ABSTRACT

Behets, Frieda M.T.F., Justin Ranjalahy Rasolofomanana, Kathleen Van Damme, Georgine Vaovola, Jocelyne Andriamiadana, Adeline Ranaivo, Kristi McClamroch, Gina Dallabetta, Johannes van Dam, Désiré Rasamilalao, Andry Rasamindra, and the Mad-STI Working Group. 2003. “Evidence-based treatment guidelines for sexually transmitted infections developed with and for female sex workers,” Tropical Medicine and International Health 8(3):251–258.

Background
Sex work is frequently one of the few options women in low-income countries have to generate income for themselves and their families. Treating and preventing sexually transmitted infections (STIs) among sex workers (SWs) is critical to protect the health of the women and their communities; it is also a cost-effective way to slow the spread of HIV. Outside occasional research settings, however, SWs in low-income countries rarely have access to effective STI diagnosis.

Objectives
To develop adequate, affordable, and acceptable STI control strategies for SWs.

Methods
In collaboration with SWs we evaluated STIs and associated demographic, behavioral, and clinical characteristics in SWs living in two cities in Madagascar. Two months post-treatment and counseling, incident STIs and associated factors were determined. Evidence-based STI management guidelines were developed with SW representatives.

Results
At baseline, two of 986 SWs were HIV-positive; 77.5 percent of the SWs in Antananarivo and 73.5 percent in Tamatave had at least one curable STI. Two months post-treatment, 64.9 percent of 458 SWs in Antananarivo and 57.4 percent of 481 women in Tamatave had at least one STI. The selected guidelines include speculum exams; syphilis treatment based on serologic screening; presumptive treatment for gonorrhoea, chlamydia, and trichomoniasis during initial visits, and individual risk-based treatment during three monthly follow-up visits. SWs were enthusiastic, productive partners.

Conclusions
A major HIV epidemic can still be averted in Madagascar, but effective STI control is needed nationwide. SWs and health professionals valued the participatory research and decisionmaking process. Similar approaches should be pursued in other resource-poor settings where sex work and STIs are common and appropriate STI diagnostics lacking.

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