Sexually Transmitted Infections

Sexually transmitted infections / reproductive tract infections (STIs/RTIs) are an important public health problem in India. Studies suggest that 6% of the adult population in India is infected with one or more kinds of STI/STD/RTI. Individuals with STIs/RTIs have a significantly higher chance of acquiring and transmitting HIV. Moreover, STIs/RTIs are also known to cause infertility and reproductive diseases. Controlling STIs/RTIs helps decrease HIV infection rates and provides a window of opportunity for counseling about HIV prevention and reproductive health. STI prevalence is a good marker for HIV, as both share common modes of transmission

Convergence of NACP III with RCH II

The first national STD control programme was initiated in 1946. Provision of STI/RTI care services is a very important strategy to prevent HIV transmission and promote sexual and reproductive health under the National AIDS Control Programme (NACP III) and Reproductive and Child Health (RCH II) of the National Rural Health Mission (NRHM).

Technical strategies reflected in the RCH Programme aim to create a primary health care delivery system, targeted to improve the health of women and children. Similarly, implementation plan for NACP III makes a strong reference to services for prevention and management of STIs/RTIs among high-risk groups, bridge populations and the general population, especially women and youth.

Clearly, the programme and policy environment supports giving emphasis to interventions addressing STIs/RTIs. A large segment of general populations will be reached through the involvement of private practitioners, and overall service utilization is enhanced through demand generation for STI/RTI services

Services rendered in Tamil Nadu

STI programme components include: Risk reduction communication, Referral linkage to ICTC / Govt Health faclities, documentation and reporting. All these programmes are being provided through --

Government facilities:
Syndromic case management (SCM or management of illness based on symptoms) is provided to the general population, bridge population and high-risk individuals (female sex workers, MSM and transgender) through 106 government STI clinics in Tamil Nadu. These clinics are known as ‘Sugavazhvu Maiyam’.

The services are provided at primary health centre level, taluk and non-taluk hospitals and at district HQ hospitals and medical college hospitals. The secondary and tertiary STI clinics also serve as referral sites for STI/ RTI services, and as resource centers for STI/RTI training, monitoring and supportive supervision on a regular basis. The service delivery is entirely supported by NACO through the State AIDS Control Societies (SACS) and District AIDS Prevention and Control Units (DAPCUs).

Private providers:

Health workers (HW), Accredited Social Health Activists (ASHA) and AYUSH practitioners conduct STI/RTI prevention and health promotion activities and refer individuals with STI/RTI symptoms to PHCs, community health centers (CHCs) and franchised allopathic practitioners. STI/RTI clinical services are provided at these locations, using the SCM approach. Laboratory services, wherever available, are used to corroborate syndromic diagnosis (based on symptoms of illness).

TANSACS has also identified community-preferred private providers (CPPP) for providing STI services to the high-risk groups, referred by the Targeted Intervention- linked NGOs.

APAC has also identified and trained community-preferred providers in seven districts. These clinics are known as ‘Nakshatra clinics’ and provide STI services for high-risk groups referred by the NGOs. APAC-VHS supports 80 Nakshtra clinics in collaboration with private practitioners

Tamil Nadu has 102 Targeted Interventions programmes to halt and reverse the epidemic. The Targeted Intervention in Tamil Nadu is implemented through NGOs supported by TANSACS, APAC-VHS-USAID and TAI.

NGO run STI clinics

STI services are also provided in NGO-run Drop in Centers (DICs), where the medical officers provide SCM for high-risk groups.

Syndromic case management (SCM):

Syndromic case management (SCM) is the cornerstone of STI/RTI management under NACP III. The SCM achieves high cure rates because it provides immediate treatment on the first visit, and at little or no laboratory cost. It also provides the other important components of STI/RTI -- uniform case management, treatment compliance and follow-up, counseling, partner treatment and condom promotion.

Pre-packed color coded STI/RTI drug kits are available at all STI clinics for SCM.
Flow charts have been developed to guide the service provider for appropriate SCM.