From: Disease Control Priorities in Developing Countries, D.T. Jamison and others, eds., New York: Oxford University Press, 1993,  pp. 455-527.

Reproduced with permission from the publisher.

The health programs of developing countries have not traditionally accorded a high priority to the prevention and control of diseases which are predominantly transmitted by sexual intercourse. With the realization that sex is the primary mode of transmission for the human immunodeficiency virus (HIV), however, international donors are helping national health ministries of developing countries allocate large human and financial resources to the fight against at least one sexually transmitted disease (STD). In many cases these programs for the prevention of acquired immunodeficiency syndrome (AIDs) are large enough to rival preexisting programs to prevent other diseases, like malaria and measles, which currently kill more people in most of these countries. By supporting this proposed expenditure pattern, the international donors and national health ministries have implicitly raised the priority attached to the prevention of STDs far above the position formerly occupied by this class of diseases. In addition, because of a growing awareness that at least one important cancer (cervical cancer) and a significant proportion of maternal morbidity and mortality result from STDs, there is a renewed interest in STD control in the public health community.

Our objective in this chapter is to examine the case for assigning a high priority to the prevention (primary and secondary) of the spread of STDS, including AIDS and its causative agent, HIV. Although it would be possible and in some ways more convenient to separate the discussion of AIDS from that of other STDs a central theme of this chapter is the examination of the epidemiological, medical, and economic arguments for integrating AIDS prevention efforts with efforts to combat other STDs. Furthermore, the transmission dynamics of all STDs have strong similarities, which benefit from a common analytical examination. These considerations lead us to address AIDS and "classic STDs," or CSTDs in the same chapter but often to separate the discussions into different sections.

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