The Effects of SES on Previous History of STDs and Clinical Service Attended in the Republic of Georgia

Benjamin Nieto-Andrade, University of Texas at Austin

OBJECTIVES: The purpose of this study is to analyze the effect of respondent’s socio-economic status (SES) on the history of STDs in women between 15 and 49 years old in the Republic of Georgia, as well as the relationship between respondent’s SES and the type of clinic attended to treat STD’s. These preoccupations rise from the dramatic declines of health and standards of living associated to socioeconomic, political and geographical redefinitions in the Republic of Georgia and other Soviet Nations. With increasing poverty and economic crisis, these nations experience important rises in the incidence of STDs and declines in the quality of treatment and prevention. DATA AND METHODS: The analysis is based on the 1999 Reproductive Health Survey of Georgia, carried out by the Georgian Center for Disease Control (NCDC). The survey contains information on education, employment, sexual experience and contraceptive use for women in reproductive ages (15-44 years old). From a total of 7798 women interviewed, this study analyzes information from those women who have had sexual intercourse (5703, which represents 73% of the original sample). The dependent variable in the study is whether a woman have experienced an episode of STD in her life, including syphillis, gonorrhea, chlamydia, yeast infection, genital herpes, genital warts, and trichomoniasis. This variable was constructed from individual questions on each one of these diseases [Have you ever been told that you have: a) syphilis, b) gonorrhea, c) etc.? Yes, No]. The main independent variable is socioeconomic status, which effect on previous episodes of STDs is measured by an index based on whether a household posses any of a list of 10 amenities and goods: flush toilet, heating system, refrigerator, tv, automobile, vcr, household phone, cellular phone, vacation home, and crowded conditions. This socioeconomic index ranges from 0 to 10 where a score between 0-3 represents a household of low socioeconomic index; a score between 4-6 represents a household of middle socioeconomic index; and 7-10 a household of high socioeconomic index. The reliability of this index was assessed with the Cronbach coefficient alpha (0.61). (See methodological section of CDC final report). Other variables included in the model as controls variables are: education, ethnic background, age, marital status, place of residence (urban vs. rural), number of sexual partners in life, and having ever used a condom. Using logistic regression the study presents the odds-ratio of having experienced an STD for women of different socioeconomic status, after controlling for socio-demographic and behavioral variables. RESULTS: It is observed that 15% of the women interviewed ever had an STD, among the most common being yeast infection and trichomoniasis (reported by 72% and 59% of those who ever had an STDs). It is also observed that women of medium and high SES had greater percentages of previous history of STDs, Georgian background, secondary education and more, living in urban areas, ever using a condom, and two or more sexual partners in life. Results of logistic regressions indicate that socioeconomic status is statistically significant to explain a previous history of STDS (p= .001), after controlling for socio-demographic and behavioral variables. Women of middle and high SES were more likely to have experienced an STD when compared to women of low SES. Education, a variable strongly associated to individual SES, is also statistically significant at the level of 0.01, showing that women with higher education had a greater likelihood of having had an episode of STDs. Having technicum education or university education show odds ratio of 1.3 and 1.9, respectively, when compared to women with no more than secondary education. Other factors also associated to having had an STD are: Georgian ethnic background, living in urban areas, having had 2 or more sexual partners in life, and ever using a condom. Age and marital status showed no significant association with having experienced an STD. Results also show that a greater proportion of women of medium or high SES attend specialized clinics to detect and treat STDs, as opposed to women of low SES who in greater proportion attend non specialized places. A similar pattern is found when information is broken down by education: women with more than secondary school attended in greater proportion specialized clinics to treat STDs, while women with secondary school or less education attended in greater proportion non specialized places. CONCLUSIONS: According to the 1999 Reproductive Health Survey, socioeconomic status in the Republic of Georgia is positively associated with having experienced at least one episode of STDs in women of reproductive ages. After controlling for socio-demographic and behavioral factors, respondents of high SES were more likely to report an episode of STDs. The explanation of this finding requires nevertheless further investigation: on the one hand, greater proportions of respondents of high SES report sexual practices associated to increased risk of STDs transmission (like greater number of sexual partners); but on the other hand, this study also shows that women of high SES are more likely to attend specialized clinics, which have better technology and trained personnel to efficiently detect an STDs. One limitation of the study is that it relies on information provided by respondents and not on previous and current serological tests on STDs. It is impossible to know if some respondents have experienced an STDs but have not been able recognized the symptoms or to go to the doctor for detection.