Poor risk perception responsible for low syphilis testing among male sex workers

Racheal Ninsiima

Dr. Richard Muhindo led the study team (PHOTO/Racheal Ninsiima)

A first-of-its-kind study in Uganda has revealed that the majority of male sex workers in Uganda are hesitant to screen for syphilis because of limited knowledge and low-risk perception. The study, ‘HIV and syphilis testing behaviors among heterosexual male and female workers in Uganda’ was published in the AIDS Research and Therapy Journal.

Syphilis, a sexually transmitted infection (STI), causes infected sores, blisters, or ulcers on one’s genitals, anus, or mouth. It’s normally passed on through sex without a condom or by sharing sex toys with someone who has the infection.

Led by Dr. Richard Muhindo as principal investigator, the research team conducted a cross-sectional survey of 100 heterosexual male sex workers (MSWs) in Kampala and Mbarara municipality between August and December 2019. Participants were aged over 17 and had spent two years in the business of selling sex for goods or money. Many of these serviced one to two clients per week and preferred female clientele aged over 35, whom they solicited through brokers, dating and social media sites, and recreational venues.

The World Health Organization (WHO) recommends that people engaging in sex work test every 3-months for syphilis but according to this study 32MSWs (32%) had ever tested for syphilis and only 19 (19%) had intentions to test for the infection in the next three months. Syphilis non-testing was associated with the low-risk perception of acquiring the infection, negative testing attitudes (not feeling sick), and low intention to seek testing because they thought it was not beneficial.

“Syphilis is a less stigmatized disease than HIV in Uganda and is thus not perceived as a significant threat to personal health. This is compounded by inadequate comprehensive knowledge regarding the infection and benefits of regular testing,” said Dr. Muhindo.

Additionally, MSWs usually do not identify as sex workers and are often missed by HIV and STI public health interventions. This is unlike female sex workers who obtain information about syphilis testing during moonlight HIV counselling and testing outreaches and antenatal care.

WHO recommends STI screening for sex workers every three months as an important entry point for treatment uptake and disease prevention. Syphilis can be cured with antibiotics, but it’s important to get tested and treated early on, as, without treatment, it can cause lasting health problems such as loss of sight and hearing.

Disturbingly, in addition to the minimal syphilis testing, MSWs sexual activities are often conducted without a condom. For this study, condom use at last sex was reported by only 16% of the participants. Similarly, consistent condom use was reported by only 10% of MSWs.

These findings show that MSWs form a hidden key population that impacts the transmission of STIs among the heterosexual population.

Therefore, they require specific HIV and STI intervention programs targeting them (MSWs). The study was supported by the NURTURE Research Training and Mentoring Program for Career Development at Makerere University’s College of Health Sciences (D43TW010132).

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