AIDS continues to be the commonest cause of death in Tanzania among those aged between 15 and 45 years. Both ulcerative and non-ulcerative sexually transmitted diseases have been identified as major co-factors in HIV transmission. Certain groups including long distance truck drivers and their sexual partners have been reported as having a disporportionate effect on the transmission dynamics of STD including HIV, in a population. In 1993 African Medical and Research Foundation decided to add an STD component to their HIV/AIDS prevention programme along the Tanzania-Zambia highway which had been targeting truck drivers and their sexual partners through peer education and condom distribution since 1989. A study to evaluate the acceptability and feasibility of four different approaches of delivering STD services, was conducted over a period of one year. The approaches for delivering STD services were: special STD services offered twice a week at a site and at hours of the women's choice, special outreach services once every three months, or STD services integrated into the nearest Primary Health Clinic. Drugs were provided at three of the four interventions. 1,330 women at seven truckstops, participated in the evaluation study. The women were generally satisfied with all approaches that included the provision of drugs. The most expensive and ineffective way of treating STD was by not providing drugs. These findings confirm the fact that it is feasible to provide STD services to women at high risk in HIV high transmission areas. These women would utilise STD services provided in a manner that suits them if mobilised and encouraged by their peer educators.
PIP: Long-distance truck drivers and their sexual partners have a disproportionate effect on the transmission dynamics of sexually transmitted diseases (STDs), including HIV infections, in Tanzania. In 1993, the African Medical and Research Foundation added an STD component (peer education and condom distribution) to its HIV/AIDS prevention program along the Tanzania-Zambia highway. The present study of 1330 women (mean age, 27.3 years) recruited from 7 highway truckstops assessed the acceptability and feasibility of 4 approaches to the prevention of STDs: special STD services offered twice a week at a site and hours chosen by women, special clinic-based outreach services for women once every 3 months, integration of STD services into the nearest primary health care clinic, and provision of STD drugs. Most study participants were local brew sellers (47.2%), bar/guest house attendants (27%), and petty traders (21.1%). The overall HIV prevalence was 50%. Attendance per woman was higher when services were offered outside a health facility (1.23) or at times other than normal clinic hours (1.43) than when STD services were integrated with primary health care (1.0). The total cost per patient was US$11 when the clinic did not provide STD drugs, $12 for special clinic-based services for women, $11.50 for non-clinic-based services, and $11 for the integrated STD/primary health care approach. Women were equally satisfied with the 3 service delivery strategies, but highly dissatisfied when STD-specific drugs were not provided and their infection was not cured.