Insights from a Survey of South African Women

Authors: Mrs Yashmita Naidoo CEO of HIV SA, Dr Venessa Timmerman (PhD) and Mr Siraaj Adams (MBA, MPH)

HIVSA is an NGO that commissioned the national survey.

Introduction

According to research, South Africa has the highest prevalence of sexually transmitted infections (STIs), including Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) in Africa. In 2017, there were an estimated 6 million new CT, 4.5 million NG and 71,000 Treponema pallidum infections among South African men and women of reproductive age(1).

In our recent market survey conducted in South Africa, we aimed to gain a deeper understanding of the sexual health practices, preferences, and treatment experiences of female respondents aged between 20 and 35. An online survey was conducted targeting 500 female respondents in the 20 to 35 age group and 469 responses were received. This exploration focused on assessing the current landscape for sexually transmitted infection (STI) treatment, shedding light on awareness, accessibility, and the evolving preferences of young women.

Understanding Sexual Health Practices

Our respondents provided a comprehensive view of sexual health practices among South African women in the specified age range. The survey explored key aspects, including the prevalence of casual sexual partners, awareness of STI treatment facilities, and the frequency of STI treatment.

Key Survey Findings

1. Casual Sexual Partners

Approximately 33% of respondents reported having confirmed some form of casual sexual partnership (including friends with benefits, multiple casual partnerships, situationships and open relationships), highlighting the diversity of sexual health preferences within this demographic.

2. Awareness of STI Treatment Facilities

A commendable 90% of respondents indicated awareness of where to receive STI treatment, suggesting successful dissemination of information regarding available treatment facilities.

3. STI Treatment Uptake

Over 23% of respondents confirmed receiving STI treatment, signalling a proactive approach to seeking medical intervention when faced with STIs. The disparity between 90% of participants having been tested for an STI compared to only 23% receiving treatment may indicate a need to research barriers to STI treatments more in-depth.

4. Commonly Treated STIs

Specific STIs treated included 48% for urinary tract infections, 10% for chlamydia, 8% for genital warts, and 7% for gonorrhoea, providing valuable insights into the prevalence of different STIs.

5. Preference for Treatment Delivery

A notable 47.8% of respondents expressed a preference for receiving STI treatment or treatment delivery at home. This inclination suggests a growing demand for convenient and discreet healthcare options.

6. Online Consultation Preference

Significantly, 54.8% of respondents expressed a preference for online consultations for their STI treatment. This finding underscores the evolving dynamics in healthcare preferences, emphasizing the need for innovative solutions to meet the demands of a changing telehealth landscape.

7. **Sexual Activity Frequency

More than 65% of respondents reported engaging in sexual activity either daily or weekly, highlighting the importance of accessible and timely STI treatment services to support the sexual health of this demographic.

Implications and Considerations

Although research has shown that a high percentage of sexually active people in SA understand the importance of condom use, there is still a need to emphasise better STI screening and management strategies (1).

The Choma survey findings carry implications for healthcare providers and policymakers. While the high awareness and treatment uptake is positive, efforts should continue to ensure accessibility and address potential barriers to seeking treatment.

Untreated sexually transmitted infections (STIs) can lead to significant morbidity, particularly among women, resulting in complications such as pelvic inflammatory disease, ectopic pregnancy, infertility, pregnancy complications, and newborn infections. Additionally, STIs can induce genital inflammation and increase the risk of HIV acquisition and transmission, even in asymptomatic cases. The majority of STIs occur in low- and middle-income countries, with sub-Saharan Africa bearing the highest burden in terms of age-standardized incidence rates and disability-adjusted life years lost. In southern Africa, there’s a notable epidemiologic overlap between curable STIs and HIV, especially among adolescents and young adults who face the highest risk of STI acquisition and have the highest HIV incidence rates. Therefore, improved diagnosis and treatment of curable STIs are crucial in reducing morbidity and are integral components of multimodal HIV prevention efforts(2).

The expressed preferences for home-based treatment delivery and online consultations emphasize the need for innovative and flexible healthcare solutions to cater to the evolving needs and preferences of the population.

Conclusion

Our survey provides valuable insights into the current state of STI treatment awareness, preferences, and practices among young South African women. The identified preferences for home-based treatment delivery and online consultations underscore the importance of adapting healthcare services to meet the evolving needs of the population.

References

1. Harryparsad R, Meyer B, Taku O, Serrano M, Chen PL, Gao X, Williamson AL, Mehou-Loko C, d’Hellencourt FL, Smit J, Strauss J, Nanda K, Ahmed K, Beksinska M, Buck G, Morrison C, Deese J, Masson L. Prevalence and incidence of sexually transmitted infections among South African women initiating injectable and long-acting contraceptives. PLoS One. 2023 Nov 10;18(11):e0294285. doi: 10.1371/journal.pone.0294285. PMID: 37948399; PMCID: PMC10637674.
2. Jarolimova, Jana MD, MPH; Chidumwa, Glory PhD; Chimbindi, Natsayi PhD; Okesola, Nonhlanhla BSN; Dreyer, Jaco NDipIT; Smit, Theresa PhD; Seeley, Janet PhD; Harling, Guy ScD; Copas, Andrew PhD; Baisley, Kathy MSc; Shahmanesh, Maryam PhD; the Isisekelo Research Group; Herbst, (Carina MSc; McGrath, Nuala ScD; Zuma, Thembelihle PhD; Khoza, Thandeka MBChB; Behuhuma, Ngundu MBChB; Bassett, Ingrid V. MD, MPH; Sherr, Lorraine PhD). Prevalence of Curable Sexually Transmitted Infections in a Population-Representative Sample of Young Adults in a High HIV Incidence Area in South Africa. Sexually Transmitted Diseases 50(12):p 796-803, December 2023. | DOI: 10.1097/OLQ.0000000000001871