Wednesday 25 August, Noumea, SPC - For all the beauty and extraordinary richness of the Pacific, the region also holds some sad records.

Recent surveys on HIV and other STIs (sexually transmitted infections) in the region show that on average, one in four sexually active young people in the Pacific have an STI, with a chlamydia prevalence in youth of up to 40% - among the highest rates in the world*.

In response to these disturbing findings, the Pacific Regional STI Working Group was established to review the situation and provide evidence-based recommendations to countries to help reduce the prevalence of STIs such as chlamydia, gonorrhoea and syphilis. The Working Group comprises technical specialists from the Secretariat of the Pacific Community (SPC), the World Health Organization (WHO), the United Nations Children's Fund (UNICEF), the United Nations Population Fund (UNFPA) and the Oceania Society for Sexual Health and HIV Medicine (OSSHHM).

Often STIs do not present any symptoms, but if left untreated may lead to miscarriage and infertility in women, as well as eye and lung infections in newborns. The presence of STIs has also been shown to favour the transmission of HIV for both men and women.
Current STI testing and treatment methods in most Pacific Island countries are not effective in reducing the prevalence of STIs such as chlamydia. Therefore the STI Working Group has released a policy guideline for health officials called 'Breaking the silence: Responding to the STI epidemic in the Pacific', which outlines a comprehensive package of interventions for enhancing STI control.
"The STI Working Group is recommending simple yet effective measures that can be implemented immediately to drastically reduce STI prevalence in the population and the impact on infants," says Dr Jimmie Rodgers, SPC Director-General.

Some countries are adopting a recommendation that all antenatal women and their partners should be treated for chlamydia without being tested first. This 'epidemiological treatment'-or presumptive treatment-of chlamydia is based on the established epidemiological pattern among antenatal women. Only a single dose of antibiotics is required.
Epidemiological treatment does not lessen the importance of routine testing, counselling or management of other STIs in antenatal women. Its advantage is, however, that it will allow laboratories in those countries to expand testing for chlamydia and other STIs to other 'at risk' population groups because there will be less demand to process tests for antenatal women. Most laboratories have limited resources and the new treatment strategy should help them make more efficient use of their facilities.

To be effective, and to have long-term benefits, epidemiological treatment will need to be implemented in combination with increased awareness and behaviour change interventions, including the use of condoms.
Other interventions recommended in the paper include ensuring up-to-date knowledge and capacity for management of STIs at all levels of the health care system. This requires training of primary health care providers in diagnosing STI symptoms and giving them the authority to provide treatment for patients and their sex partner(s).
"The main objectives of the interventions are to reduce the prevalence of chlamydia by 50% by 2013, eliminate mother-to-child transmission of chlamydia, prevent other infections in newborns whose parents have an STI, and reduce the long-term consequences of STIs," says Dr Rodgers.