Every country needs a national sexual health strategy
Every country needs a national sexual health strategy |
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Key words: Sexual health, strategy, sexually transmitted infections, HIV
Introduction
Sexual health is important to every nation for several reasons one of which
is that sexual activities are essential for the propagation of the population.
The basic unit of a community is the family consisting of “a man and a
woman” and, the couple may be blessed with a child or with children. Sexual
ill-health in the man or woman has short term, medium term and long term consequences
for the individuals, the community and the nation as a whole. There are ramifications
for the children as well eg. AIDS orphans.
This term sexual health encompasses issues like fertility control; care of pregnancies
- planned or unplanned; psychological aspects of sexual activities; infections
- diagnosis, treatment and control; sexuality and gender issues; sexual behaviour;
cervical cytology; prostitution and commercial sex work etc.
For the social and economic development of any nation, sexual health must be
addressed. In the 21st century sexual health is not be considered as an “after
thought” or something to be addressed at “the back of the hospital”
somewhere in the shed! This part of the lecture will concentrate on infections,
“sexually transmitted infections”. Countries and nations that are
challenged in terms of resources often suffer most.
We need all hands on deck if we are to go beyond scratching the surface. There
is room for epidemiologists; scientists; public health staff; elders; religious
organisations; research workers; clinicians; administrators and politicians
and volunteers. The importance of effective leadership cannot be over-emphasised.
“Where there is no vision, the people perish”.
The social and economic wellbeing of a nation
This can be sub divided into:
a) Human resources
It is important that every country makes full use of her human resources. As
long as the people are healthy they will contribute to the development of a
country through their various skills whether manual or non-manual. This is because
health is wealth. The working population bears the burden for the non working
population - children and old people. If ill health results in many lost working
days then the economic and social development if that country will be comprised.
b) Natural resources
Natural resources are necessary for the economic development of a country. However
in order to tap into these natural resources a country needs skilled and unskilled
labour as mentioned above under human resources. These natural resources include
solid minerals like diamond and gold and liquid minerals like oil and petroleum.
This list is not exhaustive. Apart from minerals, countries that have rivers
and oceans can harvest from these areas.
c) Trade and industry
In a stable country trade and industry make for economic growth. However for
sustained growth the people of that nation need to be in good health. The trading
may be within the country or with other countries near or far. All countries
that enjoy stability have policies so that there is order and not chaos
Relations with neighbouring countries
It is very unfortunate that in many parts of Africa there have been civil wars
and wars between neighbouring countries resulting in many displaced people and
refugees. This situation has not made for progress and has resulted in lost
revenue, several morbidities and several mortalities. Since that is the case
in order to have progress it is necessary to have a national sexual health policy.
What are sexually transmitted infections?
As the name implies these are infective organisms that are passed from one person
to another during the act of sexual intercourse. They could be bacteria, viruses,
parasites or protozoa. Once the organism gets inside a person there is a period
of incubation that ranges between a few days and a few weeks.
Following the incubation period the person then has symptoms and signs of
the disease. These organisms include:
a) Bacteria e.g. gonorrhoea; chlamydia; syphilis
b) Viruses e.g. human papilloma virus (warts); hepatitis B; HIV
c) Parasites e.g. pubic lice
d) Protozoa e.g. Trichomonas vaginalis
How do they present and what are the clinical features?
Usually there is a list of possible symptoms and signs following acquisition
of a sexually transmitted infection. The presentation is often more obvious
in men than it is in women. One of the reasons for this is because the inflammation
of the urethra (urethritis) results in painful micturition and this draws the
attention of the man to his disease. However in women inflammation of the cervix
(cervicitis) and urethra (urethritis) occur but the women may associate these
symptoms with their periods, cystitis or "thrush". The common symptoms
and signs include: discharge, dysuria, pruritus (itching) blisters/ulcers, lower
abdominal pain, genital pain, genital swelling, dyspareunia (painful coitus).
What are the consequences of sexually transmitted infections?
On many occasions people view acquisition of sexually transmitted infections
as a nuisance and do not associate these diseases with serious consequences.
We now know that this is not true because of the devastation caused by HIV and
AIDS. The epidemiology of the various sexually transmitted infections in various
parts of the world reveal that the prevalences are very high in developing countries.
Since this is the case it only emphasises the importance of a national sexual
health strategy. The consequences of sexually transmitted infections can be
viewed as the morbidities and mortalities resulting from these diseases. Chronic
bacterial sexually transmitted infections in a woman can result in chronic pelvic
inflammatory disease with low back pain, tiredness and absenteeism from work.
Bilateral tubal blockage will cause infertility with physical and psychological
sequalea. It may also result in ectopic pregnancies, which will require major
operations. Chronic viral infections like Hepatitis B and C can cause cirrhosis
of the liver and heptocellular cancer. Since most of the sexually active people
are in their productive years, these various symptoms and signs will keep them
away from work and this will affect the economy of the country. In some cases
unfortunately sexually transmitted infections results in
death. This has been shown by the epidemic of HIV and AIDS. Acquisition of some
types of HPV has caused squamous cancer of the cervix and has resulted in death
of some woman. Neonatal and infant deaths are due to sexually transmitted infections
like syphilis and HIV.
Socio-economic costs
There are social economic costs associated with the management of sexually transmitted
infections and HIV. These costs will affect the individuals, the nation and
the healthcare institutions. Apart from lost working days which result in lost
income to the individual. The drugs for treating these infections are expensive.
One of the ramifications of this is that many individuals take ineffective and
sometimes inappropriate medicines. This has unfortunately led to organisms that
are resistant to common drugs. Some individuals feel ashamed of their predicament
and do not seek appropriate healthcare at the right time thus leading to chronicity
of the disease and propagation of the infection because they continue to engage
in sexual activities.
All the things mentioned above add to increase in healthcare costs and screening costs. The nation is not exempt from this economic burden. Disability and death in the various affected people decrease the working population. There is disruption of rural populations and rural economies. As has been shown in the case of HIV/AIDS, there is loss of human resources especially of young professionals. In places like South Africa, Zimbabwe and Malawi, the resultant AIDS orphans are left in the care of their grandparents. This is a sorry situation and every effort must be made to remedy the situation.
(Part of a lecture given at Lagos State University Teaching Hospital, Ikeja,
Nigeria on 15th October 2003).
©2004 Sexual Health Matters. Published Quarterly by Express
Print Works, Middlesbrough, UK
ISSN 1469-7556
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