Abstract

PIP: A team from the London School of Hygiene and Tropical Medicine led a clinical trial in 12 rural communities in Tanzania to determine if better treatment of sexually transmitted diseases (STDs) would result in reduced transmission of HIV. After determining that the prevalence of HIV in each community averaged 4%, the Tanzanian and European investigators chose half of the communities at random to receive improved STD services. After two years, the incidence of new cases of HIV was 1.2% in the treatment communities and 1.9% in the controls. After adjusting for other risk factors, it was concluded that better STD treatment reduced HIV infection by 42%. The improved services have been extended to the former control communities. The results of the clinical trial were presented at the 11th meeting of the International Society for STD Research in 1995. During that meeting, a World Health Organization (WHO) official presented an estimate gleaned from the WHO's Global Programme on AIDS (GPA) that at least 333 million new cases of curable STDs would occur worldwide during 1995 and that millions of lives could be saved from AIDS through control of STDs. Treatment for curable STDs is considered one of the most cost-effective ways to improve global health. In countries where safer sex practices have been adopted in response to the AIDS epidemic and in countries that have attempted to detect and treat all existing STD cases, a sharp drop in the number of STDs has been seen. The WHO approach to STDs includes 1) the promotion of safer sex behavior, 2) the widespread availability and affordability of condoms, 3) integration of STD care into all basic health care facilities, 4) good quality case management of STDs, 5) encouragement of STD sufferers to seek help early, and 6) screening for silent STDs.