Understanding the burden of bacterial sexually transmitted infections and Trichomonas vaginalis among black Caribbeans in the United Kingdom: Findings from a systematic review.

Sonali Wayal,Paula B Blomquist,Catherine H Mercer,Catherine Griffiths,Catherine R H Aicken,Gwenda Hughes

doi:10.1371/journal.pone.0208315

Abstract

BackgroundIn the UK, people of black Caribbean (BC) ethnicity continue to be disproportionately affected by bacterial sexually transmitted infections (STIs) and Trichomonas vaginalis (TV). We systematically reviewed evidence on the association between bacterial STIs/TV and ethnicity (BC compared to white/white British (WB)) accounting for other risk factors; and differences between these two ethnic groups in the prevalence of risk factors associated with these STIs, sexual healthcare seeking behaviours, and contextual factors influencing STI risk.MethodsStudies presenting relevant evidence for participants aged ≥14 years and living in the UK were eligible for inclusion. A pre-defined search strategy informed by the inclusion criteria was developed. Eleven electronic databases were searched from the start date to September-October 2016. Two researchers independently screened articles, extracted data using a standardised proforma and resolved discrepancies in discussion with a third researcher. Descriptive summaries of evidence are presented. Meta-analyses were not conducted due to variation in study designs. Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed.ResultsOf 3815 abstracts identified, 15 articles reporting quantitative data were eligible and included in the review. No qualitative studies examining contextual drivers of STI risk among people of BC ethnicity were identified. Compared to the white/WB ethnic group, the greater STI/TV risk among BCs was partially explained by variations in socio-demographic factors, sexual behaviours, and recreational drug use. The prevalence of reporting early sexual debut (<16 years), concurrency, and multiple partners was higher among BC men compared to white/WB men; however, no such differences were observed for women. People of BC ethnicity were more likely to access sexual health services than those of white/WB ethnicity.ConclusionsFurther research is needed to explore other drivers of the sustained higher STI/TV prevalence among people of BC ethnicity. Developing holistic, tailored interventions that address STI risk and target people of BC ethnicity, especially men, could enhance STI prevention.

Highlights

In the United Kingdom (UK), sexually transmitted infections (STIs) continue to be a public health concern [1, 2]
Studies since the late-1980s have shown disproportionately high rates of bacterial STI diagnoses among black compared to white ethnic groups [3, 4]
Since 2000, clinic-based studies [5, 6], national probability surveys [7, 8], and surveillance data [9, 10] have distinguished between ‘black Caribbean’ (BC), ‘black African’ (BA) and ‘black other’ (BO) ethnicities, and have consistently shown that people of BC ethnicity in particular experience the highest rates of infection with Trichomonas vaginalis (TV) and bacterial STIs

Summary

Introduction

In the United Kingdom (UK), sexually transmitted infections (STIs) continue to be a public health concern [1, 2]. Studies since the late-1980s have shown disproportionately high rates of bacterial STI diagnoses among black compared to white ethnic groups [3, 4]. Since 2000, clinic-based studies [5, 6], national probability surveys [7, 8], and surveillance data [9, 10] have distinguished between ‘black Caribbean’ (BC), ‘black African’ (BA) and ‘black other’ (BO) ethnicities, and have consistently shown that people of BC ethnicity in particular experience the highest rates of infection with Trichomonas vaginalis (TV) and bacterial STIs. Rates of gonorrhoea are 8–12 times higher among people of BC ethnicity compared to people of white ethnicity [9, 11]. In the UK, people of black Caribbean (BC) ethnicity continue to be disproportionately affected by bacterial sexually transmitted infections (STIs) and Trichomonas vaginalis (TV). We systematically reviewed evidence on the association between bacterial STIs/TV and ethnicity (BC compared to white/white British (WB)) accounting for other risk factors; and differences between these two ethnic groups in the prevalence of risk factors associated with these STIs, sexual healthcare seeking behaviours, and contextual factors influencing STI risk

Methods

Results

Conclusion