Prevention of unwanted pregnancies and of sexually transmitted infections: The linkages

This paper deals mainly with the issue of integrating counselling, diagnostic and treatment activities for sexually transmitted infections (STIs) including human immunodeficiency virus (HIV) to routine family planning (FP) and maternal and child health (MCH) services in developing countries. It is argued that this integrated approach is an ethical and public health priority in 'high risk' settings (where HIV prevalence in the general population is more than 5% and prevalence of classical STIs is more than 10%). The main components to be added (and attendant limitations) are summarized. In low risk settings, where HIV is still largely confined to groups with high risk behaviour and the prevalence of classical STIs is below 10 per cent, the expansion of FP and MCH services to include STI/HIV activities may not be cost-effective. Such a policy would involve large expenditure for a modest impact and massive over-prescription of antibiotics (because of poor sensitivities and specificities of existing diagnostic techniques). In such settings alternative approaches to STI/HIV control will be more cost-effective. These include information, education and counselling campaigns, condom promotion schemes and enhancement of private sector provision of STI services.