Management and Control of Sexually- transmitted Infections and their Implications for AIDS Control in South-East Asia

Abstract

Sexually-transmitted infections (STIs) are highly prevalent in developing countries, including many parts of South-East Asia. The burden of diseuse due to these infections and their complications is enormous, particularly among women. STIs thus present a major public health problem in their own right. Accessible, affordable and effective treatment services need to be made available everywhere. The syndromic approach to STI diagnosis and case management based upon locally adapted standard treatment algorithm is byfarsuperiorto the presumptive clinical diagnostic approach that is still used in many parts of the region. This approach is particularly suitable in areas where efficient and affordable laboratory services are not available. STIs are known to enhance HIV transmission. Effective control of curable STIs has been shown to significantly reduce HIV incidence in popula tions. Such control measures should address all major steps of the Piot model: they should include primary prevention, screening to detect asymptomatic or neglected STI particularly among high- risk behaviour groups, and effertive treatment services for those who seek care forsymptomatic STI. So far the public health response to STI in South and South-East Asia has been varied. Some countries have addressed the problem quite vigorously, but most need to mount a much stronger coordinated response in the face of the accelerating HIV epidemic in the region. There is also a substantial need to systematically monitor and evaluate ongoing activities, including the quality of STI case management, and to make an attempt towards bridging the wide rift between policy and actual practices.