Symptoms of Sexually Transmitted Infections and Care-Seeking Behaviors of Male Clients of Female Sex Workers in Bangladesh

Abstract

Background: In Bangladesh, male clients (MCs) of female sex workers

(FSWs) represent diverse occupational categories from different socioeco- nomic strata, and they are considered a bridging group to transmit sexually

transmitted infections (STIs) to their spousal and nonspousal female part- ners. This study aimed to better understand sexual behaviors, STI symptoms,

and care-seeking behaviors among MCs of FSWs in Bangladesh. Methods: A cross-sectional study was conducted among MCs from November 2005 to July 2006 in 3 types of sex trade settings in Bangladesh. Of 1565 MCs included in this study, 531 were from brothels, 515 from hotels, and 519 from street-based settings. Results: Among the MCs, 32.2% reported having had STI symptoms within the last 1 year before the interview and 81.5% sought care for those symptoms. Among those who reported symptoms, 44.5% received treatment from pharmacies, 37.4% received treatment from qualified medical professionals, 8.6%, received treatment from nongovernment organization clinics, and 7.8% went to herbal providers. Male clients who had only 1 to 4 years of schooling were 2.4 times more likely to have STI symptoms (adjusted odds ratio [OR], 2.4; 95% confidence interval [CI], 1.5Y3.8) compared with the MCs having 10 or more years of schooling. The MCs who had sex with more than 3 nonmarital sexual

partners in the last month were 2 times more likely to have STI symp- toms (adjusted OR, 2.0; 95% CI, 1.4Y2.8). The MCs who used condoms

consistently in their non-marital sexual contacts were significantly less likely (adjusted OR, 0.4; 95% CI, 0.3Y0.6) to have STI symptoms. Conclusions: Reported risk behaviors, STI symptoms and care-seeking behavior suggest that MCs are a potential risk group for transmission of HIV and STIs. The study findings underscore the need to target HIV/ STI prevention intervention for MCs, which are predominantly geared toward FSWs.