Sexually Transmitted Diseases

Sexually transmitted diseases (STDs) are a critical public health issue in the U.S., especially in rural areas where they pose a tremendous health and economic burden. The goal of public health is to control sexually transmitted infections (STIs) at the population level. Applicable population level strategies may include educating youth about safe sex, social marketing campaigns for condom use, voluntary counselling and testing for HIV, and promotional initiatives for behavior change targeting high risk population groups. All of this is not possible without the collaboration and active involvement of the community. A diverse group of community stakeholders, including community members, community leaders, local governments, schools, nonprofit organizations, healthcare providers, religious groups, social service agencies, etc., all have to partner up to tackle the issue of sexually transmittable infections (STIs) in the community.

Local and state government can be reached to provide additional resources and enhance support for STI screening initiatives, as well as for behavioral interventions. For example, mass media campaigns may be appropriately designed by the government and funded at a state or local level to provide sexual health education for young people. Communication systems, such as radios, televisions, and mobile telephones allow the exchange of timely health information, especially for people who may be in distant locations. Local churches and community leaders can be helpful and need to be advised on how to confront the cultural taboos and stigmas that prevent open talk about sex education in schools and churches. Partnering with community clinics and health workers may be useful to reach more at-risk or infected individuals and to encourage them to seek screening and treatment. STI prevention programs in rural areas tend to be compartmentalized due to stigma related issues and may fail to address in an integrated approach to combat the issue.

In order to mobilize them, they need to be educated on the concept of coordinated action plans. In order to strengthen existing organizations and expand STI prevention programs in rural areas, effective partnerships are crucial, especially to minimize the struggle for resources. Approaches, such as case-findings and evidence-based interventions that are beyond rural people’s reach can be used to promote sexual health. Overall, to achieve results, the relevant partners need to be convinced that controlling sexually transmitted infections (STIs) is achievable, leads to better sexual health, and helps in preventing HIV transmission, which can create even bigger problems in the community.

When addressing the topic of sexually transmitted infections, rural areas can pose some unique moral and ethical challenges. Along with the prevalent issues such as lower literacy rates and lack of economic and medical service resources, STI-related stigma and fear of isolation, is another vital problem among rural communities. The negative attitudes attached to having an STI in a rural area can lead to underdiagnoses and under-treatment of such infections in rural residents. Proper planning and training should include how to best educate the community about STIs to prevent confusion, how to protect the privacy of those infected, how to handle STI-related stigma and social exclusion, how to protect patients’ rights to receive treatment without discrimination, how to tackle cultural taboos to openly talk about sex education, and most importantly, how to control the STI form spreading further. Fear of rejection, stigma, and discrimination can prevent people at risk from being fully compliant with public health recommendations related to treatment, partner notification, and safer sex practices. Therefore, avoiding the issue of stigma, will make it very difficult to implement any preventative measures to reduce prevalence of STI’s in rural areas. Hence, the partners in the program need to be informed about making it a priority to reduce/eliminate stigma in the community. Anti-stigma programs should target vulnerable populations such as, adolescents, racial and ethnic minorities, people who inject drugs, homosexual men who engage in high-risk sexual behavior, and people who are infected with STIs.

The goal of the program should be two-fold: to prevent injury to the patients infected with STIs and to control the spread of infections at the population level. This can be achieved by a combination of health care, behavioral, and educational interventions. In order to tailor prevention and intervention programs we need to identify infected people, the source/modes of transmission, and available resources in the rural communities. STI screening and testing can be used to identify individuals for targeted interventions. The process should guarantee utmost confidentiality and non-discrimination to prevent harm to those who are infected. People who are considered high-risks in the rural setting need to be directed and encouraged to access STI screenings. More people living with STI can increase the risk of further infection in the community. Therefore, it is important to identify the source of infection and try to stop it from spreading. Treating STIs in individuals breaks the chain of transmission, and thus reduces STI prevalence in the greater community. Last, combatting these issues require assessing the possibility of addressing each issue and how much support and resources can be gathered from the community.

This is done by getting the right people together who can then reach out to those who can make positive changes happen. Partner resources, such as mobile van units, testing kits, and structural locations for testing are all helpful resources that “reduce the cost, expand the reach, and ensure sustainability of the interventions,”. Partnering with schools and churches to educate young people about STIs and contraception, how STIs are transmitted between partners, and effective ways that they can protect themselves against STIs are all educational interventions that can play an important role in furthering the public health message about STIs. When planning implementations, it is important to focus on the notion that the ultimate goal is to promote healthy sexual behaviors, strengthen community capacity, and increase access to quality services to prevent sexually transmitted infections.

The core functions of public health includes, assessment that is to identify the health problems, policy development, that is to decide how to handle the problem, and assurance that is to make sure the problem is controlled correctly. Effective policies and programs need to address the culturally-specific issues in order to develop goals which can convincingly be executed in rural settings. For example, stigma is a big problem in rural areas and people often compromise their willingness to get tested or engage in care for sexually transmitted diseases. One possible intervention is to utilize technology to educated people, and provide them with options, such as online support groups.  Is one such website where people can get more information about STI and its related treatment options. Online support group is a great option for people who want to maintain their privacy and anonymity. Telehealth and technology intervention will be an effective way to assist rural citizens both in educating and delivering specialty care. Last, the Health Resources and Services Administration can be contacted to seek help. They can identify programs, such as Ryan White HIV/AIDS program that can provide support to rural community’s unique challenges.

Barriers can make it impossible to develop, deliver and sustain public health programs. To overcome barriers, it’s important to identify the root causes of the problems. For example, the barrier could be a church that is divided on the issue or has a different stand and belief on STI, or it could be sociocultural factors, such as customs and issues associated with culture, stigma, and prejudice toward STI. Once the root cause is identified, strategies can be implemented to tackle barriers. For example, if a church does not support safe-sex education, having a network of stakeholders and partners in the community may be beneficial for providing resources and support for a program. Similarly, Involving members from the community who can promote the program can help achieve reduce stigmas and encourage participation. Program implementers also have to be mindful about adapting materials that are culturally appropriate.

Quality assurance monitoring and evaluation are the foundation for starting and sustaining STI control programs and keeping them relevant and significant. A process evaluation, impact evaluation and outcome evaluation process is the best way to measure the progress of the program. A process evaluation should include clearly defined procedures manuals to help clarify responsibilities and accountabilities. Short-term goals should include, impact evaluation, such as if the program is achieving its objective of identifying risky behaviors and implementing appropriate interventional methods. Long-term goals should focus on measuring the incidence rate and morbidly rates etc., as well as strengthening the STI support system in the community. Moreover, any effort to appraise a program must involve the program stakeholders, so that their unique perspectives are understood and used to further strengthen the program