent Communities: the role of community groups in managing HIV/AIDS in rural Zimbabwe. AIDS Care 2013; 25 S114–22.
Social capital and HIV Competent Communities: the role of community groups in managing HIV/AIDS in rural Zimbabwe.Crossref | GoogleScholarGoogle Scholar | 23745625PubMed |

[28]  Wasserstein RL, Schirm AL, Lazar NA. Editorial: moving to a world beyond “p < 0.05”. Am Stat 2019; 73 1–9.
Editorial: moving to a world beyond “p < 0.05”.Crossref | GoogleScholarGoogle Scholar |

[29]  Baral SBC, Muessig K, Poteat T, Wirtz AL, Decker MR, Sherman SG, et al Burden of HIV among female sex workers in low-income and middle-income countries: a systematic review and meta-analysis. Lancet Infect Dis 2012; 12 538–49.
Burden of HIV among female sex workers in low-income and middle-income countries: a systematic review and meta-analysis.Crossref | GoogleScholarGoogle Scholar |

[30]  Anema A, Joffres MR, Mills E, Spiegel PB. Widespread rape does not directly appear to increase the overall HIV prevalence in conflict-affected countries: so now what? Emerg Themes Epidemiol 2008; 5 11
Widespread rape does not directly appear to increase the overall HIV prevalence in conflict-affected countries: so now what?Crossref | GoogleScholarGoogle Scholar | 18664265PubMed |

[31]  Supervie V, Halima Y, Blower S. Assessing the impact of mass rape on the incidence of HIV in conflict-affected countries. AIDS 2010; 24 2841–7.
Assessing the impact of mass rape on the incidence of HIV in conflict-affected countries.Crossref | GoogleScholarGoogle Scholar | 20859191PubMed |

[32]  Decker MR, Wirtz AL, Baral SD, Peryshkina A, Mogilnyi V, Weber RA, et al Injection drug use, sexual risk, violence, and STI/HIV among Moscow FSWs. Sex Transm Infect 2012; 88 278–83.
Injection drug use, sexual risk, violence, and STI/HIV among Moscow FSWs.Crossref | GoogleScholarGoogle Scholar | 22287530PubMed |

[33]  Watts CH, Foss AM, Hossain M, Zimmerman C, von Simson R, Klot J. Sexual violence and conflict in Africa: prevalence and potential impact on HIV incidence. Sex Transm Infect 2010; 86 iii93–9.
Sexual violence and conflict in Africa: prevalence and potential impact on HIV incidence.Crossref | GoogleScholarGoogle Scholar | 20972241PubMed |

[34]  Shannon K, Kerr T, Allinott S, Chettiar J, Shoveller J, Tyndall MW. Social and structural violence and power relations in mitigating HIV risk of drug-using women in survival sex work. Soc Sci Med 2008; 66 911–21.
Social and structural violence and power relations in mitigating HIV risk of drug-using women in survival sex work.Crossref | GoogleScholarGoogle Scholar | 18155336PubMed |

[35]  Bhattacharjee P, Isac S, McClarty LM, Mohan HL, Maddur S, Jagannath SB, et al Strategies for reducing police arrest in the context of an HIV prevention programme for female sex workers: evidence from structural interventions in Karnataka, South India. J Int AIDS Soc 2016; 19 20856
Strategies for reducing police arrest in the context of an HIV prevention programme for female sex workers: evidence from structural interventions in Karnataka, South India.Crossref | GoogleScholarGoogle Scholar | 27435708PubMed |

[36]  Shannon K, Goldenberg SM, Deering KN, Strathdee SA. HIV infection among female sex workers in concentrated and high prevalence epidemics: why a structural determinants framework is needed. Curr Opin HIV AIDS 2014; 9 174–82.
HIV infection among female sex workers in concentrated and high prevalence epidemics: why a structural determinants framework is needed.Crossref | GoogleScholarGoogle Scholar | 24464089PubMed |

[37]  Awungafac G, Delvaux T, Vuylsteke B. Systematic review of sex work interventions in sub-Saharan Africa: examining combination prevention approaches. Trop Med Int Health 2017; 22 971–93.
Systematic review of sex work interventions in sub-Saharan Africa: examining combination prevention approaches.Crossref | GoogleScholarGoogle Scholar | 28449198PubMed |

[38]  Gupta GR, Parkhurst JO, Ogden JA, Aggleton P, Mahal A. Structural approaches to HIV prevention. Lancet 2008; 372 764–75.
Structural approaches to HIV prevention.Crossref | GoogleScholarGoogle Scholar | 18687460PubMed |

[39]  Shannon K, Strathdee SA, Goldenberg SM, Duff P, Mwangi P, Rusakova M, et al Global epidemiology of HIV among female sex workers: influence of structural determinants. Lancet 2015; 385 55–71.
Global epidemiology of HIV among female sex workers: influence of structural determinants.Crossref | GoogleScholarGoogle Scholar | 25059947PubMed |