Infectious Diseases in an Age of Change The Impact of Human Ecology and Behavior on Disease Transmission (1995) / Chapter Skim
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Human Ecology and Behavior and Sexually Transmitted Bacterial Infections
Human Ecology and Behavior and Sexually Transmitted Bacterial Infections
Pages 189-212
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From page 189... ...
infection among the top 25 diseases causing loss of healthy days of life in a representative high prevalence urban area of sub-Saharan Africa (1~. The prevalence of bacterial STDs in many developing countries is extremely high (2~.
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From page 190... ...
identify treatment of bacterial STDs as one of three available public health strategies (along with condom promotion and sexual behavior change) for preventing sexual transmission of HIV.
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From page 191... ...
Better definition of the ecologic and behavioral determinants of the emergence of the bacterial STDs—all curable—provides the basic conceptual framework for rethinking prevention and control of STD/HIV in the 1990s. The following discussion begins with current epidemiologic models of STD, then highlights available data on the three direct determinants of the rate of spread of STD, and finally, examines key ecologic and behavioral factors that operate through these direct determinants to explain the emergence of the four major bacterial STDs in developing countries and in subpopulations of the United States.
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From page 192... ...
In summary, STD prevalence and incidence in a particular sociogeographic setting is determined by factors that influence ,`3, those that influence sexual behaviors (mean rate of partner change in the population, variance in rate of change, and patterns of partner mixing) , and those that influence D (availability and use of good STD health care)
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From page 193... ...
Thus absence of the necessary clinical, laboratory, pharmacy, and public health infrastructure results in a very long average duration of infectiousness for bacterial STD. When combined with high-risk sexual behaviors and efficient transmission, very high equilibrium prevalence rates result.
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From page 194... ...
Screening is particularly effective in reducing transmission of chlamydial infection, because of the often silent nature and long duration of infectiousness. In summary, inadequate health services for STD treatment provide an obvious explanation for the high rates of bacterial STD found in developing countries and in the inner cities and rural south of the United States.
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From page 195... ...
, concerning sexual behaviors of men 20-39 years old, appeared in Family Planning Perspectives, March/April 1993. Age and race/ethnicity differences in numbers of sexual partners paralleled age and race/ ethnicity disparities in bacterial STD rates in the United States and the General Social Survey results (33~.
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From page 196... ...
During the AIDS era, gay men decreased risky sexual behaviors, but some young gay men now resume such behaviors. Surveys through 199~1991 do not suggest dramatic reduction in multipartner, casual, or risky sex among heterosexuals, though more recent data are urgently needed.
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From page 197... ...
Other strains that tend to cause disseminated gonococcal infection, with bacteremia and tenosynovitis, are highly susceptible to fecal acids, and uncommon in gay men, perhaps explaining why disseminated gonococcal infection has been relatively uncommon among gay men. ECOLOGIC FACTORS INFLUENCING THE EMERGENCE OF BACTERIAL STD Having considered the three direct determinants of the rate of spread of bacterial STD, we next consider underlying ecologic factors that have influenced the emergence of bacterial STD.
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From page 198... ...
Many tremonematologists believe all clinical and epidemiological differences between venereal syphilis of adults and endemic syphilis in children, and perhaps even between syphilis and yaws, reflect ecologic factors and sexual behaviors, rather than essential differences in pathogenicity of Treponema pertenue (the cause of yaws) and the variants of Treponema pallidum associated with endemic syphilis of children or venereal syphilis of adults.
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From page 199... ...
While sexual behaviors and health care most directly determine the rate of introduction and removal of bacterial STDs in the population, the patterns of introduction, spread, and removal within and between communities are determined by social networks and spatial factors, influenced by urban/community planning and services. War, Travel, and Migration Quinn (46)
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From page 200... ...
This leads in turn to an epidemiologic transition, in which aging of the population, improved economic and health infrastructures, and declining rates of death from childhood communicable diseases result in older average age at death and growing morbidity from noncommunicable diseases of adults. However, in developing countries, especially in Africa and South Asia, birth rates remain high, and child survival improves due to successes of the extended program on immunization, use of oral rehydration solution treatment for diarrhea, and improved care of acute respiratory infection.
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to the size of the older population. The success of child survival programs and comparative failure of family planning programs in sub-Saharan Africa and South Asia have led to an unanticipated stage in the epidemiologic transition (49)
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populations, a steeply rising proportion of children being born to unmarried mothers, fragmentation of the family and community, counter-productive social welfare policies, and a unique form of commercial sex related to use of crack cocaine have been the prime determinants of changing sexual behaviors; and the failure of the public
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From page 203... ...
In a disturbing recent article entitled "The Coming of the White Underclass," Murray (55) argues that this extraordinary increase in births to young poor single women and the resulting family fragmentation are due to social welfare policies that encourage single parenthood, policies that are the root cause of the growing problem with antisocial behavior in young people in the United States.
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Drug Abuse Warning Network (DAWN) surveillance system]
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Crack use leads to several STD risk behaviors, including exchange of sex for drugs or money (62~. New Technology and Product Development Epidemic increases in gonorrhea and other STD in industrialized countries closely followed the introduction of oral contraceptives, which liberalized the sexual behavior of women, increased the efficiency of sexual transmission of chlamydial infection and perhaps of gonorrhea, and decreased condom use for contraception.
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From page 206... ...
As summarized in Figure 6, for any individual, the risk of exposure to an STD depends upon the ecological (i.e., sociogeographic) setting in which partners are chosen as well as upon the individual's own sexual behaviors (such as choice of partner within that setting and frequency of partner change and sexual practices)
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From page 208... ...
are sexual behaviors, the mean duration of infectiousness, and the mean efficiency of sexual transmission of each STD. Underlying ecological and behavioral factors that operate through one or more of these direct determinants lie on a continuum, ranging from those most proximate back to those more remote (in time or mechanism)
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From page 209... ...
(1991) in Research Issues in Human Behavior and Sexually Transmitted Diseases in the AIDS Era, eds.
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(1984) in Sexually Transmitted Diseases, ed.
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From page 211... ...
Sexually Transmitted Bacterial Infections / 211 70. Billy, J
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