Chlamydia trachomatis, Human Immunodeficiency Virus

(HIV) Distribution and Sexual Behaviors across Gender

and Age Group in an African Setting
Joel Fleury Djoba Siawaya*
Unite de Recherche et de Diagnostic Specialise, Laboratoire National de Sante Publique (LNSP) BP 10736, Libreville, Gabon

Abstract
Objective: The purpose of this study was to (1) describe the distribution of Chlamydia trachomatis (CT) and Human
Immunodeficiency Virus (HIV) cases across gender and age groups in Libreville (Gabon); (2) examine Gabonese Sexually
Transmitted Infections (STIs)-related risk behaviour.

Methods: The sampled population was people attending the Laboratoire National de Sante Plublique. Between 2007 and
2011, 14 667 and 9 542 people respectively, were tested for CT and HIV infections. 1 854 of them were tested for both
infections. We calculated CT and HIV rates across gender and age groups. Also analysed was the groups contribution to the
general CT and HIV epidemiology. STIs-related risk behaviours were assessed in 224 men and 795 women (between July
2011 and March 2013) who agreed and answered a questionnaire including questions on their marital status, number of sex
partners, sexual practices, history of STIs, sex frequency and condom use.

Results: Data showed a 24% dropped in the CT infection rate between 2007 and 2010, followed by a 14% increase in 2011.
The HIV infection rates for the same period were between 15% and 16%. The risk of a CT-positive subject getting HIV is
about 0.71 times the risk of a CT-negative subject. Young adult aged between 18 and 35 years old represented 65.2% of
people who had STIs. 80% of women and 66% of men confessed to an inconsistent use of condoms. 11.6% of women and
48% of men declared having multiple sex partners. 61% of questioned women and 67% of men declared knowing their HIV
status.

Conclusions: In this Gabonese setting, the population-aged from18 to 35 years is the most affected by STIs. Other matters
of concern are the inconsistent use of protection and sex with non-spousal or non-life partners.
Citation: Djoba Siawaya JF (2014) Chlamydia trachomatis, Human Immunodeficiency Virus (HIV) Distribution and Sexual Behaviors across Gender and Age Group
in an African Setting. PLoS ONE 9(3): e90174. doi:10.1371/journal.pone.0090174
Editor: Bernhard Kaltenboeck, Auburn University, United States of America
Received October 24, 2013; Accepted January 27, 2014; Published March 3, 2014
Copyright: 2014 Djoba Siawaya. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Funding: The authors have no support or funding to report.
Competing Interests: The author has declared that no competing interests exist.
* E-mail: [email protected]

According to the 2011 UNAIDS report 68% of people living

with HIV resided in sub-Saharan Africa [7]. The report also
Chlamydia trachomatis (CT) is the most common sexually
revealed that the continent accounted for 70% of new HIV
transmitted infection (STI) worldwide with prevalence ranging infection cases with 1.2 million deaths [7].
from 1.5% to 5% in the developed world [1,2,3] and 3.7% to
Controlling and reducing the transmission of STIs remain
15%
public health priorities in Africa where, high-risk behaviours,
in developing countries [4,5,6]. The human immunodeficiency precariousness, low literacy rate and the lack of proper sexual
virus (HIV) infection on the other hand is the highest killing
education are in the list of STIs programs bottlenecks
sexually transmitted infection. Worldwide, more than 30 million [8,9,10,11,15,16]. In Uganda, between 2001 and 2005 there was
of
a 5% (from 24% to 29%) increase in sex with multiple partners
people are living with HIV. In 2010 the number of new HIV
and sex with non spousal partners in the population of men whose
infections was estimated at 2.7 million [7], whereas the
age is between 15 and 49 years old [17].
number of
Although few reports on behavioural interventions and STIs
people dying from Acquired Immunodeficiency Syndrome
incidence exist [18], we are in agreement with the thought that
(AIDS)-related causes was 1.8 million [7].
reducing STIs-related risk behaviours among youth and other
Women, young people and people from modest backgrounds vulnerable population groups is essential for the effectiveness of
are thought to be particularly vulnerable to STIs
any prevention programs [17,19,20,21,22,23,24]. However, opti[7,8,9,10,11,12].
mization of developing countries response to prevent the
In 2009 in the USA, persons aged from 15 to 29 years
transmission of STIs requires both information and the capacity
represented
21% of the population but accounted for 39% of all new HIV
infections [13]. In 2011, the Centre for Disease Control and
Prevention (CDC) in the USA showed that 13.1% of students
had
four or more sex partners [14].

Introduction

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Sexually Transmitted Infections and Sexual Behavior in an African

Table 1. Chlamydia trachomatis (CT) and the human immunodeficiency virus (HIV) infections a the Gabonese National Laboratory
of Public Health (2007-2011).

2007

2008

2009

2010

2011

Number of patients

[F: 1719 (77%);

3596 [F: 2887 (80%);

2574 [F: 2075 (80.6%);

3308 [F: 2641 (80%);

2960 [F: 2341 (79%); M:

tested in the year

M: 510 (23%)]

M: 709 (20%)]

M: 299 (19.4%)]

M: 667 (20%)]

619 (21%)]

Seropositive

1657 [74.3%] [F: 77.6%; 2546 [71%] [F: 79%;

1248 [48.5%] [F: 86%;

1554 [47%] [F: 85%;

1802 [61%] [F: 83%; M:

M: 22.4%]

M: 21%]

M: 14%]

M: 15%]

17%]

Active Chlamydia
Infection

1485 [65.4%] [F: 75%;

2372 [66%] [F: 77%;

1123 [43.6%] [F: 80%;

1396 [42%] [F: 81%;

1620 [55%] [F: 88%; M:

M: 25%]

M: 23%]

M: 20%]

M: 19%]

12%]

Seronegative

572 [25,7%] [F: 74%;

1050 [29%] [F: 75.6%;

1326 [51.5%] [F: 76%;

1754 [53%] [F: 75.5%;

1158 [39%] [F: 73%; M:

M: 26%]

M: 24.4%]

M: 24%]

M: 24.5%]

27%]

Number of patients

73 [F: 59 (81%);

2671 [F: 2162 (81%);

2071 [F: 1677 (81%);

2578 [F: 1950 (75.6%);

2149 [F: 1600 (74.5%); M:

tested in the year

M: 14 (19%)]

M: 509 19%]

M: 394 (19%)]

M: 628 (24.4%)]

549 (25.5%)]

Seropositive

12 [16.4%]

398 [15%] [F:75%;

285 [16%] [F: 82%;

386 [15%] [F: 75.4%;

323 [15%] [F: 73%; M: 27%]

[F: 75%; M: 25%]

M: 25%]

M: 18%]

M: 24.6%]

61 [83.6%]

2273 [85%] [F: 73.6%;

1786 [86%] [F: 81,6%;

2192 [85%] [F: 76%;

[F: 82%; M: 18%]

M: 26.4%]

M: 18,4%]

M: 24%]

1826 [85%] [F: 75%; M:

25%]

Number of patients

20 [F: 14 (70%);

472 [F: 371 (78.6%);

465 [F: 292 (63%);

478 [F: 357 (75%);

422 [F: 328 (78%); M: 94

tested for both infection

in the year

M: 6 (30%)]

M: 101 (21.4%)]

M: 173 (37%)]

M: 121 (25%)]

(22%)]

Chlamydia (2)/HIV (2)

7 [35%] [F: 57%;

141 [30%] [F: 72%;

182 [39%] [F: 77%;

266 [55.6%] [F: 74%;

167 [40%] [F: 75%; M: 25%]

M: 43%]

M: 28%]

M: 23%]

M: 26%]

2 [10%] [F: 100%;

31 [6.5%] [F: 84%;

10 [2%] [F: 80%;

15 [3%] [F: 87%;

M: 0%]

M: 16%]

M: 20%]

M: 13%]

10 [50%] [F: 80%;

272 [57.5%] [F:81%;

249 [54%] [F: 50%;

163 [34.4%] [F:76%;

M: 20%]

M: 19%]

M: 50%]

M: 24%]

217 [51,4%] [F: 80%; M:

20%]

1 [5%] [F: 100%;

28 [6%] [F: 82%;

23 [5%] [F: 82.6%;

34 [7%] [F: 70.6%;

11 [2.6%] [F: 64%; M: 36%]

M: 0%]

M: 18%]

M: 17.4%]

M:19.4%]

Chlamydia

HIV

Seronegative

Chlamydia/HIV

Chlamydia (+)/HIV (+)

Chlamydia (+)/HIV (2)
Chlamydia (2)/HIV (+)

25 [6%] [F: 80%; M: 20%]

doi:10.1371/journal.pone.0090174.t001

to use this information to build an efficient response.

Materials and Methods
UnderstandVoluntary testing for STIs is not common practice in Gabon.
ing STIs epidemiological dynamics, population behaviours and
Therefore clinicians are encouraged to include HIV testing when
what drives them is crucial [11,22].
prescribing blood exams to their patients. This practice allows
The HIV prevalence in Gabon at the time of this study was
estimated around 5% [25]. The country has the particularity of many to know their STIs status.
This study was carried out at Gabonese National Laboratory of
having a high literacy rate (87%). The school enrolment rate of
children aged less than 18 years old is estimated at 96.5%. No Public Health (LNSP). Data used in the study comes mainly from
reported data exists regarding CT infection and no reliable data subjects who got tested for STIs after consulting a clinician. The
exists on both CT and HIV distribution across gender and age Gabonese National Laboratory of Public Health review board has
approved the present study. When required, all patients signed an
groups. CT being the most common sexually transmitted
informed consent form.
disease,
analysing its rates and distribution in a population where HIV
rate
Evolution of CT and HIV infection cases and distribution
is relatively low can give a proper insight on peoples safe sex across gender and age groups between 2007 and 2011
practices, allow the identification of populations at risk and
Between January 2007 and December 2011, 14 667 and 9 542
provide a good indicator on what could be the progression of
people attending the LNSP were respectively tested for CT and
HIV
HIV infections. 1 854 of them were tested for both infections.
infection in the absence of proper interventions.
Serological testing was the method used to diagnose CT trachomatis
The present study represents a unique effort not only to
(IgG/IgA) and HIV (Ab/Ag). The population age range was 13 to
obtain
85 years old.
the distribution of CT and HIV infections across gender and age
groups in the particularly interesting setting; but also to have a Association between CT and HIV infections
view of the evolution of the selected STIs and highlight the
The association between CT and HIV infections (relative risk and
determinants of sexually transmitted infections control in a
odds ratio at a 95% confidence interval) was assessed using a
relatively educated African population. This is very important contingency table. GraphPad Prism version 6 was the software
because as stated by Bertozzi et al., [22]: insufftcient data for used for the analysis.
intervention strategies leaves programs managers to operate in a fog
of
uncertainty.

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Sexually Transmitted Infections and Sexual Behavior in an African

Assessment of STIs-related risk behaviours

Table 3. Chlamydia trachomatis (CT) and the human

Between July 2011 and March 2013, 224 men and 795 women immunodeficiency virus (VIH) infections distribution across
who attended the LNSP for fertility and infectious diseases
gender and age groups.
checkup agreed to participate in this study. After signing an informed
consent form, all the subjects were given a questionnaire
Patients tested for both infection between 2007 and 2011
including
questions on their marital status, number of sex partners, sexual
practices, history of STIs, sex frequency and condom use. We
HIV-prevalence
compiled and analyzed data collected (using GraphPad Prism
rate
HIV (+)
HIV (2)
Total
version 6 was the software).

Results
Evolution of CT and HIV infections (table 1)

Chlamydia (+)

83

911

994

8.3%

Chlamydia (2)

97

763

860

11.3%

Total

180

1674

1854

9.7%

CT- prevalence

46.1%

54.4%

53.6%

The rate of people with positive CT serology dropped from

doi:10.1371/journal.pone.0090174.t003
74% in 2007 to 47% in 2010. In 2011 this rate increased
reaching
61%. Active CT infection rate followed the same trend, going
from 65.4% in 2007 to 42% in 2010. In 2011 the rate of active CT Population aged 1835 years. People aged 18 to 35 years
infection went back up to 55%. HIV rate among people tested old represented 70.2% of people infected with CT in 2007. This
at
rate dropped to 60.7% in 2011. The same population represented
the LNSP stayed relatively constant, between 15% and 16.4%. 58% of people infected with HIV in 2007. This rate dropped to
46.1%, in 2011.

CT and HIV Co infection

Data shows that between 2007 and 2011, the CT-HIV Co

Population aged over 35 years.
Between 2007 and 2011
infection rate followed the CT trend, going respectively from
the part of the population over 35 years old in the CT burden
10%
increased from 23.7% to 37%. This population accounted for 42%
(2007), 7% (2008), 2% (2009), 3% (2010) and 6% (2011).
of people infected with HIV in 2007. This rate increased to 50.5%
Between
in 2011.
2007 and 2011, the prevalence of CT infections among HIVpositive people was 46% (range: 30.6%69.4%). In 2011 69.4%
of
HIV infected people had CT.
Students (High school and University).
Students age
range was 13 to 37 years old. They represented 20%, 48%,
32.4%, 32.4% and 21.6% of people infected with CT for the years
Association between CT and HIV infections
The odds ratio of getting HIV with positive CT serology in our 2007, 2008, 2009, 2010 and 2011 respectively. They accounted for
setting was 0.71 (95% confidence interval (CI): 0.53 to 0.97). 24% of people infected with HIV in 2008. This rate dropped to
6.5% in 2011.
The
relative risk of getting HIV when infected with CT was 0.74
(95%
STIs-related risk behaviours
CI: 0.56 to 0.98). The risk of a CT-positive subject getting HIV is
The frequency of sexual intercourse was higher in men
about 0.71 times the risk of a CT-negative subject. Details on compared to women. On average men had sex 10 times per
CT
month and women four times per month. Also men had
and HIV-infection prevalence for the period going from 2007 to significantly more sexual partners than women (p = 0.0001[Mann
2011 are confined in table 2.
Whitney test]) (figure 1a and 1b). No real differences were seen

CT and HIV infections cases distribution across gender

and age groups (table 3)
Population aged under18 years. The population aged less
than 18 years old accounted respectively for 6.1% and 5.4% of
people infected with CT for the years 2007 and 2008. After
reaching a pic of 9% in 2009, this population only represented
1.3% of people infected with CT in 2011. In 2007 we had no
record of HIV infection for the population aged less than 18
years
old. In 2008, 2009 and 2011 respectively, 5%, 5.3% and 3.4%
of
people infected with HIV were under 18 years old.

between men and women when comparing their STIs history.

61% of men and 58.4% of women had a history of STIs (figure 2).
STIs-related risk behaviours in men.
225 sexually active
men from different backgrounds aged between 19 and 61 years old
were included in this study. Of these men 48% declared having
multiple sexual partners. 46.3% of men engaged in a committed
relationship had sex with non-spousal or non-life partners. 65.5%
of men (51.2% of single men) admitted to an inconsistent use of

Table 2. Chlamydia trachomatis (CT) and human immunodeficiency virus (VIH) infection prevalence for the period 20072011.

2007

2009

2010

Chlamydia

HIV

Chlamydia

HIV

Chlamydia HIV

Chlamydia

HIV

Chlamydia

HIV

All subjects

1657

12

2546

398

1248

285

1554

388

1809

323

Under 18 years

101 (6.1%)

0 (0%)

138 (5.4%)

20 (5%)

113 (9%)

15 (5.3%)

35 (2%)

2 (0.5%)

23 (1.3%)

11 (3.4%)

old

2008

2011

1835 year old

1910 (75%)

238 (60%) 866 (69.5%) 172 (60.4%)

1025 (66%)

211 (54.4%)

1099 (60.7%)

Over 35 year old 392 (23.7%)

1164 (70.2%) 7 (58%)

5 (42%)

498 (19.6%)

140 (35%) 269 (21.5%) 98 (34.4%)

494 (32%)

175 (45.1%)

667 (37%)

163 (50.5%)

Pupils or

0 (0%)

1224 (48%)

95 (24%)

504 (32.4%)

36 (9.3%)

391 (21.6%)

21 (6.5%)

450 (27.1%)

404 (32.4%) 35 (12.3%)

149 (46.1%)

Students
doi:10.1371/journal.pone.0090174.t002

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Sexually Transmitted Infections and Sexual Behavior in an African

Figure 1. Sex with multiple partners. (a) Number of sex partners by gender groups: men had in average 1.9 sex partners and women 1.1. The
difference between the groups was statistically significant (p = 0.0001; [Mann Whitney test]). (b) Percentage of men and women with one, two and
three or more sex partners: a higher rate of men engaged in sex with multiple partners compared than women.
doi:10.1371/journal.pone.0090174.g001

condoms. 32% declared practicing cunnilingus (oral sex). 67% a history of STIs. 64% of women declared practicing cunnilingus
of
(oral sex); multiple sex partners were the highest in educated
men declared knowing their HIV status, whereas 33% declared workingwomen (14.3%) followed by female students (13%)
not knowing their HIV status. Multiple sex partners were the
(table 5).
highest in male students (59%) followed by educated
workingmen
Discussion
(53%). More details on age and social groups behaviours are
The Gabonese National Laboratory of Public Health is the
confined in table 4.
countrys first medical laboratory with 50 000 to 70 000 medical
STIs-related risk behaviours in women. 795 sexually
laboratory tests realised per year. The present study set at the
active women from different backgrounds aged between 14
National Laboratory of Public Health in Gabon gives us a general
years
trend on the CT and HIV evolution over the past years. It also
old and 55 years old were included in this study (table 5).
gives a particular view on how population groups are affected by
11.6%
declared having more than one sexual partner. 8.5% of women both CT and HIV infections. Although data from this study
engaged in a committed relationship had sex with non-spousal provides important information on STIs distribution and trends
across gender and age groups, the LNSP prevalence rates cannot
or
non-life partners. 78% of single women declared the
inconsistent
use of protection when engaged in sexual activities. 61% of the
questioned women declared knowing their HIV status, whereas
39% declared not knowing their HIV status. 58.4% of women
had

Figure 2. History of STIs in men and women. Overall the percentages of male and female with a history of STIs were similar. Within the male
group, student and unemployed male were less affected by STIs (31.6% and 50% respectively). Among females student and less educated employed
women were less affected by STIs (51% and 56.6% respectively).

doi:10.1371/journal.pone.0090174.g002

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Sexually Transmitted Infections and Sexual Behavior in an African

Table 4. Sexually transmitted infections -related risk behaviours in men.

N = 224
Marital Status

Use of condoms

Committed Relationship (CR)

Single (S)

Engaged

Married

49.3%

29.3%

21.4%

[A: 2%; O: 32%; ST: 30%;

[A: 0%; O: 21%; ST: 21%; N: 58%]

[A: 4%; O: 47%; ST: 32.6%; N: 16.4%]

54%

38%

60%

More than twelve times a

At least eight times a month

Less than eight times a month

N: 36%]
2 or more sexual
partners
Sex Frequency

month

Social status

Use of condoms

53.5%

25.5%

21%

Unemployed

Student

Employed (a)

Employed (b)

6 (2.7%)

22 (9.9%)

111 (49.8%)

84 (37.6%)

[A: 0%; O: 33%; ST: 17%;

[A: 9%; O: 41%; ST: 32%; N: 18%]

[A: 2%; O: 35%; ST: 31%; N: 32%]

[A: 0%; O: 25%; ST: %; N: 51%]

33%

59%

53%

39%

1835

Over 35

122 [CR: 64%; S: 36%]

102 [CR: %; S: %]

[A: 3%; O: 33%; ST: 30.4%;

[A: 1.3%; O: 31%; ST: 24%; N: 43.7%]

N: 50%]
2 or more sexual
partners
Age groups

Use of condoms

N: 33.6%]
2 or more sexual
partners

49%

46%

(a): teachers, nurses, assistants, managers, engineers etc.; (b) domestic workers, street traders without a degree etc.; CR: committed relationship, S: single; A: always; O:
often; ST: sometime; N: never, (*) more than 3 sexual partners.
doi:10.1371/journal.pone.0090174.t004

Table 5. Sexually transmitted infections-related risk behaviours in women.

N = 795
Marital Status

Use of condoms

Committed Relationship (CR)

Single (S)

Engaged

Married

36%

10%

[A: 2%; O: 13%; ST: 51%; N: 34%]

[A: 4.3%; O: 24%; ST: 39.1%; N: 32.6%][A: 0.5%; O: 21.3%; ST: 45.2%; N: 33%]

2 or more sexual 11%

54%

7.4%

14%

partners
Sex Frequency

Social status

Use of condoms

More than four times a month At least four times a month

Less than four times a month

33%

26.7%

40.3%

Unemployed

Student

Employed (a)

Employed (b)

173 (22.2%)

392 (50.3%)

132 (17%)

82 (10.5%)

[A: 0%; O: 11.7%; ST: 52.6%; N:

[A: 2.4%; O: 23.2%; ST: 52.2%; N:

[A: 1.6%; O: 16%; ST: 39%; N: 43.4%] [A: 0%; O: 17.7%; ST: 25.3%; N:

35.7%]

22.2%]

2 or more sexual 11%

57%]

13%

14.3%

5%

1317

1835

Over 35

23 [CR: 8.7%; S: 81.3%]

653 [CR: 56.7%; S: 43.3%]

119 [CR: 65.7%; S: 34.3%]

[A: 0%; O: 26%; ST: 52%; N: 22%]

[A: 1.4%; O: 20%; ST: 48%; N: 30.6%] [A: 1.7%; O: 11.5%; ST: 36.7%; N:

partners
Age groups

Use of condoms

50.4%]
2 or more sexual 22%

11.6%

10.4%

partners
(a): teachers, nurses, assistants, managers, engineers etc.; (b) domestic workers, street traders etc.; CR: committed relationship, S: single; A: always; O: often; ST:
sometime; N: never.
doi:10.1371/journal.pone.0090174.t005

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Sexually Transmitted Infections and Sexual Behavior in an African

be generalized to the whole country as studies have shown

differences between urban and rural populations [26,27]. Also,
the
Gabonese setting is particularly interesting because in term of
sexual behaviours, it provides us with an opportunity to study
sexual lifestyles in a relatively educated African population.
Data showed 24% drop in the CT rate infection between
2007
and 2010, followed in 2011 by a 14% increase; while HIV
infection rates for the same period remained relatively
constant
(around 15%16%). Furthermore, the risk of a CT-positive
subject
getting HIV was not higher than the risk of a CT-negative
subject
getting HIV. This could be explained by the high prevalence of
CT-positive subjects among the HIV-negative population and
the
prevalence of HIV-positive, which is higher than CT-negative
subjects compared to CT-positive subjects. Although, the
plateauing of the HIV rate observed over the past 5 years is good
news, it
should not be a cause of relaxation; because the increase of CT
if
not controlled portends a spike in HIV cases as the rise of CT
indicates an increase in unsafe sexual practices.
Also the analysis of our data revealed no positive association
between HIV and CT infections. The absence of association
observed here could be explained by (1) Libreville low HIV
prevalence (3.9%) [28] and by (2) the huge gap or difference in
the
recorded number of both infections. But these explanations
may
not be sufficient. The limitation of this section of the study is
that
we did not investigate whether HIV positive people changed
their
sexual behaviors to prevent themselves and others from
getting
infected with STIs.
Between 2007 and 2011, 65.2% of people who had STIs were
young adults aged between 18 and 35 years old. Similar
patterns
are observed in the developed world [29,30]. The high rate of
sexual activity among young adults may explain why they
represent more than half of people who had STIs.
Under-aged people (,18 years old) engaging in sexual
activities
should be a concern in emerging countries. Studies on
adolescent
sexual behavior in sub-Saharan Africa revealed the hazardous
character of sexual encounter in young people, thereby predisposing them to the risks of STIs [31]. In our setting 4.2% of
people
with STIs and 3.2% of people who had HIV were under aged
children (,18 years old). We observed between 2007 and 2011
a
decline in the contribution of adolescents to the general
epidemiology of STIs. This decline could be attributed to the
multiplication in the recent years of STIs prevention campaigns
targeting adolescent and school children. However with 22% of
under aged girls having more than one sex partner compared
to
11.6% of young adult women, under aged girls seemed to be
more
vulnerable.
Another matter of concern is the inconsistent use of
condoms by

our population (about 80% of women and 66% of men). As

demonstrated by Wand et al., [32] inconsistent use of
protection
during sex is highly associated with STIs. We observed that
inconsistent use of condoms was higher in men with lower
level of
education. The rate of men with multiple partners was 4
fold

References
1. Adams EJ, Charlett A, Edmunds WJ, Hughes G (2004) Chlamydia
trachomatis
in the United Kingdom: a systematic review and analysis of prevalence
studies.
Sex Transm Infect 80: 354362.
2. Marangoni A, Foschi C, Nardini P, DAntuono A, Banzola N, et al. (2012)
Chlamydia trachomatis serovar distribution and other sexually transmitted
coinfections in subjects attending an STD outpatients clinic in Italy. New
Microbiol 35: 215219.
3. Goulet V, de Barbeyrac B, Raherison S, Prudhomme M, Semaille C, et al.
(2010) Prevalence of Chlamydia trachomatis: results from the first
national
population-based survey in France. Sex Transm Infect 86: 263270.
4. van der Helm JJ, Bom RJ, Grunberg AW, Bruisten SM, Schim van der Loeff
MF, et al. (2013) Urogenital Chlamydia trachomatis Infections among
Ethnic

risk seem to increase with wealth in developing countries [34,35].

Therefore, programs against STIs should design intervention
strategies that take into consideration the specific psychology of
society groups. Understanding the specific psychological state of
society groups could lead to the understanding of why in the
developing world or in a given ethnic group increased awareness is
not always associated with a reduction in STIs.
We hope that our study will contribute towards improving and
understanding STI epidemiology and in informing the development of future public health strategies in the field of sexual health.

higher than the women rate. Sex with non-spousal or non-life

partners reached 46.3% in men and 8.5% in women.
Male students and men who represented a higher socioeconomic level engaged themselves the most in sexual intercourse
with multiple partners. Risky sexual behaviors among students are
well documented [33]. Also documented is the positive association
between risky sexual behaviors and wealth index [34,35], which
Bingenheimer JB., [36] explained by: mens control of financial
resources and freedom from social control mechanisms embedded
in society.
Sex with multiple partners was the highest in educated
workingwomen and female students than other women (unemployed and employed with a lower level of education). Others have
also reported similar findings in sub-Saharan Africa [5,37]. This
could be explained by the initial state of women acceding to
emancipation, a state where they are bridging all sexual taboo and
experimenting their sexuality as men do, a state of irrational
exuberance. Also, In the United States of America, Annang et al.,
[38] showed that determinants such as education, although an
important factor associated with STIs prevalence, it has a
differential impact on ethnic groups. Our data also showed that
sexual activity and the percentage of men reporting more sexual
partners was higher than the one of women. A possible
explanation is that that men are more sexually assertive than
women. Also, some men gauge their virility in terms of how many
sexual partners they have therefore, they may feel compelled to be
truthful or even exaggerate. However, women, believing that they
should have few partners, may minimize their past [39,40].
Our study suggests that poverty is no longer the principal driver
of STIs epidemic, as sexual risk-taking behaviors that put people at

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Acknowledgments
I wish to acknowledge the help provided by Mrs. Madeleine DIANOU and
Mr. Pascal LOSSANGOYE. I would like to thank them for their assistance
with the collection of my data. I also want to thank the Ms. Amandine
MVEANG-NZOGHE serology service and the bacteriology service of the
LNSP.

Author Contributions
Conceived and designed the experiments: JFDS. Performed the experiments: JFDS. Analyzed the data: JFDS. Contributed reagents/materials/
analysis tools: JFDS. Wrote the paper: JFDS.

Groups in Paramaribo, Suriname; Determinants and Ethnic Sexual Mixing

Patterns. PLoS One 8: e68698.
5. Kohli R, Konya WP, Obura T, Stones W, Revathi G (2013) Prevalence of
genital Chlamydia infection in urban women of reproductive age, Nairobi,
Kenya. BMC Res Notes 6: 44.
6. Ngandjio A, Clerc M, Fonkoua MC, Thonnon J, Njock F, et al. (2003) Screening
of volunteer students in Yaounde (Cameroon, Central Africa) for Chlamydia
trachomatis infection and genotyping of isolated C. trachomatis strains. J Clin
Microbiol 41: 44044407.
7. (2011) UNAIDS World AIDS day report

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Sexually Transmitted Infections and Sexual Behavior in an African

8. Catalano RF, Fagan AA, Gavin LE, Greenberg MT, Irwin CE, Jr., et al. (2012)
Worldwide application of prevention science in adolescent health. Lancet 379:
16531664.
9. Blum RW, Bastos FI, Kabiru CW, Le LC (2012) Adolescent health in the 21st
century. Lancet 379: 15671568.
10. Blum RW (2009) Young people: not as healthy as they seem. Lancet 374: 853
854.
11. Pettifor A, McCoy SI, Padian N Paying to prevent HIV infection in young
women? Lancet 379: 12801282.
12. Jewkes RK, Dunkle K, Nduna M, Shai N (2010) Intimate partner violence,
relationship power inequity, and incidence of HIV infection in young women in
South Africa: a cohort study. Lancet 376: 4148.
13. CDC (2011) HIV among youth. Atlanta, GA: US Department of Health and
Human Services.
14. Nys S, Okeke IN, Kariuki S, Dinant GJ, Driessen C, et al. (2004) Antibiotic
resistance of faecal Escherichia coli from healthy volunteers from eight
developing countries. J Antimicrob Chemother 54: 952955.
15. Gupta GR, Parkhurst JO, Ogden JA, Aggleton P, Mahal A (2008) Structural
approaches to HIV prevention. Lancet 372: 764775.
16. Le Marchand C, Evans J, Page K, Davidson PJ, Hahn JA (2013) Hazardous
alcohol consumption among young adult IDU and its association with high risk
behaviors. Drug Alcohol Depend.
17. Opio A, Mishra V, Hong R, Musinguzi J, Kirungi W, et al. (2008) Trends in
HIV-related behaviors and knowledge in Uganda, 19892005: evidence of a
shift toward more risk-taking behaviors. J Acquir Immune Defic Syndr 49: 320
326.
18. McCoy SI, Kangwende RA, Padian NS (2010) Behavior change interventions to
prevent HIV infection among women living in low and middle income countries:
a systematic review. AIDS Behav 14: 469482.
19. Caviness CM, Anderson BJ, Stein MD (2012) Prevalence and predictors of
sexually transmitted infections in hazardously-drinking incarcerated women.
Women Health 52: 119134.
20. Johnson WD, Diaz RM, Flanders WD, Goodman M, Hill AN, et al. (2008)
Behavioral interventions to reduce risk for sexual transmission of HIV among
men who have sex with men. Cochrane Database Syst Rev: CD001230.
21. Eaton DK, Kann L, Kinchen S, Shanklin S, Ross J, et al. (2011) Youth risk
behavior surveillance - United States, 2009. MMWR Surveill Summ 59: 1142.
22. Bertozzi SM, Laga M, Bautista-Arredondo S, Coutinho A (2008) Making HIV
prevention programmes work. Lancet 372: 831844.
23. Carael MaG, J.R. (2007) HIV Infection in Young Adults in Africa: Context,
Risks, and Opportunities for Prevention. HIV, RESURGENT INFECTIONS
AND POPULATION CHANGE IN AFRICA: Springer. pp. 123154.
24. Stein MD, Anderson BJ, Caviness CM, Rosengard C, Kiene S, et al. (2009)
Relationship of alcohol use and sexual risk taking among hazardously drinking
incarcerated women: an event-level analysis. J Stud Alcohol Drugs 70: 508515.

PLOS ONE | www.plosone.org

25. UNIAIDS WHO (2009) Gabon Epidemiological Fact Sheet on HIV and AIDS
26. Doyle AM, Mavedzenge SN, Plummer ML, Ross DA (2012) The sexual
behaviour of adolescents in sub-Saharan Africa: patterns and trends from
national surveys. Trop Med Int Health 17: 796807.
27. Banandur P, Rajaram SP, Mahagaonkar SB, Bradley J, Ramesh BM, et al.
(2011) Heterogeneity of the HIV epidemic in the general population of
Karnataka state, south India. BMC Public Health 11 Suppl 6: S13.
28. Direction Generale de la Statistique (DGS), International eI,. (2013) Enquete
Demographique et de Sante du Gabon 2012. Calverton, Maryland, et Libreville,
Gabon DGS et ICF International. 255273 p.
29. Agency HP (2008) Sexually Transmitted Infections and Young People in the
United Kingdom. Health Protection Agency.
30. (2011) Bulletin des reseaux de surveillance des infections sexuellement
transmissibles (IST) Bulletin IST des reseaux ResIST, Renago et Renachla:
Institut de veille sanitaire.
31. Neema S, Ahmed F, Kibombo R, Bankole B, (2006) Adolescent sexual and
reproductive health in Uganda: results from the 2004 Uganda National Survey
of Adolescents, Occasional Report. New York:: Guttmacher Institute.
32. Wand H, Guy R, Donovan B, McNulty A (2011) Developing and validating a
risk scoring tool for chlamydia infection among sexual health clinic attendees in
Australia: a simple algorithm to identify those at high risk of chlamydia infection.
BMJ Open 1: e000005.
33. Mengistu TS, Melku AT, Bedada ND, Eticha BT (2013) Risks for STIs/HIV
infection among Madawalabu university students, Southeast Ethiopia: a cross
sectional study. Reprod Health 10: 38.
34. Awusabo-Asare K, Annim SK (2008) Wealth status and risky sexual behaviour
in Ghana and Kenya. Appl Health Econ Health Policy 6: 2739.
35. Berhan Y, Berhan A (2013) Meta-analysis on risky sexual behaviour of men:
consistent findings from different parts of the world. AIDS Care 25: 151159.
36. Bingenheimer JB (2010) Mens multiple sexual partnerships in 15 Sub-Saharan
African countries: sociodemographic patterns and implications. Stud Fam Plann
41: 117.
37. Berhan A, Berhan Y (2012) A Meta-Analysis on Higher-Risk Sexual Behavior of
Women in 28 Third World Countries. World Journal of AIDS 2: 7888.
38. Annang L, Walsemann KM, Maitra D, Kerr JC (2010) Does education matter?
Examining racial differences in the association between education and STI
diagnosis among black and white young adult females in the U.S. Public Health
Rep 125 Suppl 4: 110121.
39. Jonason PK (2007) An evolutionary psychology perspective on sex differences in
exercise behaviors and motivations. J Soc Psychol 147: 514.
40. Jonason PK, Fisher TD (2009) The Power of Prestige: Why Young Men Report
Having more Sex Partners than Young Women. Sex Roles 60: 151159.

March 2014 | Volume 9 | Issue 3 | e90174

Reproduced with permission of the copyright owner. Further reproduction prohibited without
permission.

Source:
Siawaya, J. F. (2014). Chlamydia trachomatis, human immunodeficiency virus (HIV) distribution and
sexual behaviors across gender and age group in an african setting. PLoS One, 9(3)
doi:http://dx.doi.org/10.1371/journal.pone.0090174