STD RESEARCH IN AFRICA

The control of sexually transmitted diseases (STDs) is vital to combat AIDS in developing countries. The 1993 World Development Report showed the cost effectiveness of STD control per healthy life-year saved. A meeting of the Network of AIDS Researchers in East and Southern Africa was held on this issue in Mwanza, Tanzania, attended by 20 experts from 5 countries in the region. The World Health Organization recommends that STDs should be managed without laboratory tests, at the primary health care level in developing countries, using drugs of proven local efficacy. In Africa, this policy has been implemented only in Zimbabwe, but without a striking fall in STDs, since in 1991 STDs were responsible for over 20% of visits by adults at primary health care clinics in Harare. A contact-tracing study in Harare indicated that only 20 contacts were found after 3 months' work by 6 staff members. Asymptomatic STDs in women have hampered STD control, but a community study from Mwanza has also shown that 6% of men were infected with gonorrhea or chlamydia and 90% had no symptoms. A WHO risk-assessment protocol is being evaluated in Mwanza among women with vaginal discharge. A controlled trial of mass treatment for gonorrhoea, chlamydia infection, chancroid, and syphilis is to start in Uganda early in 1994 in a community where the incidence of HIV has remained static at 2% per annum in the general adult population (over 6% in young women) despite intensive education campaigns. Even when symptoms are present, most patients seek unofficial treatment in Africa. Increasing antimicrobial resistance among sexually transmitted pathogens in Africa makes STD treatment more expensive. The introduction of user charges in Nairobi led to a sudden fall in attendances at the main STD clinic and in other countries in the region. The treatment of the STDs prevents future infections, thus STD treatment should be free with the help of international donors.