(Sexuality and health: the hidden costs of screening for Chlamydia trachomatis)
Any plans to introduce a predominantly woman-centred chlamydia screening programme into the UK should take account of the potential down sides as well as benefits that such an initiative may have, say Dr Barbara Duncan and Professor Graham Hart of the Medical Research Council in this week's BMJ. Such screening can have negative psychological effects on women and also by not screening men, the programme could further reduce men's responsibility for sexual and reproductive health, say the authors.
They argue that there are lessons to be learnt from other woman-centred programmes, such as cervical screening. Some women associate cervical abnormalities with perceptions of promiscuity and deviant sexual practices, leaving them with feelings of contamination, which in turn impact negatively on self-perceptions of attractiveness and sexual functioning.
Duncan and Hart also suggest that social changes have generated a popular belief in men and women that it is women who bear sole responsibility for contraception and avoidance of pregnancy. They say that the strategy of involving men peripherally in a chlamydia screening programme (only as contacts of infected women) may reinforce these existing inequalities.
As little is known about men's beliefs and attitudes to sexual and reproductive health, the authors believe that if they were to be included in the chlamydia screening programme, as well as the obvious gains for detecting infection, health professionals would also have the opportunity to investigate and ultimately address men's understanding of their sexual behaviour.
Duncan and Hart conclude that these issues should be fully considered to ensure any future screening programme does not have the unintended consequence of implying that women are to blame for sexually transmitted infections and of neglecting men's sexual health needs. Public and professional education to increase awareness and reduce stigma is an essential prerequisite of a successful screening programme, say the authors.
Contact:
Dr Barbara Duncan PhD, Research Associate, MRC Social and Public Health Sciences Unit, University of Glasgow barbara.d@msoc.mrc.gla.ac.uk