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made available. As previously mentioned, lack of physician compliance with standard practice for prevention and management of STDs has been documented (Gemson et al., 1991; Hessol et al., 1996) and additional training of clinicians in STD-related skills has been recommended (Boekeloo et al., 1991; Gemson et al., 1991; Steinberg et al., 1991; Hessol et al., 1996).
Federal Efforts in STD Training
Federal efforts to provide STD training have focused almost exclusively on training health professionals who provide services in the public sector. Since 1979, the CDC has funded 10 to 12 regional STD Prevention Training Centers. These centers have provided instruction composed of didactic lectures and clinic-based experiences to nearly 100,000 nurse practitioners, physician assistants, and physicians working in public health or family planning clinics throughout the United States. These centers are comanaged by medical schools and local or state health departments, but have not, until recently, specifically provided training to medical students or residents in training. In contrast, the AIDS Education and Training Centers funded by the Health Resources and Services Administration have focused on training primary care providers, but have not generally offered STD-related training. The Health Resources and Services Administration puts most of its sexuality-related training funds into programs related to family planning and HIV infection to the exclusion of other STDs. Generally, the National Institutes of Health's funding for STD-related training is primarily directed at training researchers, not clinicians.
To strengthen training of health professional students and trainees, the CDC plans a new initiative to support faculty positions in a limited number of medical centers to initiate clinical training of students and residents. However, the existing Regional STD Prevention Training Centers have not been adequately utilized to provide clinical training to health professional students and residents, who are often strongly motivated to obtain elective training in STDs. For example, the Seattle STD Prevention Training Centers cannot accommodate most of the medical and physician assistants and residents who seek training and have actually reduced training for these groups during the past year (King Holmes, University of Washington, personal communication, August 1996). To the committee's knowledge, no specific agency is responsible for training medical or other health professional students. Medical school curricula, which address human sexuality, do so from a perspective of sexual dysfunction and sexual ''deviance" rather than from a perspective of healthy sexuality. The CDC also supports training of disease intervention specialists, who generally coordinate HIV testing, provide patient education, and conduct partner notification for STDs, including HIV infection. This type of training support, however, is changing as described previously.