Control of sexually transmitted infections and prevention of HIV transmission: mending a fractured paradigm

Abstract

Control of sexually transmitted infections (STIs) is feasible, leads to improved sexual and reproductive health and contributes to preventing HIV transmission. The most advanced HIV epidemics have developed under conditions of poor STI control, particularly where ulcerative STIs were prevalent. Several countries that have successfully controlled STIs have documented stabilization or reversal of their HIV epidemics.STI control is a public health outcome measured by reduced incidence and prevalence. The means to achieve this include: (i) targeting and outreach to populations at greatest risk; (ii) promoting and providing condoms and other means of prevention; (iii) effective clinical interventions; (iv) an enabling environment; and (v) reliable data.Clinical services include STI case management, screening and management of STIs in sex partners. Syndromic case management is effective for most symptomatic curable STIs and screening strategies exist to detect some asymptomatic infections. Presumptive epidemiologic treatment of sex partners and sex workers complement efforts to interrupt transmission and reduce prevalence. Clinical services alone are insufficient for control since many people with STIs do not attend clinics. Outreach and peer education have been effectively used to reach such populations.STI control requires effective interventions with core populations whose rates of partner change are high enough to sustain transmission. Effective, appropriate targeting is thus necessary and often sufficient to reduce prevalence in the general population. Such efforts are most effective when combined with structural interventions to ensure an enabling environment for prevention. Reliable surveillance and related data are critical for designing and evaluating interventions and for assessing control efforts.Une traduction en français de ce résumé figure à la fin de l'article. Al final del artículo se facilita una traducción al español. ‫املقالة.‬ ‫لهذه‬ ‫الكامل‬ ‫النص‬ ‫نهاية‬ ‫يف‬ ‫الخالصة‬ ‫لهذه‬ ‫العربية‬ ‫الرتجمة‬ a

A (p)ppGpp-Null Mutant of Haemophilus ducreyi Is Partially Attenuated in Humans Due to Multiple Conflicting Phenotypes

“…Pilot experiments showed that there was no reduction in bacterial viability for up to 4 h in this media. For the labeling experiments, the bacteria were suspended in phosphate-limited RPMI media supplemented with 5% fetal bovine serum (FBS) and KH 2 32 PO 4 (PerkinElmer) (specific activity, 900 to 1,100 mCi/mmol) at 100 Ci/ml. The bacteria were incubated for 3 h, washed, and incubated for an additional 15 min in phosphate-limited RPMI medium.…”

“…Due to a short duration of infectivity, H. ducreyi can be maintained only in populations with high sex partner change rates, such as commercial sex workers. As a result of syndromic management of genital ulcers, chancroid prevalence has declined in many areas of endemicity and the overall global prevalence of chancroid is now undefined (2). However, reports of chancroid persist from Africa and Asia, implying that these regions have reservoirs of infected sex workers (3)(4)(5)(6)(7)(8).…”

DksA and (p)ppGpp Have Unique and Overlapping Contributions to Haemophilus ducreyi Pathogenesis in Humans

“…Chancroid has a short duration of infectivity and is maintained only in populations with high sex partner change rates, such as commercial sex workers (2). Due to widespread implementation of syndromic management of genital ulcers, the epidemiology of chancroid is poorly defined, but its prevalence has declined in many areas where chancroid formerly was endemic (2). However, reports of chancroid persist from several countries in Africa and Asia, implying that these regions have clinical reservoirs of infected sex workers (3)(4)(5)(6)(7)(8).…”

Housing First and Unprotected Sex: A Structural Intervention

“…In recent years, however, increasing attention has been given to the importance of structural factors that impact sexual risk behaviours (Aidala et al, 2005;Auerbach, 2009;Evans, Jana, & Lambert, 2010;Lippman et al, 2012;Seeley et al, 2012;Steen, Wi, Kamali, & Ndowa, 2009 (Sumartojo, 2000, p. S3) that are mostly outside of the individual's immediate control (Aidala & Sumartojo, 2007;Blankenship, Friedman, Dworkin, & Mantell, 2006). …”

“…In the meantime, it is important to test structural interventions, such as housing, on their effects in reducing sexual risk behaviours, like unprotected sex, by altering the environment from a constraining (Blankenship et al, 2006) to an enabling one (Steen et al, 2009). Based on the accumulated evidence thus far among various homeless populations, several researchers have argued for the potential effect of stable housing and permanent supportive or supported housing on reducing sexual and other risk behaviours associated with HIV, many of which share common risk factors with other STIs (Aidala et al, 2005;Aidala & Sumartojo, 2007;Dickson-Gomez, McAuliffe, Convey, Weeks, & Owczarzak, 2011;Elifson, Sterk, & Theall, 2007;Forney, Lombardo, & Toro, 2007;Kennedy, Wenzel, Brown, Tucker, & Golinelli, 2013;Stein, Nyamathi, & Zane, 2009).…”