By Madalitso Wills Kateta:
One afternoon, patients with Sexually Transmitted Infections (STIs) are being turned away from Kochilira Health Centre in Mchinji district because the institution is out of STI drugs.
The medical officer at the clinic, Psyela Kaunda, says this has been the case sometimes for the past five years, and that when the medicines arrive, they only last for some weeks or a month due to high demand for the therapy.
“For the past five years, we have been having the STI medications problem. When the medicines arrive, they last within a week while in some cases some might last for a month,” says Kaunda.
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Untreated STI can cause infertility, birth defects, mental illness, heart disease, and increases the risk of HIV infection. The periodic STI drug shortages means that many infected patients go without medication for extended periods of time, posing a public health concern because untreated individuals return to the community, where the threat of infection becomes a reality.
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According to Kaunda, the clinic gets 600 cases every month on average, and the majority of patients are encouraged to seek treatment at private pharmacies which, in most circumstances, have the drugs.
Kaunda says the area is faced with a huge STI problem because of lack of knowledge on STIs which creates a web of STI infections. She says there is urgent need of awareness on STIs mostly among men who prefer to go for traditional cures to hide an STI infection from their wives.
“The STI medications are not procured by the government. They come as a package with HIV medications and these can’t meet the demand created by the huge STI cases we receive on a monthly basis,” she says.
Professor Adamson Muula, head of community and environmental health at Kamuzu University of Health Sciences, says shortage of STI drug is uncommon and that accurate data is needed to dispute or concur with the assertion.
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“Medicines for the treatment of sexually transmitted infections are the most widely available because they are obtained through an effective and efficient system,” adds Muula.
He says one difficulty could be that some of the medicines used to treat STIs are also efficient in treating other infectious diseases, and that when antibiotics for many other diseases go out of stock, STI treatments can simply be substituted.
Jacob Chatsika, chair of the Health Center Management Committee at Kochilira, says when STI drugs run out of stock, it forces community members to seek traditional medicines which might not be as effective as the clinical medicines.
“Some of the people infected by STIs go to traditional healers for help, but these remedies cannot be as effective as the clinical medicines. And dependence on them [traditional medicines] risks creation of drug resistant strains of STIs,” he said.
Despite the fact that sexually-transmitted infections are on the rise in Malawi, diagnosis and treatment for the infections are lacking, with some health institutions, such as Kochilira, being out of medicines for extended periods of time.
With global statistics indicating an increase in STI infections, the development is concerning for countries such as Malawi, where, despite an increase in STI cases, treatment for the infections is at times be unavailable.
Maziko Matemba, a health rights activist, says a situation where there is lack of STI drugs is concerning because the country’s young population is at high risk of developing sexually transmitted infections.
“Sexually transmitted infections are a major challenge in Malawi, particularly given our younger population and gaps in sexually-transmitted infection treatment coverage,” adds Matemba.
He says while a recent UNAIDS report indicates that Malawi has managed to suppress sexually-transmitted illnesses including HIV and Aids, the increase in adolescent pregnancies and unsafe abortions is a signal that STIs may be on the rise.
“One of the challenges we face is that, while we have many partners in HIV and Aids prevention, STI coverage is funded entirely by local resources,” Matemba explains.
He says there is a need for a reform in how the country manages STI and HIV programmes so that bottlenecks in access to STI services such as testing and treatment are swiftly detected.
He also expresses concern that the majority of STI patients may have HIV, emphasizing the importance of strengthening and enforcing methods for detecting, testing and treating STIs.
“We need to make sure that the issue of STI treatment is addressed so that the diseases do not spread to the general community,” Matemba said.
According to a recent STI landscape analysis by JournAids Malawi several factors, including a lack of STI treatment advocacy by NGOs, are driving the surge in STIs.
The desk review also establishes that while Malawi has developed policies and plans including implementation of programs on Sexual Reproductive Health and Rights, HIV and Aids the documents under these initiatives contain general statements and strategic actions on Sexual Reproductive Health and gender without specifically mentioning STIs.
“It appears that STIs have long been ignored because the HIV and Aids pandemic seems to have overshadowed the response to sexually transmitted infections,” says Dingani Mithi, a project officer at JournAids.
Muula, on the other hand, says STIs have gained public health significance since they are related with HIV, and that any health system strengthening resources directed at supporting HIV and Aids prevention, care and support are also used for STI prevention, treatment and care.
He says the health-care system has improved as a result of HIV and Aids, and that the pandemic cannot be blamed for ruining the system.
While data on STI prevalence is hugely missing, the 2015 to 2016 Demographic Health Survey monitoring report on STIs indicates that 15 percent of women and 10 percent of men in the age group 15-49 reported had an STI or symptoms of an STI 12 months prior to the survey.
