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their infections will likely go untreated and spread to others in the community at large. As a final example, a fragmented system of information and educational services for STDs can result in inadequate awareness and misperceptions of risk. Data presented in Chapters 3 and 4 show that awareness of STDs in the United States is low and misperceptions of risk are common, even among those at highest risk for STDs. This is likely a result of the lack of open public education about STDs and the failure of the mass media to provide accurate information regarding the consequences of high-risk sexual behavior.
To develop an effective system for STD prevention, many existing programs need to be redesigned and improved through innovative approaches and closer collaboration. In addition, new programs and initiatives that address important gaps in the current fragmented system of prevention services need to be designed and implemented. In this chapter, the committee proposes an effective national system of STD prevention that can be developed from the currently fragmented set of services and funding streams for STDs. Unless otherwise indicated, the background and support for the committee's strategic plan for reducing the adverse health and economic impact of STDs in the United States are found in Chapters 2 through 5.
Laying The Foundation For A National System
In formulating a national strategy to prevent STDs, the committee developed the following vision statement and principles to guide its deliberations (Box 6-1).
To realize this vision, the committee recommends that:
An effective national system for STD prevention be established in the United States.
The committee uses the word ''system" to describe an interacting or independent group of services and organizations that function as a whole. By an "effective" system, the committee means a system that is coherent, comprehensive, and coordinated. A coherent system is founded on a clear strategy for prevention that ensures that the components of the system are logically consistent and synergistic. A comprehensive system fully utilizes all types of relevant approaches and effective interventions. A coordinated system ensures that the components of the system relate to each other in order to maximize efficiency and effectiveness. By a "national" system, the committee means a system that is based on a national policy coordinated at all levels and composed of local, state, and national (including federal) programs. A nationally coordinated system is necessary because STDs are a threat to the nation's health and do not recognize geographic borders. In addition, many interventions are most effectively or efficiently developed and implemented at the national level. It is expected that state and local systems will be developed and implemented concurrently and coordinated at all levels. Coordination