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1.5. STI prevention and control
The main objectives of STI control are: 1) to interrupt the transmission of STI; 2) to prevent
the development of complications and sequelae; 3) to reduce the incidence of HIV infection.
These objectives can be achieved by programs through primary and secondary prevention.
Primary prevention aims at reducing the incidence of disease through prevention of
acquisition of infection and disease. This can be done through safer sexual behavior and
condom use. Secondary prevention is directed at reducing prevalence by shortening the
duration of disease thus minimizing the probability of complications or sequelae, through the
provision of treatment and care for infected and affected persons.
Growing emphasis has been placed on behavioral interventions to reduce exposure, in view
of the growing importance of incurable viral STIs including HIV infection. A comprehensive
priority public health package for STI control in developing countries should include 1) health
promotion to reduce risk of exposure to infection and adoption of “safe sex” practices,
including the use of condoms and the maintenance of these safer behaviors; 2) promote
early STI healthcare-seeking behavior; 3) adequate management of patients with STIs and
their partners; 4) intensified interventions in population groups with highest rates of risk
behavior. For the implementation of this package it is essential that a supportive national
policy be adopted that endorses and elaborates these components (WHO 1999).
Both for STI and HIV prevention and control, it is essential that health education and
promotion efforts be intensified and sustained to achieve an urgently needed change in risktaking
behavior, to maintain safe behaviors and to develop an environment that enables
people to adopt and sustain safe behavior. Many societies however are reluctant to openly
address issues involving sex and sexuality and to recognize the realities of sometimes
widespread existence of pre- and extramarital sexual intercourse.
Furthermore, the effect of poor healthcare-seeking behavior coupled to ineffective STI
services result in lack of a major impact in view of the large number of people with infection
who fail to obtain treatment. (WHO 1997, 1999). As described in the Operational model of
effectiveness of STI services, also called the Piot-Fransen model (Figure 1), the success of
an STI program should be measured in terms of the proportion of cases of STI occurring in
the population that is successfully treated, considering that STI infected individuals will have
to overcome a series of hurdles before they can be considered cured. The model shows
“leakage” at each step, determining what proportion of patients is lost from treatment at
successive points in the process from infection to possible cure.
INTRODUCTION 9