WHO global research priorities for sexually transmitted infections.

Sexually transmitted infections (STIs) are widespread worldwide and negatively affect sexual and reproductive health. Gaps in evidence and in available tools have long hindered STI programmes and policies, particularly in resource-limited settings. In 2022, WHO initiated a research prioritisation process to identify the most important STI research areas to address the global public health need. Using an adapted Child Health and Nutrition Research Initiative methodology including two global stakeholder surveys, the process identified 40 priority STI research needs. The top priorities centred on developing and implementing affordable, feasible, rapid point-of-care STI diagnostic tests and new treatments, especially for gonorrhoea, chlamydia, and syphilis; designing new multipurpose prevention technologies and vaccines for STIs; and collecting improved STI epidemiologic data on both infection and disease outcomes. The priorities also included innovative programmatic approaches, such as new STI communication and partner management strategies. An additional six research areas related to mpox (formerly known as monkeypox) reflect the need for STI-related research during disease outbreaks where sexual transmission can have a key role. These STI research priorities provide a call to action for focus, investment, and innovation to address existing roadblocks in STI prevention, control, and management to advance sexual and reproductive health and wellbeing for all.

Sexual Health and Wellbeing through the Life Course: Ensuring Sexual Health, Rights and Pleasure for All.

This commentary summarizes the context and positioning of sexual health, sexual rights and sexual pleasure, as three interlinked and indivisible aspects of sexual health and wellbeing (SH&W). In turn, sexual health is a major domain within broader sexual and reproductive health and rights (SRHR), both in its own right as a human right, and owing to the importance of good sexual health for ensuring good reproductive outcomes. Furthermore, SRHR is a necessary, core part of overall health, thus sexual health and wellbeing is a fundamental aspect of general health that is often overlooked or even denied for some. In this commentary, we utilize a life course approach to illustrate how the tripartite of sexual health, rights and pleasure manifest themselves with different interlocking linkages, and actively contribute to overall health throughout life. As other papers in this series attest, the linkages of pleasure with the right to and attainment of health has received inadequate attention to date, both within the scientific literature and in policy narratives.

Putting the t in tools: a roadmap for implementation of new global and regional transgender guidance.

Transgender (trans) activists and global health partners have collaborated to develop new tools and guidance for assessing and addressing HIV and other health needs within trans populations. Trans women experience a heavy burden of HIV and other sexually transmitted infections (STIs), high incidence of violence and difficulties accessing gender-affirming services. At the same time, little has been published on trans men's health, HIV issues, needs and experiences. Young trans people are especially marginalized and vulnerable, with few programmes and services specifically tailored to their needs. Trans-specific data and guidance are needed to adapt the global response to HIV to meet the needs of the trans population. While the needs of this group have only recently received attention, global, regional and other technical guidance documents are being developed to address these gaps. Regional blueprints for comprehensive care for trans people in Latin America, the Caribbean, and Asia and the Pacific are now available. These tools - supported by the Pan American Health Organization, World Health Organization, US President's Emergency Plan for AIDS Relief and the United Nations Development Programme, in collaboration with regional trans groups - provide a contextual map, indicating opportunities for interventions in health, HIV, violence, stigma and discrimination, social protection and human rights. Global guidance includes the World Health Organization's Policy Brief: Transgender People and HIV, and the interagency publication, Implementing Comprehensive HIV and STI Programmes with Transgender People. Community empowerment and capacity building are the focus of the new tools for global and regional transgender guidance. The goal is to strengthen and ensure community-led responses to the HIV challenge in trans populations. This article describes the new tools and guidance and considers the steps needed to use them to appropriately support and engage transgender populations within national AIDS, STI, and sexual and reproductive health responses and programmes. The time to use these tools and guidance for advocacy, strategic planning, capacity building, programme design and training is now.

Sexually transmitted infections: progress and challenges since the 1994 International Conference on Population and Development (ICPD).

BACKGROUND: Despite being recognized as an important challenge at the 1994 International Conference on Population and Development (ICPD), sexually transmitted infections (STIs) other than HIV are one of the most neglected dimensions of sexual and reproductive health. STIs, often undiagnosed and untreated, have especially harmful consequences for women and their neonates. PROGRESS SINCE ICPD: During the last two decades, substantial knowledge and experience have accumulated in behavior change programming during the global response to the HIV epidemic which can also be used for prevention of STIs. There has been progress in development and implementation of vaccines against certain STIs such as hepatitis B and the human papilloma virus. Development of a rapid, point-of-care test for syphilis has opened the door to control this infection. CHALLENGES: The estimated annual incidence of non-HIV STIs has increased by nearly 50% during the period 1995-2008. The growth in STIs has been aggrevated by a combination of factors: lack of accurate, inexpensive diagnostic tests, particularly for chlamydia and gonorrhea; lack of investment to strengthen health systems that can deliver services for diagnosis and management of STIs; absence of surveillance and reporting systems in the majority of countries; political, socioeconomic and cultural barriers that limit recognition of STIs as an important public health problem; and failure to implement policies that are known to work. RECOMMENDATIONS: Governments, donors and the international community should give higher priority to preventing STIs and HIV; fully implementing behavior change interventions that are known to work; ensuring access of young people to information and services; investing in development of inexpensive technologies for STI diagnosis,treatment and vaccines; and strengthening STI surveillance, including of microbial resistance.

Incidence and risk factors for hepatitis C seroconversion in injecting drug users in Australia.

AIMS: To determine the incidence of hepatitis C virus (HCV) infection and identify risk factors for seroconversion. DESIGN: Prospective cohort study. Participants were recruited through direct approaches, street-based outreach, methadone and sexual health clinics and needle and syringe programmes. SETTING: Urban, regional and rural settings in New South Wales, Australia. PARTICIPANTS: Injecting drug users (IDUs) (n = 584) were screened and tested for exposure to HCV. Between 1999 and 2002 antibody HCV negative IDUs (n = 368) were enrolled and followed-up every 3-6 months until seroconversion or study completion. MEASUREMENTS: Interviewer-administered baseline and follow-up questionnaires consisted of 131 items and included demographics, drug use and risk behaviour. Approximately 10 cc of whole blood was drawn at each visit. Specimens were stored at -70C and serology performed using one or two third-generation enzyme-linked immunosorbent assays and polymerase chain reaction testing. FINDINGS: Sixty-eight seroconversions were observed and incidence was 30.8 per 100 person-years, with incidence in IDUs injecting < 1 year, 133 per 100 person-years. Independent predictors of seroconversion were female gender, duration of injecting, injecting cocaine, shared use of filters and recruitment strategy. CONCLUSIONS: Women, new initiates and IDUs recruited via outreach appear to be at increased risk of infection. Results confirm the significance of cocaine injection as a risk factor and provide the first evidence outside North America of the link between shared use of drug preparation equipment and incident HCV infection. Prevention efforts should attempt to raise awareness of the risks associated with drug sharing and, in particular, the role of potentially contaminated syringes in HCV infection.

Use of a geographic information system to track smelter-related lead exposures in children: North Lake Macquarie, Australia, 1991-2002.

BACKGROUND: To determine patterns of childhood lead exposure in a community living near a lead and zinc smelter in North Lake Macquarie, Australia between 1991 and 2002. METHODS: An analysis of serial blood lead levels (BLL) of children less than 13 years of age in North Lake Macquarie participating in voluntary blood lead screening. Distance to the smelter and soil lead concentration of the child's place of residence was calculated. Categorical analysis of BLL by residential distance from smelter, residential soil lead concentration, age and year of sample was calculated. Linear regression models were fit for blood lead levels against residential distance from smelter, the log of residential soil lead concentration, age and year of BLL sample. RESULTS: Geometric mean BLLs were statistically significantly higher for distances less than 1.5 kilometres from the smelter and for residential soil lead concentrations greater than 300 ppm. Yearly BLLs since 1995 were statistically significantly lower than for preceding years, with an average decrease of 0.575 microg/dL per year since 1991. BLLs are statistically significantly higher for children whose age is 1 to 3 years old. Linear regression modelling of BLL predicted a statistically significant decrease in BLL of 3.0831 microg/dL per kilometre from the smelter and a statistically significant increase in BLL of 0.25 microg/dL per log of lead in residential soil. The model explained 28.2% of the variation in BLL. CONCLUSION: Residential distance to the smelter, log of residential soil lead concentration, child's age and year of BLL sample are statistically significant factors for predicting elevated BLLs in children living near a North Lake Macquarie lead smelter.

Twenty years of HIV surveillance in the Pacific--what do the data tell us and what do we still need to know?

BACKGROUND: Most Pacific Island countries and territories (PICTs) provide some level of HIV testing for their populations and record demographic data for diagnosed cases of HIV and AIDS. These routine HIV data are usually held within the national Department/Ministry of Health or National AIDS Council. Summary HIV data can illustrate important trends in HIV infection over time and by age, gender and exposure. For some countries no other data are available to illustrate the extent and distribution of HIV infection in the region. METHODS: Annual HIV and AIDS data were requested from all PICT reporting authorities disaggregated by year, age group, sex and exposure. Data were grouped to provide regional and sub-regional totals. Descriptive statistics were reported, including age-adjusted rates and trends. RESULTS: The first cases of HIV in the Pacific were reported in the mid-1980s in all three sub-regions (Melanesia, Micronesia and Polynesia). Many early cases were acquired either by men who have sex with men (MSM) or by recipients of blood products. Some early cases migrated from outside the region. Since then numbers have increased, with 12,169 HIV cases reported across the Pacific to December 2004, including 2,335 AIDS cases and 617 AIDS-related deaths. The majority have been observed in Papua New Guinea (PNG)--11,139 HIV, 1,926 AIDS and 353 AIDS deaths). Other countries with relatively high HIV rates are New Caledonia, French Polynesia, Guam and Kiribati. Fiji, despite a high case count (182), has a mid-range rate of HIV infection due to its large population. Zero or very few cases have been reported in many other PICTs. Nearly two thirds of HIV cases have been diagnosed in the predominant risk group--young, sexually active adults. The ratio of male to female cases is 1.1 to 1 (2.5 to 1 excluding PNG), much lower than in countries like Australia (14.2) and New Zealand (5.5) where MSM predominates exposure. Rates of observed cases in women and young people are increasing with heterosexual contact being an increasingly important mode of spread. Other exposures include injecting drug use (mostly imported), perinatal transmission (rising more recently with increased heterosexual risk) and blood exposures. DISCUSSION: Apart from Papua New Guinea (PNG), which is currently experiencing an exponential increase in HIV infection, observed rates for most of the Pacific are currently low, and are either static or rising very slowly. Low observed HIV prevalence in pregnant women lends some support for this observation. However these data do not reflect the total HIV disease burden due to variable access to and uptake of testing, and incomplete notification. Several factors make the Pacific vulnerable to rapid spread such as close proximity to countries with high HIV prevalence, increasing migration, both in and outward, and expanding economic links with other regions. High levels of STIs and risk behaviours across the Pacific indicate significant potential for rapid spread where HIV is introduced. Efforts are currently under way to improve routine screening, complement with targeted surveillance surveys of at-risk and vulnerable groups. This expanded monitoring of HIV trends is designed to guide increasing efforts to prevent and control HIV in the region.

Health impacts of pesticide exposure in a cohort of outdoor workers.

We compared mortality of 1,999 outdoor staff working as part of an insecticide application program during 1935-1996 with that of 1,984 outdoor workers not occupationally exposed to insecticides, and with the Australian population. Surviving subjects also completed a morbidity questionnaire. Mortality was significantly higher in both exposed and control subjects compared with the Australian population. The major cause was mortality from smoking-related diseases. Mortality was also significantly increased in exposed subjects for a number of conditions that do not appear to be the result of smoking patterns. Compared with the general Australian population, mortality over the total study period was increased for asthma [standardized mortality ratio (SMR) = 3.45; 95% confidence interval (CI), 1.39-7.10] and for diabetes (SMR = 3.57; 95% CI, 1.16-8.32 for subjects working < 5 years). Mortality from pancreatic cancer was more frequent in subjects exposed to 1,1,1-trichloro-2,2-bis(p-chlorophenyl)ethane (SMR = 5.27; 95% CI, 1.09-15.40 for subjects working < 3 years). Compared with the control population, mortality from leukemia was increased in subjects working with more modern chemicals (standardized incidence ratio = 20.90; 95% CI, 1.54-284.41 for myeloid leukemia in the highest exposure group). There was also an increase in self-reported chronic illness and asthma, and lower neuropsychologic functioning scores among surviving exposed subjects when compared with controls. Diabetes was reported more commonly by subjects reporting occupational use of herbicides. These findings lend weight to other studies suggesting an association between adverse health effects and exposure to pesticides.