The challenges of controlling STIs across a diverse continent

Differences between the 53 countries of Europe are far greater than is generally recognized. Health care systems, and, accordingly, treatment standards, in different European countries vary to a considerable extent. Also, there is large variation in economic conditions. The economic crisis has led to a scaling back of expenditure on free, open access STI clinics in all countries yet those economically less developed have suffered most. The vulnerable groups (e.g., young people, immigrants) have been especially affected by the crisis-induced changes. Specifically, these people cannot afford to be tested, particularly in asymptomatic cases. Paradoxically, the situation seemingly reduces the statistics of STI-related problems since data from clinics are becoming less reliable and problems appear to “go away”. STI clinics have never been a priority anyway due to the stigma attached to the STIs that makes the patients less vocal about the services received. The problem is compounded by a fragmentation of services between dermatologists, gynaecologists and family practitioners, for all of whom STIs are a minority interest, not a priority. In addition, dermatologists are increasingly more interested in lucrative private practices (often focusing on cosmetology) than in treating STIs. All of the above makes dealing with such persistent problems as the HIV epidemic in former Soviet countries, the high level of antibiotic resistance in all parts of Europe, etc., more challenging.