REPRODUCTIVE TRACT INFECTIONS

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					                           REPRODUCTIVE TRACT INFECTIONS

                           Reproductive tract infections (RTI) is made up of the following: sexually trans-
                           mitted diseases (STD), which are infections transmitted through sexual inter-
                           course or intimacy like gonorrhea, syphilis, chlamydial infection, warts and Hu-
                           man Immunodeficiency Virus (HIV)/Acquired Immune Deficiency Syndrome
                           (AIDS); endogenous infections, which are caused by overgrowth of organisms
                           normally present in the vagina like yeast infection and bacterial vaginosis; and
                           iatrogenic infections, which result from medical procedures or instrumentation
                           such as pelvic examination, episiotomy and episiorrhapy, dilation and curettage,
                           catheterization, IUD insertion and abortion performed by modern or traditional
                           health providers.

                           With the advent of AIDS in the Philippines during the 1980s, programs and
                           services for the prevention and control of STDs have been geared toward an
                           integrated approach to these problems. In the late 1990s, with reproductive
                           health as the core framework, a redirection was initiated to expand the program
                           to include other RTIs.

                           Since the time the first AIDS case in the country was reported in 1984 until the
                           end of 1998, a cumulative total of 1,168 HIV positive cases have been reported
                           to the AIDS Registry, 362 had AIDS and 186 have died. Seventy-eight percent
                           of these cases have acquired the disease through sexual exposure. Data on the
                           other modes of transmission are limited.

                           Hardest hit by the virus is the economically productive age group. Among males,
                           the prevalence is highest in the 30 to 39 age groups. Among females, it is highest
                           in the 19 to 29 age group. The disease is higher among males than females at a
                           ratio of 1.4:1. The prevalence of HIV infection in the general population is less
                           than 1 percent.

                           While the reported cases over a decade appear low, it is estimated that in 1999
                           there will be around 35,000 Filipinos infected with HIV, and by year 2000, this
                           may increase to around 43,000. In the 15 years since the virus was reported in
                           the Philippines, the annual average of reported cases has increased from 50 new
                           infections a year between 1987-90 to 100 new infections a year between 1991-
                           97. The highest number of new cases was reported in 1998.




National Objectives for Health
                           National Objectives for Health                                                 69
     The result of the Behavioral Surveillance System (BSS) showed that some
     major determinants for an epidemic to explode have started to surface in the
     Philippines. These include the practice of multiple sexual partners, low con-
     dom usage, sharing of drug injection equipment and increasing rates of syphi-
     lis. Syphilis rates, used as a surrogate indicator for risky behavior, appear
     highest and increasing among freelance female sex workers.

     STDs are considered public health threat because of their devastating compli-
     cations like pelvic inflammatory disease (PID), ectopic pregnancy, infertility
     and neonatal syphilis. In this country, STDs are often underreported and
     misclassified. In the 1997 Regional STD Statistics, diagnosed cases reported
     were highest in Regions 11, 7, 3, 5 and 9. Most common cases were chlamy-
     dia, gonorrhea, trichomonas and syphilis.

     The STD Prevalence Survey done in 1994 among female sex workers (FSWs)
     revealed the prevalence of gonorrhea at 16 percent, chlamydia at 20 percent,
     trichomonas at 18.6 percent and syphilis at 4.6 percent. The survey also showed
     that among ante-natal women who represent the general population, the preva-
     lence of STDs is much lower, with gonorrhea at 1 percent, chlamydia at 6
     percent, trichomonas at 1 percent, and syphilis at 0.5 percent.

     Baseline studies on the other RTIs, particularly on endogenous and iatrogenic
     infections, are yet to be established.

     Despite the apparent low and slow progression of the HIV epidemic in the
     country, it is a major public health problem as no cure and no effective vaccine
     has been discovered yet. With an increasing rate of risk behaviors and fertile
     sociocultural milieu, a single case can grow into hundreds, thousands and
     eventually millions over time. Other RTIs and STDs help in the spread of
     HIV/AIDS. Their prevention and control can be used as an effective strategy
     in curbing the HIV/AIDS epidemic.




70                                                     National Objectives for Health
   Goal: Transmission and impact of HIV/AIDS and other sexually transmitted diseases
         and reproductive tract infections are prevented and mitigated.


                          National Objectives for Health by 2004

                          Health Status Objectives

                          1. Reduce the prevalence rate of STDs and other RTIs.



                                  Special Target             1994 Baseline       2004 Targets
                                   Population              STD Prevalence Survey

                                 Female sex workers
                                    a. Gonorrhea                  16.0%                12.0%
                                    b. Chlamydia                  20.0%                14.0%
                                    c. Trichomonas                18.6%                13.0%
                                    d. Syphilis                     4.6%                 3.0%
                                    e. Other RTIs             Baseline data to be established in 2000
                                 Men having sex with men      Baseline data to be established in 2000
                                 Clients of sex workers       Baseline data to be established in 2000
                                 Women attending ante-natal
                                 clinic
                                    a. Gonorrhea                  1.0%                  0.8%
                                    b. Chlamydia                  6.0%                  5.0%
                                    c. Trichomonas                1.0%                  0.8%
                                    d. Syphilis                   0.5%                  0.4%
                                    e. Other RTIs             Baseline data to be established in 2000


                          2. Confine the annual prevalence of HIV infection.


                                  Special Target             1994 Baseline      2004 Targets
                                   Population                 HIV Sentinel
                                                            Surveillance System

                                  General population             <1%                 <1%
                                  More vulnerable groups         <3%                 <3%




National Objectives for Health                                                                          71
     Risk Reduction Objectives

     1. Increase the proportion of more vulnerable groups who report condom use dur-
        ing their last sexual intercourse at risk.

         Special Target               1998 Baseline          2004 Targets
          Population               Behavioral Surveillance
                                          System

         Registered female sex            69%                   92%
           workers
         Freelance female sex             62%                   75%
           workers
         Men having sex with men          27%                   61%
         Intravenous drug users           29%                   54%


     2. Increase the proportion of more vulnerable groups who have knowledge of three
        correct ways of preventing transmission of HIV infection (staying with one faith-
        ful partner, using a condom during sexual intercourse and making sure that clean
        needles are used when injecting).

          Special Target               1998 Baseline         2004 Targets
           Population                      (BSS)

          Registered female sex            63%                   79%
             workers
          Freelance female sex             60%                   75%
             workers
          Men having sex with men          74%                   88%
          Intravenous drug users           62%                   73%


     3. Reduce the proportion of intravenous drug users who share drug injection equip-
        ment to 40 percent.
        (Baseline: 77 percent in 1998, Behavioral Surveillance System)
     4. Reduce transfusion-transmitted HIV infection to less than 1 percent.
        (Baseline: 1.1 percent in 1998, HIV/AIDS Registry)
     5. Increase the proportion of hospitals with HIV/AIDS Core Team (HACT) prac-
        ticing universal precaution to 100 percent.
        (Baseline data is established in 2000)




72                                                             National Objectives for Health
                     Services and Protection Objectives

                     1.    Ensure in all DOH Regional Hospitals and Medical Centers the capability of
                          providing proper diagnosis, management, care of and support to people living
                          with HIV/AIDS.
                          (Baseline: Only three hospitals in 1998, AIDS/STD Unit)
                     2.   Increase the number of Social Hygiene Clinics (SHC) and regional laboratories
                          with upgraded capability for STD laboratory services to eight and two, respec-
                          tively.
                          (Baseline: Two SHC in 1998, DOH-JICA Project)
                     3.   Increase the proportion of RHUs and SHCs providing STD services using the
                          National STD Case Management Guidelines.
                          (Baseline data is established in year 2000)
                     4.   Increase the number of private medical practitioners providing appropriate STD
                          care.
                          (Baseline data is established in 2000)
                     5.   Establish three sentinel sites in STD surveillance using syndromic reporting.
                          (Baseline: 0 in 1998)




National Objectives for Health                                                                       73