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

Ahmed, Anisuddin MS*; Reichenbach, Laura J. MPA, ScD*; Alam, Nazmul MPH, DrPH*†

doi: 10.1097/OLQ.0b013e318273718e
Original Study

Background In Bangladesh, male clients (MCs) of female sex workers (FSWs) represent diverse occupational categories from different socioeconomic strata, and they are considered a bridging group to transmit sexually transmitted infections (STIs) to their spousal and nonspousal female partners. 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], 1.5–3.8) 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 symptoms (adjusted OR, 2.0; 95% CI, 1.4–2.8). The MCs who used condoms consistently in their non-marital sexual contacts were significantly less likely (adjusted OR, 0.4; 95% CI, 0.3–0.6) 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.

A study of male clients of female sex workers in Bangladesh found a high rate of HIV risk behaviors and self-reported sexually transmitted infection symptoms and also high overall care-seeking behaviors for those symptoms, mostly from informal providers.

From the *Centre for Reproductive Health, International Centre for Diarrhoeal Disease Research, Bangladesh, Mohakhali, Dhaka, Bangladesh; and †Unité de santé internationale, Université de Montréal/CRCHUM, Montréal, Canada

Supported by Australian Agency for International Development, Grant Number 00376. The International Centre for Diarrhoeal Disease Research, Bangladesh, acknowledges with gratitude the commitment of Australian Agency for International Development to its research efforts.

Conflict of interest: None declared.

Correspondence: Nazmul Alam, MPH, DrPH, Centre for Reproductive Health, International Centre for Diarrhoeal Disease Research, Bangladesh, Mohakhali, Dhaka 1212, Bangladesh. E-mail:

Received for publication May 17, 2012, and accepted August 28, 2012.

© Copyright 2012 American Sexually Transmitted Diseases Association