Abstract

PIP: Regional estimates prepared by the World Health Organization of the prevalence of HIV infections and curable sexually transmitted diseases (STDs) reveal that the HIV epidemic parallels STD incidence and is likely to undergo explosive growth in areas such as Asia where the ratio of HIV to STDs is currently low. HIV has had an especially severe impact on young women, and quickly moves into a general population through the gateway presented by sexually active youth. The impact of HIV has been severe in Africa where it has negated advances in child survival in some countries and created hundreds of thousands of orphans in others. The impact of curable STDs is also severe and is greatest among women who suffer from infertility and in children who develop ocular infection. The sex behavior that places individuals at risk of HIV or STDs is better understood today than ever before as are biological factors such as the increased risk of acquiring HIV for individuals infected with a genital ulcer. The biological and behavioral link between HIV and STDs is so close that the same strategies are important for prevention of both. The adoption of safe sex practices, especially promotion of condom use, is an important goal, and development of a female-controlled method of prevention (especially one that could not be detected by the male partner) would be a valuable alternative to the male condom. The second major prevention strategy is early diagnosis and treatment of STDs through a syndromic approach to diagnosis. Syndromic management will improve with advances in sensitivity and specificity, health-seeking behavior, and partner notification, but the approach still faces major problems caused by the overuse of antibiotics and the asymptomatic nature of many infections in women. While STD incidence is dropping in many countries, the mixture of HIV subtypes is increasing as is the resistance of STDs to antibiotics. With a significant worldwide decline in STDs within reach, complacency must be avoided and additional tools for STD/HIV prevention and control must be developed to avoid a backslide. Research and development of vaginal microbicides, STD diagnostic tests for use in resource-limited settings, HIV vaccines, and new antibiotics must continue.