STIs and HIV/AIDS

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Objectives
 Definition of STIs
 Explain Epidemiology of
STIs/HIV
 Discuses Complications, Health
and Economic Impacts of STIs
 Discuses Challenges of Controlling
STI

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 STI/Ds are infectious diseases
transmitted by sexual activity
and, sometimes, by blood
transfusion and from mother
to child

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Epidemiology
of STI

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 Epidemiology...
 More than 20 diseases including HIV are spread by
sexual contact
 Every day more than a million people are infected
with a curable STIs – an estimated 357 million
cases worldwide each year. (WHO 2019 Report)
 The risk of transmission from infected young men
to young women is greater than the vice versa

 Many people with STIs, may not have any

symptoms and do not know that they need
treatment

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 Epidemiology...
Infertility in men due to STIs is estimated
to be high in developing world.
Pelvic Inflammatory Diseases (PID) is

found up to 8-10% of females.

Ectopic pregnancy has an annual
incidence rate of 0.01-0.04% in those who
had PID.

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Epidemiology...
 - 24.3 million people living with HIV/AIDS in sub
Saharan Africa in 2017 out of a global total of 36.9
million.
 - globally a total of 1.8 million new HIV infections
occurred in 2017 , 66 % in sub Saharan Africa.
 - 695,600 million deaths in sub Saharan Africa from
HIV in 2017 out of a global total of 940,000 million.
(UNAIDS Global report, 2017)
 HIV/AIDS
 HIV/AIDS represents the major killer of young
people worldwide.
 In Africa it is the number one killer of young adults
between the age of 15 and 29 years.
 Since starting more than 77.3 million people have
been infected with HIV, half of whom became
infected between the ages of 15 and 24 years.
 More than 12 million young people are living with
HIV/AIDS today (UNSID report 2015)
 In 2016, 2.1 million people aged between 10 and 19
years were living with HIV
 260,000 became newly infected with the virus.
 The number of adolescents living with HIV has risen
by 30% between 2005 and 2016. (USAIDS 2016)
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What are the distinctive features of
STIs?

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Distinctive features of STIs
 STIs typically have long latent or incubation
period before symptoms become apparent
 transmission occurs during this time.

 Genetic variation of STI causing organisms

 difficult to develop vaccine against them.

 Associated with cultur

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 Distinctive features of STIs
 Many people seek treatment out side the formal
health system.
 Incomplete treatment may mask symptoms with
out cure
 thus facilitating disease spread.
 Proper treatment for STIs are expensive
 Sex is embarrassing to discuss

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 Epidemiology of STIs in
Ethiopia
 There is little information of STIs in Ethiopia
 Overall, 4% of women and men age 15-49
reported having an STI and/or symptoms of
an STI in the past
 Among men, the percentage was 6% in
Oromiya, and 5% in Harari compared to
less than 1% in the Tigray and Benishangul-
Gumuz. (EDHS 2016)

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Epidemiology of STIs in
Ethiopia
 Fewer than one in three women and men
(32% for each) who had an STI or STI
symptoms sought advice
 However, 67% of women and 66% men
did not seek any advice or treatment(EDHS
2016).
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 Distribution of STIs
 Prevalence higher in urban than rural
 Higher in unmarried & young adults
 More frequent among females than males
between the ages of 14-19
 After the age of 19, there is slight male
predominance

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 STI statistics are underestimated

What are the Reasons for underestimation???

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STI statistics are underestimated
 people with asymptomatic STIs do not seek treatment
 Poor access: health facilities offering treatment for STIs
may be too far away for many people
 Missed opportunity: people seeking other health care
such as antenatal services may not be routinely screened
for STIs
 Stigma: many patients perceive a stigma in attending
modern STIs services
 Non-reporting facilities: large number of people visit
private and traditional care providers that are not
reporting,
 Cost of services etc…

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The accuracy of STI statistics
cont….

Symptomatic

Asymptomatic

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STI transmission dynamics at population level

General population

Bridging population

Core
transmitters

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 Factors Affecting Transmission

 Behavioral Factors  Socio-economic

-Many partner -Poverty
-Change of partners -Religious Restrictions
-Not using condoms - Women’s position
- Casual sex  Cultural
- Sex with CSW & partner
-HTP
- Alcohol & substance use  Biological & clinical
 Personal factors - Assymptomatic STIs
- Delay in getting Rx - Age
- Stigma being ashamed - Sex
- non-cooperativ to Rx - Vulnerability, immunity
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 Factors influencing transmission of
STI: Socio-cultural factors

 Cultural and social pressure on Women

 Little decision making power over sexual practices and choices,

including use of condoms

 Sexual violence directed

 Early marriage of girl-child to an adult

 Permissive attitude for men to have more sexual partner.

 Harmful traditional practices
 Skin-piercing

 Unsterile needles to give injections or tattoos

 Scarification or body piercing

 Circumcision using shared knives

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The Complications and
Health and Economic
Impacts of STIs

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 Medical Complications of STIs

CAUSE COMPLICATIONS
Gonococcal & Infertility, Eectopic pregnancy,
Chlamydial infections chronic pelvic pain, urethral
stricture, peritonitis
Gonorrhea Blindness in infants,
Disseminated gonococcal infection

Chlamydia pneumonitus in infants

Acquired syphilis Permanent brain, Heart disease
Congenital syphilis Extensive organ & tissue damage
Human papilloma virus Genital cancer, obstructed labor
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 Other Impacts of STI
 Social:
 Stigmatization
 Divorce & family disruption as a result of infertility

 Economic:
 Cost of STI drugs may place heavy financial burden
on families , communities, & the country at large
 Unproductivity

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Strategies for STI
Prevention and Control

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 The Main Aims of STI Prevention
and Control are:-

 Interrupting the transmission of STI

 Prevent development of disease and

complications

 Reducing the risk of acquiring and transmitting

HIV

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Challenges of
Controlling STI

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 Challenges are due to:

 Factors relating to health system

 Biological factors
 Social & behavioral factors

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 Health System Factors
 Health service may be unavailable, too far
away , expensive, or considered stigmatizing
 There may be little emphasis on preventive
education & other efforts to prevent infection
 Health services may not have effective drugs
 Difficulty of partner management

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 Stage 1 Health Care Seeking Behaviour – People with STIs
Total adult
population
Target for Control
Stage 1 Preventing new infection
Stage 2 Detection & Rx of asymptomatics
STI so far
prevented
Stage 3 Improving health seeking behavior
Stage 4 Improving Rx

Stage 2
Population
with any
STI Inadequate
Rx
symptoms symptoms

Stage 3
Without

Symptoms
With STI

recognized
Adequate
Stage 4 Rx
Not
Seeking Presenting
With

Rx for Rx
Seeking
Rx 29
 Biological factors

 70%-80% of infected women may be

asymptomatic and so will not seek
treatment
 Such people will continue to be infected,
risking complications and perhaps infecting
others

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Social & behavioral factors
 Reluctance to seek health care
 Ignorance or misinformation
 A preference for alternative health care
service- usually with poor quality
 Reluctance to follow safe sex practices
 The social stigma often attached to STIs
 Failure to take full prescribed course of
treatment
 Difficulty of notifying sexual partners
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 Barriers to changing behavior

1. Gender barriers
a) Women have little control over when,
with whom, and under what
circumstances they have sex.

a) For men, young men in particular can

be under peer and social pressure to
conform to local male norms.
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 Barriers to changing behavior

2. Cultural practices
 age differences at marriage

 wife inheritance

 child-rearing

 values of family and community

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 Barriers to changing behavior

3. Religion

 May contribute if discourages open

discussion about sexuality and use of
protective measures ex. condom

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 Barriers to changing behavior

4. Poverty, social disruption and civil

unrest
 Force women and girls in particular into

exchanging sex for material favors or even for

survival
 Lack of access to education and employment

may force women to exchange sex with a

number of partners

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STIs

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