The Hidden Epidemic Confronting Sexually Transmitted Diseases (1997) / Chapter Skim
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EXECUTIVE SUMMARY
EXECUTIVE SUMMARY
Pages 1-18
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They are hidden from public view because many Americans are reluctant to address sexual health issues in an open way and because of the biological and social factors associated with these diseases. In addition, the scope, impact, and consequences of STDs are underrecognized by the public and health care professionals.
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The sociocultural taboos related to sexuality are a barrier to STD prevention efforts on a number of levels. Effective STD prevention efforts also are hampered by biological characteristics of STDs, societal problems, unbalanced mass media messages, lack of awareness, fragmentation of STD-related services, inadequate training of health care professionals, inadequate health insurance coverage and access to services, and insufficient investment in STD prevention.
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· Government agencies and private organizations concerned with cancer prevention should support STD prevention activities as an important strategy for prevention of STD-related cancers. Strategy 1: Overcome barriers to adoption of healthy sexual behaviors.
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Despite their current lack of involvement in promoting healthy sexual behaviors, the mass media can be extremely powerful allies in efforts to prevent STDs by increasing knowledge and changing behavior. Mass media messages that promote healthy sexual behaviors will facilitate needed changes in social norms regarding sexual behaviors because mass media help define these norms.
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support and implement a long-term national initiative to increase knowledge and awareness of STDs and promote ways to prevent them; and (c) develop a standing committee to function as an expert resource and to develop guidelines and resources for incorporating messages regarding STDs and healthy sexual behaviors into all forms of mass median · Television, radio, print, music, and other mass media companies should accept advertisements and sponsor public service messages that promote condom use and other means of protecting against STDs and unintended pregnancy, including delaying sexual intercourse.
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The barriers to an effective national system for STD prevention are found in government, private sector organizations, and political factors and social norms. Overcoming these barriers is a challenge that requires the active participation of all levels of government, the private health care sector, businesses, labor leaders, the mass media, schools, and many community-based organizations.
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Private health plans, in particular, need to increase support for STD-related services that benefit their enrolled population, and ultimately benefit the health plan's financial status. In addition, because STDs are emerging infections and a global public health problem, the United States has a national interest in preventing STDs worldwide.
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, managed care organizations and other health plans, and other health care professionals to develop and utilize information systems that effectively integrate preventive services performance data with community health status indicators and STD program data. · STD-related performance measures should be included in the Health Plan Employer Data Information Set (HEDIS)
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Prevention-related research allows program managers and policymakers to maximize the effectiveness of interventions and available resources. Areas of prevention-related research that should be emphasized include determinants of sexual behavior and sustained behavior change; determinants of initiation of sexual intercourse among adolescents; influence of social and other community-related factors on risk of STDs; interventions to improve condom use and reduce high-risk behaviors; effectiveness of sexual risk behavior assessment and counseling; biomedical interventions that do not rely primarily on individual behavior, such as vaccines; female-controlled prevention methods; cost-effectiveness of interventions; methods for preventing STDs among disenfranchised populations; interventions for preventing STDs among persons of all sexual orientations; and methods to assess prevention program effectiveness.
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Many school-based programs and mass media campaigns are effective in improving knowledge regarding STDs and in promoting healthy sexual behaviors, and these two interventions should be major components of an STD prevention strategy. The committee believes that there is strong scientific evidence in support of school-based programs for STD prevention, that adolescence is the critical period for adopting healthy behaviors, and that schools are one of the few venues available to reach adolescents.
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. · Prisons and other detention facilities should provide comprehensive STD-related services, including STD prevention counseling and education, screening, diagnosis and treatment, partner notification and treatment, and methods for reducing unprotected sexual intercourse and drug use among prisoners.
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Depending on local situations, health departments should incorporate STD-related services into public and private primary health care services. Depending on epidemiologic patterns, health insurance coverage, population density, and other community characteristics, they may continue to support dedicated public STD clinics, or may shift such services to community-based clinics or the private sector.
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Standards to maintain access to confidential services and to monitor quality should be developed for STD-related services provided by public STD clinics, health plans, and public-private sector arrangements. With respect to the above issues, the committee makes the following recommendations: · Based upon local conditions and health department determination, dedicated public STD clinics should continue to function as a "safety net" provider of STD-related services for uninsured and disenfranchised persons and for those who prefer to obtain care from such clinics.
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· Federal, state, and local health agencies should educate employers, Medicaid programs, and other purchasers of health care regarding the broad scope and impact of STDs and the effectiveness of preventive services for STDs. · Health plans, including managed care organizations, should develop collaborative agreements with local public health agencies to coordinate STD-related services, including payment for STD-related services provided to plan enrollees by public sector providers, including public STD clinics.
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Family planning clinics, prenatal clinics, and other settings where obstetric or gynecological care is available should screen and treat women and their partners for STDs. With respect to the above issues, the committee makes the following recommendations: · All primary care providers, including managed care organizations and other health plans, should implement the recommendations of the U.S.
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The optimal combination of activities that are most effective in reaching partners at risk for STDs will vary depending on the local epidemiology of STDs, available staff and other resources, and the spectrum of local health care professionals providing STD-related care. STD programs need to develop new strategies and techniques for community outreach in partnership with other professionals rather than relying solely on public sector staff.
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The committee believes that health plans and clinicians have an ethical and public health obligation to ensure that sex partners of infected patients are appropriately identified, screened, and treated, regardless of health insurance status. This belief is based on the concept that health plans have a responsibility to improve the health of the communities from which they draw their revenue and that treating partners is in both the short- and long-term interest of the health plan.
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