Sexually transmitted infection testing integrated with HIV prevention and contraceptive services in hair salons in urban South Africa.

Abstract

Introduction: Curable sexually transmitted infections (STIs) cause morbidity for women and increase HIV transmission and acquisition. To address barriers to STI care, we are implementing STI testing integrated with HIV prevention and contraceptive services in hair salons in urban South Africa.

Methods: Women attending hair salons are offered oral HIV pre-exposure prophylaxis (PrEP), hormonal contraception, and testing for gonorrhea, chlamydia, trichomoniasis, and syphilis within an ongoing pilot trial. Participants with positive STI results are offered treatment at the salon or local clinic. Demographics, symptoms, and risk factors are collected using structured questionnaires.

Results: Of 125 women enrolled and taking PrEP and/or contraceptives in the hair salons (median age 26y, 28.8% living with HIV), 121 (96.8%) accepted STI testing and 117 (93.6%) had complete results. Nearly half (47.8%) reported a primary sex partner ≥5 years older, 32.2% thought their partner had other partners, and 62.6% reported never using condoms. 42/117 women (35.9%) had at least one STI: 7.7% gonorrhea, 21.4% chlamydia, 4.3% trichomoniasis, and 9.4% syphilis. Only 8/42 (19.0%) women with an STI reported symptoms. In adjusted models, having an STI was associated with perceived male partner concurrency (p=0.049). Among women with any STI, 38/42 (90.5%) elected treatment at the salon.

Conclusions: STI testing in hair salons in South Africa reaches women with risk factors for STIs and HIV, appears acceptable and feasible, and reveals a high STI prevalence. Hair salons may serve as novel venues to increase the reach of STI testing to women at risk for HIV and STIs.