Prevalence and correlates of selected sexually transmitted infections among adolescent girls and young women domestic workers in Kampala and Wakiso Districts

Abstract

Introduction: Out-of-school adolescent Girls and Young Women (AGYW) are disproportionately affected by sexually transmitted infections (STIs) which cause adverse sexual reproductive health outcomes, are costly to health care and strongly associated with HIV transmission and acquisition. AGYW in domestic work are especially at higher risk due to economic dependence, gender inequality, social isolation, power dynamics and limited access to healthcare and sexual health education that make it difficult for them to protect themselves from sexual exploitation, coerced sex, and unprotected sexual encounters, all of which increase their risk of acquiring STIs. This study determined the prevalence and correlates of selected STIs among this population.

Methods: A community-based cross-sectional study used structured questionnaires to collect demographic and behavioural characteristics from 262 female domestic workers aged 14-24 years in Kampala and Wakiso districts. Self-collected vaginal swabs were used to test for Neisseria Gonorrhoea (NG) and Chlamydia Trachomatis (CT) using a molecular test, GeneXpert (Cepheid, HBDC, Maurens-Scopont, France). HIV-serostatus and syphilis were tested using the SD Bioline HIV/Syphilis Duo-testing kit (Abbott, Illinois, US) at the study site, with confirmatory algorithmic testing done when required. Modified Poisson regression model assessed factors associated with STIs.

Results: We enrolled 262 respondents with a median age 20 years (IQR 18-23). The overall prevalence of STIs was 33.2% with individual STIs; NG 2%, CT 28%, Syphilis 6% and HIV 5%. Participants engaged in risky behavior that increased STI risk. At multivariable analysis, lower education level of primary and below (aPR: 1.73, 95% CI: 1.73 (1.1-2.57); P=0.007), being paid non-cash (aPR: 2.26, 95% CI:1.04 - 4.92; P=0.04), transactional sex (aPR: 1.43, 95% CI:1.01-2.04; P=0.045) and alcohol use in the last 6 months (aPR: 1.72, 95% CI:1.12-2.64; P=0.013) were positively associated with STIs. On the contrary, sexual abuse was negatively associated with STIs (aPR: 0.48, 95% CI :0.28-0.83; P=0.008).

Conclusion: There is a high prevalence of STIs and high rates of risky sexual behaviour reported among AGYW employed in domestic work. Lower education level, non-cash payment, transactional sex, alcohol use and sexual abuse were associated with STIs. These findings warrant advocacy for decent employment conditions; and targeted interventions that increase education/awareness and access to STI health services in this vulnerable population.