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Sexually transmitted disease (STD) case management was evaluated through observation and interviews at 2 urban and 4 rural health centres and 2 district hospital STD clinics in one urban and 2 rural districts in Central Province, Zambia. The analysis was limited to 59 patients (42 men and 17 women) who paid first visits for their disease and were managed by a clinical officer. The evaluation suffered from the lack of a standard for case management. Results showed that the patients engaged in risky sexual behaviour without being aware of the risks. At the health institutions, few patients were informed about condoms, the risk of HIV, and abstinence from sex during treatment and few were asked to notify their partners. Clinical officers with special STD training performed better than others but sill informed only one-fifth of the patients. Few clinical officers managed patients according to the syndromic approach recommended by the STD control programme. [ABSTRACT FROM AUTHOR]

Clinical diagnosis of STDs is unreliable and therefore constitutes a poor basis for choice of treatment. A syndromic approach has been suggested to increase effectiveness of treatment in resource poor settings. Algorithms for the treatment of STD syndromes were evaluated. A total of 436 patients were followed; cure rates were defined and estimated for genital ulcer disease (GUD), urethral and vaginal discharge. Cure rates for the discharge syndromes were high, 97-98%, for both sexes. The cure rate for GUD was 83% for female and 69% for male patients. A higher prevalence of syphilis in the female study population probably contributed to this. It is likely that a large proportion of the treatment failures were due to decreased susceptibility of Haemophilus ducreyi to trimethoprim-sulpha. The determination of cure rates met with a number of methodological problems. This makes it difficult to evaluate the algorithms as part of routine activities, as suggested earlier by WHO. [ABSTRACT FROM AUTHOR]

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Aims : Building on the experiences of an initial study in 1993, the current survey was conducted to enhance understanding of men's sexual health and prospects for behaviour change in Chiawa, rural Zambia. Methods : Seventy-nine randomly selected men in the age range 16-25 years were interviewed using a questionnaire. Results : The obstacles to good sexual health reported were: inadequate access to health facilities (35%); unemployment (24%); diseases in general (20%); and HIV/AIDS (17%). Nineteen (24%) had suffered from an STI in the past. Five (13%) of the married and 16 (33%) of the single men had extra or pre-marital relationships at the time of the interviews. In 1993, 50% of the single men had pre-marital relationships. A real man ( murume chaiye ) was considered to be married, have children, have a job and sexually satisfy his wife; 97% considered themselves to be real men. Some 91% perceived themselves to be at risk of HIV infection; 76 (96%) were aware that HIV could be passed from mother to child, although 51 (61%) would not think about HIV when making decisions about having children. Sixty-eight (86%) believed that condoms could reduce the risk of HIV and 27% used condoms all the time they had sex. In 1993, 6% used condoms all the time they had sex. Conclusions : There are prospects for behaviour change among the men. Prevention messages need to build on what they already know and practise. The messages must aim to change their local sexual norms, which perpetuate risky practices. [ABSTRACT FROM AUTHOR]