Analysis Of KAP Survey And Serological Investigation Among FSWs In Ulaanbaatar And Darkhan, Mongolia

Since first AIDS cases were reported in June 1981 in the United States, AIDS epidemic is rapidly spreading in the world. According to Report on the Global HIV/AIDS Epidemic, the estimated number of persons living with HIV worldwide is 33.2 million at the end of 2007. Foreign experience and the survey showed that the AIDS epidemic has caused serious impact on human life, the family, economic, and social aspects, while because of the lack of an effective management of the source of HIV transmission, the lack of an effective intervention of HIV transmission, large number of susceptible population, AIDS has not been successfully controlled. Mongolia discovered the first case of HIV infection in 1992, and as that of the end of 2007, has a total number of 36 cases of HIV infection. Although Mongolia is still at low level of HIV epidemic, the rate of HIV spreading is accelerated according to the data from surveillance. Mongolia's special geographic position, economic poverty, incomplete knowledge among high-risk groups for AIDS awareness, the high incidence of high-risk behavior, sexually transmitted diseases, as well as related policies and cultural influences, may also promote the spread of the AIDS epidemic. Mongolia has the large number of female sex workers, and among 36 confirmed infected, 20% are female sex workers, which shows this subgroup is one of the high-risk groups in Mongolia . Therefore, effective intervention measures are necessary targeting female sex workers. AIDS KAP survey, also known as the "Knowledge, Attitude and Practice" investigation, through understanding the extent of AIDS-related knowledge, the attitude to community, works, living ways and sexual behavioral characteristics, provides data to suggest and implement further acts of intervention and the formulation of relevant policies.ObjectivesThis study aims to understand demographic characteristics of FSWs; to understand of AIDS related knowledge, attitude, sexual characteristics, satisfaction with life among FSWs; to learn prevalence of HIV and syphilis among FSWs. With the above analysis, the study put forward recommendations and control policy for the prevention of AIDS epidemic among FSWs in our country.Methods:Cross-sectional study method was used in this survey, which was performed in entertainment areas of Ulan Bator city and Khan City from October 2007 to January 2008. Investigators were those working in the Centre for Disease Control and Prevention who had received professional training and had a good grasp of the investigating techniques. The national standard questionaire"sex workers conduct surveys", involving one-on-one interview, was used in this survey, which was full compliance with "respect, equality, non-judge, confidentiality" principle.After obtaining the consent of subjects, 7-10 ml venous blood was collected, and then sent to Mongolia CDC to check syphilis antbody and HIV-1 antibody. Rapid plasma regain circle card test(RPR), Treponema pallidum hemagglutination assay(TPHA), Enzyme-Linked Immuno Sorbent Assays,(ELISA) were used in the antibody serological investigation. EXCEL software was used for data entry, and SPSS12.0 was used to analyze the data.Results:1. 600 FSWs, 400 from UlanBator and 200 from Darkhan, were collected in this survey, who were fit for the criteria of object selection and agreed to provided blood sample,. The average age of the cases was 24.2 years old, including 50.2 % cases under the age of 25; grades 9 to 10 accounted for 62.0%, while college and universities accounted for 2.3%; married, unmarried but living with boyfriend had the respective proportions of 6.5%, 19.3%; 47.1% of the cases had habit of every day drinking alcohol or drinking several times in a week.2. Regarding the prevention measure of HIV transmission mentioned in the questionaires, the rate of correct answers was high, but the proportion of completely correct answer of three questionnaires was only 49.7 %. Regarding the non-transmission modes, such as contact with HIV patients or mosquito bites, the correct answer rate was still relatively low, with 52.7% and 51.7% respectively. The survey results showed that if colleagues or friends were found to be infected with HIV, 12.5 % of the cases replied on discontinuing relationship with HIV patient while 15.5% of the cases replied that the community should discontinue its relationship with the infected person. Some did not know how to solve the problems.3. Percent of condom using every time or most of time was 92.0% between FSWs and their clients, while the percent in temporary and long-term sexual partners was 18.8% and 18.7% respectively. It showed the trend of HIV spreading through FSWs to the general population. During the forthcoming publicity activities, we should focus on improving proportion of the use of condoms among temporary and long-term sexual partners to reduce the chance of infection in the general population.4. About 1/3 cases were satisfied with their accommodation, health, diet conditions, clothing conditions, with an average score of 3.34, 3.13, 2.99 and 2.93 respectively. Most of the cases were dissatisfied over their level of education, work and family income as shown by 2.36, 2.34 and 1.91 respectively.5. About 20% of subjects in the past year had STD symptoms, 63.4% of whom would like to choose treatment options and most of whom prefer to large hospital for treatment. Regarding the AIDS awareness, knowledge of sexually transmitted diseases should be combined with the publicity programs to promote positive treatment of sexually transmitted diseases, thereby reducing the risk of HIV infection.6. Among 600 blood samples, 142 samples were detected syphilis antibodies positive by TPHA, the prevalence was 23.7%. ELISA method was use for HIV antibody testing, but no positive sample was found. Conclusion:1. The major FSWs in Mongolia are below the 25-year-old, less educated, some married or cohabiting, high frequency of drinking.2. HIV-related knowledge among Mongolian FSWs has greatly improved, but is still not complete. We should propagandize them according to their weakness.3. Percent of condom use between FSWs and their temporary or long-term sexual partners is low. Therefore attention should be paid for improving proportion of use condoms with temporary and long-term sexual partners to reduce the chance of infection among the general population.4. Syphilis infection status is serious among Mongolian FSWs. We need to concern about the healthy sexuality among FSWs, and promote the positive standard treatment of STDs.