|Year : 2012 | Volume
| Issue : 3 | Page : 238-241
Male health clinic strategy in control of STI/HIV: A program review
Karun Dev Sharma1, Yuvaraj B Chavan2, Deepak S Khismatrao3, Radha Y Aras4
1 Assistant Professor, Department of Community Medicine, G.S.L. Medical College, Rajahmundry, India
2 Associate Professor, Department of Community Medicine,Seth G.S. Medical College, Mumbai, India
3 Associate Professor, Department of Community Medicine, Smt. Kashibai Navale Medical College, Pune, India
4 Professor, Department of Community Medicine,Yenepoya Medical College, Mangalore, India
|Date of Web Publication||3-Dec-2012|
Karun Dev Sharma
Assistant Professor, Department of Community Medicine, G.S.L. Medical College, NH 5, Lakshmipuram, Rajahmundry, Andhra Pradesh - 533 296
Source of Support: None, Conflict of Interest: None
| Abstract|| |
A community-based, longitudinal interventional study was conducted in a slum in north-east (NE) Mumbai, using a pretested, semi-structured proforma and a pre- and follow-up interview schedule to assess the male health clinic (MHC) strategy as an approach for the control of sexually transmitted infections (STIs) in males. The focus groups that emerged for behavior change communication (BCC) activities were clients in second and third decades of life, unmarried and married but not staying with wife, clients with no permanent place of occupation, clients with habit of alcohol, and illiterate clients. Postintervention, there was an overall increase in STI knowledge score, alcohol habit score, and high-risk sexual activity score. Less than 50% of the clients received advice on substance abuse and information on consequences of STI/human immunodeficiency virus (HIV). The study concluded that MHC strategy is an effective approach for control of STIs in males and recommended strengthening of the weaker components of the strategy with focus on the important client groups.
Keywords: Behavior change communication, High-risk activity, Male health clinic, Sexually transmitted infection knowledge
|How to cite this article:|
Sharma KD, Chavan YB, Khismatrao DS, Aras RY. Male health clinic strategy in control of STI/HIV: A program review. Indian J Public Health 2012;56:238-41
|How to cite this URL:|
Sharma KD, Chavan YB, Khismatrao DS, Aras RY. Male health clinic strategy in control of STI/HIV: A program review. Indian J Public Health [serial online] 2012 [cited 2019 Nov 21];56:238-41. Available from: http://www.ijph.in/text.asp?2012/56/3/238/104265
The concern about male sexual health and concomitantly the health of their sexual partners is set in the context of rapid spread of human immunodeficiency virus (HIV) and increasing rate of sexually transmitted diseases (STDs) in India. In the present scenario, men, in general, do not feel comfortable in seeking services from family planning clinics and young people, in particular, often feel embarrassed. Men's reproductive health needs include a wide range of services such as family planning, treatment and prevention of sexually transmitted infections (STI)/HIV, infertility, sexual problems, and others. Men need clinics and staff that provide confidential and nonjudgmental care.  To encourage male involvement in effective STI/HIV risk reduction, a research-based intervention project (research and intervention in sexual health: Theory to action, RISHTA) was established in 2002 at a population research institute in Mumbai. At the provider level, the RISHTA project established a male health clinic (MHC) at a government Urban Health Center (UHC) in north-east (NE) Mumbai. The service package of MHC strategy comprised of physical examination and medication for general and STIs complaints, advice on medication, behavior change communication (BCC) on risky sex, safe sexual practices and substance abuse, and information on causes and consequences of STI/HIV. This study was an attempt to assess the MHC strategy as an approach for control of STIs in males in an urban slum setting.
The study was carried out as a longitudinal interventional study, over a period of one and a half years (April 2004 to September 2005) with a follow-up period of 6 months for evaluation of BCC activities (October 2005 to March 2006). The study was approved by the institutional ethics committee. All the clients attending the MHC, during the study period, were the study subjects. The inclusion criteria for the study population for evaluation study were (1) age between 21 and 40 years, (2) giving history of "exposure ever" in life, and (3) residing in the project intervention area. They were followed up after a gap of 6 months and evaluated for changes in STI/HIV knowledge, alcohol habit, indulgence in high-risk sexual activity, and consistent condom use.
Total number of clients attending MHC during the study period was 1587 paying 2286 visits in total. For evaluation of intervention, total numbers of clients fulfilling the inclusion criteria were 205, of which 15 clients did not give consent. The sample size for evaluation of intervention was 190. On following up the clients in the community, 103 clients were interviewed as rest had either migrated or left for their native place (two visits were made before declaring the clients as lost to follow-up). A pretested semi-structured schedule was used to collect information on the demographic features and high-risk activities of clients. A pre- and follow-up interview schedule to assess the change in STI knowledge, high-risk activities, alcohol habit, and condom use were used. The follow-up schedule also assessed the range of services provided.
The data were analyzed using SPSS package version 10.0. The variables were represented as Mean±SD and in percentages and significance tests such as Chi-square test and Wilcoxan signed rank test were used to analyze the data. P value <0.05 was taken to be significant.
[Table 1] depicts the percentages of ever exposure, recent exposure, consistent condom use, and STI and, the relationship with some sociodemographic characteristics like age, literacy, occupation, marital status, and alcohol habit.
|Table 1: Distribution of exposure (duration and type), STI and condom use according to sociodemographic variables|
Click here to view
A total of 249 (41%) clients in the 21-30 years age group reported exposure "ever" (other than the spouse or regular partner) followed by 145 (37.3%) in the 31-40 years age group (P<0.05). A total of 33 (75%) clients in the 16-20 years age group and 125 (50.2%) in the 21-30 years age group reported recent exposure (exposure within last 6 months (P<0.05). The consistent condom use was highest (38.6%) in the 16-20 years age group. Highest proportion of STI (9.8%) was in the 16-20 years age group followed by 8.1% in the 21-30 years age group (P<0.05).
A total of 120 (67.4%) unmarried clients and 45 (33.3%) married clients not staying with wife reported recent exposure (P<0.05). Proportion of commercial exposure (exposure with commercial sex worker) was highest (63.5%) in the clients staying with their wives (P<0.05). Highest proportion of STI was 8.3% in unmarried clients.
As perceived from [Table 2], there was an overall significant increase in "STI knowledge" score (P<0.05) and "High-risk sexual activity" score (P<0.05), post intervention. The overall increase in "alcohol habit" score, postintervention was not significant.
|Table 2: Results of BCC on STI knowledge, alcohol habit, and high-risk sexual activities|
Click here to view
With respect to the service package of the MHC, of the 103 clients followed up, only 45 (43.7%) recalled having received advice on substance abuse and 40 (38.8%) recalled having received information on consequences of STI/HIV. For rest of the services, more than 60% clients recalled having received the services.
In our study, the focus age groups for prevention of the high-risk behavior and STIs were the clients in second and third decades of life, which have also been recommended by Awasthi et al.  The consistent condom use was reported to be highest in second decade followed by third decade as youth form an important target group for information, education, and communication (IEC) activities under National AIDS Control Program. 
Mehendale et al.  recommended unmarried clients and those not staying with their spouse as focus groups for BCC activities.  The commercial exposure was highest in married clients staying with their wives as observed in this study. The married clients can act as a bridge between the core and the general population. The importance of STI in married males and targeting the group with no permanent place of occupation (migrating population) had also been highlighted by Godbole and Mehendale.  In our study, commercial exposure was more in the illiterate clients. Lack of formal education as an independent factor for HIV had also been reported by Rodrigues et al.  Poor educational background had been reported to be linked to higher risk of STD and HIV acquisition by Mehendale et al.  and Shepherd et al. 
As found in our study, Madhivanan et al.  observed that alcohol consumption in routine, in a slum set up, was conducive to high-risk behavior and acquiring of STIs. 
The overall increase in alcohol consumption score was not significant, thus supporting the observation that providing information on substance abuse was a weaker component of MHC package. Both the literate group and clients with no permanent place of occupation showed a significant increase in high-risk activity score; this was commendable in view of this study as both groups have high rates of exposure.
Increase in the condom use score though calculated was considered unreliable, since there was a considerable loss to follow up of the clients, and number of clients for evaluating the condom use came down considerably.
Our study concluded that MHC strategy is an effective approach for control of STIs in males in an urban slum setting as reflected by an overall significant increase in "STI knowledge" score, "high-risk sexual activity" score, and "alcohol habit" score. The study recommends strengthening of service aspects such as advice on substance abuse and information on consequences of STI/HIV. The clients in second and third decades of life, unmarried and married but not staying with wife, clients with no permanent place of occupation, clients with habit of alcohol, and illiterate clients should be main focus of BCC activities.
| Acknowledgment|| |
The authors express their deep and sincere thanks to Professor Stephen L. Schensul - Director, Centre for Community Health Studies, University of Connecticut Health Centre, Farmington, Connecticut, Dr. Sharad Narvekar - Project Co-coordinator, RISHTA project, Dr. Niranjan Sagrugutti - Ex reader IIPS, and all the staff of RISHTA project for their constant support.
| References|| |
|1.||Sharma KD. Control of STIs and HIV: The male reproductive and sexual health context - The paradigms. Indian J Sex Transm Dis 2010;31:55. |
|2.||Awasthi S, Nichter M, Pande VK. Developing an interactive STI-prevention programme for young men: lessons from a North Indian Slum, 2000. Available from: http://www.psi.org.in/keyclinics/Abstract/Compilation%20of%20Abstracts%20for%20SM%20June%2028%202006/STI%20and%20HIV/Men%20and%20STIs%20North%20Indian%20Slum.pdf. [Last accessed 2010 Jul 15]. |
|3.||National AIDS Control Organisation. Information, education and communication (IEC): Operational guidelines. Communication Matrix. New Delhi: NACO; 2007. p. 7. |
|4.||Mehendale SM, Shepherd ME, Divekar AD, Gangakhedkar RR, Kamble SS, Menon PA, et al. Evidence for high prevalence and rapid transmission of HIV among individuals attending STD clinics in Pune, India. Indian J Med Res 1996;104:327-35. |
|5.||Godbole S, Mehendale S. HIV/AIDS epidemic in India: Risk factors, risk behaviour and strategies for prevention and control. Indian J Med Res 2005;121:356-68. |
|6.||Rodrigues JJ, Mehendale SM, Shepherd ME, Divekar AD, Gangakhedkar RR, Quinn TC, et al. Risk factors for HIV infection in people attending clinics for sexually transmitted diseases in India. BMJ 1995;311:283-6. |
|7.||Shepherd ME, Gangakhedkar RR, Sahay S, Reynolds SJ, Ghate MV, Risbud AR, et al. Incident HIV infection among men attending STD clinics in Pune, India: Pathways to disparity and interventions to enhance equity. J Health Popul Nutr 2003;21:251-63. |
|8.||Madhivanan P, Hernandez A, Gogate A, Stein E, Gregorich S, Setia M, et al. Alcohol use by men is a risk factor for the acquisition of sexually transmitted infections and human immunodeficiency virus from female sex workers in Mumbai, India. Sex Transm Dis 2005;32:685-90. |
[Table 1], [Table 2]