GHENT UNIVERSITY Karoline FONCK - International Centre for ...

Wasserheit 1992, Laga 1993). In Nairobi, STDs represent 5% to 10% of the caseloads at
many outpatient clinics (Reach 1988). Although the overall prevalence of STDs in the
general population is not known, studies among specific population groups have illustrated
high STD prevalence in both low- and high-risk groups.
Work performed in 1989 among pregnant women in Nairobi showed prevalence rates of 6%
for HIV, 3% for Neisseria gonorrhoeae, and 2% for syphilis (Temmerman 1992). Among
women attending a family planning clinic in Nairobi, the prevalence rate was 10% for HIV-1,
4% for Chlamydia trachomatis, 2% for N. gonorrhoeae, 2% for syphilis, and 1% for genital
ulcer disease (GUD) (Temmerman 1998 and 1995). A 1991 study of men attending an STD
clinic in Nairobi showed an HIV seroprevalence of 24% (Tyndall 1994) among men with nonspecific
symptoms as well as prevalence rates of 37% for N. gonorrhoeae and 33% for C.
trachomatis (Tyndall 1999).
The effectiveness of STD prevention and treatment programs depends, among other factors,
on adequate knowledge about the health behavior and health-seeking behavior of the
population, and on the sexual behavior characteristics of the target group. It is important to
understand the dynamics and interactions that make a person decide why, when and where
to seek care, and which health care facility to attend. To provide adequate health care, it is
imperative to know whether the choice of the health facility for an STD differs from the choice
for other common health problems. Issues such as accessibility and acceptability of services
are key to the provision of successful STD services.
This study examined the reasons for and patterns of health-seeking and related sexual
behaviors of patients with STD-related signs and symptoms who present at STD referral
clinics. The objective was to identify health-seeking behavioral factors and health servicerelated
issues that can be used to improve STD services, and to develop education
campaigns for the general public about seeking timely and correct STD treatment.
Methods
This study was conducted at the main public health STD referral clinic in Nairobi, also known
as the Special Treatment Center. The clinic is located downtown and draws its patients from
public and private institutions both within and outside Nairobi. The clinic, operated by the
Nairobi City Council, serves as a referral clinic for approximately 50 primary health care
clinics in Nairobi. Most of the peripheral public health clinics in Nairobi do not provide STD
care, but reroute the patients with STD-related symptoms to the STD clinic.
HEALTHCARE-SEEKING BEHAVIOR AND SEXUAL BEHAVIOR IN NAIROBI 38