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Epidemiology poster session 5: Transmission dynamic + behaviour
P1-S5.21 Self-esteem and STI/HIV prevalence among residents of a Tanzanian sugar plantation
  1. C Rice1,
  2. A N Turner1,
  3. A Norris2,
  4. S Mtweve3
  1. 1The Ohio State University, Columbus, USA
  2. 2Johns Hopkins University Bloomberg School of Public Heath, USA
  3. 3Kilimanjaro Christian Medical College, Department of Social Welfare, Moshi, Tanzania


Background Sexually transmitted infections (STIs), including HIV, lead to significant reproductive morbidities worldwide. The association between risky sexual behaviours and increased STI/HIV prevalence has been well-documented. In addition, low self-esteem appears to lead to higher-risk sexual behaviours. However, the direct association between self-esteem and STI/HIV has not been well studied. We aimed to examine whether self-esteem directly affects STI/HIV prevalence, after adjusting for risky sexual behaviour.

Methods We conducted a secondary analysis of a cross-sectional study of sugar plantation residents in Tanzania. The 2004 study included a self-administered survey with self-esteem assessment and testing for syphilis, herpes simplex virus type 2 (HSV-2) and HIV. We restricted our analysis to individuals with valid STI/HIV results and complete self-esteem data. Through principal component analysis, the 8-item self-esteem scale was reduced to a single variable. This variable was further categorised as low, medium, and high self-esteem and was the primary exposure variable in a multivariable log binomial model with a combined outcome representing any prevalent STI/HIV (syphilis, HSV-2, or HIV).

Results From the full study sample of 556 residents, 431 (78%) individuals had both complete STI/HIV data and self-esteem assessment and were included in the analysis. The analysis population was 51% male and 49% female. Nearly 60% (n=254) had at least one STI/HIV. We observed no significant heterogeneity by gender in the effect of self-esteem on STI/HIV prevalence. Gender, transactional sex and alcohol use were retained as confounders in the final model; no other demographic or behavioural variables met our a priori statistical criteria for confounding. The adjusted prevalence ratios (PR) for STI/HIV for individuals with low self-esteem compared to those with medium self-esteem and high self-esteem were 0.95 (95% CI 0.80 to 1.13) and 0.92 (95% CI 0.67 to 1.27), respectively.

Conclusion Self-esteem was not independently associated with STI/HIV prevalence in plantation residents in Tanzania. Our findings suggest that the role of self-esteem in reproductive health may be limited to its association with increased sexual risk behaviour, which subsequently affects STI/HIV prevalence. Interventions aimed at improving self-esteem may only be appropriate if they reduce likelihood of participation in risky behaviours.

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