Sexually transmitted diseases in rural Africa [letter]

To learn why sexually transmitted diseases (STDs) are a major problem in rural Africa many public health specialists are examining the joint effect of a poor infrastructure with inferior training and inadequate motivation among the government staff who treat drug-resistant organisms with a limited supply of drugs. Perhaps they need to also consider that inappropriate health-seeking behavior by symptomatic individuals limits the effectiveness of rural health services. Four recent studies show that Africans do indeed care about their own sexual health (except they still expose themselves to STDs). Even though they tend to seek treatment slowly due to various obstacles (e.g. no money or available transport) they eventually do seek treatment. For example 96% of men and 90% of women in rural Tanzania with a history of discharge or genital ulcers seek treatment. Rural Africans usually seek treatment from the appropriate health care providers (in Tanzania 68% of men and 61% of women). In southwest Uganda STD patients go to health centers when they know drugs are available. Rural Africans often are aware of the signs and symptoms of STDs. In fact they tend to overreport genital complaints. These findings support the belief that STD patients are conscientious and that the infrastructure is weak. Further investigation reveals however that rural African STD patients fail to refer contacts for treatment. For example just 5 of 155 STD patients in a Mozambique study referred their partner for treatment. Thus behavioral changes and improved infrastructure are important. However limited resources force African governments to set priorities. Health officials should again conduct patient education which would be more cost effective than strengthening the infrastructure. They and their nongovernmental counterparts should do local assessments of health- seeking behavior before they decide that patients do not receive adequate treatment. Increased referrals would help in the identification and treatment of asymptomatic patients.