Suffering in Silence
Suffering in Silence
Treating Sexually Transmitted Infections (STI) and Reproductive Tract Infections (RTI)is not an easy task due to stigma, ignorance, fear and embarrassment associated with sexual diseases
by Dr Suneela Garg
| Sexually Transmitted Infections (STI) and Reproductive Tract Infections (RTI) pose a huge burden on the health care facilities with globally 499 million new episodes of curable sexually transmitted infections (syphilis, gonorrhoea, chlamydia and trichomoniasis)reported yearly (2008 estimates). A community based STI/RTI prevalence study conducted during 2002-03 by the Indian Council of Medical Research (ICMR) has shown that 6% of the adult population in India has one or more STI/RTI. This amounts to occurrence of about 30-35 million episodes of STI/RTI every year in the country. Sexually transmitted infections are an important cause of infertility in men and women. According to the WHO, globally, among pregnant women with untreated early syphilis, 21% of pregnancies result in stillbirth and 9% in neonatal death. |
It is also established that the risk of acquiring HIV infection increases manifold in people with current or prior STI. This is corroborated by high HIV prevalence rates among clients of sex workers: 22.8 percent in Andhra Pradesh, 15.2 percent in Maharashtra, 12.2 percent in Manipur and 7.4 percent in Delhi. If left untreated, they lead to complications such as infertility, ectopic pregnancy and cervical cancer.
STI/ RTI pose challenges to health care settings in terms of having to deal with increased burden of patients and training needs of health care providers. Because of the stigma related to RTI/STI, there is a culture of silence. This is also attributable to cultural sensitivity, conditioned behaviour, ignorance, fear and embarrassment. Many of these can be prevented and treated, if present. However, many men & women suffer pain, stress and even death from inability to seek assistance.
These are also compounded by various factors like lack of access to health services, early marriage and childbearing, lack of adequate education, poor financial status, lack of adequate nutrition, and gender-based violence
Role of NACO and Other organisations in
STI/ RTI Prevention:
National AIDS Control Organisation (NACO) is duly addressing the issues of STI/RTI morbidity and National AIDS Control Program (NACP) envisages coverage of about 15 million STI/RTI episodes annually during the programme. NACO through its network of designated STI/RTI clinics (situated at government health care facilities at district level and above) is providing free standardized STI/RTI services. These clinics have been branded as “Suraksha Clinics” and provide sexual & reproductive health services. Standardized training to the medical and paramedical personnel based on syndromic case management approach is being provided and counselling services from trained counsellors are made available at these clinics. Colour coded syndromic drug kits and RPR test kits are being centrally procured and supplied to these clinics. Laboratory support for STI/RTI has been strengthened through a network of seven regional STI centres.The number of clinic visits by HRGs in the year 2014 is given in the figure below.
STI/RTI services are also being expanded though effective integration with the RCH programme. NACO and RCH division have jointly drafted technical guidelines on management of STI/RTI so as to ensure uniformity of service delivery across all facilities. New guidelines have also been released in 2014 for the management of RTI and STI. Private sector has been meaningfully involved through identification of preferred private providers to give services to the high risk group population served through TI projects.
(The author is Director Professor, Department of Community Medicine, Maulana Azad Medical College, New Delhi)
According to the WHO, globally, among pregnant women with untreated early syphilis, 21% of pregnancies result in stillbirth and 9% in neonatal death.