To the Editor: It was pleasing to see Bowden and Fethers raising the issue of public health approaches to sexually transmissible infection (STI) control in remote Indigenous communities.1 However, their suggestion that mass treatment programs would be more effective than screening programs is flawed.
They note that screening programs have had some success in reducing the prevalence of STIs, but that an unacceptable prevalence persists. Rather than rejecting screening as an appropriate strategy, it would be more useful to investigate the reasons why screening programs have had limited success. It is likely that the main drawback has been inadequate coverage, and one of the main reasons for this is that there are hard-to-reach groups who are not being included in screening programs. In particular, this would include people with alcohol problems or other addictions, whose lifestyle makes them more at risk for STIs. People in this group, who often live a transient or homeless lifestyle in regional centres, have problems of access to health care and health programs. A mass STI treatment program would not overcome this difficulty and would be just as likely as current screening programs to miss this crucial target group.
What is needed is better support for comprehensive primary health care programs, to allow an extension of current health programs to reach out to these groups. Bowden and Fethers suggest that screening programs are inadequate because of problems with current levels of staffing and health infrastructure. This is what needs to be addressed. Greater support for community-controlled comprehensive primary health care, to ensure adequate levels of staffing and infrastructure for STI screening (including outreach programs for hard-to-reach populations), would produce better results from STI screening and would also allow better control programs for other health problems. Furthermore, it would help reduce the problem of increasing antibiotic resistance that is likely to result from mass treatment programs.
- David J Scrimgeour
- Discipline of Public Health, University of Adelaide, Adelaide, SA.
- 1. Bowden FJ, Fethers K. “Let’s not talk about sex”: reconsidering the public health approach to sexually transmissible infections in remote Indigenous populations in Australia. Med J Aust 2008; 188: 182-184. <MJA full text>