STD control for HIV prevention—it works!

Abstract

A well-designed community randomized trial in rural Mwanza Tanzania demonstrates that improved sexually transmitted disease (STD) case-management reduces the incidence of HIV infection. STD care activities integrated into primary health care services included training of health care workers in STD syndrome management securing available effective antibiotics for STDs through a separate distribution system and promoting health- seeking behavior. Essentially the reduced duration of self-reported STDs (especially in men) led to a 42% reduction in HIV infection incidence. The HIV infection incidence would have been even higher if health workers had implemented even more aggressive strategies (e.g. case-finding of asymptomatic STD cases among vulnerable groups). In both intervention and control villages sexual behavior and condom use were the same. The interventions had the greatest impact on HIV infection incidence among women 15-24 years old. Integration of STD services in family planning and maternal and child health services does not serve this very vulnerable age group or another very vulnerable group sex workers. Lack of simple technical tools to detect gonococcal and chlamydial infections in women presents an obstacle for providing accessible and effective STD care for vulnerable groups. Outreach activities as opposed to waiting for clients to come to a clinic community involvement and low-threshold services are means to reach vulnerable populations. These findings highlight the role of STDs as cofactors in HIV infection incidence and the need for health workers to discuss safe sex and promote condom use with STD patients. Health personnel should focus reaching vulnerable groups.