Accessible health care is critical to the effective control of sexually transmitted infections
Christopher K. Fairley
A B * , Eric P. F. Chow A B C , Ian Simms D , Jane S. Hocking C and Jason J. Ong A B E
+ Author Affiliations
- Author Affiliations
A Melbourne Sexual Health Centre, Alfred Health, Melbourne, Vic., Australia.
B Central Clinical School, Monash University, Melbourne, Vic., Australia.
C Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Vic., Australia.
D Blood Safety, Hepatitis, Sexually Transmitted Infections (STI) and HIV Division, UK Health Security Agency, London, UK.
E Faculty of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK.
Sexual Health - https://doi.org/10.1071/SH22042
Submitted: 2 March 2022 Accepted: 2 May 2022 Published online: 28 June 2022
© 2022 The Author(s) (or their employer(s)). Published by CSIRO Publishing. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)
Abstract
Bacterial sexually transmitted infections (STIs) are rising relentlessly in virtually every country and among most risk groups. These infections have substantial individual and community consequences and costs. This review summarises the evidence for the effectiveness of different strategies to control STIs and assumes countries have sufficient financial resources to provide accessible health care. Reducing the probability of transmission essentially involves increasing condom use, which is problematic given that condom use is currently falling in most risk groups. Interventions to increase condom use are expensive and hard to sustain. Only a limited number of studies have shown it is possible to reduce the rate of partner change and sustained changes are difficult. In contrast, the provision of accessible health care has a powerful effect on the incidence rate of STIs, with dramatic falls in STIs in virtually all countries following the discovery of antibiotics. More recent studies support the powerful role of accessible health care as a strategy for putting substantial downward pressure on STI rates. Accessible health care has a powerful effect on the incidence of STIs. The professionals who are responsible for funding these services need to appreciate that they are ultimately responsible for the rates of STIs in their communities. In contrast, personal behaviour plays a less powerful role in determining the incidence of STIs and is hard to change and sustain at a population level. The public needs to appreciate that it is the governments they elect and not individuals who are responsible for the rates of STIs in their communities.
Keywords: condom use, control, health care, HIV, partner number, sexually transmitted infections.
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