Prevalence of Sexually Transmitted Infections Among HIV/AIDS Patients in Bandung, Indonesia
Sexually transmitted infections (STIs) and HIV/AIDS are significant health issues that pose a threat to human resources and contribute to socio-economic problems. This study examines the prevalence and risk factors of STIs among people living with HIV/AIDS (PLWHA) in community health centers (CHCs) in Bandung, Indonesia.
Overview of STIs and HIV
STIs can be transmitted through various sexual activities, including vaginal, anal, and oral intimacy. They can complicate HIV infections, making these conditions more severe and increasing the risk of HIV transmission. Early diagnosis and treatment of STIs are crucial for controlling both STIs and HIV infection.
STIs often exhibit minimal symptoms, allowing for asymptomatic transmission. Untreated STIs can lead to serious health complications, such as infertility, pelvic inflammatory disease, ectopic pregnancy in women, nerve damage, and blindness.
Global and Local Statistics
The global number of people living with HIV/AIDS (PLWHA) in 2023 was estimated at 39.9 million. Annually, over 374 million new cases of curable STIs, including chlamydia, gonorrhea, syphilis, and trichomoniasis, occur worldwide. In Bandung City, the number of STI cases reported in 2022 totaled 1,023 patients, comprising both men and women.
In the first quarter of 2023 in Indonesia, 13,279 PLWHA were reported, and 10,924 received antiretroviral therapy (ART). Key populations such as men who have sex with men (MSM), pregnant women, tuberculosis patients, female sex workers (FSWs), transgender individuals, and injecting drug users (IDUs) were most affected.
Importance of Screening
Regular HIV and STI testing are essential for preventative care. In Indonesia, several programs provide free screening tests to key populations at community health centers every three months.
These centers offer comprehensive HIV/AIDS services, from testing to ART and opportunistic infection management. The Indonesian government emphasizes the need to make testing, diagnosis, and treatment more accessible to PLWHA through these services.
Human Immunodeficiency Virus and Sexually Transmitted Infections
Several studies highlight factors linked to HIV/Syphilis co-infection such as male gender, low education, younger age, multiple sexual partners, inconsistent use of condoms, MSM status, injecting drug use, presence of other STIs, duration of HIV disease, and drug resistance.
In Indonesia, research on STIs and risk factors among adolescents, MSMs, and FSWs has been conducted. However, a study focused on PLWHA in CHCs with HIV/AIDS support and treatment services in Bandung City was missing. This study aimed to investigate this gap.
Study Methods
The study is based on a retrospective analysis of medical records of PLWHA from March 2019 to March 2024 in a CHC with HIV/AIDS support and treatment services in Bandung City, Indonesia.
STIs included in the study were syphilis, gonorrhea, chlamydia, and genital herpes. Diagnostic criteria were based on clinical signs and symptoms by a medical doctor or confirmed by laboratory tests.
Study Population
The study population comprised PLWHA registered at the CHC with complete sociodemographic and clinical data. Independent variables included gender, age, education level, marital status, occupation, population group, referral origin, length of illness, duration of ART, clinical stage, and comorbidities.
Results
The study analyzed 161 medical records of PLWHA, with five records excluded due to incomplete data. The majority of PLWHA were male, 16 to 44 years old, had a higher education level, were unmarried, and employed.
MSM represented the largest group, and most referrals came from NGOs. The prevalence of STIs among PLWHA was 32.1%, with syphilis being the most common (72%), followed by gonorrhea (22%), genital herpes (4%), and condyloma (2%).
Factors Associated with STI Prevalence
Several factors were found to be significantly associated with STI prevalence: MSM population group, NGO referrals, disease duration of 12 to 36 months, ART duration of 12 to 36 months, and early HIV clinical stage.
Other factors, such as gender, age, education level, marital status, occupation, and comorbidities, were not significant.
Discussion
The study revealed a 32.1% prevalence of STIs among PLWHA in Bandung City. High-risk sexual behaviors, particularly in MSM, play a significant role in these statistics.
The findings suggest that MSMs, referrals from NGOs, longer illness and treatment durations, and early HIV clinical stages increase the likelihood of STI infections. These factors could inform targeted intervention strategies aimed at high-risk populations.
Implications and Future Directions
This study is groundbreaking in its focus on PLWHA in CHCs with HIV/AIDS support and treatment services in Indonesia. Further research with a larger, more diverse sample could provide more comprehensive insights.
Future studies should use primary data, explore additional variables such as knowledge, attitudes, and risk behaviors, and employ multivariate regression analysis to understand the complex relationships between variables and STI prevalence.
Conclusion
Over one-third of PLWHA at a CHC with HIV/AIDS support and treatment service in Bandung, Indonesia, were found to have STIs, with syphilis being the most prevalent. Understanding the risk factors, such as MSMs, NGO referrals, longer illness and treatment durations, and early HIV clinical stages, is crucial for effective STI prevention and control.
Targeted intervention strategies are essential to improve STI prevention and control in these populations.
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