Sexually transmitted disease, ethnomedicine and health policy in Africa.

Compared with both industrialized countries and other less developed parts of the world, most of sub-Saharan Africa suffers inordinately from sexually transmitted diseases (STDs). It has high prevalence rates of traditional STDs, such as gonorrhea and syphilis, and if accurate seroprevalence surveys were to be done, it would probably prove to have the highest HIV seropositive incidence in the world. Unlike the pattern in the West, AIDS is primarily a heterosexually transmitted disease in Africa. This appears to be largely because of the prevalence of other untreated or improperly treated STDs. Therefore to lower the incidence of STDs would be to curtail the spread of HIV infection. The problem becomes how exactly to accomplish this. Most STD cases are never even presented at biomedical health facilities; they are presented to traditional healers. Both healers and their patients seem to believe that traditional STD cures are more effective than 'modern' cures, although the former are probably biomedically ineffective. While there is scant ethnomedical literature on STDs in Africa, the present paper presents Swaziland findings and related evidence from other African societies that the ultimate cause of several common STDs is believed to be the violation of norms governing sexual behavior, requiring traditional rather than biomedical treatment. Traditional healers therefore need to be a central part of any scheme to lower the incidence of STDs.     

Gender,sexual health and reproductive health promotion

The underlying factors of poverty, migration, marginalization, lack of information and skills, disempowerment, and poor access to services which affect HIV/STD risk are also closely related to those which affect sexual and reproductive health. Reproductive health problems include unplanned and unwanted pregnancies, unsafe abortions, pregnancy-related illness and death, and STDs including HIV/AIDS. This interrelationship between factors is leading increasingly to the integration of HIV/STD education and prevention within the broader framework of sexual and reproductive health promotion. Such intervention allows the possible reinforcement of the impact of interventions upon important underlying factors and behaviors linked to individual, family, and community vulnerability to HIV/STDs as well as other reproductive health problems. Integration will also optimize the use of increasingly scarce resources and increase the likelihood of responses, interventions, and programs being sustainable. Sexual and reproductive health, placing HIV/STD prevention into context, and focus upon men are discussed.     

The fight against sexually transmitted diseases in Ivory Coast: what strategies can we use in the face of HIV/AIDS?

In the AIDS era, sexually transmitted diseases (STDs) have become a major health problem in developing countries, particularly in Africa. Delays in the diagnosis and treatment of such infections may result in complications, many of which primarily affect women. Epidemiological studies in Abidjan have shown that more than 10% of the pregnant women attending antenatal clinics present STDs potentially serious for their own health or that of their infants (gonorrhea, chlamydia infection, genital ulcers or active syphilis). There is evidence that STDs increase the transmission of HIV and that improving the syndromic management of STDs reduces the incidence of HIV infection. This provides a strong argument in favor of controlling STDs in areas of high HIV prevalence. In Ivory Coast, as in other African countries, a STD control program has been integrated into the AIDS control program since 1992, as recommended by the World Health Organization. During the first six years of the STD program, considerable progress was made in some areas, but not without difficulty. Simple syndrome-based decision trees have been adopted for the management of STDs in primary health care. Clinical studies have shown these therapeutic algorithms to be effective. At the same time, effective and affordable drugs for treating STDs were added to the list of essential drugs in Ivory Coast, after an international invitation to tender. The entire staff of the public health sector in Abidjan has been trained in syndromic STD management. Training is now being extended to other parts of Ivory Coast, including the private health sector and, in particular, private nurses. The surveillance of syndromic STDs, mainly genital ulcers in both sexes and urethral discharge in men, facilitates monitoring and evaluation of the STD program, following health care activities and adapting orders for drugs for treating STDs to real needs. In the near future, some parts of the STD program will be strengthened, particularly the management of sexual partners of STD patients and reduction of the cost of STD treatment for pregnant women.     

Nonoxynol-9 spermicide contraception use--United States, 1999

Most women in the United States with human immunodeficiency virus (HIV) become infected through sexual transmission, and a woman's choice of contraception can affect her risk for HIV transmission during sexual contact with an infected partner. Most contraceptives do not protect against transmission of HIV and other sexually transmitted diseases (STDs), and the use of some contraceptives containing nonoxynol-9 (N-9) might increase the risk for HIV sexual transmission. Three randomized, controlled trials of the use of N-9 contraceptives by commercial sex workers (CSWs) in Africa failed to demonstrate any protection against HIV infection; one trial showed an increased risk. N-9 contraceptives also failed to protect against infection with Neisseria gonorrhoeae and Chlamydia trachomatis in two randomized trials, one among African CSWs and one among U.S. women recruited from an STD clinic. Because most women in the African studies had frequent sexual activity, had high-level exposure to N-9, and probably were exposed to a population of men with a high prevalence of HIV/STDs, the implications of these studies for U.S. women are uncertain. To determine the extent of N-9 contraceptive use among U.S. women, CDC assessed data provided by U.S. family planning clinics for 1999. This report summarizes the results of that assessment, which indicate that some U.S. women are using N-9 contraceptives. Sexually active women should consider their individual HIV/STD infection risk when choosing a method of contraception. Providers of family planning services should inform women at risk for HIV/STDs that N-9 contraceptives do not protect against these infections.     

Zambia's STD control programme: a model for Africa?

The annual incidence of sexually transmitted diseases (STD) in Zambia is 34 per 10,000 population with an 1.9:1 male:female ratio. Complaints related to STDs is the third most common reason for attending health establishments and constitute a significant burden upon limited financial health resources already overwhelmed by other programs such as leprosy and nutrition. STDs are therefore a major health problem in Zambia, constituting 10% of adult outpatient attendances in both hospitals and primary health care centers. Due to the enormous health, social, and economic consequences of STDs, the Zambian health ministry launched in 1980 the national STD control program, a program which is particularly important in recent years given the appearance of HIV infection and increasing evidence that concomitant STDs are significant cofactors in the sexual transmission of HIV. Program objectives are to assess the extent and nature of STDs in Zambia on the basis of existing institutional data and population sample surveys, to improve the management of STDs through the establishment of specialized STD clinics at provincial and district levels, to train in-service personnel to man STD clinics, to increase public awareness of STDs by health education and factual information, and to coordinate research, treatment, and preventive activities to reduce the incidence of STDs. Program implementation, program activities, and achievements thus far are discussed.     

Topical microbicides: missing link for HIV prevention

This article features intravaginal microbicides available in various forms, such as gel, suppository, cream, film or sponge, preventing HIV infections and other sexually transmitted disease (STD) pathogens. Microbicides also vary in their action by boosting the body's natural defense, by killing or inactivating STD pathogens, or by creating a protective barrier between the virus and the vaginal wall. Despite the potential of these products to prevent HIV and other STDs, large pharmaceutical companies are hesitant to invest in them because they assume that the only market would be in the developing world. The Global Campaign for Microbicides and HIV/STD Prevention Alternatives for Women was launched having the priority goal of educating individuals about female condoms and microbicides as promising technologies that deserve more attention and investment. While microbicides are not available yet, the use of condom still provides the best protection against HIV/STDs.     

Survey: most adults don't notify sex partners of STDs

A telephone survey of 1,000 men and 500 women shows that while most people with sexually transmitted diseases (STDs) have a responsibility to inform their sexual partners, only about one-third of men and women with STDs revealed the existence of the STD to their partner before having sex. For American adults, there is a 1 in 4 chance of contracting an STD during their lifetime compared to a 1 in 250 chance of getting HIV. However, most men and women have not been tested for any STDs besides HIV. American adults seriously underestimate their risk of contracting STDs, and very few are aware of the different types of STDs that exist.     

某市性病流行特征及数学模型在发病趋势中的应用

目的：探讨广州市近5年性病疫情流行特征，为政府部门制订预防控制措施提供科学依据。方法：对近5年性病疫情报告资料进行流行病学分析，并对近5年性病报告发病率进行曲线拟合，运用线性模型预测未来3年广州市性病发病率。结果：广州市近五年性病报告发病率逐年下降，但AIDS／HIV、胎传梅毒及三期梅毒发病数及发病率呈上升趋势；性病人群中老年患者人数增加。拟合的4种数学模型均有统计学意义，其中以直线模型为佳。经预测，未来3年性病发病率仍保持下降势态。结论：根据近几年性病流行特征及未来几年发病趋势，该市应及时调整性病工作防治策略及控制工作重点。     

Original Research: Sexual Risk in Lesbians and Bisexual Women

Objective: To describe the frequency of human immunodeficiency virus (HIV)/sexually transmitted diseases (STDs) sexual risk behaviors in lesbian and bisexual women. Design: Cross-sectional anonymous self-administered questionnaire. Setting: Women's cultural events; HIV/STD service organizations; women's health collectives. Participants: 504 self-identified lesbian and bisexual women. The sample was composed of predominantly white, well-educated women with a mean age of 35 years. Results: Both lesbian and bisexual women engaged in behaviors that potentially lead to transmission of HIV and other STDs. Lesbians were more likely to have a single sexual partner than were bisexual women. Bisexual women were more likely to report a history of STD. Of those sexually active with male partners, one-third reported multiple male partners in the previous year. Significantly more bisexual women reported condom use. Women with multiple partners were more likely to consider themselves at risk for HIV/STD. Having unprotected sex or male partners was not associated with an increased risk perception. Conclusions: Lesbian and bisexual women are engaging in sexual behaviors that may increase their risk for HIV or STD infection. Culturally sensitive prevention programs are needed.     

HIV and STDs: how are they linked?

I write in response to Dr. Gina Dallabeta's article with this title (HIV and STDs: How Are They Linked?). Prospective studies in sub-Saharan Africa have established the following: 1. Seropositive commercial sex workers have a higher prevalence of genital ulcer disease (GUD) and positive serology for syphilis. 2. Seropositive men with chancroid more frequently have a history of prior GUD. 3. Seronegative men with a history of recent contact with a commercial sex worker are more likely to seroconvert if they have GUD than urethritis. GUD increases the infectiousness of HIV. Similarly, there is increased susceptibility to the virus in cases of genital chlamydial infection and Trichomonas vaginalis. The mechanisms are basically two--mechanical and biological. Mechanically, the raw area resulting from the STD provides a portal of entry for the virus. Biologically, activated lymphocytes and macrophages enhance HIV shedding and increase the susceptibility of the individual to HIV.     

HIV and STDs: how are they linked? [letter

I write in response to Dr. Gina Dallabeta's article with this title (HIV and STDs: How Are They Linked?). Prospective studies in sub-Saharan Africa have established the following: 1. Seropositive commercial sex workers have a higher prevalence of genital ulcer disease (GUD) and positive serology for syphilis. 2. Seropositive men with chancroid more frequently have a history of prior GUD. 3. Seronegative men with a history of recent contact with a commercial sex worker are more likely to seroconvert if they have GUD than urethritis. GUD increases the infectiousness of HIV. Similarly, there is increased susceptibility to the virus in cases of genital chlamydial infection and Trichomonas vaginalis. The mechanisms are basically two--mechanical and biological. Mechanically, the raw area resulting from the STD provides a portal of entry for the virus. Biologically, activated lymphocytes and macrophages enhance HIV shedding and increase the susceptibility of the individual to HIV.     

Sexually transmitted diseases in Africa: time for action

Sexually transmitted diseases (STDs) are major public health problems which often lead to serious complications and sequelae, including infertility. Infection with STDs also facilitates the transmission of HIV, making the early diagnosis and care of STDs integrated into other services one of the most cost-effective strategies to prevent the spread of HIV. The direct and indirect costs of STDs worldwide are considerable. Sub-Saharan Africa ranks first in STD yearly incidence compared to other world regions. The World Health Organization has estimated that every year in Africa there are 3.5 million cases of syphilis, 15 million cases of chlamydial disease, 16 million cases of gonorrhea, and 30 million cases of trichomoniasis. STDs are a high public health priority especially because of their widespread prevalence and treatability. Herpes simplex virus infection and human papillomavirus infection are growing problems in sub-Saharan Africa. While STDs are caused by more than 20 microorganisms, they present themselves mainly in 4 syndromes and may therefore be treated syndromically. Africa must implement effective and comprehensive integrated activities against the STD epidemic. Elements of such a strategy will include disease prevention, screening and case finding, and the early diagnosis and treatment of cases.     

RURAL YOUTH: HIV/STD KNOWLEDGE LEVELS AND SOURCES OF INFORMATION

ABSTRACT: Though it is recognised that a sound knowledge of HIV/STD transmission is insufficient on its own to ensure that young people practise safer sex, knowledge of this sort is a necessary prerequisite to safe sex behaviours. Research on the HIV/STD knowledge levels of young people has shown that, while they have high levels of HIV knowledge, they generally have little idea about the transmission of other STDs. Moreover, most of this research has been conducted with more accessible youth in large urban centres. The research reported in this paper focused on HIV/STD knowledge levels, awareness of safe and unsafe sexual practices, and the information sources accessed by 1168 young people living in small rural towns in Queensland, Tasmania and Victoria. As with mainstream youth, the participants in this study had high levels of HIV knowledge and very low levels of knowledge about the transmission of other STDs, their names and symptoms. Practical knowledge of the safety of sexual practices was good, although a number of students confused high risk practices with high risk groups. Students mainly accessed informal information sources such as parents, peers and magazines and took little advantage of more formal sources even when they were available in their towns. There were few gender differences in levels of knowledge; however, girls accessed more information sources and knew more names of STDs. The implications of these findings are discussed in relation to young people developing critical attitudes towards more informal sources, and the better use of more formal sources.     

Understanding sex partner selection from the perspective of inner-city black adolescents

CONTEXT: Black adolescents in inner-city settings are at increased risk for HIV and other STDs. Sex partner characteristics, as well as individual behavior, influence individuals' STD risk, yet little is known about the process of sex partner selection for adolescents in this setting. METHODS: Semistructured in-depth interviews were conducted during the summer and fall of 2002 with 50 inner-city black adolescents (26 females and 24 males) who had been purposively recruited from an STD clinic. Content analysis was used to study interview texts. RESULTS: Young women desire a monogamous romantic partner, rather than a casual sex partner; however, to fulfill their desire for emotional intimacy, they often accept a relationship with a nonmonogamous partner. Young men seek both physical and emotional benefits from being in a relationship; having a partner helps them to feel wanted, and they gain social status among their peers when they have multiple partners. For men, these benefits may help compensate for an inability to obtain jobs that would improve their financial and, as a result, social status. Both women and men assess partners' STD risk on the basis of appearance. CONCLUSIONS: HIV and other STD prevention initiatives must go beyond the scope of traditional messages aimed at behavior change and address the need for social support and socioeconomic opportunities among at-risk, inner-city adolescents.     

Sentencing risk: history of incarceration and HIV/STD transmission risk behaviours among Black men who have sex with men in Massachusetts

This study investigated the role of incarceration in HIV/STD risk among 197 Black men who have sex with men in Massachusetts, USA. More than half (51%) reported a history of incarceration (28% 相似文献   

Health policies for controlling AIDS and STDs in developing countries

In developing countries the control and prevention of SexuallyTransmitted Diseases (STDs) and the ensuing complications hasreceived renewed attention since the emergence of the latestsexually transmitted disease, AIDS. Prevention via behaviouralchange has become more important than ever because of the currentlack of therapy or vaccination for HIV infections. Considerationsabout STD and AIDS control programmes are discussed, and theoption employed by the European Community to combine STD andAIDS control, is discussed. The strategies used for STD and AIDS control are health promotionand adequate management of patients with STDs. It is arguedthat health promotion should be targeted, and take into considerationpriority activities and groups; that condom promotion shouldbe an integral part of health promotion rather than being anautonomous activity; and that promotion of health seeking behaviouris an important part of the strategy. Adequate management of patients with STDs is effective for AIDSprevention because some STDs are associated with an increasedrisk of HIV transmission, but also because people coming spontaneouslyto a clinic can be considered a self-referred group, at an increasedrisk from HIV infection. The methodology used to implement thosestrategies is discussed, on three levels: the programming andmanagement level; the expertise unit; and implementation atperipheral levels. Experiences, obstacles and technical problemsencountered by the AIDS Task Force of the European Communityare enumerated.     

Sexually transmitted diseases among foreigners in Italy. Migration Medicine Study Group.

A sentinel surveillance system for the control of sexually transmitted diseases (STD) among foreigners was developed in Italy in 1991. From January 1991 to June 1995, 4030 foreigners with a new STD episode were reported. More than one-third of them were North-Africans. The most frequent STDs were non-specific urethritis and genital warts among men, and non-specific vaginitis and latent syphilis among women. The overall HIV prevalence was 5%, with large differences in rates in people from different continents. Very high HIV-positivity rates were observed among homosexuals and homosexual IDUs from Central-South America, with 39.1% and 77.8% seropositive individuals respectively. These data stress the need for increased knowledge of both the spread of risk factors for STDs among immigrants. Particular attention should be paid to counselling procedures focused on the prevention of risk behaviours for acquiring STDs and HIV infection.     

HIV-related services for persons with severe mental illness: Policy and practice in new hampshire community mental health

Rates of HIV and HIV risk behaviors are elevated among people with severe mental illnesses (SMI). Little is known about the extent to which community mental health (CMH) centers screen, refer, and educate their clients regarding HIV and sexually transmitted diseases (STDs). The authors surveyed CMH administrators and clinicians in New Hampshire regarding HIV/STD policy, practices, knowledge, and attitudes. HIV/STD service availability varied, and the amount of services provided was unrelated to the prevalence of HIV and AIDS in that region. Clinicians were knowledgeable about general HIV information but lacked specific knowledge about HIV related to persons with SMI. CMH staff had positive attitudes about helping clients with HIV issues. Administrators were interested in receiving training. Policy leadership, CMH practice guidelines, and training are warranted in light of the pressing public health implications of HIV/STDs among people with SMI.     

Gender, sexuality, and the prevention of sexually transmissible diseases: a Brazilian study of clinical practice

Epidemiological tendencies in the spread of HIV/AIDS in Brazil demonstrate the increasing importance of heterosexual transmission to women who are not included in those traditional categories of 'risk' which have so far guided research and attempts at prevention. While more attention is now being given to other STDs as part of HIV prevention, this same view of 'risk' prevails, as does a tendency to rely on strictly quantitative indicators and conceptions which treat health care workers' beliefs and attitudes as individual phenomena. This study, an examination of clinical practices of STD management in gynecological and antenatal programs in public health posts in Rio de Janeiro, reveals the mutually-reinforcing relationship between gender norms in sexuality and gynecological clinical practices, which results in the reproduction of both gender hierarchy and vulnerability to infection by all STDs.     

Developing HIV / AIDS and STD workplace policies

Employers and/or community leaders carry the primary responsibility for setting up workplace HIV/AIDS and STD (sexually transmitted disease) policies. They should include workers from the beginning to help identify policy objectives and content. Major objectives of a workplace policy include ensuring the health and rights of workers, reducing the effects of poor health on workplace productivity, and contributing to the general welfare of the community. Clearly stated principles of workplace policy may encompass freedom from mandatory HIV testing for job applicants and workers, ensuring a safe working environment, supporting treatment of HIV/STD-related illnesses, assuring confidentiality of HIV status, establishing a climate in which HIV-positive workers feel they can tell their employers about their status, and ensuring freedom from discrimination. HIV/AIDS and STD workplace policies are likely to include management and employee training, education and support services, and observance of employee rights. Examples of heeding employee rights are application and promotion procedures that do not require HIV testing, opportunities for HIV-positive workers to do work other than their usual work when their physical condition deteriorates, establishment of and adherence to disciplinary and grievance procedures if confidentiality of HIV status is violated, and treatment for STDs and other illnesses. A few persons should be responsible for monitoring implementation of HIV/AIDS and STD workplace policy. Monitoring may consist of regular meetings to reassess and, if needed, adapt the policy; a system of feedback from employees; assessment of use of support services; and conversations with HIV-positive workers to learn of the success of the workplace program in tending to their concerns and needs.