Sexual behavior and sexually transmitted infections in men living in rural Madagascar: implications for HIV transmission.
BACKGROUND
Madagascar is in the midst of a large HIV epidemic. Therefore, it is important to obtain relevant epidemiologic data that can be used to develop a preventive strategy.


OBJECTIVE
The goal of the study was to assess sexual behavior and sexually transmitted infections (STIs) among men living in two coastal villages and one highland village with different levels of endemicity of urogenital schistosomiasis.


METHODS
Data were obtained from cross-sectional studies on male reproductive health. All men aged 15 to 49 years were offered enrollment.


RESULTS
Of 401 men evaluated, 6.5% had used a condom and 45.6% reported having multiple partners in the previous 3 months. Symptoms of urethritis during the previous 7 days were reported by 128 men (31.9%). Urethritis was associated with the youngest age group (15-19 years) and the coastal villages, in which HIV antibodies were found in 0.9% and 2.5%, respectively. The prevalence of Schistosoma hematobium was 31.0% and 55.0% in these two villages, whereas none of the men in the highland village were infected. In bivariate analyses, urogenital schistosomiasis was associated with reported symptoms of urethritis, but it acted as a confounder in multivariate analyses.


CONCLUSIONS
Several risk factors for HIV propagation exist in these rural areas in Madagascar. Young men in particular should be targeted for HIV/STI prevention. Treatment of urogenital schistosomiasis could be considered part of the syndromic STI treatment in areas where S hematobium is endemic, for patients seeking primary care for urethritis.
Leutscher
Peter D C
PD
Institut Pasteur, Antananarivo, Madagascar. peter@pasteur.mg
Behets
Frieda
F
Rousset
Dominique
D
Ramarokoto
Charles-Emile
CE
Siddiqi
Omar
O
Ravaoalimalala
Elisabeth V
EV
Christensen
Niels O
NO
Migliani
René
R
D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D005832:Genital Diseases, Male / Q000453:epidemiology; D006801:Humans; D008270:Madagascar / Q000453:epidemiology; D008297:Male; D008507:Medically Underserved Area; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D012423:Rural Health; D012552:Schistosomiasis / Q000453:epidemiology; D012725:Sexual Behavior; D012749:Sexually Transmitted Diseases / Q000453:epidemiology* / Q000209:etiology* / Q000517:prevention & control; D012959:Socioeconomic Factors