Adolescent STIs – “We need to think out the box” (Part 2)
Posted on 27 August 2020
In examining the growing trend of adolescent STI infections, Dr Anusha Naidoo, Gynaecological Oncologist at Mediclinic Sandton looks at how we can address these issues within our practices, hospitals and homes.
“We as care givers need to think out the box. We need to learn to read the situation better, understanding fears and concerns. Some patients present with a primary complaint of suspected pregnancy when it is actually an STI for which they are too scared to request treatment,” she explains.
“Are we looking at our patients and trying to understand where they are coming from. Are they in an abusive relationship where they do not believe they can ask for assistance? Is it an uneven power relationship of a young girl and ‘blesser’ where they do not feel able to confront the partner that infected them? Gender based violence happens at all levels of society – we cannot risk making assumptions and missing out on giving our patients the care they need or deserve.”
Another isolated group of patients are those in the LGBT community. This minority are at serious risk because of associated behaviour that is often present such as multiple partners, use of stimulants and drugs as well as lack of condom use. Their risk of HIV is high – which then relates to increased risk of contracting other STIs or HPV because of a compromised immune system. “We need to ensure that our centres are accommodating, are empathetic and are equipped to deal with a generation of patients needing accessible care without the risk of breaking privacy.”
While this situation is bigger than one person is able to control or change, Dr Naidoo has practical suggestions on where our society and community can change the outcomes for at risk adolescents. “Change the way we are thinking. Let’s consider our roles and our involvement in diagnosing patients. Improve the training our healthcare providers receive, allowing them to diagnose and treat accurately while also learning how to strengthen their approach and provide greater privacy,” she suggests.
“Let’s move the care to centres that are already interacting with this generation,” she continues, “Universities, youth centres, schools. Our youth are already there. They can receive the right care timeously and without needing healthcare funder or parental approval for the care.” These areas are rich with groups of people needing care and education within these environments, which could improve the speed with which they receive care.
“And more importantly – let’s open the conversation with parents. Do you want your children to learn everything off social media or a friend at school? Is this the right platform to encourage discussion around sexual behaviour and cultural norms? Do you want to equip your children with the right information to make informed decisions or should they learn this off other social media platforms? Parents, engage with your children, explain why contraceptives are not barriers for infection. That condoms are a second level of protection against transmission of HIV, HPV and STIs. These discussions could save their lives,” Dr Naidoo states.
“HIV is a very real threat. Contracting HIV raises the risk of contracting HPV and STI’s. They go hand in hand. Let us educate and equip this generation to make appropriate choices regarding their care.” According to Dr Naidoo, the risk of HIV is a reality, with a ratio of 3:1 women vs men contracting the disease in South Africa within the 15 -24 year old age range.
But it is not all bad news. Dr Naidoo is exceptionally positive about the progress made in HPV vaccinations. “We have seen a drop in numbers of patients contracting HPV. The vaccine is already having an impact even though it was only introduced just over ten years ago. While the vaccine is targeted at young women between 9 and 26, some research has showing benefits for women in their thirties and forties. We are learning so much,” she says. An added ‘win’ for the vaccine is the herd immunity that it is bringing to young men in the country. “Our research is showing that the reduced rates of contraction of HPV amongst women is leading to a drop in rates amongst men. The evidence is showing clear signs of progress.”
Another win, in her opinion, is the success in ARV treatment for HIV. “You cannot isolate HIV, HPV or STIs. ARVs are now more accessible, there are different treatments available and new drugs are reducing the side effects. Even compliance has improved as the accessibility is improving. We can see a clear drop in the maternal to foetal transmission rates of HIV as infection is being prevented during the birth process.” If we can improve the HIV treatment we can also reduce the risk of STI and HPV, each of them impacts the others.
“I believe the key moving forward is education. Not just for young people. For care givers. For parents. For educators. Let’s use the platforms available to us to give out healthy, informed advice. If our children are on social media – should we not also be there giving the information they need? Being informed and applying this information is the best tool we have,” she concludes.
Read Part 1 in this story.