Both public and private sector clinical services for STDs are currently fragmented, inadequate, and, sometimes of poor quality. This situation leads to coverage gaps, inadequate access to services, and ineffective clinical care.
Access to services is facilitated by expanding the availability of STD-related services through primary care and by coordinating services at the local level. Universal and timely access to curative and preventive services are supported by eliminating financial barriers to obtaining health services, minimizing other barriers, ensuring that patients are not stigmatized, and ensuring that services are culturally appropriate. Given the broad spectrum of risk groups, access to STD-related services in multiple settings—including private sector clinics, family planning clinics, prenatal clinics, adolescent and school-based clinics, HIV clinics, community health centers, and other settings not traditionally targeted by STD programs—is important. STD-related services need to be incorporated into primary care because primary care fosters ongoing relationships between the clinician and the individual, increasing the likelihood of effective preventive interventions and early detection of STDs. In addition, incorporating STD-related services into primary care may increase access to and improve quality of STD-related care.
Each community has responsibility for ensuring universal access to comprehensive STD-related services. However, because communities differ widely in their health needs and capacity to support a system of STD-related services, the organization of community STD-related services should be tailored to local needs and conditions. 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.
With respect to the above issues, the committee makes the following recommendations: