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Rumbidzayi Zinyuke
Health Buzz
The phrase “Akarumwa nechekuchera” is not new to many of us.
It is something we used to hear frequently when people spoke about someone who had fallen ill.
Particularly someone who had acquired a sexually transmitted infection (STI) or ‘siki’, as many would call syphilis or any other similar infection.
Back then, it was rare to hear someone openly tell people that they had an STI.
The only way to find out was through the grapevine.
Somehow, everyone knew who had what STI without that person having said a word.
And it was almost always associated with promiscuity.
Till today, no one is willing to speak out about having an STI because they fear the stigma surrounding the disclosure of such.
So they suffer in silence.
But since time immemorial, intimacy has been a significant part of human life. While the act itself ordinarily involves two people, it becomes the world’s problem when sexually transmitted infections start rising.
According to the World Health Organisation, more than 30 different bacteria, viruses and parasites are known to be transmitted through sexual contact.
Some STIs can also be transmitted from mother-to-child during pregnancy, childbirth and breastfeeding.
Eight pathogens are linked to the greatest incidence of STIs, four of which are curable.
These are syphilis, gonorrhoea, chlamydia and trichomoniasis. The other four are viral infections; hepatitis B, herpes simplex virus (HSV), HIV and human papillomavirus (HPV).
Globally, more than 1 million curable sexually transmitted infections are acquired every day among people aged 15 to 49 years.
In 2020 alone, it is estimated that there were 374 million new infections with one of the four curable STIs of which 129 million cases where of chlamydia, 82 million cases of gonorrhoea, 7,1 million of syphilis and 156 million of trichomoniasis.
More than 490 million people were estimated to be living with genital herpes in 2016, and an estimated 300 million women have an HPV infection, the primary cause of cervical cancer and anal cancer among men who have sex with men.
In addition, updated WHO estimates indicate that 254 million people were living with hepatitis B in 2022.
Of course countries in sub Saharan Africa were disproportionately affected, Zimbabwe included.
Statistics show that the incidence of STIs in Zimbabwe has been rising since 2013.
Data from the Ministry of Health and Child Care indicates that in 2023, urethral discharges which constituted about 80 000 cases while other forms of STIs made up about 55 000 cases.
There were also 40 000 estimated cases of genital ulcers recorded.
Over 70 percent of the men who presented with urethral discharge had gonorrhoea.
Worried yet?
These are just but a small portion of the suspected STI burden in the country.
Because many people with STIs are asymptomatic.
This means a huge chunk of people with STIs are walking around with undetected infections and most likely spreading them.
Ministry of Health and Child Care national coordinator for STI prevention and condom distribution, Ms Anna Machiya, said the reported cases are only a small part of a bigger problem.
There is a whole different story underneath the one being told by the statistics.
“The number of officially recorded cases for STIs in Zimbabwe is just but a tip of the iceberg and more numbers are recorded in females as opposed to males. However, what is going unrecorded is what we don’t know, and these are the asymptomatic STIs and they constitute the majority of STIs in Zimbabwe,” she said recently during a Health Communicators Forum media science cafe.
She said the reasons behind the increase in STI trends include inconsistent use of condoms, stock out of STI medicines, drugs and alcohol use which hinder judgement and decisions on safe sex, the issue of user fees associated with seeking health care as well as the asymptomatic nature of STIs where infected individuals continue to spread the STIs unknowingly.
Although the real magnitude of the STI burden is not clear, it is apparent that there is a significant challenge.
So there is need to be worried!
Beyond the immediate impact on the affected people, STIs can have much more serious consequences on their lives in the future.
STIs like herpes, gonorrhoea and syphilis can increase the risk of acquiring HIV.
There are also serious problems that result from mother-to-child transmission of STIs including stillbirth, neonatal death, low-birth weight and prematurity, sepsis and congenital deformities.
HPV infection causes cervical and other cancers while hepatitis B can result in death mostly from cirrhosis and liver cancer. Gonorrhoea and chlamydia are major causes of infertility in women.
These are just a few of the problems that come with STIs.
Yet many people remain in the dark.
Government is running an STI prevention and control programme which aims to prevent the development of diseases, complications and sequelae that follows when STIs are not treated.
It also seeks to interrupt the transmission of STIs using treatment and to reduce the risk of HIV infection.
“The programme also prioritises prevention education and information where the public is educated and informed that STIs are avoidable, treatable and curable and that early treatment is essential.
“They are also informed about the asymptomatic nature of infection in some cases and the recognisable signs and symptoms of STIs to promote the uptake of post exposure prophylaxis (PEP) and Presumptive STI treatment,” added Ms Machiya.
While this is a step towards eliminating the scourge of STIs, more still needs to be done.
The solutions?
Enhanced sexual education
Investing in comprehensive sexual education programmes, starting from schools and extending to communities, is crucial. Educating young people about the risks of unprotected sex, promoting abstinence, and providing accurate information on condom use and other safe sexual practices can help prevent STI transmission.
When used correctly and consistently, condoms are an effective method to protect against STIs and HIV.
“When we look at prevention we also need to look at the social and cultural determinants. Promotion of safer sexual behaviours such as abstinence which is no longer being spoken about. Abstinence still has a place,” said Ms Machiya.
Accessibility to healthcare services
Improving access to affordable and reliable healthcare services, particularly in rural areas, is vital. This includes creating more health centres, increasing the availability of STI testing and treatment, and ensuring the confidentiality of patients seeking medical assistance.
Breaking the stigma
“If you look at stigma, there are two aspects. There is self-stigma. The question is are you comfortable to come and seek help? Or will you stand in line and when you get to the health worker you report a different illness to the one which brought you there in the first place. Of course there are health workers with attitude but a lot of the stigma is also within the individuals affected by STIs,” she said.
There is need for more efforts to destigmatise STIs, promoting open conversations that encourage individuals to seek proper testing and treatment without feeling ashamed. By normalising discussions around sexual health, community awareness and support for prevention and regular check-ups can be increased.
“We also need to have some surveillance that gives us an indication as to how big the problem of STIs in the country is. Without data on the magnitude of STIs, it is difficult to know what is happening. What we see now are those that become sick and present at our facilities. So the ones that are asymptomatic continue to spread,” noted Ms Machaya.
The WHO recommends countries to enhance syndromic management by gradually incorporating laboratory testing to support diagnosis.
This is the direction that Zimbabwe is moving towards.
Also the availability of much cheaper point of care tests makes it easier for the country to be able to screen more people.
Currently, health facilities offer point of care tests where people who present with symptoms and pregnant women are tested for both syphilis and HIV at the same time.
As more investments are made in proactive measures to fight STIs now, not only will this safeguard the people but also contribute to a healthier Zimbabwe.
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