2010-04-14
Despite advances in prevention and treatment of sexually transmitted infections(STI), STI is still a major cause of morbidity and mortality in a global perspective.
In Sweden, there are more people than ever living with HIV, while chlamydia has increased by over 200 percent since 1997. In line with the increase in STI, the numbers of induced abortions are increasing in all age groups except among teenagers.
The work to prevent sexually transmitted infections is therefore also important for
avoiding unintended pregnancies. These two topics overlap each other and prevention efforts should be coordinated nationally, regionally and locally. It is evident that there is room for more action in society to reduce sexual risk-taking in order to reduce the spread of infection and unplanned pregnancies. More knowledge is also needed about effective methods for the client-centred work in primary care.
The purpose of this report is to present knowledge in effective counselling
methods feasible in primary care settings, which can prevent sexual transmitted
infections and reduce sexual risk taking. The report is based on an American systematic review. The majority of the 21 articles are based on randomized controlled trials that evaluated different types of behavioural counselling methods. These methods were defined as any intervention that included some provision of education, skills training, and/or guidance on how to change sexual behaviour, delivered alone or in combination with other interventions intended to promote sexual risk reduction or risk avoidance.
Good-quality evidence suggests that behavioural counselling interventions with
multiple sessions conducted in STI clinics and primary care effectively reduces STI incidence in adolescent and “at-risk” adult populations. There is no evidence that the counselling interventions given were harmful or increased the incidence of STIs.
The populations’ risk exposure and the intensity of the intervention are correlated
with the intervention effect on STI incidence and self-reported sexual risk-taking
behaviour. More trials among women than among men were included in the review. Additional trial evidence for both lower-intensity behavioural counselling interventions and lower-risk populations would nonetheless be judicious.
Conclusion: The incidence of sexually transmitted infections and unplanned pregnancies in Sweden are more common in youth groups when compared with the adult population. Adults are therefore conceivably at lower risk than young people to be infected with an STI or become unintentionally pregnant. The potential benefits of counselling interventions are likely to be higher for youth groups. Opportunistic chlamydia screening among adult women in Sweden has not proven effective for reducing the incidence of this STI.
Given the current lack of research and evaluations in the field, the cost in time and money to work with high intensity interventions is significant for primary care actors. Counselling intervention should therefore be prioritized in groups with higher risk, regardless of sexual identity: sexually active teenagers, young adults with many sexual partners, currently or recently infected individuals, girls and women in unplanned pregnancies and their male counterparts.
The studies presented in this review strongly support national educational efforts
in motivational interviewing methodology that professionals in the health care
system have been trained for in recent years in Sweden. These educational efforts should nonetheless be developed and include sexual risk-taking in advisory situations in cases of suspected sexually transmitted infections or unplanned pregnancies, and increase the focus on men’s responsibilities and needs in these issues.
updated Thursday, August 12, 2010
