Sexually Transmitted Infections - Term Paper Example

Health Issue Rationale Introduction: Sexually transmitted infections (STI) occur primarily as a result of sexual contact with an infected person. Several types of STIs exist worldwide among them been syphilis, chlamydia, human papillomavirus, gonorrhea, genital herpes, hepatitis and HIV (World Health Organization [WHO], 2015). Although some of these infections can be transmitted via other means such as mother-to-child transmission of HIV and syphilis, the sexual route shall be of concern in this discussion (WHO, 2015a). WHO (2013) estimates that the number of people acquiring STI infections daily is about one million, an infection rate that is equally high in Australia particularly Northern Territory (NT) state (Australian Bureau of Statistics [ABS], 2012). This paper justifies the need for health promotion regarding STIs in NT citing the high prevalence among teenagers and young adults, the cost of the health issue, the risk and accompanying contributing factors, theories underpinning the risk factors and finalizes with the identified objectives regarding the health issue. The Health Issue: STIs STIs are commonly transmissible via unsafe sexual activities and behaviors (Fenton et al., 2005). They can be caused by viruses such as the HIV and herpes simplex virus, by bacteria such as Neisseria Gonorrhea, Chlamydia, trachomatis, and Treponema Pallidum that cause gonorrhea, chlamydia and syphilis or by parasites such as Trichomonas vaginalis that cause trichomoniasis (Ginocchio et al., 2012). However, if untreated or medical therapy is delayed, they can potentially result in various complications including infertility, chronic abdominal pain, brain, heart and genital damage (Geisler & Hook, 2003). Chronic abdominal pain is primarily due to pelvic inflammatory disease (PID) (Gradison, 2012). Viral infections such as HIV have no known cure and have the potential to cause lesions and lower the body’s immunity increasing the susceptibility to opportunistic infections (Geisler & Hook, 2003). STIs can affect any age group, but they predominantly affect adolescents and young adults even in NT (ABS, 2012). The 18-29 age group is the dominantly affected group in Australia and In NT (ABS, 2012). Symptoms of most STIs may not always manifest in individuals affected. Some have a symptomatic phase followed by a non-symptomatic phase such as syphilis (Euerie, 2014). The asymptomatic stages of these diseases are equally infective posing risks to other unsuspecting individuals. This pauses a challenge in identification of individuals who are infected in order to facilitate treatment unless they are identified through routine testing (Euerie, 2014). The Scope of STIs in NT, Australia and the World: NT is among Australian states that have had a high STI notification rates in the past years and the state has over the years reported the highest number of cases of chlamydia infection (Kirby Institute, 2014; ABS, 2012). ). In 2011, the chlamydia and gonorrhea rates were 3 and 16 times respectively the rates of Australia (ABS, 2012). The STIs are significantly more predominant among aboriginals NT residents compared to non-aboriginals, a picture that is replicated in national statistics (Kirby Institute, 2014; DHNT, 2012). Notification rates (Figure 1) of various STIs affecting individuals aged at least 13 years such as gonorrhea (Figure 1) have been increasing since 2001 to 2011 with a slight decline only in 2007 and 2008 as reported by ABS (2012). Chlamydia notification rates (Figure 2) have been consistently increasing since 2001 at 130 per 100 000 persons to 435 per 100 000 individuals in 2011 (ABS, 2012). The only drop in chlamydia notification was observed in 2012 and 2013. However, this decline was observed in other states but not in NT (Kirby Institute, 2014). Syphilis (Figure 3) and HIV had the lowest notification rates over the 10 year period with HIV rates been fairly constant averaging between 5 and 6 per 100 000 population aged at least 13 years (ABS, 2012). HIV is not as prevalent in NT as in other states. Apart from HIV, the other STIs are significantly more prevalent among Aboriginals and Torres Strait Islanders (ATSI) population. From 2009 to 2013, chlamydia and gonorrhea notification rates have been highest in NT among the other Australian states (Kirby Institute, 2014). Figure 1: Trend of Australia Gonorrhea Notification per 100 00 people aged at least 13 years (ABS, 2012). Figure 2: Trends of Chlamydia notification in Australia per 100 000 person aged at least 13 years (ABS, 2012) Figure 3: Australian Syphilis notification rates per 100 000 population aged at least 13 years (ABS, 2012). Females and males aged between 20 to 24 exhibit the highest number of chlamydia and gonorrhea diagnosis reported in Australia (Kirby Institute, 2014). Whereas HIV diagnosis rates are highest in major cities across the states. The diagnosis rates for the other STIs are highest in remote and very remote areas. Cost of STI: Direct costs are related to the medical costs while indirect costs are associated with loss of productivity (Harrel, Dayne & Kathryn, 2008). STI complications result in indirect costs in that complications such as PID have the potentially to cause infertility, ectopic pregnancy and loss of quality of life and reproductive years due to its chronic pelvic pain (Gradison, 2012). Direct costs include the government and individual, health insurance expenditure on the treatment and management of STIs. For instance, STI infection such as chlamydia costs Australia about $90 to $160 million every year (Infectious and Immunology Health Network [IIHN], 2008). Furthermore, it is estimated that the average cost for a single case of PID is about $ 1995 (Harrel, Dayne & Kathryn, 2008). Therefore, the direct cost of treatment of the infections shall be high given the increasingly high rates and numbers of chlamydia and gonorrhoea diagnosis. Risk and Contributing Factors: There are various risk factors that increase the susceptibility of the teenagers and young adults to STI. The table below classifies the risk factors and its contributory factors as postulated by Green in the PRECEDE-PROCEED model (Green & Kreuter, 2004). Risk Factor Contributing Factor Behavioural risk factor 1 Having unprotected sex (Miller, Law, Torzillo & Kaldor, 2001). Predisposing Factor: They have no knowledge of the transmission mechanism of the various STIs and what measures they can take in protecting themselves from STI such as through the use of condoms predispose individuals to STIs (Rollins, 2013). Lack of knowledge of the symptomatic presentation of some STI is also a predisposing as it limits individuals in relationships in making informed decision about using protection to prevent a partner from getting infected (WHO, 2013). Enabling Factors: Lack of or inadequate platform of STI-related knowledge dissemination and acquisition denies the teenagers and youth adults a source of knowledge (Strobel & Ward, 2012). Unavailability or inaccessibility of means of protection such as condoms is a hindrance to engaging in protected sex for even knowledgeable individuals (WHO, 2013). Reinforcing Factors: Insufficient support from health providers and families to encourage and cement the importance of having protected sex while emphasising the use of condoms allows the message to wane off (Strobel & Ward, 2012). Behavioural risk factor 2 Previous STI history (Fairbairn et al., 2010). Predisposing factor: Teenagers and young adults with past history of STI expose others who are sexually active to STI as some of the STI do not completely heal initially but just lapse into a non-symptomatic phase (Ginnochio et al., 2012). Treatment failure is common in some individuals making previously infected persons to be susceptible to the symptomatic manifestation of the disease again in addition to infecting others too (Euerie, 2014; Geisler & Hook, 2003). Failure of sexual partners to disclose to each other in case they are diagnosed with STIs puts the uninfected partner at risk too (WHO, 2013). Enabling factors: Inadequate medical treatment of STI without routine follow-up of cases increases the reoccurrence of STIs among individuals previously infected (Lea, 2010). Limited frequency of routine test delays the recognition of STIs among individuals allowing the spread of the infection (Lea, 2010). Reinforcing factors: Insufficient reminders and encouragement from family members to previously infected individuals to go for retesting does not fortify the retesting initiative among these individuals (WHO, 2013). Environmental risk factor Inadequate testing and treatment health services (Fairbairn et al., 2010). Predisposing Factor: Insufficient health service providing centres to serve a high number of individuals at risk is a contributory factor to this risk factor (Fairbairn et al., 2010). At risk individuals distant from health service providing centres may find it inconvenient to travel and seek testing or treatment services. Enabling factors: Inadequately equipped facilities in terms of staff and infrastructure impedes the provision of testing, treatment and counselling services to the population at risk or affected by STIs. Furthermore, slow and unsatisfactory services discourage individuals from seeking services (WHO, 2013; Fairbairn et al., 2010). Reinforcing factors: Lack or insufficient encouragement and support from close relatives and peers of individuals at risk such as giving them company during hospital visits and offering transport services does not encourage adherence to testing, retesting and treatment appointments comprehensively (DHNT, 2012; WHO, 2013). Target Group: The target group for this health issue are Northern Territory ATSI teenagers and young adults aged between 15 to 29 years. Generally, STIs especially chlamydia and gonorrhoea are more prevalent in NT than other Australian states (ABS, 2012; DHNT, 2012). The 15-29 age group has the highest rates of diagnosis of most STIs except for hepatitis and HIV in NT (DHNT, 2012). ATSI are more affected than other NT residents (DHNT, 2012). Other Related Programs: NT has a ”safe sex no regrets” that targeted individuals aged between 15-29 living in NT urban areas (Leach, 2009). However, the campaign primarily targeted enhancing awareness of STI. This program targets enhancing awareness and availing sufficient health services and means of STI protection. Nevertheless, the campaign whose evaluation is still in progress can be augmented by this program that is more specific for ATSI residents of NT. Similar programs in Western Australia and South Australia are a good source of benchmarking the creation, implementation and evaluation such a program in NT (Southern Australia Department of Health, 2012; IIHN, 2008). Behavioural Theories: The various risk factors and behaviours of the target group are underpinned by social cognitive models such as “the health belief model [HBM], self-efficacy theory [SET], theory of reasoned action [TRA], and protection motivation theory [PMT]” (Sutton, 2002). HBM and PMT theories have an outstanding construct that perceived vulnerability or susceptibility to a health issue such as STIs informs the kind of risk factors for STIs. For instance, lack of knowledge regarding the adverse effects of STIs and how to prevent STIs does not make the target group feel susceptible to STIs. This argument also underpins the significance of health education in aiding the target group make informed choices. TRA highlights the importance of how a person’s intention informs the indulgence in certain behaviours (Sutton, 2002). The subjective norm of intention also regards the value of important others to the intentions of a person. This latter point augments the significance of close persons such as family members to behaviour change and, lack of which is a contributory risk factor to behaviours. Perceived expectancy related to performing a given behaviour is common in the four theories (Sutton, 2002). A perceived positive outcome affiliated to, for instance, condom use will encourage adoption of this behaviour and vice versa (Sutton, 2002). Objectives: 1. To increase the use of condoms among NT residents aged between 15-29 years by 30% in the first two years of running the health promotion program. 2. To ensure that in the first two years of program implementation, more than 90% of target group individuals who have undergone treatment for an STI are retested again after three months. 3. To ensure that by the second year of running the program the number of individuals from the target group reporting easy accessibility to STI testing and treatment services increases by at least 30%. 4. To lobby for an increase in budgetary allocation for STIs’ prevention and treatment services in NT by 20% in the first year of program implementation. 5. To ensure that at least 90% of target group individuals receiving testing and treatment services in the first year of program implementation are satisfied with services offered. Conclusion: STIs are highly prevalent among ATSI teenagers and young adults of the NT compared to other states. The main risk factors for STI infections are engagement in unprotected sex, previous history of STI and inadequate testing and treating services. To lower the increasing prevalence of STIs in this target group, a program targeting the reduction or elimination of the risk factors to the STIs is required. The success of such a program shall be enhanced by the multidisciplinary input of health professionals, the State and National government and the individuals directly or indirectly affected by the health issue in the community. 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