GHENT UNIVERSITY Karoline FONCK - International Centre for ...

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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
to protect themselves and be empowered to use them. However, although use of female condoms may be an option for FSWs, its use in stable couples may be limited. Furthermore, no effective microbicides are available as of yet, although research is promising. Since empowerment of women in linked to socio-cultural changes and may not happen overnight, it is of utmost importance to increase men’s awareness and responsibility towards safer sexual behavior. Simultaneously, improved partner notification and treatment of the frequently asymptomatic female partners of men seeking STI care may be one of the very few feasible strategies for the management of women with STI. The alarming reports of high STI prevalence rates among young people, especially women, call for urgent action and implementation of appropriate programs targeted towards behavior change. FINAL REMARKS 110
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GHENT UNIVERSITY STI PREVENTION AND
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AIDS Acquired Immune Deficiency Syn
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1.1. Sexually Transmitted Infection
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countries, the rate of reporting co
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district of Uganda randomized villa
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By identifying where significant
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4.5%, 3.9%, 67.7% and 30.1% while t
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female primary health care or anten
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The research data have been publish
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2.1. OBJECTIVES 2.1.1. General obje
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2.2.3. Laboratory procedures The mi
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C HAPTER 3 PREVALENCE AND RISK FACT
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After registration by the clinic cl
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The majority of the women were infe
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eing single, ever having been treat
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prevalence found in a family planni
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3.2. Declining Syphilis Prevalence
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Training Nurses at the antenatal cl
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We believe that the observed declin
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Wasserheit 1992, Laga 1993). In Nai
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Table 1: Demographic data of 471 pa
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women. Overall, significantly fewer
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Stigmatization by health staff also
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4.2. Health-Seeking Behavior and Se
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Between September and November 1998
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Table 2: Healthcare-seeking behavio
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Thirteen women had engaged in sex w
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Men reported more extramarital affa
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C HAPTER 5 DIAGNOSIS AND MANAGEMENT
Page 59 and 60: discharge and abdominal pain-two co
Page 61 and 62: Data were entered and analyzed in S
Page 63 and 64: One of the peripheral health center
Page 65 and 66: Evaluation of Algorithms The result
Page 67 and 68: In this study of symptomatic women,
Page 69 and 70: C HAPTER 6 PREVENTION OF SEXUALLY T
Page 71 and 72: Table 1: Syphilis Rapid Plasma Reag
Page 73 and 74: One should keep these problems in m
Page 75 and 76: The use of mailed reminders did not
Page 77 and 78: Table 1: Characteristics of women w
Page 79 and 80: studies, indicating that couples ar
Page 81 and 82: 6.3. A Randomized, Placebo-controll
Page 83 and 84: esistance patterns in bystander flo
Page 85 and 86: In univariate analysis, the odds ra
Page 87 and 88: Widows, divorcees and separated wom
Page 89 and 90: They did not report much condom use
Page 91 and 92: The low prevalence of the other STD
Page 93 and 94: There is some evidence that frequen
Page 95 and 96: Table 1. Characteristics of HIV- po
Page 97 and 98: A significantly higher prevalence o
Page 99 and 100: There is now considerable evidence
Page 101 and 102: patients. The analysis revealed hig
Page 103 and 104: contributory factor may be that mal
Page 105 and 106: use in Kenya. In a supplement of Se
Page 107 and 108: with intensive behavioral change in
Page 109: C HAPTER 8 FINAL REMARKS STIs illus
Page 113 and 114: Bell G, Ward H, Day S et al. Partne
Page 115 and 116: Fleming D and Wasserheit J. From ep
Page 117 and 118: Jackson DJ, Rakwar JP, Chohan B et
Page 119 and 120: Manning B, Moodley J, Ross SM. Syph
Page 121 and 122: Oberlander L, Elverdam B. Malaria i
Page 123 and 124: Serwadda D, Gray R, Wawer M et al.
Page 125 and 126: Van Dam J, Anastasi MC. Male Circum
Page 127 and 128: WHO Collaborating Center on HIV/AID
Page 129 and 130: S UMMARY Sexually transmitted infec
Page 131 and 132: notification. Innovative and locall
Page 133 and 134: connaissance des femmes sur la sant
Page 135 and 136: Nous avons démontré que le coût
Page 137 and 138: vonden we een hoge prevalentie van
Page 139 and 140: We hebben aangetoond dat de kost va
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