For Chinese Men, Education Increases STI Stigmatization But Not Delay of Treatment
Among men with sexually transmitted infections (STIs) being treated at clinics in Hefei, China, eight in 10 felt stigmatized because of their infection and three in 10 had had STI symptoms for more than a week before seeking medical attention.1 Men who had attended college and those with greater knowledge about HIV and other STIs were more likely than others to feel stigmatized (odds ratios, 2.8-3.4). Those who had herpes (HSV), syphilis, or a urethral discharge not caused by gonorrhea or chlamydia had elevated odds of delaying treatment (5.7-6.1), while those with a university education and those who had had premarital or extramarital sex in the past three months had decreased odds of waiting to seek medical care (0.2-0.5).
To determine the factors associated with feelings of stigmatization, delay of treatment and sexual behavior among men with STIs, researchers surveyed male patients at four urban STI clinics in Hefei, a city in eastern China, between May and July 2000. Men who reported having STI symptoms (i.e., urethral discharge, dysuria or genital ulcers) and were seeking treatment for the first time for their current symptoms were eligible to take part in the study. Trained interviewers administered an initial questionnaire asking men about their social and demographic information, HIV and STI knowledge (rated on a 16-point scale) and medical history. Participants completed a second questionnaire on sexual behaviors, which was self-administered using a tape player. All men were examined by a physician, who took fluid samples to test for gonorrhea, chlamydia, HSV and syphilis.
Men who requested confidentiality from the STI clinic staff, preferred to go to the clinic at night or were afraid to be seen at the clinic were classified as feeling stigmatized. Those who had waited a week or more after the onset of STI symptoms to seek medical care were classified as having delayed treatment.
A total of 406 men with STI symptoms were interviewed. Twenty-three percent were aged 18-25, 28% 26-30 and the remainder 31-83. Two-thirds had had 6-10 years of education and 16% had attended college; nearly seven in 10 were married. The majority (86%) of men reported having urethral discharge or painful urination, with the remainder complaining of genital ulcers (14%). Among the participants with urethral discharge, 46% had gonorrhea, 8% chlamydia, 16% both and 29% other infections. Of men with genital ulcers, 22% tested positive for syphilis and 29% for herpes; 49% had other infections. Overall, 40% of men reported having sex after the onset of STI symptoms.
The great majority of men (80%) felt stigmatized because of their STI. Participants who had attended college and those who had the highest HIV and STI knowledge scores were significantly more likely than other men to feel stigmatized (odds ratios, 2.8-3.4). Twenty-eight percent of men had had symptoms for more than a week before seeking treatment; 17% had waited more than two weeks. In multivariate analyses, men who had urethral discharge not caused by gonorrhea or chlamydia and those with HSV or syphilis were more likely to delay seeking treatment than were those with both gonorrhea and chlamydia (5.7-6.1); having a university education and having had premarital or extramarital sex in the previous three months were associated with decreased odds of waiting to seek medical care (0.2-0.5). Feeling stigmatized was not significantly associated with delaying treatment. Twenty-three percent of married men who were currently living with their wife said that they were willing to tell her about their infection. Men who felt stigmatized were less likely than those who did not to be willing to notify their spouse (0.4), and men who had 6-8 years of education were less likely than those who had gone to school for 0-5 years to tell her (0.3).
The researchers comment, "Stigmatization and discrimination against people [with STIs] undermines the ability of individuals, families and societies to protect themselves, and to provide support and reassurance to those infected." They propose that in the interest of public health, this stigma needs to be confronted "by means of health education, the media, and social leaders."--J.Rosenberg
1. Liu H et al., Stigma, delayed treatment, and spousal notification among male patients with sexually transmitted disease in China, Sexually Transmitted Diseases, 2002, 29(6):335-343.