A woman who walks into a standard family planning clinic in Kenya is often not told an obvious truth – only condoms can protect you from Sexually Transmitted Infections (STIs). For that simple advice, she must go to a separate outpatient clinic, or an STI or HIV clinic.
This needs to change. The recent results of the ECHO study, for which Professor Elizabeth Bukusi and I were lead researchers for the Kenya site at Kemri-Kisumu, provide a sobering reminder of the devastating STI crisis facing girls and women of reproductive age.
We saw high rates of STIs among the women in our study site. One in five had chlamydia, a third had genital herpes (HSV-2), and nearly 5 per cent had gonorrhoea.
Chlamydia is a leading cause of infertility in women, HSV-2 can be managed but is incurable, and we currently have only one drug to treat gonorrhoea, because of its increasing antimicrobial resistance.
While STIs may not be life threatening, they can cause significant health problems if not treated. The ECHO study sought to answer a public health question that had for decades cast a shadow on the use of the injectable contraceptive Depo Provera by women in areas with HIV prevalence.
The purpose of ECHO was to compare the HIV risk associated with three methods – intramuscular Depot Medroxyprogesterone Acetate (commonly known as Depo), Copper Intrauterine Devices (IUDs), and Levonorgestrel (LNG) Implant commonly known as Jadelle. Study countries were Kenya, South Africa, Zambia and Eswatini and involved some 7,829 women.
The study results, which we presented on June 13 in Durban, were met with relief – we found that risk of HIV infection among women using any of the three family planning methods tested was not significantly different. Besides, the three methods were all safe and well accepted, and were excellent at preventing pregnancy.
However, ECHO found a HIV incidence of 3.8 per cent among study participants overall. This high incidence — in study settings where women were offered comprehensive HIV prevention counselling and STI screening and treatment — is another wake-up call that HIV is far from being conquered in our countries.
Sexually active women can choose various methods to prevent HIV and other STIs, from male and female condoms to the daily pre-exposure prophylaxis pill, PrEP. But clearly, these methods are not working.
We need to grasp this opportunity and change our way of working, so that it works for women. Parental and societal stigma against young women seeking reproductive health services must end, through education. The walls separating family planning and STI prevention services in our health system must come down.
In the words of novelist Chimamanda Adichie, there is the danger of a single story. A single story that promotes family planning alone, or HIV/STI prevention alone is dangerous to the lives of young girls and women.
Indeed, if we are to serve the needs of women, the story of family planning, the story of STIs and the story of HIV prevention must be told together and addressed in an integrated manner.