Preventing STIs/RTIs

Physicians and other health care providers have a critical role in preventing STIs and other RTIs. (This topic is addressed more fully in Module 6: Preventing STIs/RTIs.) STI education and prevention should be considered a standard of care for all reproductive health services and can be incorporated into various activities within a clinical setting, as well as within community-based activities.

There is general consensus that successful prevention of HIV and other STIs needs to go beyond information and awareness to directly address behavior change. A variety of related and overlapping behavior change theories and paradigms have been used to inform the development of prevention programs and interventions. In general, these theories and paradigms recognize the complexity of human behavior and the myriad of psychological, sociocultural, and structural factors that play a role. Recently, increased attention has been given to the idea of looking beyond individual behaviors to the contextual factors (conditions) that make people vulnerable to STI infection and that influence behavior. These include, for example, social norms, gender inequalities, and poverty.

Health care providers and policymakers can help reduce the prevalence of STIs by:

• Monitoring trends in existing/emerging STIs in the community
• Developing policy plans that address potential increased incidence in the future
• Promoting behaviors that prevent STIs
• Ensuring accessible, high-quality STI services

Integration into Family Planning Counseling

Integration of STI and HIV prevention into family planning counseling is not only a good way to reach women, but is also a key aspect of informed choice. A woman cannot make a fully informed choice about a family planning method if she does not understand her risks for STI transmission and the degree to which her chosen method does or does not protect her. However, simply providing information about transmission and risks during a family planning counseling session may be insufficient to effect behavior change in a client or that client’s partner(s). Through integrated counseling, clients (and their partners) can be assisted to:

• Perceive their risk: Determine and perceive their individual risk for acquiring an STI (including HIV), as well as of becoming pregnant. This requires not only providing information about transmission and risks, but also exploring the client’s and partners’ particular practices and sexual history. Providers should keep in mind the many factors that may influence a woman’s perception of her risk, including the fact that she may see herself as safe if she is monogamous, without recognizing the risks posed by the practices of her partner(s).
• Make decisions/plans: Make an informed decision about contraceptive use and disease prevention options. This should include the option of condoms alone (protection against both pregnancy and STIs) or dual-method use (using condoms for disease prevention plus another contraceptive method or emergency contraception to protect against pregnancy). It also involves helping the client consider the potential ramifications of these decisions, including the possible impact on a relationship or the potential violence or loss of economic support that could result from proposing condom use to a partner.
• Develop skills: Develop skills for correct condom use, other safer sexual practices, and sexual negotiation strategies.

  
  Prevention often requires drastic changes in behavior that may not be realistic for clients. It may be more pragmatic to encourage clients to take whatever incremental steps they can to alter their or their partners’ behavior.

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