Skip to main content

Currently Skimming:

12 Preparing for the Future of the STI Response
Pages 581-654

The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.


From page 581...
... 12 Preparing for the Future of the STI Response Chapter Contents Introduction Review of Recently Published Reports Addressing STI Prevention in the United States • National Academy of Public Administration STI Reports • Treatment Action Group Gonorrhea, Chlamydia, and Syphilis Pipeline Report 2019 STI National Strategic Plan for the United States (2021–2025) Charting a Path Forward Adopt a Sexual Health Paradigm Broaden Ownership and Accountability for Responding to STIs • Better Support for Parents and Guardians to Model Sexual Health • Engaging Community Stakeholders to Create Opportunities for Dialogue About Sexual Health 581
From page 582...
... Effective STI prevention and control emerges from a holistic, sexual health perspective involving many levels of society and a variety of approaches. An integrated approach is needed that acknowledges the centrality of biological pathogens, yet also involves taking action throughout the entire population and at all levels of the prevention and care continua.
From page 583...
... The 2018 report The Impact of Sexually Transmitted Diseases on the United States: Still Hidden, Getting Worse, Can Be Controlled recommended the following six "Actions for Consideration" (NAPA, 2018)
From page 584...
... The NAPA report argues for better integration between existing STI and HIV programs at the federal level and within state and local health departments. It makes a compelling case for the costs associated with not maintaining a more holistic approach, such as the tunnel vision of responding aggressively to HIV prevention in pregnancy without attention to syphilis or herpes simplex virus type 2.
From page 585...
... The committee observes that the 2019 NAPA report was prescient, as the public health and medical care system failed to coordinate adequately in the early days of the COVID-19 response. As with that acute pandemic, a mounting STI toll reinforces the need for the nation to enable far better interagency coordination and give local jurisdictions greater ability to respond to outbreaks and unfavorable trends.
From page 586...
... The TAG report also cites the widespread use of doxycycline for acne suppression as a rationale for its more aggressive use for STI prevention.1 Specific mention of STI suppression (syphilis and chlamydia) accompanying HIV PrEP and post-exposure prophylaxis suggests synergies for the many persons at dual risk of HIV and STIs.
From page 587...
... , simple diagnostics to transform STI screening, diagnosis, and care. The TAG report advocates for "sexual health clinics in the United States, provider education, and appropriate curricula for providers-in-training." This sexual health paradigm is distinct from the classic STI clinic model of care.
From page 588...
... The committee's report provides information about these programs' importance and may be useful for informing the STI-NSP implementation plan. Emphasis on the need for risk reduction through individual-level changes, as captured in the STI-NSP, is a vital part of the STI control narrative.
From page 589...
... Program capacity and access to prevention and care services; 4. The need to accelerate progress in STI research, technology, and innovation; and 5.
From page 590...
... . In the forthcoming implementation plans, the committee urges pursuing self-collection options as a potential solution for STI prevention and control.
From page 591...
... . Also needed is a broader discussion of specific groups or priority populations in society who have an acute need for enhanced STI prevention, testing, and treatment interventions, including women and men of color, men who have sex with men (MSM)
From page 592...
... More ambitious goals could help to motivate policy makers and practitioners to improve the STI prevention and control landscape. The STI-NSP is an important contribution to government efforts to turn the tide on rising STI rates and, given the synergies between the STI-NSP and this report, an important opportunity to implement the recommendations provided in this report to drastically reduce STIs in the United States.
From page 593...
... • Include new approaches and strategies for specifically engaging men (in cluding men who have sex with men) with readily available male-centered sexual health specialty services, implementing gender-inclusive sexual and reproductive health services in primary care.
From page 594...
... These and other legislative changes did not happen serendipitously, but were the results of long-standing, grassroots advocacy and hard-fought battles by diverse activists and LGBTQ+ community members, legal scholars, health care professionals, and others. The committee looks to these as instructive examples for how legislation and social change can impact policy and seeks to glean lessons that can inform ways for society to embrace a fuller conception of sexual health to strengthen public policy responses to STI prevention and control.
From page 595...
... These alliances could develop policy agendas and engage with elected officials and with organizations that address the rights and health of marginalized communities to further these agendas to strengthen flagging STI prevention, treatment, and education programs. Despite local and noteworthy successes, these generally are not scaled or duplicated and do not happen in all jurisdictions.
From page 596...
... • A holistic approach to sexual health programs should include new approaches and strategies for specifically engaging men (including men who have sex with men) with readily available male-centered sexual health specialty services and the imple mentation of sexual and reproductive health services in primary care.
From page 597...
... ; and identify strategies for engaging men in promoting sexual health that include STI prevention, screening, and treatment. Reorienting the popular conception of health to include sexual health may seem broad and perhaps intangible, but it offers the overarching framework for all of our subsequent recommendations and establishes the foundation for steps to better prevent and control STIs.
From page 598...
... To successfully reduce the nationwide burden and impact of STIs, there is a need for greater ownership of issues for which people and institutions are reluctant to take responsibility or where the potential power that various stakeholders could exert on better controlling STIs may not be readily apparent. The next section offers conclusions and recommendations for strengthening the existing STI services system, prevention, and care within the health sector.
From page 599...
... • Develop guidelines for pediatric and adolescent health care to support skills training and educate parents in promoting adolescent and young adult sexual health, including STI prevention. (Chapters 8 and 12)
From page 600...
... Parents often don't feel comfortable talking about their bodies and sex at all. Their parents didn't talk to them and they cannot have these conversations with their children." During the past decade, sexuality norms, including sexual behaviors among adolescents, has been an important theme in the literature on sexual health in the United States (Espinosa-Hernández et al., 2020; Ksinan Jiskrova and Vazsonyi, 2019)
From page 601...
... . Considerable evidence demonstrates the role of parents in shaping outcomes relevant to adolescent STI prevention, including delayed sexual debut, reduced frequency of sex, correct and consistent condom use, and enhanced use of sexual and reproductive health (SRH)
From page 602...
... play a central role in supporting adolescent and young adult sexual and reproductive health and STI prevention. To fully leverage their role, parents need to have access to
From page 603...
... , through the Centers for Disease Control and Prevention (CDC) Division of STD Prevention, the 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)
From page 604...
... While not an exhaustive list, the following sectors of our communities should be enlisted to play their part in promoting sexual health. Families As discussed earlier, families, primarily parents, often represent an important influence in adolescent sexual decision making.
From page 605...
... Families of choice most relevant to STI prevention include the house/ballroom community and other gay family structures. House culture (or ballroom culture)
From page 606...
... . Adolescents who participate in comprehensive sexual health education programs in school settings are more likely to delay initiation of sexual behavior, have increased knowledge of STI risks and consequences, and report enhanced contraceptive use (Chin et al., 2012; Denford et al., 2017; Kirby, 2007; Lopez et al., 2016; Santelli et al., 2017; Underhill et al., 2007)
From page 607...
... , to assist educators, as well as parents, in the development of age-appropriate curricula: • Understanding that sexuality is a natural part of life and involves more than sexual behavior; • Recognizing and respecting the sexual rights shared by all; • Having access to sexual health information, education, and care; • Making an effort to prevent unintended pregnancies and STIs and seek care and treatment when needed; • Being able to experience sexual pleasure, satisfaction, and inti macy when desired and appropriate; and • Being able to communicate about sexual health with others, including sexual partners and health care providers. Faith Communities My church had been my foundation from a very young age.
From page 608...
... The committee holds an inclusive vision of respect and appreciation for diversity in religious belief, culture, gender, and sexual orientation. The committee also asserts that promoting sexual health in a manner that facilitates STI prevention, diagnosis, and treatment does not constrain faith communities from teaching about sexual responsibility and sexual health in a way that is consistent with their own faith traditions and ethical frameworks.
From page 609...
... (2011) found that an evidence-based HIV prevention intervention focused on young African American women could be successfully adapted to the church setting with high levels of fidelity to the original intervention, and with high attendance in this two-session program.
From page 610...
... As explored in Chapter 8, social network interventions and community-level interventions can contribute to an improved STI response. Assessing effective advocacy, tools that assist in building community capacity for delivering interventions, and community mobilization models addressing related issues can offer new insights for bolstering the role of community partners in strengthening responses to STIs.
From page 611...
... (3) community-based organization, providing services to persons living with HIV in the Jackson area since 1999.5 In 2013, the organization expanded HIV testing services to include STI screening, blood pressure and body mass index measurements, glucose, and cholesterol testing to create a more holistic health focus and reduce stigma around HIV and STI testing.
From page 612...
... . Workplaces Workplaces offer an important opportunity to advance sexual health and STI prevention and control.
From page 613...
... Chapter 8 discusses the role of businesses at the community level and outlines the promising role of barbershops to disseminate information about sexual health, wellness, and STI prevention (Brawner et al., 2013)
From page 614...
... Respected celebrities and community leaders can assist with reducing stigma and promulgating prevention messages. In the committee's information-gathering sessions, multiple speakers identified how celebrity advocates could help with STI prevention and control, creating a culture of sexual health to obtain better policy support and funding, and addressing stigma (Barclay, 2019; Sofaer, 2018)
From page 615...
... Similarly, ASHA has developed campaigns that leverage individuals with large social networks and/or social media followings to educate and encourage individuals to seek STI testing services. ASHA recruits volunteers nationally and globally for its social media ambassador program6 to develop and disseminate positive sexual health messages within their networks.
From page 616...
... For example, many individuals are respected and influential on social media and passionate about STI prevention. They may not have the status of a famous actor, but they can be a type of domain-specific (e.g., specific to sexual health)
From page 617...
... These methods could play an increasing role in the future of STI prevention by cost-effectively helping to identify online influencers around sexual health, increasing the likelihood of gaining a large number of highly committed, low-cost "celebrity" advocates. PPPs for STI Prevention and Control PPPs, in which private-sector entities, including corporations and philanthropies, either work directly with governmental agencies on collaborative projects or agree to work separately toward shared goals, can be an important avenue for broadening ownership for STIs.
From page 618...
... They could be built on many themes: adolescent health, women's health, men's health, LGBTQ+ health, perinatal and children's health, POC diagnostics, and public health capacity building. STI drug development Substantive experiences with PPPs in the STI field are relatively recent and have shown great promise, with some early successes.
From page 619...
... . Public communications campaigns show promise in engaging professional advertisers with marketing expertise, as with CDC's Community Approaches to Reducing Sexually Transmitted Diseases initiative (CDC, 2020)
From page 620...
... These divisions also may have 11 Advocates for Youth, AIDS Institute, American Sexual Health Association, American STD Association, Association of Maternal & Child Health Programs, Association of State and Territorial Health Officials, GLMA: Health Professionals Advancing LGBTQ Equality, HIV Medicine Association, Infectious Diseases Society of America, National Alliance of State and Territorial Aids Directors, National Association of County and City Health Officials, National Coalition of STD Directors, National Family Planning & Reproductive Health Association, NMAC, Planned Parenthood Federation of America, SIECUS: Sex Ed for Social Change, and Treatment Action Group.
From page 621...
... • Community-Based Businesses and Other Settings: Small busi nesses and other establishments in communities where people live and socialize are ideal settings for engaging individuals in meaningful dialogue about health and wellness, including mes sages about sexual health and STI prevention. With trainings and resources from CDC and state and local health departments, com munity stakeholders should be deployed to engage on these topics.
From page 622...
... Strengthen Local Efforts to Plan and Coordinate the STI Response: • Improve coordination and strengthen population outcomes by supporting local stakeholder engagement processes involving the breadth of public and private stakeholders to develop and implement comprehensive multi-year local plans for STI control and prevention. • Develop STI Resource Centers for clinical consultation, workforce development, and technical assistance to assist in the planning process and provide consulta tion to individual clinical STI providers.
From page 623...
... Deploy Psychosocial and Behavioral Interventions for Sexual Health: Take steps to expand the reach of psychosocial and behavioral interventions to prevent and control STIs at the individual, interpersonal, and community levels: • Develop new mechanisms that provide sustainable funding for adoption, scale up, and dissemination. • Establish standard guidelines for school-based comprehensive sexual health education.
From page 624...
... Surveillance and Monitoring CDC operates numerous essential disease surveillance systems that typically fund state and local health departments to collect and analyze information, including on nationally reportable infectious diseases (see Chapters 2 and 4)
From page 625...
... STI Clinical Treatment Guidelines The STI Treatment Guidelines are widely read and downloaded;12 they are viewed nearly half a million times each month, and the guidelines mobile app is one of the top-ranked apps at CDC, with a rating of 4.3/5.0 (see Chapters 7 and 10 for more information on the treatment guidelines)
From page 626...
... Furthermore, STI professionals, especially within state and local health departments, have critical knowl edge and expertise that needs be the foundation of any efforts to improve the national response to STI prevention and control.
From page 627...
... should modernize its core sexually transmitted infection (STI) activities to strengthen the timely monitoring of STIs with less reliance on estimated rates based on case reports, to inform proper treatment of persons with STIs, and to increase consistency and accountability across jurisdictions.
From page 628...
... This should include representatives of local health departments, heavily affected communities, health insurance programs and exchanges, federally quali fied and other health centers, Ryan White HIV/AIDS Pro gram 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 municipalities 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 prog ress toward achieving established benchmarks. Regarding item 1 of Recommendation 12-4, the 2018 and 2019 NAPA reports also highlight the need for improved STI surveillance and list this as a recommended action.
From page 629...
... In recent years, significant federal efforts have been made to support the integration of HIV prevention and care planning. The committee recognizes that STI-specific community consultation and 13 See https://www.cdc.gov/std/funding/pchd/default.htm (accessed November 16, 2020)
From page 630...
... Strengthening Local Efforts to Plan and Coordinate the STI Response Just as the committee understands that it is critically important to reinforce the federal–state partnership, it also recognizes that policies and initiatives often succeed or fail at the local level. Therefore, innovative leaders and strong champions for the STI response are needed in health departments, academic institutions, public and private health care settings, and community-based organizations.
From page 631...
... • Establish formalized, funded relationships with trusted com munity-based organizations to deliver critical STI prevention and care services. CDC, in collaboration with the National Network of STD Preven tion Training Centers, NACCHO, and NCSD, should develop STI Resource Centers (SRCs)
From page 632...
... Chapter 11 examines the STI workforce in detail, highlights the need for it to refocus and improve the traditional service delivery paradigm, and identifies opportunities for leveraging health care systems and practitioners to improve STI services and strengthen the broader public health workforce to respond to public health emergencies, including STI outbreaks. Recommendation 11-1 is that sexual health promotion be operationalized and prioritized in practice guidelines and training curricula and that STI prevention and management be incentivized and prioritized as a focus area of practice.
From page 633...
... The agency is burdened with a multitude of competing demands and a wide variety of long-standing pressing health and disease threats, as well as emerging novel threats, as exemplified by COVID-19. Chapter 7 offers a clear explication of the biomedical tools available for STI prevention and management.
From page 634...
... (Chapter 9) Harness Technological Innovation to Improve STI Prevention and Control: Expand the capacity to use technology for STI prevention and control, includ ing expanding the types of expertise available and prioritizing expert consultation; developing timely, novel, and open data systems; and using artificial intelligence– based mass marketing.
From page 635...
... The federal government has a critical role to play in providing leadership, synthesizing data, and exposing trends unfolding across the country to inform and shape state-level surveillance and response that feeds into tailored local-level response and service delivery. It could be said that public health has failed STI prevention, but it would be better argued that society has failed public health.
From page 636...
... The United States is expected to need to continue to manage emerging infectious disease epidemics, such as COVID-19 and pandemic influenza, with some frequency in the future. National and statewide preparedness plans and workforce development will fail to maintain or improve STI services if pandemic preparedness plans do not consider needed mitigation for the rise in STIs and allow for workforce development and logistical planning (Nguyen et al., 2020; Rivara et al., 2020)
From page 637...
... . With or without the stress of COVID-19, STI services need to innovate in the face of rising STI rates.
From page 638...
... By approaching this with a harm reduction perspective, persons affected by COVID-19 will be better able to advocate for their sexual health and participate in intimacy while protecting themselves and those around them. A strategy commonly used in STI/HIV prevention efforts is to tighten a sexual network by limiting activity to those people know.
From page 639...
... Address Structural Racism and Other Structural Inequities That Hinder STI Control For the nation to strengthen STI prevention, screening, and treatment to effectively reduce the risk for and harms from STIs, it is necessary to not only deal with individual factors and behaviors, but look broadly at the aspects of society that generate and perpetuate inequity. As stated in Recommendation 9-1, the Secretary of HHS should lead a whole-ofgovernment, interagency response to counter structural racism and other structural inequities (such as societal-level policies, practices, and norms)
From page 640...
... As discussed in Chapter 6, this is largely irrelevant because these tools are broadly used by the population and the role they play in people's lives can be expected to increase rather than decrease. Recommendation 6-1 seeks to accept these technologies and identify strategies to apply them for digital behavior change and in other ways to strengthen STI prevention and control.
From page 641...
... . GARDP sexually transmitted infections program.
From page 642...
... 2015. 2015 sexually transmitted diseases treatment guidelines.
From page 643...
... 2012. The effectiveness of group-based comprehensive risk-reduction and abstinence educa tion interventions to prevent or reduce the risk of adolescent pregnancy, human im munodeficiency virus, and sexually transmitted infections: Two systematic reviews for the guide to community preventive services.
From page 644...
... https://www. mckinsey.com/industries/private-equity-and-principal-investors/our-insights/the rising-advantage-of-public-private-partnerships (accessed November 4, 2020)
From page 645...
... 2017. Interventions to increase male attendance and testing for sexually transmitted infections at publicly-funded family planning clinics.
From page 646...
... 2020. Behavioral counseling interventions to prevent sexually transmitted infections: Updated evidence report and systematic review for the U.S.
From page 647...
... 2019. Multi-contextual influences on adolescent pregnancy and sexually transmitted infections in the United States.
From page 648...
... 2017. Confidentiality issues and use of sexually transmitted disease services among sexually experienced persons aged 15-25 years -- United States, 2013-2015.
From page 649...
... 2001. Structural and community-level interventions for increasing condom use to prevent HIV and other sexually transmitted infections.
From page 650...
... 2017. Health department announces historic expansion of HIV and STI services at sexual health clinics.
From page 651...
... Sexually Transmitted Diseases 41(1)
From page 652...
... 2018. National Academy of Public Administration: First phase report on STDs for the National Coalition of STD Directors: Presented at Meeting 2 of the Committee on Prevention and Control of Sexually Transmitted Infections in the United States.
From page 653...
... Sexually Transmitted Diseases 46(8)
From page 654...
... 2015. Sexually transmitted diseases treatment guidelines, 2015.


This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More information on Chapter Skim is available.