Emerging Dilemmas in the Age of Resistance: The Case of Sexually Transmitted Infections
Shiva Chandra1, Alex Broom1, Michelle Peterie1
1Sydney Centre for Healthy Societies, School of Social and Political Sciences, Faculty of Arts and Social Sciences, The University of Sydney, Sydney, NSW, Australia.
Abstract:
The stage is set for a new era of precariousness in modern medicine, driven by the increasing failure of a key pharmaceutical pillar-antimicrobials. In the context of sexually transmitted infections (STIs), the rise of antimicrobial resistance is introducing urgent questions around what might constitute "best practice" in a rapidly evolving scene, including the value of asymptomatic screening (test and treat), and the consequent downstream collateral damage emerging from over-use of our diminishingly effective antimicrobial resources. Drawing on interviews with clinicians, experts, and industry representatives, we examine resistance as a site of emerging and co-constitutive moral, temporal, and economic dilemmas. Such dilemmas, as illustrated in participants' accounts, involve complexities regarding prioritization between competing health demands; doing good work while meeting business requirements; considering trade-offs between visibility and amplifying the problem; difficulties balancing presents and futures; reconciling divergent clinical opinions and expertise; and managing patient subjectivities, while considering the implications of clinical practices for resistance. Importantly, centering dilemmas in context of antibiotic-resistant STIs open greater theoretical scope to consider the challenging spaces that key actors such as clinicians and decision-makers occupy, as they attempt to curb resistance while caring for individuals and the community.
Insights
Antimicrobial resistance in sexually transmitted infections (STIs) creates complex dilemmas for healthcare. Balancing patient care with resource limitations is crucial to combatting this growing public health threat.
Area of Science:
- Medical Science
- Public Health
- Infectious Diseases
Background:
- Modern medicine faces increasing antimicrobial resistance, impacting treatments for sexually transmitted infections (STIs).
- The effectiveness of antimicrobial resources is diminishing, raising concerns about current medical practices.
- Antimicrobial resistance in STIs presents urgent challenges to established healthcare protocols.
Purpose of the Study:
- To examine the moral, temporal, and economic dilemmas arising from antimicrobial resistance in STIs.
- To explore the complexities faced by clinicians and decision-makers in managing resistance while providing patient care.
- To understand the implications of clinical practices on the spread of antimicrobial resistance.
Main Methods:
- Qualitative study drawing on interviews with clinicians, experts, and industry representatives.
- Analysis of emerging dilemmas related to prioritization, business requirements, and problem visibility.
- Examination of trade-offs between present patient needs and future resistance management.
Main Results:
- Participants highlighted difficulties in balancing competing health demands and business needs.
- Complexities emerged in managing patient expectations and divergent clinical opinions.
- Clinical practices were found to have significant implications for the development and spread of antimicrobial resistance.
Conclusions:
- Antimicrobial-resistant STIs create challenging environments for healthcare providers and policymakers.
- Effective strategies require addressing moral, temporal, and economic dilemmas.
- A balanced approach is needed to curb resistance while ensuring optimal patient and community health.
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