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An epidemiological survey of chlamydial & gonococcal infections in a Canadian Arctic community : determinants of sexually transmitted infections among remote Inuit populations Steenbeek, Audrey Ann

Abstract

Research Problem Sexually transmitted infections (STIs) pose serious health problems for Canadian Inuit people. This is compounded by ineffective screening and disease prevention strategies. Programs will have little impact on reducing infection rates if they do not target accurate disease prevalence and key determinants of transmission. Methods A cross-sectional survey (Part A) was conducted among Inuit males and females (ages 15-65 years) in a Baffin community. Participants (n = 181; mean age = 29.6) were screened for chlamydia/gonorrhea and interviewed. The questionnaire, which followed the Theories of Reasoned Action and Planned Behaviour, was used to collect information on demographics, use of health services, sexual histories, STI and contraceptive knowledge, high-risk behaviours, perceived risk and barriers of condom use. A random sample (n = 100) was selected from Part A for the longitudinal cohort. Individuals were followed every two months post baseline for four follow-up visits. At each visit, participants were screened for chlamydia/gonorrhea and questioned about their sexual/social networks and condom use. Networks were developed through "snowball"sampling. Results Overall, 35 cases of chlamydia were detected, with 21 detected at baseline and 14 during followup. The combined cases gave an overall prevalence of 15.6% in comparison with 2.7% that was previously estimated. No gonorrhea was detected. The strongest predictors for STIs included: female gender (OR 2.45, CI: 0.55, 10.89), recent STI (OR 9.82, CI: 2.70, 35.77) and a history of greater than 2 previous STIs (OR 1. 47, 0.92, 2.30). Chlamydia prevalence decreased by at least 22% post baseline screening and treatment intervention. Major barriers to condom use included: embarrassed to purchase condoms, discussing condom use, and fear of giving a bad impression. There were no significant differences between males and females (p = 0.73) and between the age groups (p = 0.67) regarding condom use. Conclusion Consistent with the literature, the results support universal screening use in populations with greater then 1 0% chlamydia prevalence. Screening should especially target individuals with prior history of chlamydia and/or gonorrhea. Universal screening, prompt treatment and comprehensive contact tracing are strongly recommended for STI prevention in all Inuit communities.

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