GHENT UNIVERSITY Karoline FONCK - International Centre for ...

of the epidemic when prevalence is more widespread, interventions directed towards core
groups may remain cost-effective but may no longer be sufficient to rapidly contain the
epidemic.
In ensuring universal access to appropriate STI care programs, it should be recognized that
patients seek care from a mixture of public and private sources. Planning of a balanced and
comprehensive program will need to consider strengthening any health care providers that
are able to provide a quality service. This means that in efforts directed at provider
behaviors, such as guideline development, training and evaluation must extend to providers
in the private sector as well.
Lack of political will and commitment, resistance from religious leaders, the culturally
accepted habits and old-fashioned ideas are all factors that may have enhanced this rapid
spread of HIV. There is a direct connection between the willingness of leaders to discuss
HIV/AIDS prevention and the success of such programs. In recent years, political leadership
in the fight against STI/HIV has improved considerably in certain countries hardest hit by the
HIV epidemic creating an enabling environment for action against the epidemic and its
negative effects on development. Other key elements needed for an effective answer to the
HIV/AIDS epidemic are the following: 1) a concerted action to integrate the HIV/AIDS
problematic in the main development instruments; 2) massive mobilization of additional
resources; 3) a multi-sectorial approach; 4) intensification of interventions based on the best
possible data.
Continued financial support for prevention and control programs is a concern. All countries
must continue to make efforts to mobilize domestic resources from all sources. The
international community is called upon to assist developing countries in their efforts. A strong
case can be made for providing free treatment for STIs on public health grounds, in the same
way it has been made for other communicable diseases such as tuberculosis, but this would
need to be supported by the international donor community in the poorest countries.
Introduction of cost-recovery mechanisms, as in place in Kenya, should not discriminate
against STI patients and should not ignore people’s needs. More adapted waiver systems as
to assure access for all, included the poorest, should be institutionalized. The coordination of
activities must be enhanced. Measures such as joint programs can improve coordination and
ensure a more efficient use of scarce resources.
Female controlled prevention methods such as female condoms and microbicides are of
particular relevance to the STI and HIV prevention agenda. Women should be given the tools
FINAL REMARKS 109