IUSTI Regions: Asia Pacific

Asia Pacific MSM Sexual Health guidelines, November 2006
(Acrobat PDF, 120 pages, 6.96MB)

Regional Report

The Training of STI specialists and the status of the speciality in the Asia Pacific Region

This report was presented at the 17th ISSTDR and 10th IUSTI World Congress in Seattle in 2007. It is derived from an email survey of 102 members in the region. Responses were received from 27 key opinion leaders from 18 countries and territories as follows: Australia (7 respondents), Brunei, China, HK SAR, Fiji, India (3 respondents), Japan, Laos, Myanmar, New Zealand, the Philippines (2 respondents), Singapore, South Korea, Sri Lanka, Syria, Thailand, the UAE and Uzbekistan.

The survey was conducted from the 16th May to the 18th June, 2007. The questionnaire was organised into 5 sections - Training in STI and the Accreditation of STI Specialists, Professional Development and Clinical Governance, Clinical Services, STI Academic Activities, and the 3 main STI challenges in the respondent's country.

Most of the respondents were medical doctors (24); 9 were administrators, 3 were public health officials, 1 was a laboratory specialist and 7 were academics. Most of the clinicians (15) were in government practice, 7 were in private practice, and 6 were in academic institutions.

STIs are included in the undergraduate curriculum in 15 countries, as a part of dermatology in 7, of microbiology or infectious disease in 4, in obstetrics gynaecology in 3, as part of venereology/sexual health in 2 countries and as part of family medicine 1. The total number of lectures/tutorials ranged from 1 hour to 10 hours (Melbourne). Three countries did not have STI in the undergraduate curriculum.  

Clinic attachment for medical students ranged from 1 day (Newcastle, Gold Coast, HK, Myanmar, Singapore, and Thailand) to 4 days (Melbourne, Sydney). When combined with dermatology it ranged from 14 days (Brunei, China, Philippines, New Delhi) to 30 days (Punjab).  

STI postgraduate training is provided as part of sexual health medicine in 4 countries (Australia, NZ, Fiji, Sri Lanka), as part of dermatology training in 8 (China, HKSAR, India, Philippines, Singapore, Syria, Uzbekistan), as part of obstetrics and gynaecology in Thailand & Laos, and as part of Infectious Diseases in Brunei and the Philippines. There is no postgraduate STI training reported in Fiji, Japan, Myanmar, and South Korea. The length of training in was 3 to 5 years in Australia/NZ/Sri Lanka and 3 years in India/China /Singapore (with dermatology)

The number of specialists in STI trained each year at National level is from 1 to 3 in Brunei, Fiji, HK SAR, Myanmar, NZ, Singapore, South Korea, Syria, UAE; from 4 to 6 in Laos, Philippines, Sri Lanka, Thailand; and more than 10 in Australia, China and India.

STI is part of Dermato-Venereology in China, HK SAR, India, Philippines, Singapore, Syria, Thailand, UAE, Uzbekistan; a separate medical specialty in  Australia, Fiji, NZ, Sri Lanka; a part of Infectious Diseases in Brunei, Myanmar, Philippines, Thailand; a part of Obstetrics and Gynaecology in Laos and Thailand; a part of urology in South Korea.

The majority of countries (14 out of 18) had an organization or professional body that looked into the development of the STI speciality. Most respondents reported regular continuing medical education programmes in STI in their institution/hospital for specialists as well as for primary care physicians. The majority of countries had regular epidemiological reports and treatment guidelines for STIs. India and Australia had national STI journals. However Brunei, Syria, and the UAE did not have regular STI reports.

The 3 main STI clinical service providers were STI/Sexual Health clinics (11 countries), general practitioners (9) and government primary health clinics (7). There was a professorial chair(s) in STI in 9 countries - Australia, China, India, Laos, Philippines, South Korea, Sri Lanka, Thailand, and Uzbekistan.

Compared with 10 years ago, STI research activities were thought to be increasing in 11 and decreasing in 3 countries; the number of STI scientific publications was thought to be increasing in 9 and decreasing in 4 countries; collaboration between clinicians and public health experts was thought to be increasing in 11 and decreasing in 1 country. Collaboration between clinicians and social scientists was thought to be increasing in 9 and decreasing in 1 country; collaboration between clinicians with community groups was deemed to be increasing in 9 and decreasing in 1 country. Political commitment to STI/HIV control programmes was thought to be greater in 10 countries and decreasing in 2 countries; funding for STI programmes was higher in 10 countries and lower in 5 countries.

The main  challenges facing STI in Asia Pacific countries are in the professional/training field. Some of the problems were: a lack of specialist recognition; aging specialists; a decreasing number of trainees; competition with better paid specialties, difficulty retaining quality trainees; difficulties in the field surviving as a separate speciality, particularly with respect to HIV infection or as part of dermatology.

Political and governmental factors were the next commonest reported challenges viz. STI not on the national government’s priority list; a lack of political interest in STIs; inadequate awareness of STI being a public health issue; inadequate funding for development of the STI  speciality. Biomedical issues were the next category e.g. increases in viral STIs/HIV infection, development of new drugs, STI/HIV in adolescent population and MSM. This was followed by social and public attitudes viz. overcoming stigma; cultural reluctance to accept the burden of disease in the population; a lack of support from religious bodies as a party to information on STI prevention. Infrastructure inadequacies were named by only a handful of respondents.

I would like to thank all who took the time to respond to the survey. The results make interesting reading and provide a snapshot of the state of our speciality in the Asia Pacific region.

Roy Chan

Updated by webmaster February 4th 2008