STI precention in Local Public Health: from theory to practice

Sexually Transmitted Infections (STIs) have been recognized as a major public health problem for many years. It is estimated that, worldwide, over 340 million new cases of curable STIs – syphilis, gonorrhea, chlamydia and trichomonas – occur every year in men and women aged 15-49 years. Annually, millions of viral STIs can also be attributed to HIV (2.6 million new cases in 2009, human herpes viruses, human papilloma viruses and hepatitis B virus. In the Netherlands risks groups for STI are young heterosexual people, with the highest Chlamydia positivity rates observed among 15-19 year olds; men having sex with men (MSM), among whom most HIV infections, gonorrhea and syphilis cases are reported; ethnic minority populations originating from HIV endemic countries, female sex workers and their clients and (injecting) drug users. HIV and STI prevention at the Rotterdam-Rijnmond Municipal Public Health Service (MPHS) is performed by the Infectious Diseases Department. Prevention for MSM is performed by outreach work through peer health educators employed by the MPHS, who conduct prevention activities at clubs, bars, sauna and cruising areas. Similarly, a team of peer health educators target migrants and young people for prevention activities, doing so through outreach activities in the communities, on the street and at subway stations; they also target groups of young people outside the school system. Since 2005, these activities have also included vocational schools. Outreach work for sex workers is performed by public health nurses, who visit brothels, bars and clubs. To be most effective, health-promoting interventions should be developed systematically, should draw on both evidence and theory, and be based on a proper analysis of the health problem and behavior. The interventions under study are: 1) health education combined with sexual health services at school sites to promote STI testing for senior vocational students; 2) a short individual counseling to promote safe sex for men who have sex with men; 3) two interventions for peer health educators to promote the use of condoms by heterosexual men with an Afro-Caribbean, Turkish or Moroccan background. This thesis describes the theory- and evidence-based development of each of the interventions in the three projects for preventing HIV/STIs at the Rotterdam-Rijnmond MPHS. The thesis has a dual objective: 1) to assess the effectiveness of the interventions under study, and 2) to evaluate the application of a framework for intervention-development – ‘Intervention Mapping’ (IM) – across the projects.

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