Vector Volume 12 Issue 2 - 2018

the test had been performed within the previous 3
months, however, several women also refused to be
tested due to the fear of stigma and discrimination
associated with a positive test. On subsequent
follow-up for those women who refused screening,
further opportunities for screening were offered,
as appropriate. All FSWs who received a positive
test result for HIV were referred to higher health
institutions for antiretroviral therapy (ART) and to
other organisations for related services.
When both clinics were included, a total of
5302 FSWs were tested for HIV over the 5-year
study duration, with 181 having positive results,
giving a prevalence of 3.4%; however, of those also
diagnosed with an STI (n = 1462), the prevalence was
12.4% (Table 3). This suggests that concomitant STI
infection is a risk factor for HIV infection. Notably,
the prevalence of HIV decreased from 10% in 2010
to 1.1% in 2015 (Table 4).
Discussion
This study aimed to describe the experience of 2
confidential sexual health clinics in northern Ethiopia,
and to quantify the prevalence of STIs and response
to education regarding preventative health activities.
The link between STI and HIV co-infection was
examined, with an increased rate of HIV infection
noted in those presenting for investigation of an STI
syndrome, as consistent with previous literature.
Establishing the clinic and peer outreach
In the first 2 months following establishment of the
clinic, the number of FSWs attending was minimal.
Subsequent efforts to educate peer promoters were
successful in increasing the number of FSWs accessing
services at the clinics. Furthermore, staff working
at the clinic also played a role in disseminating
key information to FSWs during outreach sessions.
During the 5-year period, different strategies were
implemented to mobilise FSWs for HIV testing and
counselling. Providing peer education, engaging
with bar and hotel owners, conducting forums with
various stakeholders, providing outreach services and
opening the STI clinics on weekends were among the
strategies used, with good effect.
The Mekelle STI clinic provided sexual health
services to 2549 new clients during the 5-year study
period (2010-2015), of which 889 (34.9%) were
Table 2. Provision of STI services at Mekelle STI clinic from 2010 to 2015
Screening STI syndromes Contraceptives and interventions
Year Total
visits
Screened VDS GUS LAP Condoms
provided
Depo OCP Pregnancy
test
New Rpt New Rpt New Rpt New Rpt Visits Condoms
2010 803 500 303 39 0 60 0 6 2 650 65,000 111 18 42
2011 4059 391 3668 148 2 126 0 27 1 3468 499,392 502 285 282
2012 5691 710 4981 126 1 68 0 13 1 4520 594,100 791 342 436
2013 5474 502 4972 53 1 77 2 10 1 4122 618,300 808 306 360
2014 2388 446 1942 79 2 50 1 7 1 3922 595,800 1153 388 526
2015 1229 468 761 52 0 26 0 2 0 1548 154,800 799 242 361
Total 18415 2549 15866 445 6 381 3 63 6 16682 2,372,592 3365 1339 1646
VDS, vaginal discharge syndrome; GUS, genital ulcer syndrome; LAP, lower abdominal pain; OCP, oral contraceptive pill;
Depo, Depo-Provera contraceptive injection.
Table 3. HIV testing and STI screening at Mekelle and Adigrat clinics
Screening STI syndromes Treated STIs HIV tested
Year Total Screened VDS GUS LAP New Rpt New 1 HIV+
visits New Rpt New Rpt New Rpt New Rpt
2010 803 500 303 39 0 60 0 6 2 650 65,000 111 18
2011 4619 951 3668 199 2 135 0 57 1 3468 499,392 502 285
2012 8003 2373 5630 229 1 102 0 57 1 4520 594,100 791 342
2013 7841 930 6911 127 1 92 2 18 1 4122 618,300 808 306
2014 4494 814 3680 146 2 66 1 14 1 3922 595,800 1153 388
2015 2165 720 1445 74 2 35 0 6 0 1548 154,800 799 242
Total 27925 6288 21637 814 8 490 3 158 6 16682 2,372,592 3365 1339
NB: 2010 refers to the Mekelle clinic alone, as Adigrat was not in operation until 2011. VDS, vaginal discharge syndrome;
GUS, genital ulcer syndrome; LAP, lower abdominal pain.
1. Only new patients receiving HIV tests have been included here.
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