Integration of STD services. How to reach and involve men and women

Abstract

In Kenya, a sexually transmitted disease (STD) program implemented in 10 medical centers in Nairobi allows nurses to diagnose syphilis based on symptoms, have blood tests conducted to confirm syphilis, prescribe treatment, and provide counseling. About 5% of pregnant women in Kenya have syphilis but do not know that they are infected or are afraid to seek sexually transmitted disease treatment in health centers. This program tests all pregnant women for syphilis during the prenatal examination. Once syphilis is confirmed, the nurse educates the pregnant woman about syphilis and tells her that syphilis poses a risk to her baby and that she can be treated for syphilis. The nurse must also emphasize the need to treat the pregnant woman's sexual partner. Even though most women agree that the partner must be informed, many fear that the partner will react violently. Each pregnant woman with syphilis receives several partner notification cards asking the partner to go to a health center. The card does not mention syphilis. Once at the center, the man is told that his partner has syphilis. He is told that syphilis can affect the baby. Usually, the men are concerned about the baby. The men receive education on condom use and sexual practices because they have more control and initiative in sexual activity matters. Even though the men and women are advised to abstain from sexual intercourse for a week after treatment, some men have difficulty following this advice. The nurse discusses options relevant to both sexes (e.g., condom use with all partners). It is difficult for women to propose condom use because these decisions are to be made by the men. Women can learn how to use a condom and how to persuade her partner to use the condom. Some women sleep in a separate room or return to their family if their partner insists on sexual intercourse. Almost all pregnant women involved in the project were successfully treated and their partners were informed. More than 50% of the partners were successfully treated. The nurses are pleased with the program