(WP)HSI/ICPIHSI/3 .5/001 Report series number: RS/200S/GE/36(FIJ) English only REPORT JOINT UNFPA-UNICEF-WHO MEETING ON PREVENTION AND CONTROL OF SEXUALLY TRANSMITTED INFECTIONS IN THE PACIFIC • 8-11 November 2005 Nadi, Fiji Convened by UNICEF Pacific UNFP A Office for the Pacific WHO Regional Office for the Western Pacific Not for sale Printed and distributed by: World Health Organization ~ Regional Office for the Western Pacific I Manila, Philippines WHOlWPRO LIBRARY !\1.'\~:'; .. ~ ~:": ,.H·"TlS NOTE ~I The views expressed in uis report are those of the participants in the Joint UNFPA­ • I UNICEF-WHO Meeting on Prevention and Control of Sexually Transmitted Infections in the I I Pacific and do not necessarily reflect the policies of the Organization. ~I This report has been prepared by the World Health Organization Regional Office for the Western Pacific for governments of Member States in the Region and for those who participated in the Joint UNFPA-UNICEF-WHO Meeting on Prevention and Control of Sexually Transmitted Infections in the Pacific from 8 to 11 November 2005 in Nadi, Fiji. CONTENTS SUMMARY I. INTRODUCTION........................................................................ 2 1.1 Objectives........................................................................... 2 1.2 Participants and resource persons.... .......... .......... ...... .......... ........ 2 1.3 Organization of the meeting............................ .......................... 2 1.4 Welcome statements............................................................... 2 1.5 Opening of the meeting ........................................................... 3 2. PROCEEDINGS............................................. ............................. 4 2.1 Current global and regional STI situation and control strategies........... 4 2.2 STI surveillance systems in the Pacific island countries and areas................................................................................. 5 2.3 Update on new developments and innovative approaches in STI control... 7 2.4 STI status and challenges of STI control in the Pacific island countries and areas ............................................................................ 8 2.5 STI case management: Challenges and recommendations................... 10 2.6 Role of the laboratory in STI case management... .................. ........ II 2.7 STI screening in the Pacific ................................... .................. 12 2.8 STI control among young people in the Pacific.............................. 13 2.9 STI control among high-risk groups........................................... IS 2.10 Integration ofSTI into reproductive health services ......................... 16 2.11 Concept of a network of excellence. .. .. .. .. .. .. .. .. ... .... 17 2.12 Identification of issues, gaps and key actions for the future......... ....... 18 2.13 Partnership in STI control in the Pacific ....................................... 18 3. CONCLUSIONS AND RECOMMENDATIONS .................................... 22 ANNEXES: Annex 1 - PROGRAMME OF ACTIVITIES Annex 2 - LIST OF PARTICIPANTS, TEMPORARY ADVISERS, CONSULTANT, OBSERVERS/REPRESENT A TIVES AND SECRETARIAT Keywords: Sexually transmitted diseases - prevention and control/Acquired immunodeficiency syndrome - prevention and control! HIV infections - prevention and control! Population surveillance! Pacific islands Abbreviations ADB Asian Development Bank AIDS Acquired Immunodeficiency Syndrome ANC Antenatal Clinic ARH Adolescent Reproductive Health ASHR Adolescent Sexual and Reproductive Health ATTF AIDS Task Force of Fiji AusAID Australian Agency for International Development CCM Country Coordinating Mechanism (ofGFATM) CDC Centre for Disease Control and Prevention (of USA) FSW Female Sex Worker(s) GFATM Global Fund to Fight AIDS, TM and Malaria HIV Human Immunodeficiency Virus IPPF International Planned Parenthood Foundation LCR Ligase Chain Reaction MSM Men who have sex with Men NGO Non-Governmental Organization NZAID New Zealand Agency for International Development PCR Polymerase Chain Reaction PID Pelvic Inflammatory Disease POLHN Pacific Open Learning Health Network PRHP Pacific Regional HIV/AIDS Project RH Reproductive Health RTI Reproductive Tract Infection(s) SPC Secretariat of the Pacific Community STI Sexually Transmitted Infection(s) UNAIDS The Joint United Nations Programme on HIV/AIDS UNFPA United Nations Population Fund UNICEF United Nations Children's Fund. VCCT Voluntary Counselling and Confidential Testing WHO World Health Organization SUMMARY The Joint UNFPA-UNICEF-WHO Meeting on Prevention and Control of Sexually Transmitted Infections in the Pacific was held at the Mocambo Hotel in Nadi, Fiji, from 8 to 11 November 2005 with the following objectives: (1) To review the current sexually transmitted infection (STI) situation in the Pacific island countries and areas; (2) to share experiences, lessons learnt and the latest developments in STI prevention and control; and (3) to identify issues, gaps and key actions needed for effective prevention and control of STI in the Pacific island countries and areas. The programme included technical presentations, situation reports from countries and partners and open forum discussion across a broad range of issues related to the epidemiology, prevention and control of STIs: the status of STIs in countries in the Pacific region; new STI case management strategies; the role of laboratories in STI case management, screening and surveillance systems; special needs for dealing with STIs in high-risk groups like antenatal women, sex workers and their clients, and youth; the integration of STIs into reproductive health services; and Pacific STI networking, both current and planned. Meeting participants reached a number of conclusions and made recommendations. These included: recognition of the important individual and public health hazards that STIs present in the Pacific region; the special clinical and epidemiological challenges that are presented by chlamydiosis; the utility of syndromic case management in controlling STIs, the importance of STI intervention programmes targeting "core" and "bridging" groups; and the role of partnerships and STI networks in the Pacific region. Each participating country identified its immediate priority needs as well as priorities for regional support. - 2- 1. INTRODUCTION The Joint UNFPA-UNICEF-WHO Meeting on Prevention and Control of Sexually Transmitted Infections in the Pacific was held at the Mocambo Hotel in Nadi, Fiji, from 8 to I I November 2005. 1.1 Objectives (1) To review the current sexually transmitted infection (STI) situation in the Pacific island countries and areas; (2) to share experiences, lessons learnt and the latest developments in STI prevention and control; and (3) to identify issues, gaps and key actions needed for effective prevention and control ofSTI in the Pacific island countries and areas. The detailed programme of the meeting is attached as Annex 1. 1.2 Participants and resource persons There were a total of 20 participants at the meeting, including representatives from American Samoa, Cook Islands, Fiji, French Polynesia, Guam, Kiribati, the Marshall Islands, the Federated States of Micronesia, New Caledonia, Nauru, Niue, the Commonwealth of the Northern Mariana Islands, Palau, Papua New Guinea, Samoa, Solomon Islands, Tokelau, Tonga, Tuvalu and Vanuatu. Also attending the meeting were observers/representatives from the Australian Agency for International Development (AusAID); the International Planned Parenthood Federation (IPPF); Fiji School of Medicine; Fiji School of Nursing; the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM); the New Zealand Agency for International Development (NZAID): the Pacific Regional HIV/AIDS Project, Secretariat of the Pacific Community; Sexual Health and Family Planning Australia; and the Joint United Nations Programme on HIV/AIDS (UNAIDS). The list of participants, consultants, temporary adviser, observers and secretariat staff is attached under Annex 2. 1.3 Organization of the meeting The meeting was held in the Conference Room of the Mocambo Hotel in Nadi, Fiji, from 8 to 11 November 2005. Methods used in the meeting included presentations, working group sessions and plenary discussions. 1.4 Welcome statements Fol1owing an opening benediction by Dr Seini Kupu (Tonga), representatives from the host country and sponsoring agencies made opening remarks. - 3 - The Honourable Tomasi Sauqaqa, Assistant Minister of Health, Fiji, welcomed the meeting participants on behalf of the host country. He observed that STis are a global health problem of special significance to the Pacific area especially since many STls are understood to facilitate HIV transmission. Vulnerable groups in the Pacific include the 15-29 year-old age group, sex workers, men who have sex with men (MSM) and mobile populations. Despite its recognized importance, he was of the opinion that the problem is being underreported by many countries in the area because of the stigma associated with the disease. Improved surveillance systems and prevention programmes, such as condom promotion, remain priority interventions for the Pacific. Assistant Minister Sauqaqa encouraged participants to work hard towards the objectives of the meeting and said he would be looking forward to its conclusions and recommendations. Ms Giulia Vallese of the UNFPA Office for the Pacific extended welcoming remarks to the group on behalf of the UNFPA Representative, Mr Najib