Kevin Martin, MSc Tropical Medicine & International Health alumnus, writes about his summer research project in Zimbabwe, which focused on identifying the barriers young people in the country face in accessing sexual health care. He explains the political issues at play, the barriers to healthcare access, and his hopes for the future.
A political issue
“The new hopes of 2017, when Robert Mugabe was replaced as president of Zimbabwe, have since been dashed. Zimbabwe is a truly beautiful country that unfortunately has been passed from one autocrat to another, its suffering aptly demonstrated by the inflation, fuel shortages and 18-hour power cuts which occurred while I was there. In this context, sexually transmitted infections (STIs) are often not seen as a priority, but STIs such as chlamydia, gonorrhoea, trichomoniasis and syphilis can lead to infertility, pre-term delivery, still birth and an increased risk of transmission of HIV.
Treating the symptoms – and the cause?
STIs disproportionately affect those in low-income countries, such as Zimbabwe. In settings with limited resources, the World Health Organization recommends “syndromic management” for the management of STIs, which entails providing treatment for most infections that may be the cause of the symptoms or signs that a patient has. However, in addition to treating for infections that may not present, which contributes to antimicrobial resistance (AMR), the method also misses individuals with asymptomatic infections. As the majority of STIs are asymptomatic, this is very problematic and contributes to ongoing STI transmission. As a result, there is increasing interest in the use of diagnostic STI tests in these settings.
This experience has helped me become a more well-rounded researcher, and I feel better equipped to work in similar settings in the future.
A young majority
Of note, young people are particularly susceptible to STIs. In Zimbabwe, youth aged between 15 and 24 comprise 18.9% of the population. Those under 15 make up a further 40.3%. Therefore, failure to appropriately address adolescent health now will lead to significant problems in the future.
I was based in Harare for six weeks, performing a sub-study within the CHIEDZA Trial. CHIEDZA is a cluster randomised trial which aims to determine the impact of an integrated community-based package of HIV services, sexual and reproductive health services and general health counselling for 16 to 24-year-olds. STI testing for chlamydia and gonorrhoea infections were offered as part of this package of services. My aim was to explore the facilitators and barriers to accepting STI testing among Zimbabwean youth. Hopefully, this information will be helpful when STI testing is implemented more widely in the future.
To do this, I conducted interviews and questionnaires across four different sites in Harare. I was made to feel incredibly welcome by the CHIEDZA team, all of whom were extremely committed to providing healthcare to youth. I heard from young people about the challenges they face in accessing sexual health care. This included associated stigma and costs, as well as frequent lack of knowledge about STIs, which granted me an insight into the likely future barriers to providing STI testing.
Skills in sexual health research
I really enjoyed my time in Zimbabwe. In addition to visiting a spectacular country, it enabled me to use the skills I had developed throughout my master’s programme. I believe this experience has helped me become a more well-rounded researcher, and I feel better equipped to work in similar settings in the future.”
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