A multivariate analysis of social, demographic, and behavioral factors associated with gonorrhea and chlamydia prevalence among men who have sex with men and transgender women in Papua New Guinea Open Access

Abstract

Introduction: Globally, there are an estimated 87 million gonorrhea infections, 127 million chlamydia infections, and 6 million syphilis infections annually among people aged 15-49. These STIs have significant implications for the HIV epidemic due to epidemiologic synergy driven by biological and behavioral mechanisms. Key populations, including men who have sex with men (MSM) and transgender women (TGW) are particularly vulnerable as a result of sociocontextual barriers to care that include stigma, discrimination, and violence. With the highest prevalence of HIV in the Western Pacific region, population estimates of STI prevalence among MSM and TGW in Papua New Guinea (PNG) have yet to be realized. This study estimates the population prevalence of gonorrhea and chlamydia among MSM and TGW in Papua New Guinea and explores demographic, social, and behavioral factors associated with prevalence. 

Methods: Response driven sampling was used to recruit participants for an integrated biobehavioral survey between June 2016 and December 2017. Logistic regression procedures were used to conduct multivariate analyses. Variables were selected for models based on associations with STI infections seen in the literature and significance in bivariate models.   

Results: Controlling for all variables found to be significant in the bivariate analysis, age, education level, cut foreskin, and presence of an active syphilis infection were associated with gonorrhea and/or chlamydia prevalence among MSM and TGW in Port Moresby, PNG. In Lae, total number of male partners in the last six months and an active syphilis infection were positively associated with prevalence (Table 4.). Presence of an active syphilis infection was the strongest association across sites with an aOR of 3.9 (95% CI 2.6-5.7, p<0.0001) in Port Moresby and an aOR of 2.5 (95% CI 1.3-4.8, p=0.0116) in Lae.

Conclusion: Based on previous studies that syphilis, gonorrhea, and chlamydia coinfection are associated with increased incident HIV among MSM, the results here suggest these infections may play a critical role in PNG’s HIV epidemic moving forward. Given the burden of HIV and STIs among MSM and TGW, there is a tangible need to address testing and treatment access, engagement, and programming issues among MSM and TGW. 

Table of Contents

Table of Contents

I. Introduction. 1

Consequences of the STI epidemic. 1

A relationship to the HIV epidemic. 3

Key populations and HIV.. 4

MSM, transgender women, gonorrhea, syphilis and chlamydia. 5

STIs among MSM and TGW in Papua New Guinea. 6

Problem Statement 6

Purpose statement 7

Significance statement 7

Definition of terms. 8

II. Methodology. 10

Introduction. 10

Population and Sample. 10

Research Design. 12

Procedure. 13

Instruments. 14

Survey tools. 14

STI testing materials. 14

Data analysis. 15

Ethical considerations. 16

Limitations and delimitations. 17

III. Results. 18

Demographics. 19

Sexual behaviors. 19

STI prevalence. 20

Results from the multivariate analysis. 20

IV. Discussion. 22

Limitations of findings. 25

V. Recommendations. 26

VI. Conclusion. 27

Disclaimer and a note to collaborators and funders. 28

References. 30

Table 1. Characteristics of men who have sex with men (MSM) and transgender women (TGW) in Port Moresby, Lae and Mt Hagen, Papua New Guinea. 36

Table 2. Sexual behaviors of men who have sex with men and transgender women in Port Moresby, Lae and Mt Hagen, Papua New Guinea. 39

Table 3. Sexually transmitted infections among men who have sex with men and transgender women in Port Moresby, Lae, and Mt Hagen, Papua New Guinea. 41

Table 4. Multivariate analysis for factors associated with gonorrhea or chlamydia infection among MSM and transgender women in Port Moresby and Lae, Papua New Guinea. 42

Appendix. 44

     Emory IRB letter of exemption. 44

     CDC request for determination. 45

     Papua New Guinea Institute of Medical Research protocol amendment approval 47

     Papua New Guinea IMR new protocol approval 50

     Papua New Guinea Medical Reasearch Advisory Committee ethics review.. 52

     University of New South Whale Human Research Ethics Committee. 53

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Keyword	Papua New Guinea Global Health Sexually transmitted infections
Committee Chair / Thesis Advisor	Jorge E. Vidal, Emory University
Committee Members	Avi Hakim, CDC

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