RT Journal Article SR Electronic T1 Studying complex interactions among determinants of healthcare-seeking behaviours: self-medication for sexually transmitted infection symptoms in female sex workers JF Sexually Transmitted Infections JO Sex Transm Infect FD BMJ Publishing Group Ltd SP 285 OP 291 DO 10.1136/sti.2009.036806 VO 86 IS 4 A1 Gabriela B Gomez A1 Pablo E Campos A1 Clara Buendia A1 Cesar P Carcamo A1 Patricia J Garcia A1 Patricia Segura A1 William L Whittington A1 James P Hughes A1 Helen Ward A1 Geoffrey P Garnett A1 King K Holmes YR 2010 UL http://sti.bmj.com/content/86/4/285.abstract AB Objectives To describe the frequency and determinants of self-medication for symptoms of sexually transmitted infections (STI) in a female sex worker (FSW) population. To present a methodology exploring the best predictors as well as the interactions between determinants of self-medication.Methods A cross-sectional survey of 4153 FSW carried out in Peru. The prevalence of self-medication was estimated from the subsample of participants who had experienced symptoms of STI in the past 12 months (n=1601), and used successive logistic regression models to explore the determinants.Results Self-medication prevalence for a reported symptomatic episode during the past 12 months was 32.1% (95% CI 29.8 to 34.6). It was negatively correlated with work in brothels (adjusted odds ratio (OR) 0.51, 95% CI 0.28 to 0.93; p=0.028) and awareness of STI services available for FSW (adjusted OR 0.49, 95% CI 0.29 to 0.81; p=0.006). Other determinants were organised at different levels of proximity to the outcome creating pathways leading to self-medication.Conclusions The importance of the staggered analysis presented in this study resides in its potential to improve the understanding of associations between determinants and, consequently, the targeting of interventions. The awareness of STI services available for FSW increases access to health care, which in turn decreases self-medication. In addition, the sharing of information that takes place between brothel-based FSW was also related to a diminishing prevalence of self-medication. These two main predictors provide an opportunity for prevention programmes, in particular those designed to be led by peers.