Sexually Transmitted Infections Adopting a Sexual Health Paradigm (2021) / Chapter Skim
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-- a major component of sexual and reproductive health -- however, has been chronically underfunded, stigmatized, and too frequently left out of national conversations around health. STIs are among the most common infections affecting humans and cause significant morbidity and mortality in the United States and globally.
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the direct medical and economic costs resulting from STIs, these conditions merit attention as a greater health priority, yet blame, embarrassment, shame, and stigma mean that STI epidemics are too often hidden or ignored. In 1997, the Institute of Medicine released a report, The Hidden Epidemic: Confronting Sexually Transmitted Diseases.
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FIGURE S-1 Notifiable sexually transmitted infections -- rates of reported cases per 100,000 population (per 100,000 live births for congenital syphilis) , United States, 1999–2018.
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Therefore, the committee concludes that biomedical approaches to STI prevention and control cannot be optimally effective without also addressing root causes of poor health and STI risk, namely, the structural and social determinants of health, such as poverty, unequal access to quality health care, stigma, racism, and discrimination. Moreover, successful application of this framework requires a shift in current siloed funding mechanisms to an integrated and sustained funding approach that not only addresses STIs as discrete health outcomes but also addresses interpersonal, community, institutional, and other societal factors that influence STI risk, prevention, health care access, delivery, and treatment.
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This has translated into less attention to STI services and fewer critical services being delivered. The nation pays an increasing price for neglecting to fund public health and thereby neglecting STIs or placing them in funding competition with other urgent infectious diseases control priorities.
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1. ADOPT A SEXUAL HEALTH PARADIGM2 Integrating Sexual Health as a Key Dimension of Healthy Living The nation's response to STIs has mostly focused on individual risk factors and individual behavior change, and has failed to address structural and social elements that foster infection and disease.
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For example, promoting sexual health in a manner that facilitates STI prevention, diagnosis, and treatment does not constrain faith communities from discussing sexual responsibility and sexual health in a way that is consistent with their own faith traditions and ethical frameworks. The committee holds an inclusive vision of respect and appreciation for diversity in religious belief, culture, gender, and sexual orientation.
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The vision and action plan should include a course of action for individuals, health care providers, and community members to promote positive sexual health over the life span by giving individuals more agency over their personal preferences and choices, acknowledging the role of culture in influencing these choices, and highlighting structural inequities and barriers to optimal health. Reorienting popular conceptions of well-being to include sexual health is the overarching framework for all recommendations in this report and establishes a new foundation for successful STI prevention and control.
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, through the Centers for Disease Control and Prevention (CDC) Division of STD Prevention, CDC Division of Adolescent Health and School Health, the Indian Health Service, and other key pub lic health service agencies, should develop a national, parent focused communication campaign to promote and guide paren tal communication with adolescents regarding sexual health and sexually transmitted infection (STI)
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The committee supports maintaining and enhancing this role, including encouraging DSTDP to be more assertive and, in some cases, more prescriptive in its grants to states and local jurisdictions to establish minimum national standards of data reporting and STI care. Furthermore, STI professionals, especially within state and local health departments, have critical knowledge and expertise that need to be the foundation of any efforts to improve the national response to STI prevention and control.
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This should include representatives of local health departments, heavily affected communities, health insurance programs and exchanges, federally qualified and other health centers, Ryan White HIV/AIDS Program recipients, Substance Abuse and Mental Health Services Administration recipients, and others to develop a multi-year state or major municipalities STI prevention and control plan that o leverages disparate assets within the state or major munici palities for establishing STI prevention and care priorities, aligning STI and HIV priorities; o establishes benchmarks; and o creates a process for monitoring and reporting on progress toward achieving established benchmarks.
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Working in tandem with the preceding recommendation for CDC to require statewide STI prevention and control plans, the committee recommends: Recommendation 12-5: The Centers for Disease Control and Preven tion (CDC) should encourage local health departments to develop and implement comprehensive plans for sexually transmitted infec tion (STI)
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Establish New Payment and Coverage Options to Close Gaps in Access to STI Coverage and Services Effective public health efforts to control the transmission of infectious diseases benefit the whole population, yet many people are not reached by the current fragmented health care system. Many individuals experience financial barriers to STI screening and treatment services because of their insurance status, immigration status, and/or ability to afford copayments or coinsurance for treatment and services. Recommendation 10-1: The Department of Health and Human Ser vices and state governments should identify and support innova tive programs to ensure that sexually transmitted infection (STI)
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Sexually transmitted infection (STI) prevention and management should be incentivized and facil itated as a focus area of practice for both the clinical workforce and important segments of nonclinical public health and social services professionals.
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and state and local health departments, in collaboration with STI/ HIV expert providers and the regional STI prevention training centers, should serve as a resource of clinical expertise for pri mary care providers and nonclinical health and social services professionals and paraprofessionals. This should be accom plished through consultation, technical assistance, and continu ing education (see also Recommendation 12-5)
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Deploy Psychosocial and Behavioral Interventions for Sexual Health Psychosocial and behavioral interventions to promote sexual health and prevent STIs are underused and have not been adopted and sustained in clinical or community practice. These interventions, in conjunction with biomedical, structural, informatics/technological, and health service interventions, are integral to a comprehensive strategy for sexual health and STI prevention and control.
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Divi sion of Adolescent and School Health should work in partner ship with parents and guardians, parent–teacher associations, states, districts, and local school boards to establish standard evidence-based guidelines for school-based comprehensive sexual health education that is grounded in psychosocial and behavioral theories and research. To ensure that each student receives medically accurate, age-appropriate, and culturally inclusive comprehensive sexual health education in elemen tary, middle, and high school, dedicated staff, including school based nurses and health educators, should be trained, provided adequate time, and given necessary resources.
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HHS should lead a whole-of-government response that engages all relevant federal departments and agencies to develop a coordinated approach to reduce negative STI outcomes and address inequities in the U.S. population by promoting sexual health and eliminating structural inequities that are barriers to STI prevention, testing, and treatment among marginalized groups.
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Instead, the relevant questions are how, why, when, and where these technologies increase risk; how, when, and where they can be leveraged to promote sexual health; and how public health can integrate this knowledge into daily STI prevention and control efforts to ensure safe and ethical oversight (see Chapter 6 for a discussion of implementation, cost, and feasibility considerations)
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Achieving this recommendation would entail that CDC undertake regular dialogue with leading industry and nonprofit experts, along with STI providers and community representatives; assess its STI data management capacity; and partner with state and local health departments to use highly targeted AI-based digital mass communication strategies to better address STIs. CONCLUSION Despite the dedicated commitment of many individuals and agencies, STI research, policy, and services continue to suffer from neglect.
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