STI Advocacy

In 2023, AVAC and advocacy partners set out to assess the STI prevention landscape across East and Southern Africa. By documenting existing resources, gaps, and challenges, these analyses lay essential groundwork for developing an informed, strategic, collaborative advocacy agenda.

“We remember when we started HIV advocacy, we were told that HIV is not an emergency. This is the same thing we are hearing, that STI is not an emergency. We want to say that STI is an emergency. And if we are not treating STI as an emergency, we will actually risk to be where HIV is now with STI.”
—Mandisa Dukashe, HIV Survivors and Partners Network, South Africa

Across the seven countries assessed, health professionals and key population informants alike reported lack of knowledge and inadequate testing for STIs. Low testing rates were attributed to a range of challenges including lack of awareness of the need for testing, limited supplies of test kits, testing services being inaccessible or unaffordable, and STI-related stigma. Newer, faster, and cheaper diagnostic tools could help address some of these problems, as could preventive or therapeutic STI vaccines. Several analyses also noted the need for more up-to-date, targeted STI data to inform national policies.

Specific findings by country include:

• Kenya: Kenya’s National AIDS and STI Control Program (NASCOP) has implemented strategies to raise awareness about STIs, promote condom use, and increase access to STI testing and treatment. Yet the new analysis, conducted by the Nyanza Reproductive Health Society across three diverse regions of Kenya (Coast, Nairobi, and Western), found that many people at risk for STIs do not seek testing. Their reasons include a lack of awareness of the need to test, fear of stigma, and scarcity of test kits. The analysis also highlighted a need for more locally relevant STI data to support advocacy efforts.

• Lesotho: The Lesotho Network of AIDS Service Organizations (LENASO) interviewed health professionals and conducted a series of focus groups with adolescents and adults in Mapholeneng, an area where mining and other large-scale development projects have spurred population growth. They found substantial gaps in access to STI information and services, including condoms. Many people reported they are afraid to discuss STI symptoms with parents, partners, or health providers.

• Malawi: The Journalists Association Against AIDS (JournAIDS) found that little relevant local data on STIs had been collected in Malawi. Perhaps as a result, national health policies either fail to mention STIs at all, or make recommendations based on information dating back to 2017 – before, for example, Malawi’s introduction of the HPV vaccine. JournAIDS shared their findings with a wide range of civil society influencers, policymakers, and reporters, laying the groundwork for coordinated national advocacy.

• South Africa: Through consultations with local government officials and civil society leaders in North West, Gauteng, and KwaZulu Natal Provinces, the HIV Survivor’s Partner Network identified several major STI prevention gaps. They found that test kit shortages lead providers to diagnose STIs based on symptoms alone, which may lead to under- or over-treatment and could potentially exacerbate antimicrobial resistance. They also noted that limited HPV vaccination coverage leaves significant populations, including adult women, boys, and girls who attend private schools, unprotected. And they call for greater civil society engagement to advance STI literacy and advocate for new diagnostics and vaccines.

• Uganda: An analysis from ACTS-101 showed that Uganda’s national public health response has proactively addressed STI prevention. However, STI programming is incorporated within, and often overshadowed by HIV prevention programs. The researchers note a need for specific, targeted STI advocacy and services, including advocacy for new vaccines and diagnostics.

• Zambia: In a series of focus groups with female sex workers, men who have sex with men, and transgender women, the Latu Human Rights Foundation found that most were unaware of the importance of STI testing. Health professionals were also interviewed and reported that clinics had limited testing supplies and tended to prioritize testing for pregnant women over other groups at increased risk for STIs. They recommend advocacy efforts focused on raising awareness of STI risk and reducing stigma.

• Zimbabwe: Through a series of focus groups and one-on-one interviews across 9 of Zimbabwe’s 10 districts, Pangaea Zimbabwe AIDS Trust (PZAT) found substantial gaps in STI prevention and care services, often due to structural factors including long wait times, service costs, and stockouts, as well as significant concerns about stigma. PZAT recommends advocates build an inclusive movement to address these challenges and push for increased funding and innovation in STI services.