The Hidden Epidemic Confronting Sexually Transmitted Diseases (1997) / Chapter Skim
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From page 411... ...
Index A Academic health centers, 179, 187, 280-281 Academy of Pediatrics, 267 Access to health services adolescents, 9, 10, 11, 69, 76, 82, 261 and behavioral change, 163, 223 community settings, 12, 275-277 in developed countries, 100 and diagnosis and treatment of STDs, 162 disenfranchised populations, 9 managed care role, 13, 374, 375 migrant workers, 86 primary care, 275-277 and risk of STDs, 74-76, 163 sex workers, 81 uninsured patients, 13, 375 welfare reform and, 279 Accountability for services, 374 Adolescents. See also School-based interventions access to health care, 9, 10, 11, 69, 76, 82, 261, 265-266 behavioral interventions, 134, 391-392 behavioral research, 6, 240-241 cervical cancer, 37 chlamydial infection, 37, 82, 83, 155, 195 clinical services for, 299, 372, 389, 392393, 395, 396 411 condom use, 10, 82, 83, 125, 141, 144, 146, 147-148, 268 confidentiality issue, 10, 187, 264-267, 386 counseling and education of, 16, 83, 236, 265-266, 267, 294, 371, 388-389, 390, 396 in detention, 81, 82-83, 125, 139, 266 early interventions, 264-267 family planning clinic utilization, 187 females, 37, 61, 71, 82-83 gonorrhea, 37, 82, 83 health insurance coverage for, 69, 76, 100, 265 hepatitis B immunization, 145, 268-269, 270 human papillomavirus, 37 incidence and prevalence, 1, 20, 28, 37 knowledge and awareness of STDs, 106 107, 123, 125 managed-care services for, 194, 195 and mass media messages, 4-5, 10, 135, 390-391 national system for prevention, 3, 9-11, 261, 264-270 parent/family communication on STDs, 69 parental consent issue, 142, 240-241, 265, 266, 267, 386, 392-393 risk factors, 2, 10, 36-37, 61, 81-82, 124, 236, 264
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From page 412... ...
See also HIV infection cohort study, 51 deaths, 49, 50 lag time to development of, 71 rates, 31 research, 262 AIDS Action Council, 97 AIDS Community Demonstration Projects initiative, 136 INDEX AIDS Education and Training Centers, 207 Alabama, 82 Alan Guttmacher Institute, 98, 180 Alcohol use by adolescents, 77, 79 and sexual behavior, 76, 79 and STDs, 76, 79 American Association of Health Plans, 195, 282, 379 American Association of Sex Educators, Counselors, and Therapists, 97 American Cancer Society, 232 American Counseling Association, 97 American Indians/Alaska Natives hepatitis B immunization, 145 risk of STDs, 37 American Jewish Congress-Commission for Women's Equality, 97 American Medical Association, 97, 98, 290 American Orthopsychiatric Association, 98 American Psychological Association, 98 American Social Health Association, 98, 214 Anal cancer, 32, 36, 38, 42, 43, 46, 48 gonorrhea, 204 intercourse, 32, 124 syphilis, 38 Antibiotic resistance, 34, 35, 158, 199, 313 Antibiotic therapy, 144, 145, 161, 162 Asian Americans/Pacific Islanders, risk of STDs, 37 Association for the Advancement of Health Education, 98 Association for Sex Education and Training, 98 Association of American Medical Colleges, 290 Association of Reproductive Health Professionals, 98 Association of Schools of Public Health, 212 Association of State and Territorial Health Officials, 98, 247 Association of Teachers of Preventive Medicine, 212 Asymptotic infections, 107, 151, 312, 314 chlamydia, 36, 70, 195, 312 diagnosis of, 2, 20, 158 gender and, 2, 20, 36 gonorrhea, 36, 312 hepatitis B 70, 199 herpes simplex virus, 107, 199 HIV, 70, 153, 199
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From page 413... ...
See also individual sites costs, 60, 351 413 lag time to, 70 prevention, 3, 231-232 STDs and, 32, 42-43, 231-232 Catholics for a Free Choice, 98 Centers for Disease Control and Prevention cost data, 334 Division of Adolescent and School Health, 141 Division of STD Prevention, 202, 203, 208, 209, 212 funding for STD activities, 177, 187, 208, 209, 212, 231, 250 Gonococcal Isolate Surveillance Project, 34, 35 Managed Care Working Group, 379 National Partnership to Prevent STD Related Infertility, 300 Prevention Marketing initiative, 136 public service announcements, 94 recommended role, 6, 8, 9, 11, 13, 15, 17, 231, 234, 237, 248, 256, 273, 274, 280, 287-288, 292 research in prevention, 263 STD Treatment Guidelines, 161, 188, 292 293, 335, 384, 386 survey of STD-related services, 180-181 Youth Risk Behavior Surveillance System, 103-104, 146, 200 Cervical cancer, 20, 24, 46 causes, 32, 36, 37, 42 costs, 59, 342, 352 lag time from infection, 70 mortality, 37, 43, 50, 352 rates, 37, 48 screening, 42-43, 188, 231 and STD surveillance, 199 Cervical dysplasia, 39, 43, 278 Cervical ectopy, 73 Cervicitis, 158, 179 Chancroid asymptomatic infections, 312 costs, 59, 312, 342, 351 deaths related to, 49 diagnosis, 179 and HIV infection, 49, 51, 313 interventions, 81 male circumcision and, 72, 124 partner notification, 153 prevention, 228 rates, 30, 31, 312 reporting of, 196
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From page 414... ...
See also Dedicated public STD clinics; Funding of services; Managed care organizations for adolescents, 269-270, 372, 389, 392393, 395, 396 community-based, 12, 176, 185-186, 188, 202, 206, 211, 215, 220, 275-277, 394399 components, 175 coordination of, 185, 202, 220-221, 276-277 differential treatment of women, 152 expenditures, 175 guidelines on care to gay and lesbian patients, 98 health care professionals, 176 private sector, 175, 176, 187-188, 197, 206, 221 privatization, 285-288 school-university-based, 11, 187, 190, 265266, 269-270, 280-281, 392-393 secrecy and, 95, 98-99 settings, 175-176 training for, 21, 221 Coalition to Fight STDs, 214 Cocaine crack, 33-34, 77-78, 100, 154, 271 and sexual behavior, 77 and STDs, 83, 271, 339 Cohort studies, HIV-STD relationship, 50, 55 Columbia Broadcasting Company, 93-94 Columbus, Georgia, 397-398 Committee charge, 21 Committee on Performance Measurement, 201 Committee on Using Performance Monitoring to Improve Community Health, 201 Communication between clinical facilities, 185 between sex partners, 4, 89, 90-92, 108, 130, 140, 149 clinician-patient, 95, 98-99, 108, 289 parent-child, 4, 69, 89, 90, 91, 108
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From page 415... ...
See also specific contraceptives advertisements, 97 barriers to use, 149 dual protection, 149-150, 263 effectiveness against STDs, 124, 126-127, 149-151 implantable/injectable, 72, 124, 126 pregnancy prevention effectiveness, 126127, 150 school-based programs, 138, 140 sexuality perception and use of, 91 Contributing factors to the epidemic biological, 69-73 secrecy, 73-86 social, 86-100 Costs. See Economic costs of STDs Council of State and Territorial Epidemiologists, 204 Counseling of patients, 293-294 adolescents, 16, 83, 236, 265-266, 294, 371, 388-389, 390, 396 barriers to, 16, 294 in clinics, 120, 134, 179, 180, 181 discordant couples, 135, 146 effectiveness in prevention, 120, 134 funding for, 252 Health Belief Model, 134 HIV infection, 179 mandated, 180 one-on-one, 132, 134
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From page 416... ...
School Committee of Falmouth, 143 Cytomegalovirus, 39, 46, 47 D Dade County, Florida, 156-157 Deaths AIDS, 49, 50, 352 cervical cancer, 37, 43, 49, 50, 352 ectopic pregnancy, 45, 49 hepatitis, 49, 50, 352 liver disease, 49 pelvic inflammatory disease, 49, 352 from STDs, 1-2, 28, 37, 48, 49 Dedicated public STD clinics in academic settings, 179 access issues, 74, 278-280 counseling, 120, 134, 179, 180, 181 definition, 175 n.1 education of patients, 179, 181 effectiveness, 181-182, 214-215, 277 evaluation of services, 182 federal role, 13, 182- 185 funding for, 378, 379 improvement strategy, 13, 277-281 location, 178-179 partner notification activities, 152, 179 patterns of diseases, 188 privatization of, 285-288 quality of care, 179, 182, 214-215, 280, 285-288 recommendations, 13, 279-280, 281 reporting of STDs, 197 screening, 179 services, 21, 178-181 INDEX staffing, 152, 153, 154, 179, 182-184 training in, 205, 206, 286 users, 177-178, 220, 285, 286, 287 Definitions community, 223 dedicated public STD clinic, 175 n.1 managed care, 189 n.3 prevention of STDs, 21-22 n.3, 209 n.7 sex worker, 50 n.3 sexual intercourse, 32 n.2 sexuality, 87 STDs, 1, 30 Delaying sexual intercourse, 5, 96, 132, 138, 140, 264 Denmark, 29, 100 Denver, 142 Department of Health and Human Services, 6, 8, 203, 210, 212-213, 228-229, 235, 243-244, 249, 255, 256, 272, 273 Detention adolescents in, 81, 82-83, 139, 266 adults in, 83-85, 271-272 condom use in, 84-85, 272 data collection from, 202 drug use in, 84 screening for STDs, 84, 221, 271-272, 273 sexual activity in, 84-85 sexuality education of adolescents in, 82 STD-related services, 11, 266, 272, 274 transmission routes for STDs, 84 treatment in, 221-222, 271-272 Developing countries deaths associated with STDs, 49 target populations for prevention, 40 Diagnosis of STDs. See also Screening programs antibody detection, 159-160 antigen detection, 160 barriers to, 36, 162-163, 164 chlamydial infection, 160, 161, 197 costs, 158 culturing, 159 delays in, 2 disenfranchised populations, 11, 273, 274 early, 157, 164 false-positives, 160, 161 genetic markers, 160-161 laboratory testing, 158-159 microscopy, 159 for nontraditional settings, 11, 274 syndromic, 158 specimen collection procedures, 159
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See also School-based interventions; Training and education of health professionals of adolescents, 10-11, 163, 269, 372, 396 397 barriers to, 4, 41-42, 87-88, 91 with behavioral skills training, 130-131 cancer prevention education and, 232 in clinics, 179, 181 in detention facilities, 11, 83, 84, 274 employers/health care purchasers, 14 funding for, 252 HIV, 83, 84, 230 lack of, 20 managed care organizations, 387 national initiative, 236 of patients, 4, 179, 293-294 peer, 81, 83, 298, 391, 393, 396-397, 398 of policymakers, 381
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From page 418... ...
418 secrecy on sexuality and, 4, 87, 89-90 theater programs, 388-389 Educational level, and condom use, 148 Emergency centers, hospital-based, 188, 202 Emerging infections, 39, 40 Emory/Grady Teen Services Program, 298, 398-399 Employers/health care purchasers, role of, 8, 284-285 Epidemic occurrence of STDs, 19 n.l, 20, 40 Epidemiology HIV infection and STDs, 49-51, 52 and prevention of STDs, 119-120 support for STD programs, 203-204 Epididymitis, 46, 48, 337, 338 Epstein-Barr virus (EBV) , 42 Europe, gender differences in STD transmission, 35 European Americans cervical cancer, 43 condom use, 148 genital herpes, 199 risk of STDs, 37, 38, 125 Evaluation of interventions data collection, 139 factors considered, 55 health services performance measures, 201, 202, 255, 259-261 HIV prevention mass media campaigns, 358-362 information systems development, 202-203 limitations, 202 local data analysis capacity, 203-204 mathematical modeling, 56 methodologies, 139-140 monitoring, 258 outcome measures, 132, 134, 230, 358-360 performance measures, 259-261 school-based programs, 139-140 sharing of information, 381 survey tools, 389, 392 validation of self-reported behavioral changes, 134 F Falmouth, Massachusetts, 143 Family planning services/clinics, 74, 89, 155, 162, 186, 187, 202, 211, 220, 221, 299, 344, 395-396, 398-399 Family Privacy Protection Act of 1995, 240 n.1 INDEX Federation of Behavioral, Psychological, and Cognitive Sciences, 98 Female-controlled methods for prevention, 9, 263-264 Florida, 82, 184 Food and Drug Administration, 9, 11, 147, 161, 220, 244, 245, 249, 263-264, 274 Fox Broadcasting Company, 94 France, 144, 359 Funding of services block grant proposals, 212-214, 253, 254, 398 budget proposal for 1997, 244 categorical, 8, 210-212, 213, 215, 220, 253 256 clinics, 186, 187, 211, 378, 379 government, 177, 182-185, 186, 187, 208 210, 215, 251 information systems, 203 Performance Partnership Grants, 203, 212 213, 254 prevention, 3, 7-8, 211, 212, 235, 241, 249 256 private sector, 210-211, 251 recommendations, 8, 253, 255-256 research, 175, 210, 211, 212, 250 responsibility, 8, 251-253 sources, 381 training of health professionals, 175, 207, 212 G The Gambia, 359 Gay and Lesbian Medical Association, 98 Gay men condom use, 130 consequences of STD infection, 38 herpes simplex virus infection, 51 HIV-STD relationship, 51, 52, 55, 204 intervention strategies, 134, 135, 145 risk of STDs, 33, 38, 51, 79 self-identities, 130 substance abuse, 79 syphilis, 197 uncircumcised, 72 Gay movement, 130 Gender and clinic use, 177 and condom use, 148
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From page 419... ...
, 83, 84 rates, l9n.1,28-30, 31, 37, 38,40,204, 312 419 rectal, 204 reporting of, 196, 332, 343 screening, 84, 155, 179, 186, 372 sequelae and syndromes, 30-31, 44, 47, 4849, 155, 221, 313, 337, 343-344 in sex workers, 81 substance abuse and, 77 transmission routes, 47, 312 treatment, 34, 161, 186, 313, 343 Group Health Cooperative of Puget Sound, 190, 195, 281, 390-392 H Haiti, gender differences in STD transmission, 35 Harvard Pilgrim Health Care, 190, 194, 281 Harvard School of Public Health, 238 Hawaii, 105 Health Belief Model, 125, 128, 134 Health Care Financing Administration, 187, 191, 200, 209, 220, 244, 245, 249, 287 Health Care for the Homeless programs, 186 Health care professionals. See also Training and education of health professionals approaches to prevention, 176 compliance with standard practices, 207 disease intervention specialists, 152, 153, 154, 179, 182-183, 198, 207 primary care physicians, 14- 15, 134- 135, public health advisors, 152, 182-183 risk assessment of patients, 176 sexuality comfort levels, 4, 176 Health consequences.
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From page 420... ...
See also Genital herpes asymptomatic, 107, 199 costs, 59, 312, 337, 340, 342 cross-immunity, 73 gender differences in risk, 35 and HIV infection, 51, 52 keratitis, 337 neonatal, 199, 337, 342, 348-350 partner notification, 152 rates, 33, 312 reporting of, 196 sequelae and syndromes, 33, 46, 47, 313 treatment, 199 transmission routes, 33, 47, 312 typed, 30, 40, 51, 52, 73, 107, 196 vaccine, 145 Heterosexual men HIV-STD relationship, 50-51 Hetrick-Martin Institute, 98 INDEX Hispanic Americans access to services, 75 adolescents, 143 condom use, 143, 148-149 risk of STDs, 37-38 HIV infection anal intercourse and, 72, 124 asymptomatic period, 70, 153, 199, 314 cell-free RNA in semen, 54 clinical services, 194 contraceptives and, 72, 126, 150 costs, 1, 58, 59, 60, 352 counseling and testing, 179 deaths, 49, 314, 352 diagnostic tests, 159, 161 DNA shedding from cervix, 54 gender differences in, 48, 49 high-risk populations, 38 incidence, 55 infants, 47 male circumcision and, 71-72, 124 perceptions of risk, 125 in pregnant women, 57 in prisoners (adult) , 83 progression to AIDS, 47-48 rates, 19 n.l, 31, 81, 83, 314, 323 and reactivation of STDs, 51, 54 school-based clinic policies, 187 screening for, 156, 271 STDs and, 24, 49-53, 54, 55-56 substance abuse and, 77, 78, 79, 154 susceptibility to, 51, 54 treatment, 30, 161, 278, 315 HIV infectivity, 51, 54 HIV prevention barriers to, 130 community-based interventions, 136 conditions for, 121 condoms, 54, 135, 141 counseling of discordant couples, 135 education programs, 83, 84, 90, 94, 137 effectiveness measures, 204, 358-360 heterosexual populations, 230 mass media campaigns, 94, 144, 358-362 moralistic approach, 88-89 partner notification, 153, 179 school-based programs, 137 STD prevention and, 21, 28, 54-55, 61, 229-231 syphilis prevention and, 40 theoretical approaches, 133- 134
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From page 421... ...
maternal-infant transmission, 47, 48 myelopathy, 46, 48 type 1, 32, 39, 42, 47, 48 type 2, 39 Humana Health Care Chicago, 387 I In vitro fertilization, 45 Incidence of STDs, 8, 28-30, 31, 40, 197, 312, 314 Indian Health Service, 209, 212, 220, 244, 245, 249 Indianapolis, 155 421 Infants. See Neonates and infants Infectious disease prevention model, 224-225 Infectiousness of STDs duration of, 78, 120, 164 HIV, 51, 54 reducing, 157-163, 164 Infertility causes, 1, 20, 28, 36, 44, 45, 221, 337 costs, 337, 341 gender differences in risk, 36, 45, 46, 48 postpartum infections and, 48 prevention, 60, 155, 210, 212, 221, 300 and STD surveillance, 199 tub al- factor, 44 Information systems confidentiality issue, 375 development, 202-203 funding, 204 provider-based, 199, 373-374, 375 recommendations, 8 software, 202, 203 Information technology, 236, 208, 289-290 Innovations in Syphilis Prevention in the United States, 212 Institute for Policy Studies, 353 International perspectives, 8, 40-41, 100, 256 Internet, 208, 236 Interventions.
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From page 422... ...
. See also specific organizations accountability for services, 374 access to care, 13, 374, 375 adolescent programs, 387 approaches, 189- 190 barriers to prevention, 74-75, 282-283 confidentiality of services, 284, 287, 375, 381 coordination and integration of care, 373, 380 cultural sensitivity, 374 definition of, 189 n.3 economic issues, 376 educational outreach, 372, 387 employers/purchasers' influence, 284-285, 377 federal initiatives, 378-379 growth of, 190- 191 information systems, 260, 373-374 interest and mission, 375 limitations of, 192- 193, 374-376 Medicaid beneficiaries, 74-75, 190, 191, 193, 195-196, 215, 286-287, 371-372, 378, 383-393, 398 patient preferences, 376 and prevention of STDs, 13-14, 21, 23, 191-194, 370-381 preventive health emphasis, 283, 374 public health partnerships with, 14, 190, 195-196, 287-288, 370, 372-373, 378 379, 380-381 quality of care, 13-14, 192-193, 282, 374, 375 screening for STDs, 15, 372, 373, 387 services and programs, 194-195, 215, 281, 283-284, 371-372, 383-393 STD-related activities in, 383-393 strengths, 281, 373-374 training of providers, 286, 376, 381 treatment guidelines, use of, 384, 386, 387 treatment of sex partners, 193, 284, 297, 372, 376, 386, 387 variability of organizations, 189-190, 375 376 Managed Care Working Group, 195 Marital status, and risk of STDs, 125, 128 Mass media messages/campaigns advertisements, 94, 97, 228, 237, 238 condom promotion, 134, 137, 237, 238
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From page 423... ...
See also Heterosexual men consequences of STDs, 48-49 syndromes and complications of STDs, 36, 46, 307-309 urethritis, 30-31 Mental retardation, 20 Mentally ill persons, 79, 134 Methodology, this study, 22-23 Mexico, 359 Migrant workers, 85-86, 186, 206, 272, 274, 279 Minnesota, 196 Minority Youth Health Project, 391-392 Mississippi, 84 Missouri, 196 Mobiluncus sp., 39 Molluscum contagiosum, 58 Mombasa, 52 Mothers Against Drunk Driving, 234 MTV, 94 Mucopurulent cervicitis, 58 Mycoplasma genitalium, 39 Mycoplasma infections, 31 N Nairobi, 52 Nasopharyngeal carcinoma, 42 423 National Abortion and Reproductive Rights Action League, 98 National Abortion Federation, 98 National AIDS, STD, and National Immunization Program Hotline, 212 National Ambulatory Medical Care Survey, 199, 339 National Asian Women's Health Organization, 98 National Association of County and City Health Officials, 247 National Association of School Psychologists, 98 National Campaign to Prevent Teenage Pregnancy, 234 National Cancer Institute, 232 National Center for Health Statistics, 199, 200 National Center for Tobacco-Free Kids, 234 National Coalition to Support Sexuality Education, 95, 96-98 National Commission on Adolescent Sexual Health, 233 National Commission on Correctional Health Care, 84 National Committee for Quality Assurance, 192 n.5, 200-201, 267, 282, 374 National Communicable Disease Center, Venereal Disease Branch, 151 National Conference on Venereal Disease Control, 151 National Council of the Churches of Christ, 98 National Disease and Therapeutic Index, 199, 339, 348 National Education Association-Health Information Network, 98 National Health and Nutrition Examination Survey, 199, 259 National Health and Social Life Survey, 101, 200 National Health Survey of Physician Visits, 339 National Hospital Discharge Survey, 199, 339 National Household Survey on Drug Abuse, 77 National Information Infrastructure and High Performance Computing and Communication initiatives, 203 National Institute of Allergy and Infectious Diseases, 208-209 National Institutes of Health, 6, 9, 11, 101, 207, 209, 220, 232, 237, 241, 244, 245, 248, 250, 262, 263, 274, 292, 332, 351
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From page 424... ...
424 National Lesbian and Gay Health Association, 98 National Longitudinal Survey of Youth, 104 National Minority AIDS Council, 98 National Native American AIDS Prevention Center, 98 National Partnership to Prevent STD-Related Infertility, 300 National prevention system academic health centers, 280-281 access to services, 3, 9-14, 246, 261, 265 266, 274-298 for adolescents, 3, 9-11, 16, 240-241, 261, 264-270 approaches, 261-262 barriers to, 6-7, 247 cancer prevention linked to STD prevention, 231-232 clinical management of STDs, 15-17, 265, 269, 290-298 collaboration with public-sector health programs, 247, 252, 298-299 community services and responsibilities, 12, 223, 224-225, 226, 229, 275-277, 299 300 community stakeholders in, 223, 224, 227 components of, 223 condom programs, 268, 269, 272 confidentiality, 13, 265-267 coordination of services, 13, 230, 246, 259, 273-274, 276-277 counseling and education of patients, 16, 252, 265-266, 293-294 dedicated public STD clinics, 13, 277-281 diagnosis and treatment, 11, 15-16, 273, 292-293 for disenfranchised populations, 3, 9, 11, 266, 270-274, 275, 279 education, 4, 235-237, 246, 264, 265, 269, 272 employer/health care purchaser role, 8, 284 285 evaluation of interventions, 230, 247 federal role, 6, 228-229, 234, 243-245, 298 299 female-controlled protection methods, 9, 263-264 focus, 9, 261-274 funding, 3, 7-8, 235, 241, 246, 249-256 global prevention efforts, 256 guiding principles, 222, 224-225 INDEX health services performance measures, 8, 259-261 healthy sexual behaviors, adoption of, 3, 232-241 hepatitis B immunization, 11, 231, 268-269, 270 HIV prevention linked to STD prevention, 229-231 individual responsibilities, 224-225, 226 information systems, 241 laboratory services, 17, 297-298 leadership development, 3, 6-7, 234, 241 261 local-government role, 246-247, 252-253, 257 managed care organizations/health plans, 8, 13-14, 281-288 mass media messages, 4-5, 230, 237-238 models for, 224-226 open discussion of sexual behaviors, 4, 233 235 participants, 223-224 partner notification and treatment, 16- 17, 295-297 policy and strategy formulation, 228-232 primary care, 12, 275-276, 279 prison/detention facility services, 11, 271 272 private-sector role, 6-7, 242-243, 247-248 privatization of services, 285-288 professional training and education, 13, 14 15, 238-239, 246, 276, 288-290 public-private partnerships, 6-7, 247-249, 252-253, 277 quality of services, 3, 13-14, 246, 254-255, 259-261, 278-279 reimbursement for services, 13-14, 16, 17 research, 9, 230, 262-263 roles and responsibilities in, 223, 226, 242 247 Roundtable, 247-248 school-based programs, 10-11, 252, 265, 267-270 screening programs, 15, 262, 271, 273, 291 292 sexual health behavior research, 4, 5-6, 240 241 social norms of sexual behavior, changes in, 232-235 state role, 245-246, 252-253, 254
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From page 425... ...
INDEX surveillance and other information systems, 3, 8, 230, 246, 256-261 surveys of sexual behavior, 240-241 university/college students, 268 vision statement, 2-3, 224 National Resource Center for Youth Services, 98 National Survey of Adolescent Males, 200, 259 National Survey of Family Growth, 103, 146, 197, 200 National Women's Law Center, 98 Neisseria gonorrhoeae, 30, 312-313 Neonates and infants congenital syphilis, 31, 47, 153, 198, 338 deaths from STDs, 2 health consequences of STDs, 2, 20, 24, 46 48 hepatitis B immunization, 146 herpes simplex, 199, 337, 348-350 HIV progression to AIDS, 47-48 low birth weight, 28, 32, 39, 46, 60 neurological damage, 46, 47 prematurity, 32, 39, 46 syndromes and complications of STDs, 32, 39, 46, 47, 235, 309 transmission routes for STDs, 42, 47 Neurological damage, 28 Neurosyphilis, 46 New York City, 52, 84-85, 141, 142, 143, 273 New York State, 141 Non-A, non-B hepatitis, 33 North Carolina, 214 Norway, 156 Notifiable disease reporting system limitations, 197-198, 221, 257 procedures, 196-197 validation of information from, 258 Nucleic acid amplification tests, 160 o Oakland, California, 388-389 100% Condom Program, 137, 225, 228 Office of Population Affairs, 155, 209, 212, 220, 300 Ophthalmia neonatorum, 47, 48, 337 Oral contraceptives, 72-73, 124, 126, 148, 149 Oral intercourse, 32, 124 Oregon, 196 425 p Pacific Business Group on Health, 376, 377 Panorama City, California, 389 Pap smears, 42-43, 159, 231, 278 Parental consent, 142, 240-241, 266, 267, 386, 392-393 Parental Rights and Responsibilities Act of 1995, 266 n.4 Parents, Family and Friends of Lesbians and Gays, 98 Partner notification and treatment by clinics, 178, 179, 186, 198 confidentiality, 153 detention populations, 11 effectiveness, 151-152, 153-154 gonorrhea, 151, 153, 154, 179, 198, 337 health insurance coverage, 193, 284, 297, 371, 376, 386, 387 patient referral, 152, 154 prison inmates, 85, 274 in private settings, 188, 193, 221 provider referral (contact tracing) , 152, 154 recommendations, 11, 14, 17, 296-298 reimbursement for, 14, 17, 221 surveillance and public STD programs, 198 syphilis, 151, 152, 153-154, 179, 198 techniques, 16-17, 144, 152-153, 163-164 training for, 288 Pasadena, California, 388-389 Pathogens antibiotic-resistant strains, 34, 35, 158, 199, 313 associated disease/syndrome, 305-309 bacteria, 305-306 cross-immunity, 73 culturing, 159 ectoparasites, 307 fungi, 307 immunity from, 73 new, 28, 30, 39-40 protozoa, 307 viruses, 306-307 Patterns of S TD s, 120- 121, 188 Pediculosis pubis, 58 Pelvic inflammatory disease atypical, 44 causes, 32, 34, 36, 44, 155, 337 chlamydia screening and, 155-156, 195, 283-284 contraceptives and, 72, 126
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From page 426... ...
See also Clinical services; HIV prevention; Interventions; National prevention system barriers to, 2, 20-21, 71, 74, 232 behavioral vs. biomedical approaches, 120 123 cancer prevention linked to, 3, 231-232 chancroid, 228 chlamydial infection, 186, 195, 202, 221, 225 clinician approaches to, 176 condoms and, 146-149 contraceptives and, 149-151 definition, 21-22 n.3, 209 n.7 dual protection, 149-150, 263 "enabling approaches" to, 137 epidemiology and, 119 expenditures on, 7, 175 feasibility, 220 female-controlled methods, 9, 263-264 funding, 211, 212 global efforts, 256 gonorrhea, 39, 93, 126, 202, 221, 228 and HIV prevention, 21, 28, 54-55, 61, 229 231 individual factors and, 123- 131 issues, 23-24, 118-123 managed care role, 13-14 mathematical model, 118-120, 121 moralistic approach, 88-89 noncurative programs, 221 objectives, 202 pelvic inflammatory disease, 202 perceived risk and, 128-130 personal skills and, 130- 131 primary vs.
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From page 427... ...
See also Managed care organizations clinical services, 175, 176, 187-188, 197, 206, 221 funding of services, 210-211, 251 health insurance, 7, 14, 17, 59, 177-178, 193, 210-211 partner notification and treatment, 188, 193 public-sector partnerships with, 6-7, 247 249, 252-253, 277 reporting of STDs, 221, 258 role in national prevention system, 6-7, 242-243, 285 Prophylaxis, 145-146 Prostatitis, 46, 48 Protective behaviors. See Behavior change Public health advisors, 152, 182- 183 Public Health Graduate Training Certification Program, 212 Public Health Service, Public Health Data Policy Coordinating Committee, 203 Public Health Service Act, 210, 243 Q Quality of care in clinics, 179, 182, 214-215, 280 in managed care, 13- 14, 192- 193, 374 monitoring and assessment, 13 performance measures/standards, 201, 202, 255, 259-261, 374 privatization of services and, 285-288 process measures, 254-255 standards, 280 427 R and access to care, 75 and condom use, 148 and risk of STDs, 37-38 and STD rates, 270-271 Rape, 79 Rates of STDs, 1, 20, 24, 28, 81, 187, 270-271, 332-333.
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l, 124, 128-130 biological factors, 24, 69-73, 107, 124, 232 gender and, 2, 20, 28, 37, 54, 70, 71, 128 INDEX individual factors, 123- 131 marital status and, 125, 128 perceptions of, 4, 124-130, 144, 162, 163, 178, 236 personal skills and, 130- 131, 163 racial/ethnic group and, 19 n.l, 37-38 secrecy and, 86-107 sexual behavior and, 38, 123, 124, 163 social factors, 24, 73-86, 107, 232 Roundtable for the Development of Drugs and Vaccines Against AIDS, 248 S Safer Sex Campaign, 390-391 Salpingitis, 126 San Francisco, 79, 82, 85, 145, 377 Scabies, 32, 58 School Health Services and Policies Study, 187 School-based interventions abstinence-based, 138, 139 age of students, 138-139 approaches, 121, 137- 139, 267 -270 barriers to, 138 clinical services, 187, 190, 265-266, 269 270, 299-300, 392-393 condoms, 10, 90, 138, 141-144, 269 contraceptives, 138 court challenges to, 143-144 education, 10-11, 90, 100, 137-138, 267, 269 effectiveness, 10, 139-141, 163, 265 funding, 252 HIV, 187 legal mandates for, 137-138 parental consent requirement, 142, 143 religious/personal beliefs and, 267 and sexual behavior, 163 Screening programs. See also Diagnosis of STDs barriers to, 85, 273 cervical cancer, 42-43 chlamydial infection, 15, 84, 155-156, 179, 197, 201, 283-284, 372 clinical guidelines, 156, 273, 274 cost-effectiveness, 155, 156 in dedicated public STD clinics, 21, 178 disenfranchised populations, 273 funding, 186 gonorrhea, 84, 155, 179, 186, 372 HIV infection, 156, 179
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From page 429... ...
See also specific types adolescents, 10, 36, 69, 102-105, 264, 268 definition, 32 n.2 delaying sexual intercourse, 5, 96, 132, 138, 140, 264 dry sex, 72 during menses, 72 frequency of, 124 initiation of, 104-105, 121, 124, 143 mass media messages, 4-5 pain during, 44 prisons, 274 receptive rectal, 72 transmission of STDs, 32-33, 42 Victorian code of ethics, 87 Sexual networks, 119-120 Sexuality. See also Secrecy about sexuality definition, 87 education of adolescents, 82, 89-90, 91, 137-138, 140, 264, 388-386, 396, 398 information sources on, 265 international perspectives on, 100 mass media depiction of, 88 medical school curricula, 207 research on, 239 sociocultural taboos, 2, 86, 88 Sexuality Information and Education Council of the United States, 98 Sexually Transmitted Diseases Faculty Expansion Program, 212 Social learning theory (cognitive-behavioral theory)
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See also specific surveys funding for, 175 Health Care for the Homeless programs, 186 knowledge and awareness of STDs, 105 107 managed care organization STD services, 383-387 sexual behavior, 101, 103-104, 240-241, 392 STD-related services, 180-181, 186, 194 Susceptibility to STD infection, 2, 20, 28, 37, 54, 70, 71 Sweden, 29, 30, 153, 157, 228, 295, 299 Switzerland, 144, 359 Syphilis adolescents, 82 anal, 38, 197 asymptomatic infections, 312 congenital, 31, 47, 153, 198, 338, 340, 342, 347-348 costs, 59, 88, 208, 312, 338, 339, 340, 342, 347-348 deaths related to, 49 detection and treatment, 157, 159, 160, 161, 179, 339 eradication, 157, 256 ethnic/racial differences, 37 geographic distribution, 56-57, 198 heterosexual, 197 high-risk populations, 33-34, 38 and HIV infection, 40, 49, 52, 55, 56-57, incubation period, 151 maternal-infant transmission, 47 partner notification and treatment, 151, 152, 153-154, 179, 198 in pregnant women, 56-57 prevention, 39, 40, 55, 56, 88-89, 93, 136, 202, 208, 212, 228 in prisoners (adult) , 83, 84, 85 rates, 28-30, 31, 33, 40, 187, 197, 198, 312, 333 reporting of, 196, 333 screening, 15, 83, 84, 85, 156, 179, 273, 292 sequelae and syndromes, 31, 46, 47, 48-49, 313 in sex workers, 81, 154, 339
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INDEX substance abuse and, 77, 154 transmission routes, 312 treatment, 161, 186, 313, 347 T T-cell leukemia/lymphoma, 39, 42, 46, 48 Tanzania, 55, 56, 135-136, 157 Tattooing, 84 Telemedicine, 208 Tennessee, 84 Thailand, 137, 225-225 Theory of Reasoned Action, 125, 128, 133, 134 Training and education of health professionals academic health centers and, 280-281 adequacy of, 21, 288-289 in clinical management, 276, 280-281, 289 for counseling of patients, 239 in dedicated public STD clinics, 205, 206, 286 disease intervention specialists, 184 federal efforts, 207 focus of, 14-15, 288-290 funding for, 175, 207, 212 information technology and, 208, 289-290 initiatives, 207-208, 237 managed care organizations, 376 medical school and medical graduate education, 204-205, 207, 280-281, 289 partnerships with local health departments. 13 primary care, 205-207, 221, 289-290 in sexuality and sexual health issues, 238239 in surveillance, 259 Transmission of STDs chlamydia-HIV dynamics, 316-327 core groups, 119 crack cocaine and, 77-78 cycle, 118-119 female-to-female, 38 female-to-male, 35, 51 male-to-female, 35, 51 male-to-male, 38 maternal-infant, 45, 47 rate of spread, 118, 123 routes, 32-33, 39, 42, 84, 312, 314 in prisons, 84 Treatment of STDs antibiotic resistance and, 34 availability, STD, 313, 315 431 chancroid, 161, 351 chlamydial infection, 30, 34, 161-162, 313, 343 compliance with standard practices, 207 costs, 88, 162, 335, 343, 347 drugs, 335 gonorrhea, 34, 161, 186, 313, 343 guidelines, 15-16, 161, 206-207, 292-293, 335, 384, 386, 387 hepatitis B virus, 30, 161, 313 herpes simplex, 199 human papillomavirus infection, 30, 313, 351 long-term, 278 pelvic inflammatory disease, 158, 188, 193, 206 prisoners/detainees, 271-272 settings for, 15 single-dose therapy, 16, 161-162, 293 syndromic, 158 syphilis, 161, 186, 347 Trenton, New Jersey, 77 Trichomoniasis asymptomatic, 314 diagnostic tests, 161 and HIV infection, 49, 51, 52, 315 in homeless women, 82 rates,31,40, 314 sequelae and syndromes, 31, 315 transmission route, 314 treatment, 161, 315 Tropical spastic paraparesis, 39 Tuberculosis, 83, 204 U Uganda, 56 Uninsured persons, 74, 75, 76, 145, 252, 279, 375 Unitarian Universalist Association, 98 United HealthCare, 190 United Kingdom, 29, 144, 359-360 United States gender differences in STD transmission, 35 HIV prevention mass media campaign, 358 rates of STDs, 1, 29, 81 sex workers, 81 University/college students, 187, 268 University of California at San Francisco, 353 University of Pennsylvania, Graduate School of Education, 98
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See Sexual abuse and violence Viral hepatitis. See specific types Vulvar cancer, 36, 42, 43, 46 W Warts, genital and anal, 32, 39, 199, 278, 351 Washington, D.C., 85, 141 Watts Health Foundation, 392-393 Welfare reform legislation, 279 INDEX West Central Health District, 397-398 West End Medical Centers, Inc., 394-395 West Town Neighborhood Health Center Young Adult Clinic, 298, 396 Wisconsin, 155, 225 Women's health.
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