Sexually Transmitted Diseases cause both suffering and cost throughout the world, with Sub-Saharan Africa accounting for a rising share of cases. How can information and communications technologies (ICTs) be used to trigger both prevention and help, and what are the challenges facing its deployment? Brian Kaitano, explores.

Technology and Sexual Health Education: Integrating ICT to tackle HIV and other STDs in Sub-Saharan Africa by Brian Kaitano.

Integrating ICT to tackle HIV and other STDs in Sub-Saharan Africa

Sexually Transmitted Diseases (STDs) have a profound impact on sexual and reproductive health worldwide. More than 1 million cases of STDs are recorded every day. In 2020, the World Health Organization (WHO) estimated 374 million new infections with 1 million of 4 STDs: chlamydia (129 million), gonorrhea (82 million), syphilis (7.1 million) and trichomoniasis (156 million). More than 490 million people were estimated to be living with genital herpes in 2016, and an estimated 300 million women had an HPV infection, the primary cause of cervical cancer.

Sub-Saharan Africa accounts for a rising share of these STDs which significantly affects the sexual and reproductive health of young people who are mostly affected due to lack of information on sexual health education. Drug resistance is a major threat to reducing the burden of STDs in Sub-Saharan Africa, the recent threat being the emergence of super gonorrhea that shows signs of resistance to a range of antibiotics. The strain was discovered in Kenya by the Kenya Medical Research Institute (KEMRI) a week ago and it has also been reported in other parts of the world thus posing a serious threat to sexual and reproductive health globally.

The use of technology in promoting sexual health education in Sub-Saharan Africa

The WHO defined eHealth as, “the cost-effective and secure use of ICT in support of health and health related fields, including healthcare services, health surveillance, health education, knowledge and research. Recent advances in eHealth have enabled the development of innovative HIV/STDs prevention strategies that combine multiple interactive media elements using animations, audio and video clips, gaming and social networking applications using a variety of devices such as cell phones, smartphones, tablets, and laptops.

This enables access at the most convenient times and locations. Computer and internet based interventions have gathered a significant amount of attention in recent years given their potential for overcoming barriers to cost-effective, dissemination and implementation.

However, in the last decade, the use of technology-based sexual health education has increased in Sub-Saharan Africa. This is because they have the potential to decrease prominent HIV/STDs risk factors while increasing preventative measures via the use of technologies such as social media, mobile applications (apps), dating apps/websites, virtual reality, text messaging, wearable devices, television, radio, eHealth records, blockchain among others. The COVID-19 pandemic has also played a significant role in creating potential innovations relevant for sexual health.

Recent innovation in HIV/STDs prevention with ICT-mediated behavioral support include: HIV/STDs testing and partner interventions, behavioral interventions, self-management, and provider care. Computer-based and internet-based behavioral HIV/STDs interventions have indeed demonstrated efficacy comparable to face-to-face interventions. Mobile phone HIV/STDs interventions using text messaging are being broadly utilized but more work needs to be done to demonstrate efficacy. However, digital technology is rapidly diffusing into the continent and smartphones are broadly disseminated connecting hundreds of millions of people to the internet and thus enabling lower cost, highly engaging and ubiquitous HIV/STDs prevention and treatment support interventions.

Studies have also shown that over 60% of pregnancies in Sub-Saharan Africa are unintended, meaning that the pregnancy is mistimed, unplanned, or unwanted. This increases risks for mother and child thus leading to high economic cost for society and increase in social disparities. However, ICT activities are rapidly increasing providing opportunities to reach at-risk populations with reproductive health information and pregnancy prevention interventions through mobile apps.

HIV/STDs stigma on young people in Sub-Saharan Africa

While STD affects individuals of all ages, STDs takes a hefty toll on young people in Sub-Saharan Africa. Despite continual public health efforts to reduce the rate of new HIV/STDs infections, adolescents and young adults continue to make up the majority of new STDs diagnoses.

Likewise, young people commonly experience or are in fear of experiencing HIV/STDs related stigma and social judgments that prevents them from obtaining the healthcare they need. This significantly affects their emotional well-being and mental health despite commonality of STDs diagnoses. Many young people with HIV/STDs combat stigma that may routinely leave them feeling unseen, unheard, and misunderstood.

Limitations of using technology in tackling HIV/STDs infections in Sub-Saharan Africa

Seeking sexual health information online is common, and provision of mobile medical apps is increasing for young people in Sub-Saharan Africa. Since young people are inherently at higher risk of contracting HIV/STDs; their avid usage of technology and apps could be appealing sources of information.

However, effective behavioral interventions and practices have not been widely accepted, adopted or diffused by policy makers, administrator providers, advocates, or consumers. Biomedical innovations for STDs prevention have been widely embraced but their effectiveness is hindered by behavioral factors.

As such, behavioral interventions are required to support providers and consumers for adoption and diffusion of biomedical innovations, protocol, adherence, and sustained prevention for STDs. ICTs (Information and Communications Technology) such as the internet and mobile phones can therefore deliver behavioral components for STDs prevention and care to more people at less cost.

Mobile applications (apps) for sexual health education in Sub-Saharan Africa

The mobile phone constitutes the most accessible and affordable digital tool for sexual education in Sub-Saharan Africa. Indeed, mobile apps designed for sexual health education have the potential to reach many young people in Sub-Saharan Africa that are hard to reach through traditional platform. They also provide a new platform for delivering tailored HIV/STDs prevention and care, i.e. the Apple iTunes and Google Play Stores for HIV/STDs-related apps. These apps provide six broad content areas of HIV/ STDs prevention and care:  HIV/STDs disease knowledge, risk reduction/safer sex, condom promotion, HIV/STDs testing information, resource for HIV positive persons, and focus on key populations.

However, little is known about the availability of these apps and their adherence to existing guidelines. Most available HIV/STDs apps have failed to attract user attention and positive reviews in the region. Data from a study in 2018 showed that of the 2,693 apps that were analyzed on the Apple iTunes Store and Google Play Store, only 697 (25%) addressed sexual health and only 15 (1%) of the apps met inclusion criteria for comprehensive programs when their contents were further analyzed. Moreover, these apps narrowly focused on STDs and pregnancy prevention thus lacking information on puberty, sexual identity, and personal safety. It also identified significant shortcomings in the literate design of those apps, including limited use of interactive features such as gaming, videos, and quizzes. The analysis indicated that the potential of apps as sexual health promotion tools had not yet been fully realized.

Other barriers to youths in Sub-Saharan Africa using mobile app include the limited data storage and battery life of mobile phones – the result of poor digital infrastructure development in the region.

Benefits for integrating technology into sexual health education in Sub-Saharan Africa

Sexual and reproductive health is of critical importance to overall health and well-being – the prevention and control of HIV/STDs being a major component. Some of the benefits for integrating technology into sexual health education in Sub-Saharan Africa include:

• Health technologies will allow young people in Sub-Saharan Africa who might not otherwise have access to the resources, tools, and information they need to keep themselves safe and advocate for their own health.
• Internet-based sexual health education programs are extremely low cost; their benefits in HIV/STDs preventions and care actually justify the costs.
• Digital health technologies are more easily disseminated and implemented, and have a higher efficacy and greater engagement compared with traditional behavioral interventions.
• Using technology offers the advantage of privacy particularly for groups that have been stigmatized.
• Use of technology in sexual health education provides a data driven feedback which is not available in traditional interventions.

All in all, the benefits are many and their implementation cost-effective. However, there clearly remains a gap in health technology utilization to improve health education and more generally, sexual and reproductive health among the young people in Sub-Saharan Africa. Young people in Sub-Saharan Africa must be introduced to the latest technologies and demonstrate to them on how these technologies can be used to address HIV/STDs prevention and care, along with a focus on ethical and other related issues associated with this approach.

This will also help to increase the capacity of young people in Sub-Saharan Africa to develop, to implement and to evaluate effective and evidence-based HIV/STDs interventions with technology in clinical, research and community settings. Hence, it will help to bring together researchers, clinicians and technologists to foster interdisciplinary collaborations on innovative ways to improve HIV/STDs prevention and care among young people in Sub-Saharan Africa.

References

• Dallas Swendenman (2010). Innovation in sexually transmitted disease and HIV prevention: Internet and mobile phone delivery vehicles for global diffusion.
• Jo Gibbs (2017). ‘Can you recommend any good STI apps?’ A review of current medical apps for STIs and related genital infections
• Kathryn E. Muessig (2013). Mobile phone applications for care and prevention of HIV and other sexually transmitted diseases: a review
• Martha J. Decker (2022). Educators` Perspectives on Integrating Technology Into Sexual Health Education: Implementation Study
• 2021. Sexually Transmitted Infections: Adopting a Sexual Health Paradigm.
• UNESCO (2011). Advancing Sexuality in Developing Countries: Evidence and Implications

Useful links:

• Follow Brian Kaitano on Twitter @KaitanoBrian
• Link up with Brian Kaitano via LinkedIn
• Read Brian Kaitano’s previous article on CoBS Insights: Ending sexual and gender-based violence in Kenya.

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