Abstract
Objectives
Vancouver’s DTES represents a high-risk neighbourhood, in which there exist a number of community clinics and outreach programs. The purpose of this study was twofold: 1) to describe the population of women attending a weekly women’s program with respect to demographics, risk behaviours and prevalence of STI, and 2) to assess the uptake of STI screening in this setting.
Methods
A cross-sectional survey was undertaken during a weekly community clinic-based women’s program from October to December, 2004. Women were recruited at the start of the program each week and were invited to provide urine samples for chlamydia and gonorrhea screening.
Results
Among 126 respondents, the median age was 42 (36–49), more than half (52%) self-identified as White and 40% as Aboriginal ethnicity. Forty percent were currently involved in the sex trade. Two thirds reported a Pap smear in the past year, while 14% had not accessed sexual health care (Pap smear, STI or HIV testing). Among the 92/126 (74%) women providing a urine sample, the prevalence of chlamydia and gonorrhea was 2.2% and 0.0%, respectively.
Conclusion
The majority of women accessing this program were over 35 years of age, and while nearly half were currently involved in the sex trade, cross-sectional screening did not reveal a substantial prevalence of STIs. Women who were not regular program attendees reported less sexual health care, and represented the only two cases of chlamydia found. Innovative programs that better serve the needs of populations that remain unable or unwilling to seek sexual health care in its current formats are needed.
Key words: Sexual health care, sexually transmitted infections, women
Résumé
Contexte
Plusieurs cliniques communautaires et programmes d’approche sont implantés dans le quartier défavorisé de Downtown Eastside à Vancouver, où la population est particulièrement vulnérable. Notre étude avait deux objectifs: 1) décrire le profil démographique, les comportements à risque et la prévalence des ITS dans la population féminine fréquentant un programme hebdomadaire pour femmes et 2) évaluer l’utilisation des tests de détection d’ITS dans le cadre de ce programme.
Méthode
Enquête transversale menée dans une clinique communautaire dans le cadre d’un programme pour femmes organisé un soir par semaine d’octobre à décembre 2004. Des participantes, recrutées au début du programme chaque semaine, étaient invitées à donner un échantillon d’urine pour la détection du chlamydia et de la gonorrhée.
Résultats
Sur les 126 répondantes, dont l’âge médian était de 42 ans (36-49), plus de la moitié (52 %) disaient être blanches, et 40 % disaient être autochtones. Quarante p. cent travaillaient dans le commerce du sexe. Les deux tiers disaient avoir subi un test de Papanicolaou au cours de l’année antérieure, tandis que 14 % n’avaient reçu aucun soin de santé sexuelle (ni frottis vaginal, ni test de détection d’ITS ou du VIH). Chez les 92 femmes sur 126 (74 %) ayant fourni un échantillon d’urine, la prévalence du chlamydia et de la gonorrhée était de 2,2 % et de 0 %, respectivement.
Conclusions
La majorité des participantes avaient plus de 35 ans, et la moitié travaillaient dans le commerce du sexe; malgré cela, l’enquête transversale n’a pas révélé une prévalence importante d’ITS chez ces femmes. Celles qui ne participaient pas régulièrement au programme avaient reçu moins de soins de santé sexuelle, et c’est chez elles que l’on a décelé les deux seuls cas de chlamydia. Il faudrait créer des programmes novateurs pour mieux répondre aux besoins des populations qui ne peuvent ou ne veulent pas recevoir de soins de santé sexuelle tels qu’ils sont dispensés actuellement.
Mots clés: soins de santé sexuelle, infections transmises sexuellement, femmes
Footnotes
Acknowledgements: The authors acknowledge the dedicated staff and volunteers of the community clinic, and especially the participants who gave both their time and support.
Support: Individual funding: Michael Smith Foundation for Health Research; Technical support: BC Centre for Disease Control Laboratory.
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