In America, we're well acquainted with the challenges of successfully preventing and treating sexually transmitted diseases. But researchers in Australia recently pointed out that among its aboriginal populations, these challenges are even more difficult.
As reported by the New York Times, the two main issues at hand are, first, that the rate of STDs among Australian Aborigines is disturbingly high -- a 2005 study found that in the Northern Territory, more than one in four residents had either chlamydia or gonorrhea. Second, the traditional method of testing the population for disease and then treating those afflicted doesn't work among Australia's aboriginal populations because they move around too much. (It'd be like trying to deliver test results to someone who kept changing homes and didn't have a cellphone.)
The solution suggested by the researchers is that when more than 10 percent of a population has sexually transmitted diseases, "all individuals within a particular age range would be offered antibiotic treatment without recourse to an individual risk assessment and without waiting for the results of diagnostic testing." The suggested age range is anyone over 10 years old.
The overall tactic of preemptive treatment by antibiotics makes me nervous out of concern that overtreatment might encourage the growth of antibiotic-resistant strains -- a problem that we're struggling with in the United States as well.
But if you take that potential hazard out of the equation, the proposed solution raises other interesting issues. One of the paper's authors, Dr. Frank Bowden, points out that it's common to treat entire communities for infections like trachoma, which causes blindness, and that chlamydia is caused by the same bacterium. So why not treat people preemptively for chlamydia when circumstances indicate that they have a high likelihood of carrying the disease?
Bowden answers his own question in the paper, stating that "the major difference is the way we frame the two conditions. One is seen as a disease of poverty; the other is seen to be related to personal and deeply private behavior."
I normally don't think my life has too much in common with Australian Aborigines, but the issues raised by this proposal -- i.e., preemptively treating a community, including 10-year-olds, for a sexually transmitted disease -- reminds me of the debate in America over the vaccine for cervical cancer. It's interesting that when it comes to treating disease, no matter where you are in the world, things get trickier if the disease is sexually transmitted.
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