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3. What is the evidence for causation between your selected intervention and the health concern that it is trying to address/solve? 

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3. What is the evidence for causation between your selected intervention and the health concern that it is trying to address/solve? 

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According to the National Institute of Health, the South African government rapidly expanded its Public Sector Condom Programme to help relieve the STI and HIV epidemic in South Africa⁸, which is made apparent by South Africa’s high HIV prevelance percentage, of 12.7% in 2016 (one of the highest in the world)⁵.

Many South African communities deal with financial insecurity and lack of public knowledge about unprotected sex, which can be seen as predisposing factors affecting the causation of STI’s, like HIV; either because people cannot afford to buy condoms or because of lack of knowledge of the dangers of unprotected sex.

Enabling factors affecting causation of STI’s in South Africa include poor living conditions of people, particularly in rural areas, because if people live far away from a store where a condom can be bought or if people live in very poor conditions due to lack of income and can therefore not afford condoms, the chance of “risky sexual behavior” like unprotected sex8 is greatly increased.

In the rural areas of South Africa, being a “sex-worker” or having more than one sexual partner is not uncommon. According to Global HIV/AIDS Medicine, such risky sexual behavior has a direct correlation to the contraction of STI’s through unprotected sex due to condoms not being available in all situations⁹.

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https://youtu.be/SRy9QqXbv-Y

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1.  Karien Rossouw, u17013462

2. Nicolette de Kock, u17020906

3. Leigh-anne Behrens, u17037469

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1. Sexually transmitted infections (STIs) [Internet]. World Health Organization. 2018 [cited 22 April 2018]. Available from: http://www.who.int/mediacentre/factsheets/fs110/en/

2. Condom Fact Sheet [Internet]. Usaid.gov. 2015 [cited 22 April 2018]. Available from: https://www.usaid.gov/sites/default/files/documents/1864/condomfactsheet.pdf

3. Fact sheet - Latest statistics on the status of the AIDS epidemic [Internet]. Unaids.org. 2016 [cited 22 April 2018]. Available from: http://www.unaids.org/en/resources/fact-sheet

4. Global Statistics [Internet]. HIV.gov. 2017 [cited 22 April 2018]. Available from: https://www.hiv.gov/hiv-basics/overview/data-and-trends/global-statistics

5. Mid-year Population Estimates [Internet]. Statssa.gov.za. 2016 [cited 22 April 2018]. Available from: https://www.statssa.gov.za/publications/P0302/P03022016.pdf

6. Ursoniu S. [Internet]. Bing.com. 2018 [cited 22 April 2018]. Available from: http://www.bing.com/cr?IG=A3932C012E5B4E57834EE29E896175B5&CID=293440EF91086857232E4B3690A769CA&rd=1&h=l0njJITpU1whK5GiC7ZAL7y556p9A9SbwKs4Z_Rcg_o&v=1&r=http%3a%2f%2fwww.pitt.edu%2f%7esuper7%2f10011-11001%2f10701.ppt&p=DevEx.LB.1,5068.1

7. Epidemiology and Prevention [Internet]. 2018 [cited 22 April 2018]. Available from: http://www.ump.edu.pl/files/8_483_epidemiology_and_prevention.pdf

8.  Beksinska M, Smit J, Mantell J. Progress and challenges to male and female condom use in South Africa. 2018. [cited 22 April 2018]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3286127/pdf/nihms314138.pdf

9.Volberding, P. (2008). Global HIV/AIDS Medicine. [ebook] Philadelphia, PA: Saunders/ Elsevier. Available at: https://UnivofPretoria.on.worldcat.org/oclc/489075139 [Accessed 22 Apr. 2018].

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4. What role do you play as a citizen and future doctor in this intervention? How could you support this?

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4. What role do you play as a citizen and future doctor in this intervention? How could you support this?

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As future doctors who will be involved with a wide variety of communities, including rural or low-income communities - we feel it will be our duty to ensure that protection from STI’s (like condoms) are always readily available at clinics so that it is easier for people to make the choice to not have unprotected sex. We also feel that it would be the right thing to do to advise our patients on how to practice “safe sex” so that they can make more educated choices about their sexual partners.

As citizens of South Africa, we also fully support the programme in the hope that it will help to decrease South Africa’s HIV infection rate, thus creating a healthier population which is more able to work, meaning a boost in the economy and a smaller expenditure by the government to support people who are too ill to work.

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1.What health concern is your selected intervention trying to address/solve? How big is the health concern in South Africa and/or globally?

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1.What health concern is your selected intervention trying to address/solve? How big is the health concern in South Africa and/or globally?

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An epidemic that is one of the largest burdens on South Africa's public health is the spread of sexually transmitted infections (STI's) and in particular, HIV. One of the most effective and inexpensive interventions that has been proven to provide protection for individuals as well as prevention of the spread of such diseases between sexual partners is the effective use of condoms.

STI's are a major concern for public health as well as the health of individuals, with 1 million people being newly infected every day1 . Whilst mainly being transmitted sexually, one can contract STI's via mother-child transmission during birth and therefore having an effect on the country's birth rate, as well as the incidence of neonatal disorders and congenital deformities. Condoms have been proven to be 66-75% effective in preventing STI’s2  and hence this intervention is necessary in decreasing the incidence of STI transmissions, related diseases and deaths due to STI's.

The spread of HIV, in particular, is an extremely large concern for global health. As recorded in 2016, there were approximately 36.7 million people living with HIV globally with 1.8 million being newly infected within the year³.  The development of AIDS and the diseases associated is the major concern. In 2016,1 million people died of AIDS related diseases worldwide, bringing the AIDS related deaths total to 35 million people⁴. The astounding number of deaths due to this epidemic highlights the enormity of this health concern globally.

According to the mid-year statistical release of Statistics South Africa, it was estimated in 2016 that 7.03 million people in South Africa were living with HIV and 27.9% of deaths in the country were due to HIV/AIDS related diseases⁵. More than a quarter of deaths in South Africa are due to HIV and or AIDS related diseases. Male condoms, which are the condoms that are currently being freely distributed in specific public areas around the country, have been proven to be 98.5% effective in the prevention of HIV transmission².

This intervention is trying to prevent the spread of diseases such as HIV and other STI's and by making condoms available free of charge and in areas for people that are financially incapable or have the inadequate resources to obtain condoms themselves. Education has a vital role in a campaign such as this, for people to be made aware of the health risk associated with unprotected sex and the consequences of the sexually transmitted infections that could be contracted without the use of protection.

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The Public Sector Condom Programme which entails free distribution of condoms in clinics, public bathrooms and other public places.

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2.What level of prevention would you consider it to be? Why/not?

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2.What level of prevention would you consider it to be? Why/not?

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The free distribution of condoms can be categorized as primordial prevention as it involves changes in social and environmental conditions6 with special focus on sexual behaviour and on the concept of "safe sex". Combined with education and awareness around the benefits of condom use and the potentially fatal consequences of STI related diseases such as HIV, more people living in underprivileged areas where high-risk sexual behaviour is common will become more aware and hence be able to change the social and environmental conditions in these areas.

However, it could also be considered as primary prevention⁷ on an individual level as it provides sexual partners with protection against the onset of STI's like HIV and the spread of these infections. Ultimately by choosing to use a condom will provide protection and therefore reduce the incidences of STI's like HIV which is a major health concern of the country.