1. SOCIAL IMPLICATIONS OF SEXUALLY TRANSMITTED INFECTIONS
Professor AS Vaisov
Head of the Department of Skin and Venereal Diseases Tashkent Medical Academy
  President of the Association of Uzbekistan Dermatovenereologists

2. INFECTION end of XX century
Lassa fever
Marburg hemorrhagic fever
Ebola haemorrhagic fever
legionnaires' disease
Acquired immunodeficiency syndrome (AIDS)

3. REGISTRATION OF HIV cases in Uzbekistan
year
In total
Of the local residentsf
до1990 12 2
1990 5 1
1991 7 3
1992
1993
1994
1995
1996
1997 43 16
1999 61 34
Of these, 4 patients with AIDS (all died) 3 AIDS. In 1997, the first known HIV-infected patients with signs II-syphilis.

4. SEXUALLY TRANSMITTED DISEASES
syphilis
gonorrhea
chancroid
Duran's disease

5. Sexually Transmitted Infections
trichomoniasis
ureoplazmoz
chlamydia
Bowen's disease
genital herpes
genital warts
candidiasis
bacterial Vaginosis
hepatitis B, C
granuloma inguinale
lymphogranuloma venereum
intestinal infections
crablouse
Molluscum contagiosum
NGU
acute urethral syndrome
cervical intraepithelial neoplasia
cytomegalovirus infection
scabies
bovenoidny papulosis
acquired immunodeficiency syndrome

6. Complications of STIs Infertility and Impotence
Termination of pregnancy
Infection of the newborn and child
ectopic pregnancy
Cancer of the anus and genitals
peritonitis
The birth of physically and mentally handicapped offspring

7. The incidence of syphilis in the Republic of Uzbekistan for 50 years
1946
1954
1970
1984
1997

8. in the Republic of Uzbekistan
Dynamics of syphilis
  in the Republic of Uzbekistan
(per 100,000 population)
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
1,8
1,86
2,3
4,4
11,4
25,0
40,2
47,3
45,5
37,6
29,8
27,5

9. Epidemic Update: December 2004
Number of people living with HIV / AIDS
In totally
39.4 млн. ( млн.)
adults
37.2 млн. ( млн.)
women
17.6 млн. ( млн.)
Children under 15 years
2.2 млн. ( млн.)
4.9 млн. ( млн.)
4.3 млн. ( млн.)
( )
The number of deaths from AIDS in 2004
Всего
3.1 млн. ( млн.)
2.6 млн. ( млн.)
( )

10. Intensive incidence of syphilis in Uzbekistan, Tashkent and Tashkent region

11. Dynamics and prevalence of AIDS in 2000
The end of beginning of million.
Mid million.
At the end of 2000, 36 million vehicles - 22 million died
(3 million for 2000)
25 млн
6 млн
2 млн
1 млн
0,5 млн
0,75 млн

12. AIDS transmission routes
sexual
gomosexual
geterosexual
injectible
blood transfusion
Professional medical infection
Intrauterine infection of the fetus
Childbirth and breast-feeding

13. The incidence of syphilis in some CIS countries in 1990-1998
The incidence of syphilis in some CIS countries in (number of cases per 100,000 population)

14. Forecast of syphilis in Russia up to 2005
The total number of cases (x 1000)
The number of cases per 100,000 population

15. STI network of institutions Uzbekistan in 1999

16. Availability of STI institutions professionals for 1999

17. Professional employment of syphilis

18. The age structure of syphilis

19. Sex structure of syphilis? (% Of patients)

20. Заболеваемость сифилисом среди жителей городов и районов Ташкентской области (абс. числа)

21. Заболеваемость сифилисом среди женщин (% от числа больных)
Заболеваемость сифилисом среди женщин (% от числа больных)

22. Marital status of patients with syphilis

23. Syphilis and gonorrhea in 1997-1998, at the city of Tashkent
NAME OF PARADISE. HPC
SYPHILIS
at 100 thousand.
GONORRHOEA
1997
1998
Mirabad
122
103
63,4 97
Chilanzar
131
121
81,7 89
M. Ulugbek
116 96 48 44
S. Rakhimov 80 51
46,5 32
Yunusabad
118 83 73 71
Yakkasaray
130
104
Sergeli
220
203
58,4
Hamza
162,6
129
49,1 46
SHAYKHANTAUR
61,9 54
15,2 20
A. Ikramov
108,4
107 70 84
Bektemir
152
187 40 41
GOOSE
homeless
120
100
57,7 60

24. Gonorrhea in children under 14 years for 1997-1998.
НАЗВАНИЕ ОБЛАСТИ
ГОНОРЕЯ
1997
1998
ВСЕГО
МАЛ
ДЕВ
г. Ташкент 14 7 1 6
Андижанская 4 -
Бухарская 3 10 2 8
Джизакская
Кашкадарьинская
Навоийская
Наманганская
Самаркандская
Сурхандарьинская
Сырдарьинская
Ташкентская 19 16 18 5 13
Ферганская 12 11
Хорезмская
Респ. Каракалпакстан
Респ.Узбекистан 60 54 72 61

25. The incidence of syphilis in children under 14 years for 1997-1998.
НАЗВАНИЕ ОБЛАСТИ
ГОНОРЕЯ
1997
1998
ВСЕГО
МАЛ
ДЕВ
г. Ташкент 15 6 9 12 4 3
Андижанская 8 1
Бухарская 2
Джизакская
Кашкадарьинская
Навоийская
Наманганская
Самаркандская 5 11
Сурхандарьинская
Сырдарьинская
Ташкентская 19 7 23
Ферганская
Хорезмская
Респ.Каракалпакстан
Респ.Узбекистан 61 30 31 60 37

26. Of the Prime Minister? Karakalpakstan,? Khokim and Tashkent
The Ministry of Health has increased dramatically the incidence of syphilis. In 1994, more than 2.5 thousand registered patients, or 7 times more than in In Tashkent, registered 948 (37.4%), in the Tashkent region (27.7%), Namangan region (7.8%), Khorezm region (7.8%) patients. In these areas in 1994 were almost 90% of all registered in the Republic of syphilis.
NOW, THEREFORE, requires:
- Take a personal part in the study investigating the causes of the growth rate of syphilis and other infections, the measures taken to inform the Cabinet of Ministers to 20 August 1995;
- To develop and adopt regional interagency program to reduce morbidity with installed concrete measures the responsibilities of each branch of service of the Interior;
- Restore the inter-agency commission to combat sexually transmitted diseases.
OF POSITION ON THIS ISSUE? Am reporting a quarterly basis.
Prime Minister of the Republic of Uzbekistan Tashkent. August 4, 1995.

27. Characteristics of medical care to the ailing rural STI
Characteristics of medical care to the ailing rural STI? (Example of Bukhara)
Distance SVP of CRH - from 3 to 28 km
Distance from SVP OKVD - from 4 to 70 km
For examination and hospitalization is necessary:
Residents of the city days
Villagers days
Prior to admission:
1) Transportation costs
2) multiple visits to survey
3) Problems with drugs and chemicals
4) Lack of anonymity
5) Compulsory hospitalization

28. Social factors in the growth of STI CIS
Poverty reduction and employment
sanitary illiteracy
Prostitution (forced sex)
alcoholism
addiction
The weakening of traditional
Conflicts in the country, the weakness of the law
Discrimination of Human Rights (unprotected)
Migration, refugees and movement of people
The weakening of the family, divorce

29. Screening for STIs detainees at
Screening for STIs detainees at? Working with police department (absolute numbers)

30. Screening for STIs persons detained Brothels in 1999 - 2002 GG (absolute numbers)

31. Social characteristics of the HBC. Age from 15 to 34 years
Social characteristics of the HBC? Age from 15 to 34 years? Reside in Tashkent within years % Come to Tashkent periodically or daily %

32. "Professional deployment" women who have sex work (CSW)

33. Characteristics of HCC, providing services in
Characteristics of HCC, providing services in? Hotels, brothels, massage parlors
The most "prestigious" and organized a group of women with medical control, protected from competition, violence
Persons with secondary and higher education, with information on STIs, HIV, with means of personal prophylaxis
Persons residing in Tashkent

34. Characteristic of HBC, sell services? Streets and transport
The most numerous and poorly organized category, most "single" or "compatriot", rarely (40%) have a pimp or "nurse." The lowest paid and most vulnerable groups of women
People who live in areas close to Tashkent, no registration and registration
Persons with low educational levels, all ages (mostly years) with no knowledge about STIs, HIV, contraception and personal prevention

35. STI profilactics Primary prevention. Secondary prevention.
1.Sanitarnoe education - through information, education and communication,
aimed at changing sexual behavior and risk reduction
infection.
2. Promotion of safe sex and condom provision.
Secondary prevention.
1. Advocating the need to resort to honey. institution.
2. STI treatment - free of charge and only in specialized institutions
     SRI.
3. Early diagnosis and treatment of latent infection by identifying
     of contacts, a disease screening.

36. The main objectives of the organization to STIs and HIV / AIDS
1) To ensure the availability of clinical services for STDs and improve their quality
2) Early change a person's behavior aimed at maintaining the health of STI
3) Establishment of a monitoring STIs, HIV - infection, drug addiction and their interaction

37. yes yes PRINCIPLE syndromic approach to diagnosis
And treatment of STIs
The patient complains of erosion or ulceration of the genital area
education
  counseling if necessary
  promotion (providing condoms)
SURVEY no no
Are there sores?
Are there any discharge from
urethra or vagina?
yes
yes
treatment of syphilis chancre and
  education
  counseling if necessary
  promotion (providing condoms)
  management partner
  appointment of a repeat visit after 7 days
use
  appropriate
  Flowchart

38. Conclusion
1. STD problem in the country is gradually increasing. The control of these infections should be a priority and conducted coordinated.
2. Review and determine the role and place of each of the services concerned (dermatovenereological, AIDS, obstetric and gynecological, urological, substance abuse, etc.) in STD control strategies, and, most important, to determine the mechanism of their interaction.

39. 3. Necessary, while maintaining the skin - venereal service and dispensary operation principle, to change the ratio, the role and the place of out-patient and hospital care with and priority interests of the patient, and within established standards of participation of all parts of the budget and the private health care.
4. In a market economy, the lack of health insurance in the country makes it necessary to include in the system of STI control and infectious dermatoses, in the system of certification of personnel and quality control of services active non-governmental, national and international, public associations of professionals - doctors.

40. HPC reserves in deficit spending
1. increase
knowledge
of syphilis.
2. Increase in the number of people seeking honey. by the ARC.
3. introduction
new methods
diagnostics.
4. increase
efficiency
treatment.
education
  population about
signs
syphilis.
Improving care
their health and ensure
respect confidential
majoring.
the perfection -
tence
quality
diagnostics.
use
effective
and affordable
the price of drugs.
survey
to identify
hidden forms
syphilis.
depreciation
services.
standardization
diagnostic
techniques
introduction
  outpatient
methods
treatment.
establishment
contacts.
increasing the availability of
and convenience for the patient.
reduction
cost
diagnostic tests.
after cure
one injection
drug
or inside.

41. How to improve the quality of care in deficit spending
Decide where dermatovenereological, obstetric-gynecological, urological, drug treatment services and AIDS services in STI control strategies, to determine the mechanism of their interaction.
2. Legitimize the role and place of GPs to conduct
      primary and secondary prevention and treatment
      dermatovenereological patients with pathology,
      and the mechanism of interaction between GPs and HPC.

42. 3. Develop standards of care and service quality control mechanism
4. Prohibit dispensing without a prescription from the doctor's personal stamp
5. Determine the list of nosology and forms of skin and venereal diseases, requiring guaranteed free inpatient or outpatient medical care
6. Approve the standard of free compulsory
laboratory examinations of patients and contacts with dermatovenereological pathology. All additional methods of laboratory studies were performed on a fee basis by the patient