During the 1990s, the rising prevalence of HIV and sexu-

ally transmitted infections (STIs) in low-income countries heightened international concern about the lack of means of control. The number of new HIV infections reached five million in 2001, of which 70 % occurred in Sub-Saharan Africa, where more than 8 % of adults are now infected.1 The number of new STIs throughout the world totaled 340 million in 1999.2 Because these infections contribute to the spread of HIV,3 many HIV prevention efforts focus on man-aging STIs in addition to providing health education and promoting condom use.4 At the 1994 International Conference on Population and Development (ICPD), the international community made a commitment to providing a comprehensive package of reproductive and sexual health services, including man-agement of HIV and STIs.5 Particular emphasis was placed on controlling these infections through existing mainstream services—the maternal and child health and family plan-ning services offered at most primary health care outlets in the developing world