Sexually transmitted infections in Uganda : implications for control

Abstract

Background: In Uganda, an AIDS control programme was launched in 1986. This served as an ignition for the control of sexually transmitted infections (STIs). There are indications that HIV/AIDS-control may be progressing well. However, the control of STIs/HIV in Uganda is far from ideal. There is need for more understanding of the factors influencing the control of STIs in the country with a view of suggesting appropriate interventions.

Objective: To describe and analyse factors influencing the control of STIs in Uganda and to evaluate ways of improved STI control.

Methods: Data were collected in Mbarara district and in Kampala, the capital of Uganda. In Mbarara district, ten focus group discussions were held with community members in rural and urban areas. Individual interviews were held with patients with sexually transmitted diseases (STDs) at the out-patient department of Mbarara Hospital and the STD clinic at Mulago Hospital, Kampala. Data were collected on lay people's perceptions of STIs and determinants for condom use and for sexual partner referral. A randomised controlled trial was conducted to test the efficacy of patient-delivered partner medication in the treatment of sexual partners.

Main findings: Lay people perceived STIs as naturalistic diseases caused by a tiny insect, Akakoko or Akawuka. About 60 percent of patients with STDs sought care before coming to the clinics and use of various sources of care including the private practitioners, pharmacists, drug vendors, and traditional healers was widespread. More than 70 percent of patients with STDs continued having sex while symptomatic whereas only 16 percent used condoms. Negative attitudes towards condoms were overwhelming. The independent predictors that favoured condom use were being male, being of high socio-economic status, and not having a regular sexual partner. Only 22 percent of the patients with STDs said they had had sex with a casual partner during the previous three months.

Regarding the treatment of sexual partners, about 14 percent of patients seek care with the partner and about 34 percent of the partners are referred for care by the index patient. However, evaluation of patient-delivered partner medication showed that it is more efficacious than partner referral with 74 percent of partners reported to be treated through this method. Women were often disadvantaged in sexual decisions and actions. They were less likely to use condoms, less likely to refer sexual partners, more likely to have sex while symptomatic, and more likely to say that future protection from STI will depend on the partner(s).

Conclusions: Measures aimed at empowering women for STI control and prevention should be given priority. The negative beliefs towards use of condoms should be addressed. Partner treatment strategies such as seeking care with partner and patient-delivered partner medication could complement partner referral. Since patients with STDs seek care from a variety of sources, the STD/AIDS control programme should collaborate with other health care providers than those in public health institutions.