This document discusses sexually transmitted infections (STIs) in the Eastern Mediterranean Region (EMR). It provides estimates of STI incidence and prevalence in the EMR, showing that 34 million new STI cases were reported in 2016. It also discusses challenges related to awareness, knowledge, beliefs and attitudes towards STIs in the region. Some countries have national STI policies, but implementation is slow due to lack of resources and infrastructure. The document highlights regional best practices like Marsa in Lebanon and opportunities to expand integrated STI services, prevention interventions, and advocacy. Overall, it analyzes the regional situation of STIs and identifies socio-cultural barriers to effective prevention and management in the EMR.
Using Everett Rogers' Diffusion of Innovations Theory an intervention for automatic STI screening for adolescents is applied to primary care settings in Baltimore, Maryland.
Global Medical Cures™ | HIV among YOUTH
DISCLAIMER-
Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
Using Everett Rogers' Diffusion of Innovations Theory an intervention for automatic STI screening for adolescents is applied to primary care settings in Baltimore, Maryland.
Global Medical Cures™ | HIV among YOUTH
DISCLAIMER-
Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
Join us as we discuss best practices for integrating HIV prevention (e.g. HIV testing, PrEP and linkage to care) into primary care within the context of enhancing clinical workforce development.
Panelists:
• Marwan Haddad, MD, MPH, AAHIVS, Medical Director, Center for Key Populations, Community Health Center, Inc.
• Jeannie McIntosh, APRN, FNP-C, AAHIVS, Family Nurse Practitioner, Center for Key Populations, Community Health Center, Inc.
WHO statistics indicate that Over 340 million curable and many
more incurable STIs occur each year among women worldwide and that
Non-sexually-transmitted RTIs are even more common. Failure to diagnose
and treat STIs/RTIs at an early stage may result into serious complications
and consequences including infertility, fetal wastage, ectopic pregnancy,
anogenital cancer, premature delivery, as well as neonatal and infant
infections. Proper management of STIs/RTIs also reduce the maternal and
infant mortality. STIs are also known to enhance the spread of HIV infection
in communities. STIs/ RTIs also have negative socio economic impact that
include, increase cost for health service, relationship/ marriage problems
etc.
Join us as we discuss best practices for integrating HIV prevention (e.g. HIV testing, PrEP and linkage to care) into primary care within the context of enhancing clinical workforce development.
Panelists:
• Marwan Haddad, MD, MPH, AAHIVS, Medical Director, Center for Key Populations, Community Health Center, Inc.
• Jeannie McIntosh, APRN, FNP-C, AAHIVS, Family Nurse Practitioner, Center for Key Populations, Community Health Center, Inc.
WHO statistics indicate that Over 340 million curable and many
more incurable STIs occur each year among women worldwide and that
Non-sexually-transmitted RTIs are even more common. Failure to diagnose
and treat STIs/RTIs at an early stage may result into serious complications
and consequences including infertility, fetal wastage, ectopic pregnancy,
anogenital cancer, premature delivery, as well as neonatal and infant
infections. Proper management of STIs/RTIs also reduce the maternal and
infant mortality. STIs are also known to enhance the spread of HIV infection
in communities. STIs/ RTIs also have negative socio economic impact that
include, increase cost for health service, relationship/ marriage problems
etc.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
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The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
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Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
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ASA GUIDELINE
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micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
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2. DEFINITION
• Sexually transmitted infections (STIs) are infections
caused by bacteria, viruses & parasites transmitted
through sexual contact, including vaginal, anal &
oral sex. Some STIs are transmitted through skin-to-
skin sexual contact or through non-sexual means
e.g. from mother to child during pregnancy &
childbirth.
• There are more than 30 known bacteria, viruses &
parasites that cause STIs.
3. RATIONALE - 1/2
• STIs among adolescents are an important problem: In
Although there is a lack of data on the incidence or
prevalence of STIs in adolescents at the global level, where
age-disaggregated surveillance systems exist, a substantial
proportion of STI incidence occurs in adolescents.
• Adolescent girls have greater biological susceptibility than
adult women to some STIs due to the immaturity of the
cervical mucosa & increased cervical ectopy: Adolescent girls
have a greater biological susceptibility. They are also at
greater susceptibility because social norms prevent them
from being well prepared to have safe sex & to refuse unsafe
(or unwanted) sex. Adolescent boys on the other hand
susceptible because they are under pressure to have multiple
partners because of stereotypical masculinity norms. Among
both boys & girls, specific groups are more susceptible
because of their sexual practices.
4. RATIONALE - 2/2
• STIs among adolescents have major health consequences:
STIs can immediate effects such as discomfort and pain. They
can also have serious consequences beyond the immediate
ones including infertility.
• Prevention & management services for STIs have been shown
to be effective: Proven approaches to prevent STIs, to
accurately diagnose them and to cure some STIs and
effectively treat others are available.
• Design & implementation of prevention strategies & access to
& provision of good-quality services need attention: Effective
STI prevention & management services are an urgent need for
adolescents including scale-up of STI case management and
provision of HPV vaccination.
5. HUMAN RIGHTS OBLIGATIONS
• States have obligations to ensure care & treatment
of STIs to adolescents, as part of a package of SRH
services.
• States are obliged to ensure that STI services are
accessible to adolescents, & are free, confidential
& nondiscriminatory.
• States are also obliged to remove barriers such as
third-party consent requirements.
6. KEY CONCEPTS TO CONSIDER
• Adolescents lack knowledge & understanding about
STIs & STI prevention & management services:
Adolescents should be informed about STIS when they
interact with the health system & through educational
outreach. Also HPV vaccination strategies offer opportunity
for educational outreach.
• STI prevention & management services often do
not reach adolescents. If they do, they are often not
adolescent friendly: STI prevention strategies need to be
tailored to reach & meet the needs of adolescents. Further,
efforts are needed to ensure that adolescents know where
and how to seek care for STIs, if & when needed. Finally,
STI management services must be adolescent friendly.
7. Comprehensive Sexuality Education
Filename
REVISED
INTERNATIONAL
TECHNICAL
GUIDANCE ON
CSE
INTERNATIONAL
TECHNICAL &
PROGRAMMATIC
GUIDANCE ON
OUT-OF-SCHOOL CSE
Children & adolescents need
& have a right to sexuality
education.
Sexuality education does not
harm children & adolescents.
Well designed & well
delivered sexuality education
programmes can do them
good.
9. WHO GUIDELINES 1/2
Guidelines on case management
• WHO guidelines for the treatment of Treponema pallidum
(syphilis) (2016).
• WHO guideline on syphilis screening and treatment for
pregnant women (2017).
• WHO guidelines for the treatment of genital herpes
simplex virus (2016).
• WHO guidelines for the treatment of Chlamydia
trachomatis (2016).
• WHO guidelines for the treatment of Neisseria
gonorrhoeae (2016).
• Guidelines on hepatitis B and C testing (2016).
• Guidelines for the prevention, care and treatment of
persons with chronic hepatitis B infection (2015).
• Guidelines for the screening, care and treatment of persons
with chronic hepatitis C infection: updated version (2016).
• Strategies and laboratory methods for strengthening
surveillance of sexually transmitted infections (WHO, 2012)
• Laboratory diagnosis of sexually transmitted infections,
including human immunodeficiency virus (WHO, 2013)
10. WHO GUIDELINES 2/2
Guidelines on public health policy & strategy
development
• Consolidated guidelines on HIV prevention, diagnosis,
treatment and care for key populations: updated version
(2016).
• Prevention and treatment of HIV and other sexually
transmitted infections among men who have sex with
men and transgender people: recommendations for a
public health approach (2011).
• Prevention and treatment of HIV and other sexually
transmitted infections for sex workers in low- and-
middle- income countries: recommendations for a public
health approach (2012).
• Consolidated guideline on sexual and reproductive health
and rights of women living with HIV (2017).
• Comprehensive cervical cancer control: a guideline to
essential practice, 2nd edition (2014).
• Responding to children and adolescents who have been
sexually abused (2017).
• Brief sexuality-related communication: recommendations
for a public health approach (2015).
11. COMPLEMENTARY DOCUMENTS TO WHO’s GUIDELINES
• Global strategy to accelerate the elimination of
cervical cancer as a public health problem (WHO,
2020)
• Global health sector strategy on sexually
transmitted infections 2016-2021 (WHO, 2016).
• World Health Organization. Human papillomavirus
vaccines: WHO position paper, Weekly
Epidemiology Record, May 2017, 92, 241-268
• World Health Organization. Hepatitis B vaccines.
WHO position paper. Weekly Epidemiology Record,
July 2017, 92, 369-392.
• Guide to introducing HPV vaccine into national
immunization programmes. Geneva: World Health
Organization; 2016 (142).
• Scaling-up HPV vaccine introduction. Geneva:
World Health Organization; 2016 (143).
• Sexually transmitted diseases: treatment
guidelines, 2015. Atlanta, GA: Centers for Disease
Control and Prevention; 2015 (144).
• HPV vaccine lessons learnt project overview.
Seattle, WA: PATH; 2015 (145).
12. Specific measures for delivery of services in the
context of
COVID-19 – 1/2
• Inform adolescents where and how to
access HIV and other STI testing and care,
where access is possible, through mass
media and digital media.
• In health facilities, ensure the availability
of HIV and STI diagnostics and
medications are available and that HIV
and STI testing and care are provided
discreetly and confidentially.
• Ensure the availability of condoms and
promote their use.
• Consider waiving restrictions (if these
exist), such as those based on age, marital
status or parental/spousal consent, and
providing services free of charge.
13. Specific measures for delivery of services in the
context of
COVID-19 – 2/2
• Prioritize HIV and other STI testing for
adolescents who are at higher risk of infection
and those presenting with defined conditions
(e.g. screen people with tuberculosis for HIV).
• Encourage adolescents presenting for testing
and care to refer their sexual partners, and/or
offer them the possibility of dispensing
treatment to their sexual partners themselves.
• Where possible, provide home-based HIV and
other STI tests, as well as information about
proper self-sampling and where to send
samples. Establish clear pathways for further
testing
• Where possible, use digital platforms and
mobile health strategies (to minimize clinic
visits) to provide adolescents with test results,
treatment and prevention messaging, while
ensuring privacy and confidentiality.
14. Considerations for resumption of normal services in the
context of COVID-19
• Run catch-up campaigns for HIV and other STI testing.
• Where possible, promote the institutionalization of
good practices in improving accessibility and quality
that were put in place during the period of closures and
disruption.
17. Global and regional situation: STI incidence and prevalence 1
WHO incident case estimates of four curable STIs (Chlamydia, Gonorrhea, Trichomoniasis,
Syphilis) globally and by region, 2016. 34 million new cases were reported in the EMR.
Chlamydia
M 3%, F 3.8%
N gonorrhea
M 0.6%, F 0.7%
Trichomoniasis
M 0.5%, F 4.7%
Syphillis
M 0.69%,
F 0.73%
Prevalence (%)
estimates of four curable
STIs for male (M) and
female (F) ages 15 to 49
years in the EMR, 2016.
18. Regional situation: Awareness, knowledge & misperceptions
• A survey of people aged 18-25 years in Saudi Arabia in 2008 showed: 2
• 56% of women were completely unaware of their sexual health.
• Only 60% knew that condoms do not provide 100% protection from all STIs.
• A study in Iran involving men and women engaged to be married showed: 3
• Only 4.5% people knew that a person with STI does not necessarily look ill.
• 78% were not aware that painful urination could be a sign of an STI.
• 51% were not aware that the presence of sores in the genital area is an STI
symptom in both men and women.
• A study in Egypt and the United Arab Emirates (UAE) involving university and
college students showed: 4, 5
• Only 20% of the participants knew that if one person is infected, sexual
partners need to be tested and treated (Egypt).
• Almost 70% believed that they are more likely to be infected when they are
menstruating, sharing toilets, using swimming pools as well as physical
contact such as hand shaking or hugging (UAE).
19. Negative beliefs and attitudes towards people with STIs and about the provision
of SRH education & services are prevalent in the region.
• Pakistan study (2013) 6
• Women with STI tend to be subjected to more blame and judgment
compared to men, and this gender-related discrimination was considered
normal.
• More women than men believed that there is no need for sexual
education for Muslims, believing that STIs are not an issue among them.
• Saudi Arabia study (2008) 2
• Although, 90% believed that their partners had the right to know if they
had an STI, 55% said they would ask for a divorce if their partner had an
STI.
• Iran study (2013) 3
• 62% believe that education about STIs and unintended pregnancies does
not lead to premarital sex.
• 62% males and only 27% of females believe that all young adults should
have access to contraceptives including condoms before marriage.
Regional situation: Beliefs & attitudes
20. Policy situation for STI prevention & care in the EMR 7
According to the Regional Health Policy Survey 2019;
• 13/16 countries have a national policy/guideline for STI diagnosis,
treatment, and counseling.
• 9/16 countries reported having a national policy/guideline that aligns with
the Global Health Sector Strategy on STIs (2016-2021) or latest WHO
guidelines.
• 8/16 countries stated that the national policy on STIs requires the use of a
STI surveillance system to monitor the progress to global STI targets.
• 11/16 countries have a national policy/guideline that aims to reduce N.
gonorrhea incidence.
21. I. Slow policy adoption: Discrepancies between policy formulation and its
implementation, which may be due lack of resources, infrastructure and
finances.
II. Lack of knowledge: Sexual health is not taught in any formal setting in most
countries of the Region leading to poor knowledge of sexual and reproductive
health among adolescents. For example, the study in Saudi Arabia showed that
the major sources of information on STIs among respondents were internet
(87%), books (73%), TV/radio (62%), friends (55%), newspapers/ magazines
(50%), and family (37%). 3
III. Age restrictions: Placing the conventional or widely accepted legal age of
consent at 18 years and ambiguous policies prevent access to HIV testing among
minors who are sexually active and are at risk of HIV infection. 8
IV. Misconceptions among both educated and uneducated populations. For
example, a study examining physicians’ knowledge in Saudi Arabia reported that
almost half of them identified casual kissing as a mode of HIV transmission. 9
Regional Challenges
22. V. Socio-cultural factors: Conservative views and social disapproval of sexual
health education significantly influence sexual health awareness and safer sex
practices.
VI. Low perceived risk: Due to social and cultural factors, STI rates are not
commonly reported in many countries, which might contribute to the
perception of low risk among many Muslims countries as highlighted in a
systematic review looking at the attitudes among Muslim women. 10
VII. Service providers’ attitude: Negative and judgmental attitude of the care
providers towards people attending STIs services. 11
VIII. Cost and infrastructure: A study in MENA & North Africa documented that
reasons for not using condoms included partners’ refusal, high condom prices,
and low perceived risk of infection. 12 Countries like Afghanistan, Sudan and
Yemen and Syria with humanitarian settings have poor infrastructure and
significant gaps in provision and access of these services. 13
IX. Weak Health Information System: Low reporting of STIs have bearing on
disease burden, for example low reporting on HPV and its relationship with
cervical cancer.
Regional Challenges
23. Regional best practice initiative
Marsa in Lebanon 14
Services:
• Information and education provision
• Voluntary counseling & testing for STIs and HIV
• Cervical cancer screening
• Medical consultation with family doctors and
dermatologists, with specialty skills in STI
management
• Psychosocial counseling and alternative therapies
• Promotional outreach campaigns (e.g., on how to
use condoms)
Marsa is an NGO in Beirut, which established a holistic sexual health center in 2011 with
support from WHO, the Medico and Arabic Foundation for Freedom and Equality (AFE),
and the National AIDS Program (NAP).
Aim: To provide SRH services to adolescents, adult women, and socially and/or
economically vulnerable groups with a multidisciplinary team in a safe, welcoming,
accessible, and friendly environment that is free of judgment and bias.
Key features of the services:
1. Provision of a comprehensive
package of services
2. Assurance of a non-judgmental
environment with full autonomy
and confidentiality for patients
3. Provision of services by a highly
trained and friendly team
24. Regional opportunities 15
1. Increase access and coverage to testing and treatment of STIs.
2. Where feasible, promote integration of STI services into other programs e.g.,
HIV and hepatitis.
3. Adopt the use of the new multiplex technologies for diagnosis e.g., dual
testing of HIV and Syphilis.
4. Promote the use of prevention interventions to high-risk groups.
5. Resource mobilization for STI programs.
6. Continued advocacy at policy level.
These are aligned to the WHO’s Global Health Sector Strategy on STIs, and EMR
Regional Framework and Action Plan for STI prevention and control, which emphasize
the need for an integrated approach to STI prevention and control through securing
universal access to sexual and reproductive health-care services and rights.
25. References
1. World Health Organization Global adult estimates of chlamydia, gonorrhoea, trichomoniasis and syphilis including maternal
and congenital syphilis, 2016. World Health Organization; 2020 Mar. Available from:
https://www.who.int/reproductivehealth/topics/rtis/STIs-Estimates.pdf?ua=1
2. Fageeh WM. Awareness of Sexually Transmitted Diseases among Adolescents in Saudi Arabia. JKAU Med Sci. 2008 Jan
1;15(1):77-90. http://dx.doi.org/10.4197/med.15-1.7
3. Khajehei M, Ziyadlou S, Ghanizadeh A. Knowledge of and attitudes towards sexual and reproductive health in adults in
Shiraz: a need for further education. East Mediterr Health J. 2013 Dec;19(12):982-9. PMID: 24684095.
4. El Gelany S, Moussa O. Reproductive health awareness among educated young women in Egypt. Int J Gynaecol Obstet.
2013 Jan;120(1):23-6. doi: 10.1016/j.ijgo.2012.07.027. Epub 2012 Oct 23. PMID: 23099050.
5. Haroun D, El Saleh O, Wood L, Mechli R, Al Marzouqi N, Anouti S. Assessing Knowledge of, and Attitudes to, HIV/AIDS
among University Students in the United Arab Emirates. PLoS One. 2016 Feb 25;11(2):e0149920. doi:
10.1371/journal.pone.0149920. PMID: 26913902; PMCID: PMC4767799.
6. Farid-ul-Hasnain S, Johansson E, Gulzar S, Krantz G. Need for multilevel strategies and enhanced acceptance of
contraceptive use in order to combat the spread of HIV/AIDS in a Muslim society: a qualitative study of young adults in
urban Karachi, Pakistan. Glob J Health Sci. 2013 May 27;5(5):57-66. doi: 10.5539/gjhs.v5n5p57. PMID: 23985107; PMCID:
PMC4776849.
7. WHO Regional Office for the Eastern Mediterranean. Regional report on reproductive, maternal, newborn, child and
adolescent health policy survey 2019. (unpublished report). For more details contact siddeegk@who.int
26. References
8. Fox K, Ferguson J, Ajose W, Singh J, Marum E, Baggaley R. Adolescent consent to testing: a review of current policies and issues in
sub-Saharan Africa. In: HIV and adolescents: Guidance for HIV testing and counselling and care for adolescents living with HIV:
Recommendations for a public health approach and considerations for policy-makers and managers. World Health Organization;
2013. ANNEX 15. Available from: https://www.ncbi.nlm.nih.gov/books/NBK217954/
9. Mahfouz AA, Alakija W, al-Khozayem AA, al-Erian RA. Knowledge and attitudes towards AIDS among primary health care physicians
in the Asir Region, Saudi Arabia. J R Soc Health. 1995 Feb;115(1):23-5. doi: 10.1177/146642409511500108. PMID: 7738977.
10. Alomair N, Alageel S, Davies N, Bailey JV. Sexually transmitted infection knowledge and attitudes among Muslim women worldwide:
a systematic review. Sex Reprod Health Matters. 2020 Dec;28(1):1731296. doi: 10.1080/26410397.2020.1731296. PMID: 32202220.
11. George P, Lennox Terrion J, Ahmed R. Reproductive health behaviour of Muslim immigrant women in Canada. International Journal
of Migration, Health and Social Care. 2014 Jan 1;10(2):88-101. http://dx.doi.org/10.1108/IJMHSC-09-2013-0032
12. Gökengin D, Doroudi F, Tohme J, Collins B, Madani N. HIV/AIDS: trends in the Middle East and North Africa region. Int J Infect Dis.
2016 Mar;44:66-73. doi: 10.1016/j.ijid.2015.11.008. PMID: 26948920.
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2018. UNAIDS; 2018. Available from: https://www.unaids.org/sites/default/files/country/documents/AFG_2018_countryreport.pdf
14. Marsa sexual health center. About us. Marsa; c2021. Available from: https://marsa.me/about-us/
15. World Health Organization. Global health sector strategy on sexually transmitted infections 2016-2021: toward ending STIs. World
Health Organization; 2016. Available from: https://apps.who.int/iris/bitstream/handle/10665/246296/WHO-RHR-16.09-eng.pdf
Editor's Notes
This is the first of two slides that set out the rationale for investing in STI in adolescents.
This is the second of two slides that sets out the rationale for investing in STI in adolescents.
This slide outlines government’s human rights obligations in relation to STI.
This slide lists key concepts to be considered when strengthening STI prevention and care services to meet the needs of adolescents.
This slides lists the WHO guidelines that address STIs in adolescents from a case management perspective. They are either specific to adolescents or are relevant to them, while not being specific to them.
This slides lists the WHO guidelines that address STIs in adolescents from a public health perspective. They are either specific to adolescents or are relevant to them, while not being specific to them.
Fear of family members, friends and others learning about their STI, prevents many adolescents from seeking care.
Eleven of the responding countries have a national policy/guideline that contributes to the reduction in N. gonorrhea incidence.
“Consent is defined as the agreement, expressed either verbally or in writing, to a proposed action or situation. For purposes of medical intervention or research, consent given by a subject for a procedure, course of treatment, or any other health intervention to be performed, must be informed. The subject should receive information about the intervention and must indicate that they understand the possible risks and/or benefits of participation; and, if consent is given, that it has been done so voluntarily without any feeling of coercion. Therefore, informed consent must be given by someone who has the competence to understand the elements of the intervention and the consequences of making the choice to receive the intervention”. (Fox et al., 2013 p. 3)
“The central issue in the debate over minor rights to health interventions is finding the balance between the parental responsibilities toward the adolescent, the immaturity and vulnerability of adolescent children, and his or her right to be emancipated from the decision of the parent. As a result, a patchwork of laws has been produced, making it difficult to make any overriding statements about minor and parental rights regarding medical treatment. This highlights the acknowledged conflict between the rights of the adolescent—under the Convention on the Rights of the Child—and that of the parent or guardian who understands themself to have the legal right to make medical decisions for his or her child. For adolescents, limiting the right of consent to HIV testing to parents or guardians, has serious potential implications. Studies have shown that requiring parental consent to HTC services might in fact reduce adolescent access because of perceived negative reactions from parents/guardians or health-care providers and the fear of HIV-related stigma. It has also been documented that adolescents may opt not to seek care because they want to avoid telling their parents about their health problems and sexual activities”. (Fox et al., 2013 p. 3-4).
Fox K, Ferguson J, Ajose W, Singh J, Marum E, Baggaley R. Adolescent consent to testing: a review of current policies and issues in sub-Saharan Africa. In: HIV and adolescents: Guidance for HIV testing and counselling and care for adolescents living with HIV: Recommendations for a public health approach and considerations for policy-makers and managers. World Health Organization; 2013. ANNEX 15.
According to the Health Belief Model, low perceived vulnerability is a risk factor as it reduces the individual’s motivation to take protective measures.
Through its comprehensive service provision, Marsa aims to equip its beneficiaries with needed sexual health education since it is lacking within the majority of people living in Lebanon. With the knowledge gained at the center, young individuals will be capable of determining the appropriate safer sexual practices that suit their needs; thus, empowering them to become well informed decision makers when it comes to their sexual health. Additionally, what they learn at Marsa will help foster healthy standards of communication with their partners, encouraging better decisions regarding their sexual health, and that of their partners.
Clients at Marsa can also get screened for sexually transmitted infections for free or at a subsidized price by highly skilled medical professionals who have ample experience and are familiar with the social constraints surrounding sexual health in Lebanon and the region. These medical services are complimented by psychosocial and alternative therapies that cater to the emotional well-being of the clientele. An internal and external referral system has been established at the center to provide holistic care to the clients and cater to their every need.
Counseling
Marsa has catered to the psychological and emotional well-being of beneficiaries by providing counseling sessions for subjects falling under the umbrella of sexual health, such as sexual traumas, sexual violence, and various gender and sexuality subject matters. Specialized counseling is also offered for People Living with HIV and other chronic infections to support their adaptation to the newly acquired virus and its implications, to learn that the virus is manageable, and to draw a life map and plan their healthy futures.
Medical consultation
Seven years into its endeavors, Marsa offered medical consultations with family doctors and dermatologists, with specialty skills in sexually transmitted infections management. Clients benefitted from friendly doctors that welcome their intimate details without judgment, stigma or discrimination. Screening for a package of common sexually transmitted infections is available at a subsidized cost in collaboration with a prominent Lebanese hospital.
Marsa sexual health center. Marsa: 7 years young, 2011 – 2017. Marsa sexual health center; [no date]. Available from: https://marsa.me/wp-content/uploads/2019/02/Marsa7YearReport.pdf