Understanding the factors affecting global political priority for controlling sexually transmitted infections: a qualitative policy analysis

Abstract

AbstractIntroductionSexually transmitted infections (STIs) are a significant public health challenge, but there is a perceived lack of political priority in addressing STIs as a global health issue. Our study aimed to understand the determinants of global political priority for STIs since the 1980s and to discern implications for future prioritisation.MethodsThrough semi-structured interviews from July 2021 to February 2022, we engaged 20 key stakeholders (8 women, 12 men) from academia, United Nations agencies, international non-governmental organisations, philanthropic organisations, and national public health agencies. A published policy framework was employed for thematic analysis, and findings triangulated with relevant literature and policy documents. We examined issue characteristics, prevailing ideas, actor power dynamics and political contexts.ResultsA contrast in perspectives before and after the year 2000 emerged. STI control was high on the global health agenda during the late 1980s and 1990s, as a means to control HIV. A strong policy community agreed on evidence about the high burden of STIs and that STI management could reduce the incidence of HIV. The level of importance decreased when further research evidence did not find an impact of STI control interventions on HIV incidence. Since 2000, cohesion in the STI community has decreased. New framing for broad STI control has not emerged. Interventions that have been funded, such as human papillomavirus vaccination and congenital syphilis elimination have been framed as cancer control or improving newborn survival, rather than as STI control.ConclusionGlobally, the perceived decline in STI control priority might stem from discrepancies between investment choices and experts’ views on STI priorities. Addressing STIs requires understanding the intertwined nature of politics and empirical evidence in resource allocation. The ascent of universal health coverage presents an opportunity for integrated STI strategies but high-quality care sustainable funding and strategic coordination are essential.Key messagesWhat is already know on this topic?■Setting priorities within health services is a political process.■Sexually transmitted infections (STIs) other than HIV are a significant public health issue.■STI control was high on the global health agenda in the late 1980s and 1990s, when it was promoted as a means to lower the transmission of HIV, but attention paid to STI control appears to have waned over the past two decades.What this study adds?■A range of factors, including but not limited to, empirical evidence of disease burden, have driven the attention paid to STI control over time.■The STI community has lacked cohesion, champions and engagement with civil society, thus contributing to their lowered position on health policy agendas.■STI control has been successful when framed as reaching aligned goals in other areas – HIV control, maternal and child health, cancer control – or when a biomedical intervention (vaccine, diagnostic) is available.How this study might affect research, practice or policy?■A more politically aware approach to STI control could increase policy attention and resource allocation, moving beyond technical evidence to understanding and leveraging political context.■The rollout of universal health coverage can present opportunities to integrate STI control into broader health policy reform and prioritisation, but the STI community will need to pay attention to issue-framing, community cohesion, and the role of policy entrepreneurs if they are to have success in forging a window of policy opportunity.■STI advocacy needs to be strengthened through strategic alliances with a diverse group of stakeholders, including civil society (e.g., those representing the broader sexual and reproductive health agenda and the cancer agenda).