After a four-year absence, the STI/HIV 2023 World Congress was held in Chicago last July, offering a glimpse into some of the emerging changes in sexual health.
One way to quickly incorporate change is to listen to the community. Sometimes we know best. Also, healthcare providers and researchers must approach communities of interest—often the LGBTQ+ community—with respect, intentionality and purpose. They must also provide inclusive healthcare, where services are accessible to all, and where people feel seen and understood. People want their intersectionalities, social inequities of health and traumas (those lived and intergenerational—historic) acknowledged. While none of this may be new, the fact that it’s being discussed at medical conferences means that healthcare is listening and that we are becoming more than a checkbox, a fingerprick or a number.
Community, not a fingerprick, is key to improved healthcare. A pay-it-forward model in Asia was highlighted by Joseph Tucker, MD, PhD, from University of North Carolina at Chapel Hill, which is increasing community connectedness while addressing healthcare needs. People receive a free healthcare service like a sexually transmitted infection (STI) screening, and then either give money or write a message on a postcard to motivate others to get tested. Donations help cover 20–60% of STI testing costs and give good feelings as kindness begets kindness.
ANOTHER CHANGE discussed by Jagadīśa-Devaśrī Dācus, PhD, MSSW, from Northwestern University’s Institute for Sexual and Gender Minority Health and Wellbeing (ISGMH), is that community engagement must shift to community leadership. In his presentation, he mentions Rena Janamnuaysook, a transgender woman advocate from Thailand who simply states, “key populations cannot only be service recipients,” the healthcare system must empower community members and advocates by providing education on the importance of testing, different prevention and treatment options, and the drug pipeline. Communities must further share these learnings. They must then take community-determined needs and work with public health agencies to create appropriate healthcare services. With community members as stakeholders in healthcare conversations, healthcare becomes more targeted and inclusive, helping to reduce stigma and deliver messaging that resonates.
BECAUSE OF the heavy burden currently placed on the clinical system, another tactic being explored in healthcare is to decentralize STI testing by using self-testing and artificial intelligence (AI) approaches. Self-testing or point-of-care kits became popular during COVID-19 and STI testing is ingeniously following suit. These tests can be available anywhere, from pharmacies and supermarkets to vending machines or websites. More locations and increased availability can only mean more testing. As Joseph Cherabie, MD, from Washington University in Saint Louis mentioned, home tests offer many benefits—convenience, quick results, decreased person-to-person interaction (potentially reducing stigma) and increased availability of tests (especially important in regions where same-sex relations are criminalized or heavy stigma is experienced and in rural settings where healthcare providers are distant).
- At Washington University in St. Louis, over half of patients preferred home kits, irrespective of insurance status.
- A Preventx presentation showed that in the UK, home testing led to the diagnosis of a similar number of STIs (chlamydia, gonorrhea, hepatitis B and C and HIV) to what clinic diagnoses would have been, demonstrating quality and reliability.
AI diagnostic screening tools and chatbots are other soon-to-be widely available options for people to turn to. They are confidential, accessible from mobile devices and can provide personalized answers for users.
- Screening apps require the user to submit a picture of a potential STI, which is then identified with an accuracy of 71% or higher. As more data are collected, the AIs learn and improve recognition and diagnosis.
- Tom Nadarzynski, PhD, from the University of Westminster mentioned that chatbots are great for initial conversations with clients. They can better help reach marginalized communities without judgment or stigma, offer safe spaces to discuss private, vulnerable topics and provide relevant, personalized answers.
While these apps are in their infancy, they may be potentially invaluable tools in the future as predicted by Lei Zhang, PhD, from the Melbourne Sexual Health Centre, and Yudara Kularathne, MD, from HeHealth. That being said, professor Claudia Estcourt from Glasgow Caledonian University reminds us to be mindful of systemic barriers such as no or limited access to the internet, computers and smartphones, and that action to minimize these inequalities must be taken to improve healthcare for all.
WE MUST end on the fact that people are sexual beings. Teodora Wi, MD, from the World Health Organization (WHO), called for integrating STI services with primary care, sexual/reproductive health and HIV services. She also recommended creating environments where people feel comfortable discussing STIs. Her final major point was that we must facilitate point-of-care diagnostics and other affordable technologies. People must have access to many testing options. Like in the bedroom, this should not be a one-size-fits-all situation. Options are good, and they must be affordable. Lastly, the Participatory Designathon Committee, community members from around the globe, stated that a reframing or gain-framing of STI messaging is needed. Essentially, move away from risk messaging and move towards dialogue on sexual pleasure, sexual health, sex normalization and positivity.