- Keywords > Clinical Practice Guidelines (CPGs)
- Keywords > criteria of medicines selection
- Keywords > HIV infection and STIs
- Keywords > opportunistic infections and other HIV-related
- Keywords > reproductive tract infections
- Keywords > sexual and reproductive health
- Keywords > sexually transmitted infections (STIs)
- Keywords > treatment guidelines
- Keywords > treatment protocols
(2004; 88 pages)
5.6. Access to services
The provision of accessible, acceptable and effective services is important for the control of STIs. In most developing and industrialized countries, patients will have a choice of services from which to seek STI care. Possible sources are within the public sector, the private sector and the informal sector. In ensuring universal access to appropriate STI programmes, it should be recognized that patients seek care from a mixture of these. In many countries most STI care is obtained outside the public sector. Planning of a balanced and comprehensive programme will need to consider strengthening all health care providers that are able to provide STI services.
It is generally argued that high-quality STI care can be delivered by specialist clinical staff in categorical STI clinics, but inaccessibility, unacceptability and the many human and economic resources required make this an impractical method of service provision for the general public.
Although it is recommended that routine STI services be integrated into primary health care, clinics specializing in STIs (sometimes called categorical clinics) may be useful in providing primary care in urban settings for specific groups such as sex workers and their clients, migrant workers, truckers, and any other group with poor access to health care. Additionally, because of a concentration of STI expertise, these clinics can offer referral services for primary care services, hospital outpatient departments, private practitioners etc. In a few selected cases the specialized clinics should also be strengthened as reference centres to provide health care provider training in STIs, epidemiological information (e.g. prevalence of etiological agents within the syndromes and antimicrobial susceptibility), and operational research (e.g. studies on the feasibility and validity of algorithmic approaches).
Adolescents often lack information about existing services (where they are, what times they operate, how much they cost etc). Even if they know of these services they are often reluctant to seek help for diagnosis and treatment. This is due to embarrassment and possible stigma. They also fear negative reactions from health workers and lack of confidentiality. There are initiatives under way in many countries to make health services more adolescent friendly and more responsive to their special needs.