Summer course
13 September 2018

Sexually Transmitted
Infection in Disaster Situation
Elsi Dwi Hapsari, S.Kp, M.S., D.S

School of Nursing,
Faculty of Medicine, Public Health, and Nursing
Universitas Gadjah Mada
INDONESIAElsi Dwi Hapsari
Scopus ID: 13406659900
https://www.scopus.com/authid/detail.uri?authorId=1340665990
H-index 4
Google Scholar:
https://scholar.google.com/citations?user=lzzZiTkAAAAJ&hl=en
H-index 5
Research Gate Score:
https://www.researchgate.net/profile/Elsi_Hapsari2
RG Score 5,38

Outline• Overview of Sexually Transmitted Infection(STI)• STI in Disaster Situation• STI among Youth1

Overview ofSexually Transmitted Infection

Sexually Transmitted Infections• STIs encompass a group of infections that can bespread or acquired through sexual contact.
• STIs are spread predominantly by sexual contact,including vaginal, anal and oral sex.
• Some STIs can also be spread through non-sexual
means such as via blood or blood products.
• Many STIs—including chlamydia, gonorrhoea,
primarily hepatitis B, HIV, and syphilis—can also betransmitted from mother to child during pregnancy
and childbirth.
(WHO, 2016)•

Etiology of IMS
Bacteria
YeastVirusProtozoa

Is it Curable?
Curable• Syphilis,• Gonorrhea,• Chlamydia,• Trichomoniasis

Non curable• Hepatitis B,• Herpes simplex,• Human Immunodeficiency
Virus (HIV) and• Human Papillomavirus(HPV)(WHO, 2016)

Serious Impact of STIs
Risk of HIV
acquisition

Adverse birthoutcomes

Cervical cancer

Infertility

Social and Cultural Aspects
related to Reproductive HealthIndonesia

Indonesia is the largest Islamic country

False information that HPV vaccine
given to elementary school girls inIndonesia
couldcause
earlymenopause; why it is given to girls
who is not yet sexually active?

Religion, Ethnic Groups, and Population

Social and Cultural Aspects
related to Reproductive Health
Poverty

Menstrual
hygienebehavior

Education

Female genital
mutilation
How to inform about
sexually transmitted
infections?

Early marriage

Abortion

Brief Information of STIs

2. Chlamydia• Caused by Chlamydia trachomatis.
• Symptoms appear within 3-12 days or more after infected.
• Attact area of vagina, cervix, penis, anus, urinary tract, andeye.

3. Syphilis (raja singa)• Caused by Treponema pallidum.
• Chronic and systemic.
• Poor sanitation.
• Generally no symptoms.

https://www.independent.co.uk/news/health/syphilis-rise-sexual-healthcrisis-nhs-government-cuts-warning-a8383901.html

Stages of the Disease
Stage I:

Stage II:

Stage III:• 5-90 days after
infected• 6 weeks until 6months,
condylomata• Complication:system ofneurology,
cardiovaskuler,
muckuloskeletal,
multiorgan

4. Trichomoniasis
https://www.cdc.gov/std/trichomonas/stdfacttrichomoniasis.htm• Caused by protozoa (Trichomonas vaginalis).
• Attact lower part of urinary tract in male and female.
• Painful intercourse.

Prevention of IMS
Primary Prevention- Did not perform sexualactivity
thattransmit
semen, blood, or body’s
fluid or that cause skin toskin contact- Having permanent partner
who is not infected

Secondary Prevention• Accurate diagnosis andtreatment to the infection,
prevention of complicationand transmission to others.

Prevention of STIs: Counsellingand Behavioural Approaches• Comprehensive sexuality education, STI and HIV pre- and post-test
counselling;• Safer sex/risk-reduction counselling, condom promotion;• Interventions targeted at key populations, such as sex workers,
men who have sex with men and people who inject drugs; and• Education and counselling tailored to the needs of adolescentsCounselling can improve people’s ability to recognize the symptoms of STIs
and increase the likelihood they will seek care or encourage a sexual
partner to do so. Unfortunately, lack of public awareness, lack of trainingof health workers, and long-standing, widespread stigma around STIs
remain barriers to greater and more effective use of these interventions.
WHO (2016)

Prevention of STIs:
Barrier Methods• When used correctly and consistently, condoms offer one of
the most effective methods of protection against STIs,including HIV.
• Female condoms are effective and safe, but are not used as
widely by national programmes as male condoms.

WHO (2016)

2

STI in Disaster Situation

The Eruption of Mount MerapiThe eruptions on 26 October 2010 started at 17:02 PM. It was classified as an explosive event withvolcanic bursts of ejected material, visible flame and hot air flows.
On 3 November heat clouds travelled up to 10 kilometres. The shelters were moving to 15
kilometres.
Merapi erupted early on Friday 5 November 2010 and the government extended the safety zone to 20
kilometres.

http://geospasial.bnpb.go.id/2010/11/05/peta-zona-bahaya-merapi-radius-20-km/

Profile of Mount Merapi





Since 1548, has erupted for 69 times
The youngest mountain in the south part of Jawa
Island and located in subduction zone of AustraliaIndo plant and Eurasia
Height: 2,968 m
Type: stratovolcano
Latest eruption: 2006EffectofDisaster

Positive

Tourism

Abundant source
for sand andstone

Negative

Damage of public
facilities andbuildings

Health problems including STIs

Habibullah, 2015; Mulyowati & Shanti, 2016
Kumalawati, 2014; Aditya & Ambarwati, 2010; Nuruniyah,2014

Prevention and Control of Sexually
Transmitted Diseases in Emergencies• During emergencies, changes in the behavior and emotional
condition of people reflects the need to relieve tensions whichbuild up while the emergency continues.
• Sexual gratification is a relatively common way for some adults torelieve stress.
• Studies show that at high levels of tension and anxiety, the searchfor sexual activity can become compulsive  acts of sexual
aggression, directed chiefly against women, children, the elderly,and handicapped persons.
• It can occur in the home, in public, or in shelters or temporary
refuges.
https://www.paho.org/disasters/index.php?option=com_content&view=article&id=740:r
ecommendations-for-the-prevention-and-control-of-sexually-transmitted-diseases-inemergencies&Itemid=0&lang=en

Activities in the Preparation ofEmergency Responses• Intensify the promotion of protective measures  during
emergencies the risk of contracting sexually transmitted diseases
increases, and also on how to take appropriate protective
measures.
• Confirm the existence of and promote the ongoing application ofnational standards for the prevention, control, and clinical care ofcases of sexually transmitted diseases, including HIV/AIDS.
• Confirm the availability and adequate distribution of latex
condoms and water-soluble lubricants both in medical units, andin shelters and temporary refuges.
• Determine the need for such drugs and supplies as are required toprovide for at-risk areas.
https://www.paho.org/disasters/index.php?option=com_content&view=article&id=740:r
ecommendations-for-the-prevention-and-control-of-sexually-transmitted-diseases-inemergencies&Itemid=0&lang=en

• Confirm that medical units are able to give special attention toprenatal care and delivery for pregnant women infected withHIV/AIDS.
• Insofar as possible, establish health care services with trained
staff in the shelters and temporary refuges.
• Promote the provision of water containers and disinfection
supplies, in such a way as to provide for female personal hygiene.
• Take the precautions needed to ensure the availability of safe
blood stocks for obstetric care and traumatological emergencies.
• Ensure that educational supplies are available at all times
concerning reproductive health activities, so can be drawn on for
healthpromotion
activities
ifneeded.
https://www.paho.org/disasters/index.php?option=com_content&view=article&id=740:r
ecommendations-for-the-prevention-and-control-of-sexually-transmitted-diseases-inemergencies&Itemid=0&lang=en

The Effect of the Hurricane Katrina Disaster on
Sexual Behavior and Access to Reproductive Carefor Young Women in New Orleans (Patricia et al, 2007)

Systematic review of the evidence on theeffectiveness of sexual and reproductive healthinterventions in humanitarian crises(Warren et al, 2015)
Evidence of effectiveness was available for the followinginterventions:• impregnated bed nets for pregnant women,• subsidised refugee healthcare,• female community health workers, and• tiered community reproductive health services.

3
The Education of STI Prevention
for Youth in Indonesia

Outline• Review the current condition of youth in Indonesia,• Research related to STI among youth,• Several strategy to educate STI prevention for youth

Current Condition ofYouth in Indonesia

Youth in Indonesia• Young generation play animportant role in thedevelopment of a country.
• Any health problems thatoccurred during youth
period, such as in the caseof Sexually Transmitted
Infection (STI), could affectfuture condition of theyouth and the country.

Indonesia Population Pyramid 2015
Total estimated population: 255.461.686
Total estimated number of youth: 40.000.000

Number of New HIV Positive

Number of New AIDS CaseThe Prevalence of Gonorrhea, Chlamydia,
Trichomoniasis and Syphilis

Tanudyaya F, et al. Prevalence of Sexually Transmitted
Infections and Sexual Risk Behavior among Female
Sex Workers in Nine Provinces in Indonesia, 2005.
Southeast Asian J Trop Med Public Health, Vol. 41 No.
2, March, 2010

The Prevalence of STI in Post Disaster Area (Permanent
House of Jelapan and Kuripan, Yogyakarta,
September 2016)

Dwianantoaji et al (2016)

Never Married Men and Women Age 15-24 who
Have Heard of STI, Indonesia 2012
Sex/
Age

HIV/
AIDSSyphilis

Gonorrhea

Condylomata

Chancroid

Chlamidia

CandidaGenitalherpes

Age15-19

82.988.5

20.2

0.7

0.1

0.4

0.3

2.6

Age
20-24

87.8

94.8

16.7

0.9

0.6

0.9

0.8

5.2

Age
15-19

87.6

77.5

36.0

0.6

0.5

2.4

1.1

12.9

Age
20-24

92.7

82.4

34.5

4.1

1.4

2.3

3.3

16.5

Men

Women

Indonesia Demographic and Health Survey 2012

Source of Information about STI

Women
Men

• School/teacher (65%)• Television (23%)• Friends/relatives (22%)• Internet (13%)• Friends/relatives (51%)• School/teacher (48%)• Internet (15%)

 The use of internet as a source of information is increasing comparedwith the result of similar survey in 2007
 The Internet can be utilized as an effective tool to promote healthawareness among adolescents Vs careful control of the content toavoid misconception
Indonesia Demographic and Health Survey 2012

Research related to Reproductive
Health and STI among YouthLife Experience of Fertile Age who Sexually
Active in Using Contraceptive Method inYogyakarta, Indonesia*)
Indonesian Family Planning
Associationin Yogyakarta
reported that 10% of the youth
in Yogyakarta have experienceof sexual intercourse.

*Junitasari R, Hapsari ED, Lismidiati W. Life Experience usia subur yangaktif Secara seksual dalam penggunaan kontrasepsi di Indonesia. Jurnal
Persatuan Perawat Nasional Indonesia, Volume 1/No. 1/April-Juli 2016

Methods
Qualitative research with phenomenological design.
Location: Pajangan subdictrict, Bantul District, Yogyakarta
Data collection: December 2013-October 2014.
Five male participants, age 17-20 years old 3 participants,
age 20-24 years old 2 participants; selected by snowball
sampling.
• The data collection is done by in-depth interviews.
• Data was analyzed with using Colaizzi method.
• Ethical permission granted from the Ethic Committee,
Faculty of Medicine, Universitas Gadjah Mada••••Results
Frequency and the occurrence of sexual intercourse
Sexual partner in sexual intercourse
Internal and external influence in practising sexualintercourse

Effects felt after sexual intercourse
Effect of health education in the needs of practising sexualintercourse
Condom as the main contraceptive method in practising sexualintercourse
Locally rooted, Globally Respected

www.ugm.ac.id45

Effect of Health Education in The Needsof Practising Sexual Intercourse
Categories

Start to think when Sekarang jadiberfikir kalau ingin melakukan hubunganseksualHealtheducation
seminarabout reproductive health isgiven so that the adolescenceafraid of the negative effects ofit

Feeling afraid that their partner would
get pregnant or suffering from sexuallytransmitted infection when they werepractising sexual intercourse
Knowledge about reproductive health islimited to pregnancy and sexuallytransmitted disease only
Feel curious because there is gap
between what they received in thehealth education seminar with what
they heard from friends“Yes,… what was done at school I think it wasgood enough,…but…what should I say… about
sexually transmitted disease, how to describe
it?.... If too often did that, there would be aneffect… then the transmitted disease could betransmitted from that lip kissing…” (X1)“sometimes if doing that (health educationseminar), it makes me afraid… because I did notknow that the effect would be like this…likethis… from did not know anything… becomesknowing about it… “ (X1)“iya.. mungkin seperti yang dilakukan di sekolah itu sudah lumayan
baiklah.. Cuma apa ya.. kalau penyakit seks menular itu
digambarkan seperti bagaimana.. kalau keseringan melakukan itu
ada dampaknya.. terus penyakit menular bisa melalui dari ciuman
bibir itu..” (X1)
“kadang kalau begitu malah jadi takut.. soalnya kan belum tahuyang itu akibatnya jadi seperti begini.. seperti begini.. begitu..
belum tahu.. jadi tahu..” (X1)

Effect of Health Education in The Needs
of Practising Sexual Intercourse
Categories
Start to think when Sekarang jadi berfikir kalau ingin
melakukan hubungan seksual
Health education seminar about reproductive health isgiven so that the adolescence afraid of the negative
effects of it

Feeling afraid that their partner would get
pregnant or suffering from sexuallytransmitted infection when they werepractising sexual intercourse
Knowledge about reproductive health is limited topregnancy and sexually transmitted disease only
Feel curious because there is gap between what theyreceived in the health education seminar with what
they heard from friends“Yes, at that time I was not mature,
I am afraid that my partner got
pregnant or what… or for thosewhoeverdidthat(sexualintercourse) I heard there was(sexually transmitted disease…
yes, that was I afraid of… “ (X1)
“ya kan waktu itu belum dewasa, takunya
ceweknya hamil atau bagaimana.. atau samayang udah pernah kayak gitu kan katanyakan
ada penyakit-penyakit menular itu.. ya itu,takutnya…” (X1)

Effect of Health Education in The Needs
of Practising Sexual Intercourse
Categories
Start to think when Sekarang jadi berfikir kalau
ingin melakukan hubungan seksual
Health education seminar about reproductive
health is given so that the adolescence afraid of
the negative effects of it
Feeling afraid that their partner would get
pregnant or suffering from sexually transmitted
infection when they were practising sexualintercourse

Knowledge about reproductive health islimited to pregnancy and sexuallytransmitted disease only
Feel curious because there is gap between what
they received in the health education seminar withwhat they heard from friends“Yes, I know… for example
change partner (many times) I
could suffered from diseases
such as HIV, AIDS, Syphillis,…
then if the partner got pregnant
is also a risk…” (X4)
“ya tahu sih mbak.. seperti kalau gonta-ganti
cewek bisa kena penyakit seperti HIV, AIDS,
shipilis.. terus kalau ceweknya hamil kan
juga resiko..”(X4)Effect of Health Education in The Needs
of Practising Sexual Intercourse
Categories
Start to think when Sekarang jadi berfikir kalau
ingin melakukan hubungan seksual
Health education seminar about reproductive
health is given so that the adolescence afraidof the negative effects of it
Feeling afraid that their partner would getpregnant or suffering from sexuallytransmitted infection when they werepractising sexual intercourse
Knowledge about reproductive health islimited to pregnancy and sexually transmitted
disease only

Feel curious because there is gap
between what they received in thehealth education seminar with what
they heard from friends“as for me… I got those kind of seminars, it
makes me curious… really curious” (X3)
“I felt curious to know… teacher taught
about that topic… that was just a theory…
there was no practice… so I practice it bymyself…hahaha…. Then I found there wasa difference with what was told by myfriends”(X5)“ya kalau aku sendiri sih mbak.. dapet seminar kayak gitu
malah kayak gitu itu memancing rasa penasaran e mbak..
jadi tambah penasaran..” (X3)“ya penasaran aja sih mbak.. kan guru menerangkan materi
nih.. itu kan cuma teori.. kan enggak ada prakteknya.. nahya sudah dipraktekkan sendiri.. hahaa.. terus juga kok beda
dengan apa yang diceritakan sama teman-teman..” (X5)On Going Research Work• Knowledge of STI among high school students
living in disaster and non disaster prone area
• Researchers: Elsi Dwi Hapsari, Nyoman Rani,
Nur Hasanah, Anisah Ramadhani, Vini
Normalitasari, Nuring Pangastuti

Strategy to Educate
STI Prevention for YouthStrategy to Educate STI Prevention
for Youth in Indonesia• Care for Adolescent Health Services (PKPR) /Pelayanan Kesehatan
Peduli Remaja (PKPR) in Public Health Center since 2003 foradolescent age 10-18 years old.
• Criteria for Public Health Center to conduct PKPR:1) Able to supervise minimum one school (public school, religionbased school) to conduct activity related to communication,
information and education about reproductive health minimum 2
times a year2) Training adolescent health cadre at school minimum 10% of total
number of students
3) Providing counseling to all students who contact with the PKPR
staffsFuture Planning

Different approach of STI prevention between men andwomenMore research to provide evidence-based practice that
related to the education to prevent STI with sensitivity to
the social and cultural aspectResearch collaboration

Thank You