STD care in the South African private health sector

Objectives. To establish the accessibility and quality of sexually transmit ted disease (STD) care provided by private general practitioners (GPs) and workplace health services in South Africa. Design. Structured telephone interviews were conducted with a random nation al sample of 120 GPs and 244 occupational health nurses (OHNs) between May and July 1997. The interview schedules covered indicators of access (includ ing utilisation) and processes (drug treatment, partner management, counsel ling and condom promotion) of STD care. Results. An estimated 5 million STD-related visits were made to private gen eral practices in 1997. Reported treatment of STDs was assessed for effecti veness using well-established syndromic case management guidelines. Only 28 % of GPs reported effective treatment for urethral discharge. This dropped to 14% for genital ulcer and 4% for pelvic inflammatory disease. Fifty-five per cent of the OHNs interviewed indicated that their workplace clinics pr ovided STD care. Nurses provided this care, with or without the support of doctors, in 87% of clinics. Reported urethral discharge and genital ulcer t reatment regimens were assessed as effective in 34% and 14% of responses, r espectively. Conclusions. The private sector is a major provider of STD care and is key to national efforts to achieve better STD control, thereby preventing the s pread of HIV. However, the results of the research suggest that the poor qu ality of STD care may be undermining attempts to control these epidemics in our society Although a complex task, strategies need to be found to improv e the quality of care provided within the private sector.