Acceptability of testing for anorectal sexually transmitted infections and self-collected anal swabs in female sex workers, men who have sex with men and transgender women in Papua New Guinea

Stephen Bell; Johanna Wapling; Sophie Ase; Ruthy Boli-Neo; Andrew J Vallely; John M Kaldor; Claire E Nightingale; Angela Kelly-Hanku

doi:10.1186/s12889-018-5684-2

Acceptability of testing for anorectal sexually transmitted infections and self-collected anal swabs in female sex workers, men who have sex with men and transgender women in Papua New Guinea

BMC Public Health. 2018 Jun 20;18(1):776. doi: 10.1186/s12889-018-5684-2.

Authors

Stephen Bell^{1

2}, Johanna Wapling³, Sophie Ase³, Ruthy Boli-Neo³, Andrew J Vallely^{1

3}, John M Kaldor¹, Claire E Nightingale³, Angela Kelly-Hanku^{4

5}

Affiliations

¹ The Kirby Institute, UNSW Sydney, Sydney, Australia.
² Centre for Social Research in Health, UNSW Sydney, Sydney, Australia.
³ Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands, Papua New Guinea.
⁴ The Kirby Institute, UNSW Sydney, Sydney, Australia. a.kelly@unsw.edu.au.
⁵ Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands, Papua New Guinea. a.kelly@unsw.edu.au.

Abstract

Background: Papua New Guinea (PNG) has some of the highest prevalence of urogenital sexually transmitted infections (STIs) in Pacific Asia, but to date, anorectal STI prevalence data do not exist, and diagnosis of anorectal STIs does not occur. The purpose of this study was to document the acceptability of anorectal STI testing and self-collection of anorectal swabs for testing among populations at risk of anorectal STIs, in advance of a large bio-behavioural survey during which this approach to specimen collection was planned among key populations in PNG.

Methods: Four focus groups were conducted, collecting data from a purposive sample of 35 members of two civil society groups representing female sex workers, men who have sex with men and transgender women in Port Moresby and Goroka.

Results: All participants were in favour of anorectal STI testing in PNG. Reasons given for willingness to undertake anorectal STI testing included that anal sex is practised; that anorectal STIs are not perceived to exist; there are self-reported experiences of anorectal symptoms indicative of anorectal STIs; that anorectal STI testing will enhance personal health; and that anorectal STI testing is not currently available in PNG. All participants were confident they could obtain self-collected specimens, although several stated that support from trained health workers should be available for community members who may not feel comfortable with self-collection.

Conclusions: This qualitative research is the first study of acceptability of anorectal STI testing and specimen self-collection procedures in PNG, and Pacific Asia more broadly. Our qualitative findings show support for anorectal STI testing including the use of self-collected swabs among key populations in PNG. Study findings informed the inclusion of anorectal STI testing in a large bio-behavioural survey to be used to estimate anorectal STI prevalence among key populations in PNG for the first time.

Keywords: Acceptability; Anorectal STI testing; Anorectal STIs; Key populations; Papua New Guinea; Self-collection.

MeSH terms

Female
Homosexuality, Male / psychology*
Homosexuality, Male / statistics & numerical data
Humans
Male
Mass Screening / psychology*
Papua New Guinea / epidemiology
Patient Acceptance of Health Care / psychology*
Prevalence
Qualitative Research
Sex Workers / psychology*
Sex Workers / statistics & numerical data
Sexual Behavior / statistics & numerical data
Sexually Transmitted Diseases / diagnosis*
Sexually Transmitted Diseases / epidemiology
Specimen Handling / methods*
Surveys and Questionnaires
Transgender Persons / psychology*
Transgender Persons / statistics & numerical data