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Table 5: General sexual behavior among individuals with a regular partner attending the STD clinic. Married Partners Partners With Regular Boyfriend or Girlfriend Men Women Men Women (n=120) (n=144) P (n=76) (n=57) P n (%) n (%) n (%) n (%) Do you think your spouse has extra-marital affairs: Yes 6 (5) 69 (48) =3 NS= not significant 9 (13) 1 (1) 0.006 4 (5) 3 (4) NS Discussion One parameter determining the transmission dynamics of STDs in a given population is the duration of time an individual with an STD is sexually active (Anderson 1987). The lack of successful treatment increases the duration of infectiousness, thus contributing to STD transmission and complications. Hence, the impact of an STD program depends, besides the effectiveness of the treatment regimens, on the time that infected individuals wait before seeking treatment and the extent of their unprotected sexual activity during this period. This study examined a cross-section of patients attending the STD referral clinic in Nairobi. These individuals constitute a high-risk group for transmitting STDs, including HIV/AIDS, and may be a priority target for interventions. The patients in the current study had waited one week, on the average, before seeking medical care. These findings are consistent with an earlier study conducted in Nairobi among STD patients in primary health care clinics (Moses 1994). Various reasons have been advanced for this long waiting time: (1) Lack of knowledge about the importance of seeking prompt medical care may play a role, which may be reflected by the extremely long delay before seeking care by women with pelvic inflammatory disease or cervicitis. (2) Lack of available services in the Nairobi area could be another factor. More than half of the patients in this study reported convenience of the location as the most important factor explaining why they attended a specific facility. (3) Finally, lack of financial resources, especially for women, also might play an important role in causing delayed treatment. Most of the women in this study reported not having an income. They, therefore, are dependent on their partners for money. In addition, findings show that women in this society are apprehensive about their partners' reaction on discovering that they have acquired an STD (Temmerman 1995). HEALTHCARE-SEEKING BEHAVIOR AND SEXUAL BEHAVIOR IN NAIROBI 43
Stigmatization by health staff also may play a role in preventing some patients from seeking medical care. In addition, the delay between attending a primary health facility and the STD referral clinic was considerable, which is quite worrisome. More than half of the patients had sought treatment elsewhere before attending the STD clinic. Treatment for STDs is not available at all primary health care clinics in Nairobi. Therefore, patients with STDs often must be rerouted immediately to the nearest clinic with STD treatment or to the STD referral clinic. Consequently, the clinics with STD treatment should refer only the patients with STD who do not respond to the first-line syndromic treatment approach provided. This system, although still causing some delay in appropriate treatment, seems to function well. However, more operational research on the efficiency of referral is needed. The delay in presenting to the STD clinic is considerably shorter for referred patients, indicating that referral status decreases the stigma attached to attending an STD clinic. Patients who have been to the STD clinic before find it much easier to come straight to the STD clinic for the next episode. With regard to health-seeking behavior, men more often than women report a different healthcare-seeking attitude when confronted with an STD. The men in this study reported attending the public health sector significantly less often for an STD than for other health problems. This implies that adequate STD case management must be offered as widely as possible to have a significant impact on the STD epidemic. The women were more likely than the men to have unprotected sex while symptomatic, the married women more so than the unmarried women. This observation further reinforces the belief about the imbalance in African families, with the woman possibly unable to refuse sex or negotiate safe sex with her husband or regular partner. Thus, the women, expected to be sexually and socially subordinate to men, continue to be infected by their partners (Ickovics 1998). This observation is supported by the fact that two thirds of the men in the current study admitted their extramarital sex activity, but still blamed their wives for contracting the STD (Rakwar 1999). A similar observation was made by Moses et al. in 1994, who found that married women were more likely than unmarried women to engage in sex while symptomatic, and that a large proportion of them had sex several times before seeking treatment. Men also reported more multiple partners than women. Therefore, men are more likely than women to transmit STDs to their partners. This is consistent with the belief that African women are at increased HEALTHCARE-SEEKING BEHAVIOR AND SEXUAL BEHAVIOR IN NAIROBI 44
Page 1 and 2: GHENT UNIVERSITY STI PREVENTION AND
Page 3 and 4: AIDS Acquired Immune Deficiency Syn
Page 5 and 6: 1.1. Sexually Transmitted Infection
Page 7 and 8: countries, the rate of reporting co
Page 9 and 10: district of Uganda randomized villa
Page 11 and 12: By identifying where significant
Page 13 and 14: 4.5%, 3.9%, 67.7% and 30.1% while t
Page 15 and 16: female primary health care or anten
Page 17 and 18: The research data have been publish
Page 19 and 20: 2.1. OBJECTIVES 2.1.1. General obje
Page 21 and 22: 2.2.3. Laboratory procedures The mi
Page 23 and 24: C HAPTER 3 PREVALENCE AND RISK FACT
Page 25 and 26: After registration by the clinic cl
Page 27 and 28: The majority of the women were infe
Page 29 and 30: eing single, ever having been treat
Page 31 and 32: prevalence found in a family planni
Page 33 and 34: 3.2. Declining Syphilis Prevalence
Page 35 and 36: Training Nurses at the antenatal cl
Page 37 and 38: We believe that the observed declin
Page 39 and 40: Wasserheit 1992, Laga 1993). In Nai
Page 41 and 42: Table 1: Demographic data of 471 pa
Page 43: women. Overall, significantly fewer
Page 47 and 48: 4.2. Health-Seeking Behavior and Se
Page 49 and 50: Between September and November 1998
Page 51 and 52: Table 2: Healthcare-seeking behavio
Page 53 and 54: Thirteen women had engaged in sex w
Page 55 and 56: Men reported more extramarital affa
Page 57 and 58: C HAPTER 5 DIAGNOSIS AND MANAGEMENT
Page 59 and 60: discharge and abdominal pain-two co
Page 61 and 62: Data were entered and analyzed in S
Page 63 and 64: One of the peripheral health center
Page 65 and 66: Evaluation of Algorithms The result
Page 67 and 68: In this study of symptomatic women,
Page 69 and 70: C HAPTER 6 PREVENTION OF SEXUALLY T
Page 71 and 72: Table 1: Syphilis Rapid Plasma Reag
Page 73 and 74: One should keep these problems in m
Page 75 and 76: The use of mailed reminders did not
Page 77 and 78: Table 1: Characteristics of women w
Page 79 and 80: studies, indicating that couples ar
Page 81 and 82: 6.3. A Randomized, Placebo-controll
Page 83 and 84: esistance patterns in bystander flo
Page 85 and 86: In univariate analysis, the odds ra
Page 87 and 88: Widows, divorcees and separated wom
Page 89 and 90: They did not report much condom use
Page 91 and 92: The low prevalence of the other STD
Page 93 and 94: There is some evidence that frequen
Page 95 and 96:
Table 1. Characteristics of HIV- po
Page 97 and 98:
A significantly higher prevalence o
Page 99 and 100:
There is now considerable evidence
Page 101 and 102:
patients. The analysis revealed hig
Page 103 and 104:
contributory factor may be that mal
Page 105 and 106:
use in Kenya. In a supplement of Se
Page 107 and 108:
with intensive behavioral change in
Page 109 and 110:
C HAPTER 8 FINAL REMARKS STIs illus
Page 111 and 112:
to protect themselves and be empowe
Page 113 and 114:
Bell G, Ward H, Day S et al. Partne
Page 115 and 116:
Fleming D and Wasserheit J. From ep
Page 117 and 118:
Jackson DJ, Rakwar JP, Chohan B et
Page 119 and 120:
Manning B, Moodley J, Ross SM. Syph
Page 121 and 122:
Oberlander L, Elverdam B. Malaria i
Page 123 and 124:
Serwadda D, Gray R, Wawer M et al.
Page 125 and 126:
Van Dam J, Anastasi MC. Male Circum
Page 127 and 128:
WHO Collaborating Center on HIV/AID
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S UMMARY Sexually transmitted infec
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notification. Innovative and locall
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connaissance des femmes sur la sant
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Nous avons démontré que le coût
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vonden we een hoge prevalentie van
Page 139 and 140:
We hebben aangetoond dat de kost va
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