HEALTH: Sexually Transmitted Infections (STIs), an HIV time-bomb

The rise in sexually transmitted infections (STIs) in Harare points to the indulgence in unprotected sex despite the prevention gospel that is being preached by the Ministry of Health and Child Care and its partners.

Harare alone is reported to have recorded a total of 53 000 STI cases between January and June 2014.

The Harare City Health annual report for 2012-13 indicates that STI cases rose by 22 percent from 37 123 in 2012 to 45 374 in 2013.

Harare and Masvingo have the highest STI cases in the country.

According to the National Aids Council national report, Harare recorded 9 700 cases while Masvingo recorded 7 491 cases in the first quarter of 2014.

Health experts have warned that the development suggests that people are compromising the fight against STIs by shunning condom use.

The figures are projected to be higher than those published since some people seek treatment from private hospitals and doctors, or use traditional concoctions.

Mr Amon Mpofu, the Monitoring and Evaluation director for the National Aids Council, said the rise in STIs is a health time-bomb.

“It is not a good indicator to see STI cases increasing.

“It shows that we are sitting on a time-bomb of which we will expect to see an increase in new cases of HIV,” he said.

Zimbabwe is one of the few African countries that have scored successes in the fight against the HIV and Aids pandemic on the back of the innovative Aids Levy.

This success, however, can easily be reversed if the surge in STI cases continues.

Dr Owen Mugurungi, the director of HIV/Aids and TB unit in the Ministry of Health and Child Care, said the rise in STIs is a cause for concern.

“We are concerned about the rise in STIs as a ministry.

“ We are wondering if people are taking the necessary precautions to protect themselves against sexually transmitted diseases or there is a relapse in behaviour change,” he said.

“Despite the gains we have made so far in fighting HIV, the rise in STIs might mean that we are going back to an era when HIV was rife.”

In May, the Government celebrated the seemingly overwhelming statistics on condom distribution after a total of US$7 million was spent on condoms.

In 2013, it is reported that 100 million and 5,2 million condoms were used by men and women respectively.

Condoms are distributed through public and private channels using the social marketing approach.

However, Mr Mpofu pointed out that sexual partners shun condom use due to the low-risk perception associated with long-term stable relationships.

“If partners are in a long-term sexual relationship, the risk perception reduces with time.

“Some partners use condoms but don’t use them correctly and consistently,” he explained.

Despite the fact that Zimbabwe is regarded as an internationally acclaimed best practice in condom distribution, gaps in consistent condom usage persist, particularly within concurrent sexual relationships.

Additionally, the level of condom usage among PLHIV is low despite high levels of sexual activity.

Zimbabwe has a generalised heterosexually-driven HIV epidemic with adult prevalence of 15 percent.

Despite the devastating economic meltdown that characterised the past decade, Zimbabwe’s HIV response has remained steadfast in giving hope to the nation.

A disturbing viewpoint is the natural link between STIs and HIV infection.

Dr Mugurungi said STIs increase predisposes to HIV infection.

“People infected with STIs are at least two to five times more likely than uninfected individuals to acquire HIV if they are exposed to the virus through sexual contact.

“In addition, if an HIV-infected individual is also infected with another STI, such a person is more likely to transmit HIV through sexual contact than other HIV-infected persons,” he explained.

The presence of STIs increases the likelihood of transmitting and acquiring HIV through increased susceptibility where lacerations and inflammation of the genital lining create entry points for HIV.”

For instance, clinical evidence suggests that men who are infected with both gonorrhoea and HIV are more than twice likely to have HIV in their genital secretions than those who are infected with HIV only.

In the first quarter of this year, the country experienced a decrease in the number of new STI cases recorded from 65 501 in the fourth quarter of 2013 to 42 405.

Of the 16 638 STI patients who were tested for HIV, 2 407 tested HIV positive.

The highest percentage for the HIV-positive STI patients was recorded in the 25-49 age group.

Studies have proved that testing and treatment of STIs is an effective tool in preventing the spread of HIV, the virus that causes AIDS.

An understanding of the relationship between STIs and HIV infection also helps in the development of effective HIV prevention programmes.

In the case that rigorous measures are not taken to reduce the number of STI cases and new HIV infections, Zimbabwe could be seen reversing the successes gained in the fight against HIV in the same manner that Uganda did.

Tables are turning on the Uganda HIV/Aids success story.

The gains made in the last two decades are fast being eroded by the increasing number of new infections. The country is losing the fight against HIV with the infection rates steadily rising.

The main forms of transmission of the virus remain unprotected sex and mother to child transmission.

The UNAIDS Global Report released in July indicates that Zimbabwe is one of the 15 countries that account for 75 percent of new HIV infections globally.

Of the 75 percent, Zimbabwe only accounted for 3 percent of all new global HIV infections in 2013.

It cannot be disputed, however, that even if the report shows that Zimbabwe has a major AIDS burden, it is among the countries that have made the strongest response in Sub-Saharan region.

Despite the somewhat high prevalence rate, Zimbabwe has experienced a 34 percent decline in new HIV infections in the last decade.

In 2003, the HIV prevalence for adults (15-49 years) in Zimbabwe stood at 24,6 percent with an estimated 166 000 new HIV infections.

Government, however, says it remains committed to the national response and has put in place appropriate policies, strategies, structures and instruments to ensure the country achieves the three zero’s (zero new infections, AIDS related deaths, stigma and discrimination).

From the foregoing, it is evident that strong STI prevention, testing and treatment is vital for the comprehensive prevention of the sexual transmission of HIV.

STI trends also offer vital insights into HIV hotshots, making STI surveillance data integral in forecasting where HIV rates are likely to increase.

Better linkages are thus needed between HIV and STI prevention efforts nationwide in order to prevent and control both epidemics.

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