STI Management

Fact Sheet on Youth Reproductive Health Policy

Each year worldwide there are over 300 million new cases of curable sexually transmitted infection (STIs). An untreated STI can cause infertility, chronic pain, stillbirth, and ectopic pregnancy and heighten the risk of HIV infection. Many millions more are infected with incurable viral STIs such as HPV, which can cause cervical cancer.

Its importance as Youth Reproductive Health Issue

• Youth bear a disproportionate burden of sexually transmitted infections. According the World Health Organization, a third of new STI cases occur among young people.
   
• Young females are more biologically vulnerable to contracting STIs because of their immature reproductive tract.
   
• Rates of re-infection are substantially higher among young people than in adults, in part because they are less likely to use a condom and to seek effective treatment.
   
• Young people are less informed about STIs, less likely to recognize symptoms, and more averse to seeking treatment due to stigma and societal pressures.
   
• The way health workers manage STIs in youth can be suboptimal. Some refuse to provide diagnosis and treatment of STIs even when patients do exhibit symptoms; others are not allowed because of restrictive policies; still others do not recognize that youth may be sexually active and thus exposed to the risk of contracting an STI.
   

The urgency of addressing HIV/AIDS has somewhat overshadowed policy and program action on other STIs. Policies should reflect the importance of STI treatment and diagnosis for young people. Some key policy actions include:

• Position STI diagnosis and treatment as a health problem that shares priority with and complements HIV/AIDS prevention efforts.
   
• Allow minors to consent to STI examinations and treatment without requiring consent of parent or other adult. Parents are an important source of emotional support and clinic-based counselors should encourage all minors to consult with parents or other trusted adults. Consent and disclosure requirements for mature minors should be similar to those recommended for voluntary counseling and testing programs.
   
• Promote comprehensive sexuality education programs in schools to enable youth to recognize STI symptoms and choose to seek treatment.
   
• Encourage "youth friendly" reproductive health care through stand-alone clinics or "youth corners." Sexually active, unmarried youth tend not to utilize existing reproductive health services for fear of being judged.
   
• Promote affordability of STI treatment. Young people often have limited financial resources and would be reluctant to borrow money from friends or relatives.
   
• Encourage comprehensive reproductive health services that provide STI care, family planning, and voluntary counseling and testing for youth.
   

Recent advances in HIV/AIDS policies present an opportunity for the inclusion of STI considerations. Many HIV policy documents also address STI diagnosis and treatment but few explicitly address the needs of young people. Policy language often times fails to distinguish between HIV/AIDS and other STIs and that STIs are multiple diseases. Consideration should be made to address these health issues separately.

Here are some examples of youth-specific STI policies in the policy database:

• Ghana ARH Policy
   
• Bulgaria National Strategy for Prevention and Control of HIV/AIDS and STIs
   

Research Findings to Support Policy Development

An evidence-based approach is often an effective strategy for creating policy change. Here are some recent research efforts to support the development of youth-focused STI policies.

Minors and the Right to Consent to Health Care. This study from the Alan Guttmacher Institute summarizes minor consent issues in the United States and how consent laws apply to YRH care

Reaching Youth and Men. This publication from FHI proposes a broader approach to integrating STI and family planning services.

From Rhetoric to Reality: Implementation Tips

There is no standard model for STI service delivery. Young people may be more likely to seek services at a stand-alone youth clinic but such an approach may unfeasible with limited financial and human resources. Integration of STI services with family planning clinics may offer an efficient referral network but may deter some segments of the population. Policies should stress the importance of tailoring service delivery points to maximize use while also considering resource availability

Watch out for...

Inadequate training of health providers. Policies, protocols, and guidelines must acknowledge the unique psychosocial needs of youth and equip health providers to accommodate and respond to those needs.

Related Links and Resources

Control of Sexually Transmitted Infections (FHI). A fact sheet from Family Health International.

Facts about Youth, HIV, and other STIs (YouthNet). From YouthNet.

Sexually Transmitted Infections among Adolescents: The Need for Adequate Health Services (WHO and GTZ, 2005). This literature review documents experience providing STI services to adolescents and proposes priority actions for research, policy, and services.