Khadija Magardie
Current research indicates that at least one in every 10 South Africans will contract a new sexually transmitted disease (STD) this year.
According to Department of Health statistics, the numbers of STDs are spiralling. Every year over four million new cases are reported.
Given the close association between STDs and HIV/Aids, it is clear that serious policy interventions are necessary to curb the fast spread of infections.
The health department, in conjunction with various NGO stakeholders, has piloted a number of projects aimed at raising public awareness about the implications of STD infections.
The launch of the South African Aids Youth Project, together with the partner notification tracing programme, which ensures that partners at risk are aware of their exposure, are two of the initiatives aimed at keeping STDs at bay.
But according to recently released statistics, the majority of STD sufferers do not take the public health route for treatment. Most South Africans are going to private clinics and general practitioners, all of whom are dealing inadequately with the rate of infections.
Theoretically, the private sector should be reducing the burden of public health with regards to STD management. But an independent study, documented in the South African National Health Review, has found that there is “a very poor technical quality of care being provided by general practitioners”.
In a demographic and health survey in 1998, men were asked about the symptoms of an STD. Over 12% of adult men (over the age of 15) reported having the symptoms associated with STDs, such as a discharge and/or genital sores during the previous three months.
The survey did not include women, in whom the presence of STDs is higher.
The survey found that levels were high among urban men, particularly in KwaZulu- Natal and Mpumalanga. It was also found that symptoms of STDs were more prevalent among less educated men than among those with a matric or higher.
STDs, such as syphilis and gonorrhoea, can result in serious illness and infertility in both men and women.
An infected mother can also pass on an STD to an unborn or newborn baby, resulting in serious complications such as blindness to the baby.
According to the Health Review, STDs are one of the conditions for which treatment is regularly sought from private providers, for a variety of reasons.
Firstly, the continued stigma attached to STDs, vis–vis “promiscuity” and embarrassment, makes the relative privacy and anonymity of a general practitioner’s consulting room a far more attractive option.
Other reasons include easier access, longer hours of service, shorter waiting times, being seen by a doctor (as opposed to a nurse) and more personalised attention in private hospitals or clinics.
The authors of the Health Review chapter on STD care in the private sector estimate that the private sector in South Africa treats approximately five million cases of STDs annually, outnumbering those seen in the public sector.
In a study conducted in Alexandra, north of Johannesburg, for instance, it was found that, despite poor economic circumstances, more than 63% of all visits for STDs took place in the private sector.
An independent national survey conducted by the Department of Health found that there was inferior quality of STD care in the private sector. For instance, less than 30% of general practitioners reported adequate treatment for urethral discharge, while only 15,5% treated genital ulcers effectively.
Among the reasons for poor quality in private STD care are financial constraints. Lack of health insurance and the relatively high cost of antibiotics for STD treatment are obstacles to effective STD control. Practitioners are often reluctant to dispense to uninsured, cash-paying patients.
The Department of Health has been reasonably successful in STD management. In a 1998 national survey of 294 public sector clinics, 82% and 72% of nurses interviewed knew the correct drug management of urethral discharge and genital ulcers, respectively. Around 86% of the clinics had key STD treatment drugs in stock.
The Centre for Health Policy, which authored the STD care chapter in the Health Review, suggests that stronger partnerships between relevant stakeholders in both the private and public sectors are crucial in the management of STDs. Because consumers often lack the information to judge the technical quality of treatment, private sector providers may have economic incentives to provide sub-standard services.
Instead of leaving the private sector to go on providing unregulated services, there should be a measure of state leverage to ensure adequate resource allocation, as well as to facilitate professional accountability. Coupled with sustainable awareness programmes, particularly among high-risk categories such as sexually active youth and prostitutes, the STD rate of infections can be effectively controlled. And by extension, the spread of HIV/Aids can be limited.