# P-1583. Epidemiological Trends and Risk Factors of STIs Including Syphilis Among Males, LGBT Populations, and Pregnant Women : The Role of Free Health Insurance in resource limit setting

## TL;DR

This study in Nepal finds high rates of STIs, including syphilis, among young males, LGBT individuals, and pregnant women, and highlights the role of free health insurance in improving access to care.

## Contribution

The study identifies key risk factors and demonstrates the impact of free health insurance on STI prevention and treatment in marginalized groups.

## Key findings

- STIs were most prevalent among LGBT individuals (7.5%) and pregnant women (5%) compared to males (2.9%).
- Age ≤ 30, multiple sex partners, unprotected sex, being LGBT+, and pregnancy were significant risk factors for STIs.
- Free health insurance and telemedicine are critical for improving access to STI care in marginalized populations.

## Abstract

STIs, including syphilis, are a major public health concern in Nepal, and high prevalence is shown among young males, LGBT populations, and pregnant women. The prevalence of syphilis among attendees of antenatal care is 1.3%, though it was higher among the high-risk groupsDistribution of STIRisk factors in groups

Distribution of STI

Risk factors in groups

A cross-sectional study of one year attended were screened for 200 subjects of genital skin lesions and syphilis. Data were analysed with SPSS.

Out of the total number of screened individuals, 156 (3.3%) with genital lesions or serologically positive for syphilis were found. Of these, 116(2.9%) were males, 15(7.5%) were LGBT, and 25 (5%) were pregnant women. Among these, 54% of males (n=63), 73% of LGBT(n=11), and 60% of pregnant women (n=15) were diagnosed to have STIs. Specific conditions included:Genital warts:44% males(n=51), 53% LGBT(n=8), and 20% pregnant women(n=5). Scabies: 39% males(n=45), 27% LGBT(n=4), and 12% pregnant women (n=3). Syphilis: 8% males(n=9), 13% LGBT(n=2), and 28% pregnant women(n=7)

Statistical analysis showed the following significant risk factors that contribute to STIs: Age ≤ 30 years :OR = 2.45, 95% CI: 1.78–3.38, p < 0.001, Having multiple sex partners: OR = 3.12, 95% CI: 2.15–4.52, p < 0.001, History of unprotected sexual exposure: OR = 2.89, 95% CI: 2.01–4.15, p < 0.001, Being LGBT+:OR = 2.67, 95% CI: 1.85–3.86,p < 0.001, Pregnancy: OR = 3.45, 95% CI: 2.30–5.18,p < 0.001.

The study showed the high burden of sexually transmitted infections, especially syphilis, among men, LGBT populations, and pregnant-women. Free laboratory, culture diagnostics, treatment through the Nepal health insurance program mark a significant stride forward in STI prevention and treatment. Acquisition efforts should focus on the reduction of stigma, increase awareness,and expansion via telemedicine. Reach and inclusion into the insurance-program remain critical social determinants to the realization of equity in access to health-care among marginalized populations

All Authors: No reported disclosures