GHENT UNIVERSITY Karoline FONCK - International Centre for ...

C HAPTER 8
FINAL REMARKS
STIs illustrate the complex interactions of bio-ecology, medicine, culture and politics. The
AIDS epidemic shattered expectations of a relative stable world of infectious diseases. AIDS
like syphilis in the past engenders powerful social conflicts about the meaning, nature and
risks of sexuality. STIs, including HIV/AIDS, are probably more than any other public health
problem linked to structural problems of poverty, malnutrition and underdevelopment.
Many societies are reluctant to openly address issues involving sex and sexuality and to
recognize the realities of the sometimes-widespread existence of pre- and extramarital
sexual intercourse. Both for STI control as well as for prevention and control of HIV infection,
it is essential that health education and promotion efforts be intensified and sustained to
achieve an urgently needed change in risk-taking behaviors, to maintain safe behaviors, and
to develop an environment that enables people to adopt and sustain safe behavior (Van
Dam).
STI control is one of the key components to HIV prevention and control. Intervention
programs that include condom promotion and behavior change would benefit both STI and
HIV control programs. Furthermore, the efforts against STI must reflect the diversity of their
causes and their associations. It is unlikely that any single control measure will reduce HIV
transmission sufficiently and therefore different strategies will have to be implemented
simultaneously.
In resource poor settings, STI control programs should be integrated as much as possible
with HIV/AIDS control programs, since they will assure that duplication and wastage of
scarce resources is avoided. Areas for coordination or integration include care, health
education and counseling, promotion of safer sexual behavior, provision of condoms and
evaluation.
Different levels of interventions for STI prevention and control are possible: individual,
couple-based, core-group, community based, and population based. Although a multi-level
approach is ideal, limited resources may constrain choice. Other factors may also contribute
to selection of the appropriate strategy, for example the stage of the epidemic. In later stages
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