Preventing STI morbidity, a national approach.

There are many varied strategies in place to combat the burden of STIs both globally and locally. As a general point of call the World Health Organisation (WHO) creates and implements global sexual health policy. We have briefly discussed some of their work here. In Australia sexual health (and general healthcare) is controlled by individual state and territory governments. Recently in an attempt to address the growing burden of STIs in Australia there has been a push towards a national approach.

In 2010 the Australian Government Department of Health and Aging published the Second National Sexually Transmissible Infections Stratergy (2010-2013).

"The goal of the Second National Sexually Transmissible Infections Strategy 2010–2013 [was]to reduce the transmission of and morbidity and mortality caused by STIs and to minimise the personal and social impact of the infections."

Aboriginal and non-Aboriginal gonorrhea in WA

More specific aims included: increasing young peoples knowledge of STIs, reducing in the incidence of gonorrhoea, syphilis and chlamydia, whilst increasing the testing for chlamydial infection in high risk populations. The high risk groups identified in this study were: young people (due to the low median age, 16, of first sexual encounters), Aboriginal Australians (as STIs are more prevalent in this population, see graph), sex workers (due to occupational exposure) and men who have sex with men (as they have higher risk of STI transmission)

Priority actions for health promotion and prevention

Prevention is one of the best ways we can stop the spread and thereby the burden of STIs. The importance of prevention is re-enforced by the rising rates of bacterial resistance in common sexually transmitted infectious agents like Neisseria gonorrhea. The widespread extreme drug resistance exhibited by this pathogen is likely to make it untreatable in the foreseeable future. As prevention may soon be the only option we have to prevent STI spread the actions of this strategy are of paramount importance.  I will go through each point with commentary.

Develop a national education framework to implement age appropriate sexual education

Currently sexual education is controlled at the state level. It is incredibly important to deliver a set standard of education across Australia. The three authors of this blog represent three different Australian states/territories: Queensland (rural), WA (metropolitan) and the Australian Capital Territory (metropolitan). Our experiences of sexual education in high school are widely different. A national curricula would take away these discrepancies and ensure that there are high levels of sexual health literacy across the nation. 

Develop and implement targeted prevention and health promotion programs for high risk groups (teenagers, Aboriginal Australian, men who have sex with men)

It is definitely important to target these high risk groups however if the focus is too heavily weighted to these groups people in low risk populations fall through the gaps. Anecdotal experience of the WA education system in rural and metropolitan areas shows this in full effect. In an Albany public school (rural WA) sexual health is taught yearly for years 7-12 in Albany with opportunities to practice putting on a condom correctly. Now compare this with the experience of one of our authors experience in a Perth public school (metropolitan WA) where one sexual education lesson was given in high school. It was provided to year 7 students who watch a video of how to put a condom on properly. 

Whilst I acknowledge the limited application of anecdotes this disparity is provides an interesting point for discussion. It seems plausible that this disparity would leave some adolescents unequipped to make informed decisions about safe sex. Looking at this in context of the massive amount of condom user errors present in sexually active people, it seems that a lot of adults are not equipped with adequate knowledge about safe sexual practice. By looking at high risk groups only we risk leaving low risk people behind. 

Increase amount of health promotion professionals in this area

The more health promotion in this area the better. Due to the pervasive nature of STIs in society it's clear that people need constant reminding about how to practice safe sex. Hopefully by using new and old media we this issue can be kept under the spotlight to promote this discussion. 

Improve access to condoms for high priority groups by improving current interventions and trailing new ones

Access to contraception is incredibly important to stop the spread of STIs but access alone is not enough. As the age old adage goes: give a man a condom and he'll be protected for a day, teach him about sexual health and he'll be protected for life. (sorry) Access to condoms is not enough without both educating about the need for contraception and breaking down the negative stigma around contraception use that is present in some socio-cultural groups. 

Increase access and use of HPV and Hepatitis B vaccine

Vaccination can remove the potential for infection with the HPV and heptatitis B. Whilst this is fantastic it must be remembered that these vaccines don't confer resistance to any other STIs. Now that may be self evident to some people but for many people it is not. This vaccination program would have to go hand in hand with an education program stressing the need for use of barrier protection methods to .

prevent STI transmission. 

Summary

The Second National Sexually Transmissible Infections Stratergy (2010-2013) provides a framework to build a national approach to STI prevention. A national approach is a good first step to reducing the significant burden of STIs on the healthcare system and individuals across Australia.