Sexually Transmitted Infections: Briefing Kit for Teachers WHO/WPRO

WORLD HEALTH ORGANIZATION

Regional Office for the Western Pacific

SEXUALLY TRANSMITTED INFECTIONS:
BRIEFING KIT FOR TEACHERS

2001

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Sexually Transmitted Infections: Briefing Kit for Teachers WHO/WPRO

Contents

Abbreviations and Acronyms v

Acknowledgements vi

Foreword 1

1. UNDERSTANDING SEXUALLY TRANSMITTED 3
INFECTIONS

How are STI transmitted? 4

How does someone know if he or she has an STI? 4

What are the links between STI and HIV? 5

What is risky behaviour? 5

What factors are contributing to the spread of STI? 6

What are the effect of STI on health? 7

What are the most appropriate measures for 7
prevention or treatment?

2. STI EDUCATION 9

Why is STI education important for young people? 9

Why are teachers the appropriate people to give STI 10
Education to young people?

What are the barriers to STI education? 11

What is the impact of STI education on young 12
people?

Specific issues concerning STI and young people 13

3. UNDERSTANDING YOUNG PEOPLE’S 15
BEHAVIOUR

Why and how do young people get STI? 15

What are the social and biological factors? 15

How important is peer pressure? 16

What is the role of self-esteem? 17

What are the specific risks for adolescents? 18

What is meant by teenage feelings of 19invulnerability?

TEACHING STI PREVENTION 21

What skills do teachers need to educate young 21
people about STI?

Which teachers can teach STI? 21

How can teachers implement STI education 22
programmes?

How to encourage long term healthy habits in 23
young people?

How to handle the sensitive issue of condom use? 25

What are the most appropriate strategies for 25
teaching STI in schools?

ANNEX

RESOURCES FOR STI EDUCATION 29

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Sexually Transmitted Infections: Briefing Kit for Teachers WHO/WPRO

Abbreviations and Acronyms

AIDS acquired immunodeficiency syndrome

IEC information, education and communication

HIV human immunodeficiency virus

STI sexually transmitted infections

UNAIDS Joint United Nations Programme on HIV/AIDS

WHO World Health Organization

WPRO Western Pacific Regional Office

ACKNOWLEDGEMENTS

The Western Pacific Regional Office of the World Health Organization would like to thank Marie-Noelle Belot for her contribution to this publication.

WHO Library Cataloguing in Publication Data

Sexually Transmitted Infections: Briefing Kit for Teachers

. Sexually transmitted infections - prevention and control. 2. Teachers. 3. Briefing Kit
I. World Health Organization. Regional Office for the Western Pacific.

ISBN 92 9061 156 1

The World Health Organization welcomes requests for permission to reproduce or translate its publications, in part or in full. Applications and enquiries should be addressed to the Office of Publications, World Health Organization, Geneva, Switzerland or to the Regional Office for the Western Pacific, Manila, Philippines which will be glad to provide the latest information on any changes made to the text, plans for new editions, and reprints and translations already available.

The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries.

The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters.

iii

Sexually Transmitted Infections: Briefing Kit for Teachers WHO/WPRO

1. FOREWORD

The impact of sexually transmitted infections (STI) among the world’s youth has become a cause of great concern. In most countries, people below 30 years of age account for the majority of STI patients; worldwide, over half of all new HIV infections are among young people aged 15-24.

This publication, Sexually transmitted infections: a briefing kit for teachers, is meant for secondary and further education teachers who work with young people. It is a response to a growing need for accurate information on STI, aimed at young people, as a first step towards STI prevention. Teachers are excellent channels for STI education because they are close to young people and are experts in education.

The purpose of this publication is to inform teachers about STI and their consequences for the health of young people. It contains key information on STI, as well as suggestions for teaching STI education. It aims to improve the capacity of teachers to provide accurate and appropriate information on STI.

Young people need information and services to protect themselves from STI. WHO will continue to support Member States in promoting education and services for the young. It is hoped that this work will help to enhance partnerships with young people, parents, teachers, communities, leaders and decision-makers so that we can provide a healthier and better future for the next generation. Together this can be achieved.

Dr. Shigeru Omi

Regional Director

World Health Organization

Office for the Western Pacific

1 UNDERSTANDING SEXUALLY
TRANSMITTED INFECTIONS

There are more than 20 different STI, but the four most common are:

· syphilis;

· gonorrhoea;

· chlamydiosis; and

· trichomoniasis.

All four can be cured easily provided that adequate antibiotic treatment is given. Other common STI which cannot be cured, include:

· herpes;

· hepatitis B and C; and

· the human immunodeficiency virus (HIV) which leads to the acquired immunodeficiency syndrome (AIDS).

WHO estimates that each year there are more that 300 million new cases of curable sexually transmitted infections (STI) worldwide. The majority of these infections are among 15-30 year-olds.

STI have been shown to increase the risk of transmission of HIV, the virus that causes AIDS. Worldwide, there are more than 30 million people living with HIV. Over 20 million have already died due to AIDS.

More than half of all new HIV infections are among young people aged 15-24 years. Worldwide, about 7000 young people get infected with HIV every day. The main mode of HIV transmission is unprotected heterosexual intercourse.

How are STI transmitted?

Transmission channels are:

· sexual contact;

· blood transfusions;

· blood-to-blood contact; and

· from mother to child.

The most common way is sexual intercourse, without a condom, with an infected partner. Infection becomes possible through unprotected penetrative intercourse, whether vaginal or anal. In some cases, transmission can also occur with oral sex.

Transmission can occur through transfusions with blood or blood products that have not been adequately tested for HIV, hepatitis B or C, or syphilis. Fortunately, transmission through blood transfusion is becoming less frequent due to controls on the quality of blood testing in most countries.

The sharing of needles or knives contaminated with fresh blood can also result in STI infection. Other causes include blood-to-blood contact through abrasions, cuts or open sores on the body. Syphilis, HIV, and hepatitis B and C are the most common infections resulting from such blood-to-blood contact.

STI, including HIV, can also be transmitted from a mother to her infant. HIV and syphilis can be transmitted to an unborn infant during pregnancy, while gonorrhoea and chlamydia infections might occur at delivery. HIV infections can be transmitted before birth, at birth, or after birth (through breast-feeding).

How does someone know if he or she has an STI?

It is important to remember that often STI do not have any symptoms. In particular, women with STI may not know for a long time that they are infected, although in the
meantime they can infect others.

Symptoms of common STI, other than HIV, in men and women include:

· a discharge from the genital area, including a yellow/green fluid from the vagina or penis;

· a burning sensation during urination;

· ulcers or sores in the genital area;

· itching in the genital area;

· pain in the lower abdomen; and

· sometimes, fever.

What is risky behaviour?

Behaviour increasing the risk of contracting an STI includes:

· having sexual intercourse with many partners, without using a condom;

· having a partner who has many sex partners;

· having sex with commercial sex workers, without using a condom;

· continuing to have sexual contact with symptoms of an STI and without using condoms;

· not getting any treatment for an STI; or

· not taking the medication prescribed for an STI correctly, or not finishing the treatment.

What factors are contributing to the spread of STI?

Several factors are influencing the spread of STI. These include:

People are tending to have sexual relationships at an earlier age and to have more sexual partners, particularly in urban areas where there is less social and family control.

In some areas, prostitution is increasing rapidly because of poverty and lack of access to employment opportunities for young women. Prostitutes and their clients are at high risk of STI infection

Ignorance is the most common factor contributing to the spread of STI, including HIV, especially among poor and less educated sections of the population. Such people may not know about the existence of STI, may have no information about how to prevent them, and may not know how to recognise the symptoms or seek help and treatment. Young people may also be scared to take advice from adults.

Young people looking for unfamiliar sex partners in new places to overcome their loneliness are an important factor in the spread of STI/HIV. Such behaviour is often found among those who leave their homes to see new places, seek adventure and entertainment, or find better work as migrant labourers, and also among immigrants. Lonely migrant labourers may unknowingly accept the company of infected sexual partners and then spread the infection to other sexual partners, including their wives.

People, such as soldiers, who may be quite young, or others with jobs involving daily exposure to risks, stress and danger may become indifferent towards risky behaviour. They may not care about the long-term risks posed by STI.

People, particularly young persons, who are already infected with an STI or have developed AIDS may feel so ashamed about the social stigma attached to those Infections that they may not seek adequate advice, help and treatment. At the same time, those who are not yet infected may be reluctant to protect themselves during sexual intercourse because of the stigma that is still attached to the use of condoms. Although this stigma affects both sexes, its impact is usually more severe on women, who risk being beaten or thrown out of their homes, even if their sexual partner or husband was the source of their infection. It is even worse for a teenage girl, who may be rejected by her family.

What are the health effects of STI?

The physical and psychological consequences of STI can be serious. Left untreated, STI can prevent men or women from being able to have children. Women with STI may give birth to infected babies with severe health problems, including blindness. There is no cure for HIV infection and most people infected will die within an average of 10 years.

STI are especially serious because, in many cases, infected people may have no symptoms. Women or men could have an infection for many years without knowing it. During all this time, the infection could be causing serious damage to their reproductive and other health systems.

What are the most appropriate measures for prevention or treatment?

The chief requirements for STI prevention and treatment are education, accurate information and the availability of adequate health services. If untreated, STI can lead to infertility, abortion, cervical cancer, blinding eye infections in infants and even death from HIV infection. Young people must understand at least the following about STI:

· the risks arising from STI, in particular the risks of becoming infected with HIV and the potential for death;

· the need to take preventive measures;

· the importance of knowing whom to turn to in case of need, including health and support services in the local community;

· the necessity for quick treatment if infected;

· that untreated STI can lead to infertility in women and men;

· the importance of getting the right treatment from a qualified medical professional, instead of getting medicines from a friend;

· the importance of taking the necessary treatment correctly, and completing it; and

· the importance of referring the sexual partner from which the disease was contracted.

2. STI EDUCATION

Why is STI education important for young people?

Adolescence is a period of profound physical, mental and emotional development. With improved nutrition and standards of living, young people are maturing physically much earlier than in previous generations. They are also going to school longer and marrying later. This means that, in many cases, young people may be physically mature and feeling all of the sexual and relationship desires of adults, while still unmarried.

Additionally, as a part of healthy development, adolescents tend to experiment with adult behaviour. Young people today are also exposed to a changing world, with relaxing social norms and greater expressions of sexuality in the media than ever before.

The combination of these developments leads some young people into experimentation with sexual activity before marriage. Around the world, the average age of starting sexual activity is generally falling, despite strong cultural values against premarital sex in most cultures. Generally, young men begin having sex earlier than young women, and values for premarital chastity for women still exist in many societies. The nature of sexual activity before marriage varies from place to place. In some cultures, young men will have their first sex with a commercial sex worker; in other cultures, this will be with a girlfriend; and, in some countries, premarital sex is largely limited to engaged couples.

The lives of young people today are very different from those of previous generations. For example, they are more likely to live in cities that offer many kinds of entertainment, including those that might promote unhealthy behaviour. Movies, plays and magazines in the city may offer approaches to sexuality that influence young people to adopt risky activities. Alcohol, tobacco and Illegal drug use are common throughout the Region. Young people may also be exposed to groups with very different values from those of their parents.