k2_ikk_global strategy for the prevention sti (ikk)

8/16/2019 K2_IKK_Global Strategy for the Prevention STI (IKK)

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GLOBAL STRATEGY FOR THE PREVENTION

AND CONTROL OFSEXUALLY TRANSMITTED

INFECTIONS

Dr. Juliandi Haraa!" MADr. Juliandi Haraa!" MADr. Rina A#$liaDr. Rina A#$lia" MARS" MARS

Dept. Ilmu Kesehatan Masyarakat/Dept. Ilmu Kesehatan Masyarakat/KedokteranKedokteran

PencegahanPencegahan/ Kedokteran Komunitas/ Kedokteran KomunitasFK USUFK USU


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STI PREVENTION ANDSTI PREVENTION AND

CONTROLCONTROL The WHO estimated that in 1999, 340 The WHO estimated that in 1999, 340

million new cases of curable STIs.million new cases of curable STIs.

lmost one million new infectionslmost one million new infections

occur e!er" da".occur e!er" da".

#$I%S and WHO, estimated that in#$I%S and WHO, estimated that in

&00', 4.9 million (eo(le newl"&00', 4.9 million (eo(le newl"infected with HI), another 40.3 millioninfected with HI), another 40.3 million

(eo(le li!in* with HI)(eo(le li!in* with HI)


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Pr$%al$n&$ and in&id$n&$ '( STI) ar$i*$r in +$ d$%$l'!in* ,'rld +an

in +$ indu)+riali-$d ,'rld.

T$ STD) +a+ ar$ &au)$d /0

/a&+$rial" #0&'l'*i&al and !r'+'-'al a*$n+)a%$ ... &'n+inu$d +' /$ a !u/li& $al+!r'/l$# in /'+ indu)+riali-$d andd$%$l'!in* &'un+ri$)1.In #an0 d$%$l'!in* &'un+ri$) STD) a%$ ('r

)$%$ral d$&ad$) ran2$d a#'n* +$ +'! 3%$di)$a)$) ('r ,i& adul+) )$$2 $al+ &ar$)$r%i&$).4

S$5uall0 +ran)#i++$d di)$a)$)6 !'li&i$)and rin&i l$) ('r r$%$n+i'n and &ar$.


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THE DISTRIBUTION OF STI) In *$n$ral" +$ !r$%al$n&$ '( STI) +$nd) +' /$ i*$r

in ur/an ar$a) +an in rural 'n$)" and i*$r inun#arri$d !$'!l$ and 0'un*$r adul+).

Di)+ri/u+i'n /0 a*$ M')+ &ildr$n und$r 9; 0$ar) '( a*$ ar$ n'+ a


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T$ i*$r (r$=u$n&0 a#'n* ($#al$)

a*$d 9;?9: 0$ar) #a0 /$ a++ri/u+a/l$+' )$%$ral (a&+'r)6

+ +$ )+ar+ '( )$5ual a&+i%i+0 i) u)uall0

$arli$r ('r *irl) +an ('r /'0)@

+*irl) +$nd +' a%$ )$5 ,i+ 'ld$r #al$!ar+n$r)" ,' a%$ #'r$ )$5ual $5!$ri$n&$and ar$ #'r$ li2$l0 +' &arr0 in($&+i'n)@

+du$ +' +$ &ara&+$ri)+i&) '( +$ *$ni+al+ra&+ '( 0'un* *irl)" +$0 ar$ $)!$&iall0%uln$ra/l$ +' in($&+i'n ,i+ STI).


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A(+$r +$ a*$ '( 9: 0$ar)" +$ )li*+

#al$ !r$!'nd$ran&$ #a0 /$ ('r 'n$ 'r#'r$ r$a)'n)" a) ('ll',).

+ STI) '(+$n !r'du&$ n' )0#!+'#) 'r 'nl0 #ild

)0#!+'#) in ,'#$n.+U! +' '( ,'#$n and '( #$nin($&+$d ,i+ &la#0dia #a0 n'+ a%$)0#!+'#).+U! +' '( ,'#$n and 9 '( #$nin($&+$d ,i+ *'n'rr'$a #a0 al)' a%$ n')0#!+'#)

+ S$r%i&$) in *$n$ral #a0 /$ #'r$ a&&$))i/l$ +'

#$n +an ,'#$n.


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+ ultural and economic constraints mi*htalso (re!ent a (ro(ortion of women fromattendin* for treatment.

+ lar*e number of men mi*ht be

infected after (ractisin* unsafe se- with asmall number of se- worers.

+ Older men ma" be more se-uall" acti!e

than women of the same a*e.

+ /en are more liel" to chan*e (artnersthan women.


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STI )+a+i)+i&) '(+$n und$r r$!r$)$n++$ +ru$ nu#/$r '( !$'!l$ in($&+$d ,i+STI)" 6

+ !$'!l$ ,i+ )0#!+'#(r$$ STI) d' n'+ )$$2+r$a+#$n+

+$al+ (a&ili+i$) '


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Tran)#i))i'n '( STI)Tran)#i))i'n '( STI) T$ #')+ &'##'n #'d$ '( +ran)#i))i'n '(T$ #')+ &'##'n #'d$ '( +ran)#i))i'n '(

STI) i) +r'u* un!r'+$&+$d !$n$+ra+i%$STI) i) +r'u* un!r'+$&+$d !$n$+ra+i%$)$5ual in+$r&'ur)$ %a*inal 'r anal)$5ual in+$r&'ur)$ %a*inal 'r anal Rar$6Rar$6

Fr'# #'+$r +' &ildFr'# #'+$r +' &ild Durin* !r$*nan&0 $.*. HIV" )0!ili)Durin* !r$*nan&0 $.*. HIV" )0!ili)

A+ d$li%$r0 $.*. *'n'rr'$a" &la#0dia" HIVA+ d$li%$r0 $.*. *'n'rr'$a" &la#0dia" HIV A(+$r /ir+ $.*. HIVA(+$r /ir+ $.*. HIV Tr'u* /r$a)+ #il2 $.*. HIVTr'u* /r$a)+ #il2 $.*. HIV

Tr'u* +$ un)a($ un)+$ril$ u)$ '( n$$dl$)Tr'u* +$ un)a($ un)+$ril$ u)$ '( n$$dl$)'r in$&+i'n) 'r '+$r &'n+a&+ ,i+ /l''d 'r'r in$&+i'n) 'r '+$r &'n+a&+ ,i+ /l''d 'r

/l''d !r'du&+) $.*. )0!ili)" HIV" and/l''d !r'du&+) $.*. )0!ili)" HIV" and$!a+i+i)$!a+i+i)


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Fa&+'r) in&r$a)$ +$ ri)2 '(Fa&+'r) in&r$a)$ +$ ri)2 '(

+ran)#i))i'n+ran)#i))i'n Bi'l'*i&al (a&+'r)6Bi'l'*i&al (a&+'r)6

9. A*$9. A*$

T$ %a*inal #u&')a and &$r%i&al +i))u$ inT$ %a*inal #u&')a and &$r%i&al +i))u$ in0'un* ,'#$n i) i##a+ur$ and #a2$) +$#0'un* ,'#$n i) i##a+ur$ and #a2$) +$##'r$ %uln$ra/l$ +' STI) +an 'ld$r ,'#$n#'r$ %uln$ra/l$ +' STI) +an 'ld$r ,'#$n

Y'un* ,'#$n ar$ $)!$&iall0 a+ ri)2 in &ul+ur$) Y'un* ,'#$n ar$ $)!$&iall0 a+ ri)2 in &ul+ur$),$r$ +$0 #arr0 'r /$&'#$ )$5uall0 a&+i%$,$r$ +$0 #arr0 'r /$&'#$ )$5uall0 a&+i%$durin* $arl0 ad'l$)&$n&$durin* $arl0 ad'l$)&$n&$

. S$5. S$5

8'#$n &an /$ #'r$ $a)il0 in($&+$d +an #$n8'#$n &an /$ #'r$ $a)il0 in($&+$d +an #$n. I##un$ )+a+u). I##un$ )+a+u)

I##un$ )+a+u) '( +$ ')+ and %irul$n&$ '( +$I##un$ )+a+u) '( +$ ')+ and %irul$n&$ '( +$in($&+i%$ a*$n+ a


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B$a%i'ural (a&+'r)6B$a%i'ural (a&+'r)6

9.9. P$r)'nal ri)20 )$5ual /$a%i'ur)P$r)'nal ri)20 )$5ual /$a%i'ur)

Can*in* )$5ual !ar+n$r (r$=u$n+l0Can*in* )$5ual !ar+n$r (r$=u$n+l0

Ha%in* #'r$ +an 'n$ )$5ual !ar+n$rHa%in* #'r$ +an 'n$ )$5ual !ar+n$r

Ha%in* )$5 ,i+ &a)ual !ar+n$r" )$5Ha%in* )$5 ,i+ &a)ual !ar+n$r" )$5

,'r2$r),'r2$r)

Ha%in* un!r'+$&+$d !$n$+ra+in* )$5ualHa%in* un!r'+$&+$d !$n$+ra+in* )$5ual

in+$r&'ur)$ ,i+ !ar+n$r a) an in($&+i'nin+$r&'ur)$ ,i+ !ar+n$r a) an in($&+i'n

Ha%in* ad an STI in +$ la)+ 0$arHa%in* ad an STI in +$ la)+ 0$ar ri)2ri)2'( *$++in* in($&+$d a*ain i( +$0 a%$ n'+'( *$++in* in($&+$d a*ain i( +$0 a%$ n'+

/$$n a/l$ +' &an*$ +$ir )$5ual/$$n a/l$ +' &an*$ +$ir )$5ual

/$a%i'ur/$a%i'ur


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. S'&ial (a&+'r). S'&ial (a&+'r) In #')+ &ul+ur$) ,'#$n a%$ %$r0 li++l$In #')+ &ul+ur$) ,'#$n a%$ %$r0 li++l$

!',$r '%$r )$5ual !ra&+i&$ and &'i&$)"!',$r '%$r )$5ual !ra&+i&$ and &'i&$)"

)u& a) u)$ '( &'nd'#))u& a) u)$ '( &'nd'#) 8'#$n +$nd +' /$ $&'n'#i&all08'#$n +$nd +' /$ $&'n'#i&all0

d$!$nd$n+ 'n +$ir #al$ !ar+n$r and ar$d$!$nd$n+ 'n +$ir #al$ !ar+n$r and ar$+$r$('r$ #'r$ li2$l0 +' +'l$ra+$ #$nK)+$r$('r$ #'r$ li2$l0 +' +'l$ra+$ #$nK)ri)20 /$a%i'ur '( #ul+i!l$ )$5ualri)20 /$a%i'ur '( #ul+i!l$ )$5ual

!ar+n$r.!ar+n$r. S$5ual %i'l$n&$ +$nd) +' /$ dir$&+$dS$5ual %i'l$n&$ +$nd) +' /$ dir$&+$d

#'r$ +',ard) ,'#$n /0 #$n#'r$ +',ard) ,'#$n /0 #$n In )'#$ )'&i$+i$) +$ *irl&ild +$nd) +'In )'#$ )'&i$+i$) +$ *irl&ild +$nd) +'

/$ #arri$d '< +' an adul+ #al$ a+ a %$r0/$ #arri$d '< +' an adul+ #al$ a+ a %$r00'un* a*$0'un* a*$

In )'#$ )'&i$+i$) a !$r#i))i%$ a++i+ud$In )'#$ )'&i$+i$) a !$r#i))i%$ a++i+ud$i) +a2$n +',ard) #$n all',in* +$# +'i) +a2$n +',ard) #$n all',in* +$# +'a%$ #'r$ +an 'n$ )$5ual !ar+n$ra%$ #'r$ +an 'n$ )$5ual !ar+n$r


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. O+$r !$r)'nal /$a%i'ur) #a0 /$. O+$r !$r)'nal /$a%i'ur) #a0 /$

a))'&ia+$d ,i+ in&r$a)$d ri)2 a))'&ia+$d ,i+ in&r$a)$d ri)2 S2in !i$r&in*" +a++'')" /'d0 !i$r&in*S2in !i$r&in*" +a++'')" /'d0 !i$r&in* U)$ '( al&''l 'r dru*) /$('r$ 'rU)$ '( al&''l 'r dru*) /$('r$ 'r

durin* )$5durin* )$5

;. Ri)20 /$a%i'ur) '( !ar+n$r);. Ri)20 /$a%i'ur) '( !ar+n$r) Ha%in* )$5 ,i+ '+$r)Ha%in* )$5 ,i+ '+$r)

In$&+in* dru*)In$&+in* dru*)

Mal$ !ar+n$r a%in* )$5 ,i+ '+$rMal$ !ar+n$r a%in* )$5 ,i+ '+$r#$n#$n


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Gl'/al S+ra+$*0Gl'/al S+ra+$*0

The (ur(ose of the *lobal strate*" is The (ur(ose of the *lobal strate*" is

to (ro!ide a framewor to *uide anto (ro!ide a framewor to *uide an

accelerated *lobal res(onse for theaccelerated *lobal res(onse for the

(re!ention and control of se-uall"(re!ention and control of se-uall"transmitted infections, towards thetransmitted infections, towards the

attainment of internationalattainment of international

de!elo(ment *oals.de!elo(ment *oals.


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The strate*" will focus on achie!ement of The strate*" will focus on achie!ement of

the followin* obecti!esthe followin* obecti!es to increase the commitment of nationalto increase the commitment of national

*o!ernments and national and international*o!ernments and national and international

de!elo(ment (artners for (re!ention and control2de!elo(ment (artners for (re!ention and control2

to (romote mobiliation of funds and reallocationto (romote mobiliation of funds and reallocation

of resourcesof resources

to ensure that (olicies, laws and initiati!esto ensure that (olicies, laws and initiati!esrelated to (ro!ision of care are nonsti*matiin*related to (ro!ision of care are nonsti*matiin*

and *endersensiti!e within the (re!ailin*and *endersensiti!e within the (re!ailin*

sociocultural conte-t2sociocultural conte-t2

to harness the stren*ths and ca(acities of allto harness the stren*ths and ca(acities of all(artners and institutions in order to scale u( and(artners and institutions in order to scale u( and

sustain inter!entions for (re!ention and control.sustain inter!entions for (re!ention and control.


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The *lobal res(onse will be *uided b" two strate*ic The *lobal res(onse will be *uided b" two strate*ic

com(onents.com(onents.

Technical com(onent Technical com(onent a *lobal technical strate*" ada(table a *lobal technical strate*" ada(tableat the countr" and re*ional le!els, includin* wa"s to (aca*eat the countr" and re*ional le!els, includin* wa"s to (aca*e

and deli!er the e" (ro*rammatic elements of (re!ention andand deli!er the e" (ro*rammatic elements of (re!ention and

control in a sustainable manner.control in a sustainable manner.

a!ailabilit" or suitabilit" of healthcare ser!ices for (riorit"a!ailabilit" or suitabilit" of healthcare ser!ices for (riorit"

tar*et (o(ulationstar*et (o(ulations dia*nosis and treatment of as"m(tomatic infections2dia*nosis and treatment of as"m(tomatic infections2

the s"ndromic a((roach for the mana*ement of abnormalthe s"ndromic a((roach for the mana*ement of abnormal

!a*inal dischar*e2!a*inal dischar*e2

mana*ement of se-uall" transmitted infections in se-ualmana*ement of se-uall" transmitted infections in se-ual

(artners2(artners2 attitudes of healthcare (ro!iders2attitudes of healthcare (ro!iders2

a!ailabilit" and reliabilit" of data for (lannin* (ur(oses.a!ailabilit" and reliabilit" of data for (lannin* (ur(oses.


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d!ocac" com(onentd!ocac" com(onent

a *lobal ad!ocac" cam(ai*n to raise awarenessa *lobal ad!ocac" cam(ai*n to raise awareness

and mobilie resources worldwide.and mobilie resources worldwide.

This cam(ai*n will run alon*side other initiati!es This cam(ai*n will run alon*side other initiati!essuch as cam(ai*ns for the elimination ofsuch as cam(ai*ns for the elimination of

con*enital s"(hilis, the control and eradication ofcon*enital s"(hilis, the control and eradication of

curable *enital ulcer diseases, and the control ofcurable *enital ulcer diseases, and the control of

*enital her(es and *enital human (a(illoma!irus*enital her(es and *enital human (a(illoma!irus

infections.infections.


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ll STIs, includin* HI), are (re!entable.

5re!ention can be (rimar" or secondar"

+ !ri#ar0 !r$%$n+i'n aims to (re!ent(eo(le bein* infected with STIs or HI)

+ )$&'ndar0 !r$%$n+i'n is about the(ro!ision of treatment and care forinfected (eo(le in order to a!oid furthertransmission of infection to others.


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56I/67 568)8$TIO$ This is about ado(tin* safer se-ual beha!iourand en*a*in* onl" in safer se-ual acts.

Safer se-ual beha!iour im(lies+ abstention from se-ual acti!it"

alto*ether2+ dela"in* the a*e of se-ual debut2+ lifelon* mutual mono*am".

Safer se-ual acti!it" im(lies+ en*a*in* onl" in non(enetrati!e se-acts mutual masturbation and rubbin* ofbod" (arts2

+ en*a*in* in (enetrati!e se- acts onl" if


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S8O$%67 568)8$TIO$

This ma" be achie!ed b"

+ !r'#'+in* STI &ar$)$$2in* /$a%i'ur"+r'u*6

? !u/li& $du&a+i'n &a#!ai*n)@

? !r'%idin* n'n)+i*#a+i-in* and n'ndi)&ri#ina+'r0 $al+ (a&ili+i$)@

? !r'%idin* =uali+0 STI &ar$@? $n)urin* a &'n+inu'u) )u!!l0 '( i*l0

$


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+ &a)$3ndin*6

e-aminin* minimall" s"m(tomaticwomen attendin* clinics for maternal andchild health and famil" (lannin*

(artner noti;cation and treatment

education, in!esti*ation and treatmentof tar*eted (o(ulation *rou(s who ma"ha!e (laced themsel!es at ris ofinfection, such as se- worers, lon*distance truc dri!ers, uniformed

ser!ices, and "oun* (eo(le, both in andout of school.


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INTEGRATION OF STI SERVICES 8ITHINPRIMARY CARE

In 'rd$r +' i#!r'%$ a&&$))" !$'!l$ ,i+STI) )'uld n'+ n$$d +' a++$nd a &$n+r$d$%'+$d +' STI +r$a+#$n+. STI +r$a+#$n+

)'uld /$ a%aila/l$ a+ all $al+ (a&ili+i$)+r'u*'u+ +$ &'un+r0.

I+ i) !'))i/l$ +' in+$*ra+$ STI &ar$ ,i+in

!ri#ar0 $al+ &ar$ ? !ri#ar0 &ar$ &lini&)"#a+$rnal" &ild $al+ and (a#il0 !lannin*&lini&) ? +r'u* +$ )0ndr'#i&#ana*$#$n+ '( STI). Ti) #$an) +a+

)$r%i&$ !r'%id$r) ar$ +rain$d +' r$&'*ni-$STI) ) ndr'#i&all and +$n +' '


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Si5 ($a+ur$) '( &'#!r$$n)i%$ &a)$#ana*$#$n+ ('r STI)6

9. +' #a2$ a &'rr$&+ dia*n')i).+' !r'%id$ &'rr$&+ an+i#i&r'/ial +$ra!0 ('r

+$ STI )0ndr'#$. +' $du&a+$ 'n +$ na+ur$ '( +$ in($&+i'n"

)a($r )$5ual /$a%i'ur" )a($ )$5 a&+) andri)2 r$du&+i'n in 'rd$r +' !r$%$n+ 'r r$du&$(u+ur$ ri)2+a2in* /$a%i'ur

;. +' $du&a+$ 'n +r$a+#$n+ &'#!lian&$

>. +' d$#'n)+ra+$ +$ &'rr$&+ u)$ '( &'nd'#)and !r'%i)i'n '( &'nd'#)

. +' ad%i)$ 'n ', +$ !a+i$n+K) !ar+n$r) #a0/$ +r$a+$d and +' i))u$ a Par+n$r R$($rral

&ard ('r +$ !a+i$n+ +' !a)) 'n +' i)7$r!ar+n$r).


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Conclusion:Conclusion:

(ublic health a((roach to (re!ention and control of (ublic health a((roach to (re!ention and control of

se-uall" transmitted infectionsse-uall" transmitted infections 5romotion of safer se-ual beha!iour25romotion of safer se-ual beha!iour2

5romotion of earl" healthcareseein* beha!iour25romotion of earl" healthcareseein* beha!iour2

Introduction of (re!ention and care acti!ities across all (rimar"Introduction of (re!ention and care acti!ities across all (rimar"

healthcare (ro*rammeshealthcare (ro*rammes

com(rehensi!e a((roach to case mana*ement that com(rehensi!e a((roach to case mana*ement thatencom(assesencom(asses

identi;cation of the se-uall" transmitted infections s"ndrome2identi;cation of the se-uall" transmitted infections s"ndrome2

a((ro(riate antimicrobial treatment for the s"ndromea((ro(riate antimicrobial treatment for the s"ndrome

education and counsellin* on wa"s to a!oid or reduce ris ofeducation and counsellin* on wa"s to a!oid or reduce ris ofinfection with se-uall" transmitted (atho*ens, includin* HI)2infection with se-uall" transmitted (atho*ens, includin* HI)2

(romotion of the correct and consistent use of condoms2(romotion of the correct and consistent use of condoms2

(artner noti;cation(artner noti;cation


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k2_ikk_global strategy for the prevention sti (ikk)

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