The recent explosion of sexually transmitted infections (STIs) around the world has been called a "silent epidemic."

Though the number of new cases continues to rise each year, many people are unaware of the prevalence of STIs (including HIV/AIDS) or even that they themselves are infected. In fact, many people who are infected with an STI--including up to half of infected women--exhibit no symptoms or do not recognize that their symptoms suggest a problem requiring medical attention. As a result, the STI often goes untreated until it has progressed to an advanced stage.

In addition, many people are uncomfortable talking about STIs. Admitting to having an STI often raises questions about whether the person has been sexually unfaithful to his or her partner or has engaged in unsafe sexual practices. In many parts of the world, having an STI may result in social stigmatization.

To address the health risks posed by STIs, the 1994 International Conference on Population and Development in Cairo called for the strengthening and expansion of STI services in most parts of the world, as well as the linking of these services to family planning and other health care services to assist individuals in meeting their reproductive health care needs. AVSC is working to help service providers in family planning and other health care settings become more comfortable talking about STIs with their clients and more skilled in diagnosing and treating them.

Training and Research

AVSC has been organizing training activities, developing training materials, and conducting research around the world to help improve the quality and availability of STI services.

Over 100 primary health care workers in Bangladesh participated in a training course to improve their ability to treat STIs. As part of this project, AVSC helped develop technical standards and service-delivery protocols for STI management across the country.

AVSC is working with the Seattle STD/HIV Prevention and Training Center in the U.S. to produce training materials to improve STI service providers' counseling and clinical skills. The materials, which are being created from existing materials developed by the Seattle center as well as new materials generated by AVSC, have been field tested in Russia and will have broad application to other AVSC programs.

Two sets of materials designed to improve services for men are in development. One, a guide to train providers in South Africa in how to educate young men about reproductive health, focuses on gender issues, sexuality, and STIs. The other, a men's reproductive health curriculum intended for use worldwide, has a module on STIs.

Gathering Information to Effect Change

AVSC's STI-related research is designed to help improve the quality and safety of both family planning and STI services worldwide. A project that is taking place in Ghana, Kenya, Mexico, Russia, and Vietnam seeks to identify factors that affect health care workers' ability to screen for, diagnose, and treat STIs when offering IUD services.

In South Africa, research is being conducted to identify effective, low-technology screening methods for cervical cancer, which is largely a result of the sexually transmitted human papilloma virus. AVSC's community-based research in Colombia, Bolivia, Ghana, Kenya, Tanzania, and the U.S. is designed in part to gather men's ideas and concerns about STIs.

An Example from Russia

In Russia, the incidence of STIs--particularly syphilis and HIV--has grown exponentially, presumably due to dramatic changes that have occurred in the standards of living, work conditions, and attitudes toward sexual relationships. Whereas in 1993 there were 33.9 newly identified cases of syphilis per 100,000 population, in 1996 that number jumped to 264.4. This is extremely high compared with the rate in Western Europe, which is below two cases per 100,000 population.

To help reverse this trend, AVSC, as part of a larger research project funded by the United Kingdom's Department for International Development, has done an extensive assessment of STI services in clinics in Russia. As a result of the findings, the Russian Ministry of Health asked AVSC to train STI doctors around the country in improving their counseling skills and updating their clinical knowledge.

In February, AVSC conducted the first training workshop, which was held over five days in Moscow. The 20 participants enhanced their abilities to identify clients' reproductive health care needs, explain basic information and address common misconceptions about STIs, discuss safer sex practices with clients, and help clients develop plans to protect themselves from sexually transmitted infections. The participants will serve as co-facilitators of the four additional training workshops that AVSC is planning to conduct in Russia over the next year.

AVSC's expanding work to help service providers and clients address prevention, diagnosis, and treatment of STIs is part of a growing effort to alleviate the symptoms and spread of these "silent" infections worldwide.

Anne Lang Frahn is a public affairs associate at AVSC.