Health policies for controlling AIDS and STDs in developing countries

Abstract

In response to the growing prevalence of human immunodeficiency virus (HIV) and other sexually transmitted diseases (STDs) as well as declining budgets for health and social servicesthe European Community has proposed the integration of AIDS and STD control programs. The overlap between populations at highest risk for STDs and AIDS the observation that STDs such as genital ulcers and chlamydia infection increase the likelihood of acquisition of HIV the tested effectiveness of targeted behavioral interventions in campaigns against AIDS and STDs and the need for cost-effectiveness all support such an approach. Health promotion for primary prevention of infection is the recommended strategy and 3 groups have been proposed for targeted intervention-- political and community leaders teenagers and schoolchildren who have not yet adopted high-risk behaviors and core group transmitters characterized by high-risk sexual behavior. Condom promotion should be an integral aspect of these health promotion efforts rather than an autonomous activity. Also essential is secondary prevention of STDs through adequate management of STD patients and their contacts. Visitors to STD clinics should be regarded as a self-referred group at an increased risk of HIV infection. The quality of care they receive is critical to determining whether these hard-to-reach individuals will remain in contact with the health care system. Both counseling and partner notification should be integral parts of STD case management. At present only 2 of the 25 developing countries that have expressed interest in a coordinated STD/AIDS control program have a national STD control program although most have a medium-term AIDS control program. Thus there will be a need for international assistance in planning management and training.