. "ESTABLISHING AN EFFECTIVE NATIONAL SYSTEM TO PREVENT STDs." The Hidden Epidemic: Confronting Sexually Transmitted Diseases. Washington, DC: The National Academies Press, 1997.
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BOX 6-1Vision and Guiding Principles for a National System for STD Prevention
Vision
An effective system of services and information that supports individuals, families, and communities in preventing STDs including HIV infection, and ensures comprehensive, high-quality STD-related health services for all persons
Guiding Principles
Prevention
STDs can be prevented by implementing individual- and population-based interventions that:
decrease exposure to infected persons by delaying sexual intercourse among adolescents and by reducing the prevalence of high-risk sexual behaviors;
decrease the probability of STD transmission during sexual intercourse by promoting the use of barrier methods, especially condoms; and
decrease the duration of infection by improving knowledge and promoting awareness of STDs and their consequences; promoting utilization of health care services for symptoms of STDs; encouraging early detection and effective treatment; and ensuring access to essential clinical services.
Responsibility
In an effective system for STD prevention:
individuals and the community share responsibility for prevention;
the community has a responsibility to promote social norms that encourage healthy sexual behaviors and to provide access to education, services, and resources that enable individuals to adopt these behaviors;
individuals must have the necessary knowledge, skills, and resources to practice healthy behaviors in order to assume full responsibility for their health; and
the public sector is ultimately responsible for preventing transmission of communicable diseases in the population.
Implementation/Operational Issues
An effective system for STD prevention should have:
strong leadership;
integrated and coordinated components;
programs for monitoring access and performance and for ensuring quality of services;
comprehensive educational programs for all persons;
interventions that are multisectoral (e.g., involve both private and public sectors in health, education, and other sectors), multidisciplinary (e.g., involve health professionals from various disciplines as well as nonhealth professionals), and multifaceted (e.g., involve coordinated behavioral and biomedical approaches); and
partnerships among the various stakeholders in the community.
Access and Financing
An effective system for STD prevention should have:
curative and other preventive services that are confidential, comprehensive, of high quality, and accessible to all, particularly the uninsured, adolescents, and disenfranchised groups;
no financial disincentives for accessing essential services, especially those that have a potential impact on the spread of disease and
adequate and reliable funding.
STD prevention should also become involved. These include mass media companies, social service agencies, employers and businesses, labor unions, religious organizations, and other community-based organizations. A list of potential stakeholders in the community envisioned in the model system is presented in Table 6-1. Given the wide spectrum of stakeholders in STD prevention, the committee advocates a substantial emphasis on coordination and collaboration (IOM, 1996a).
The committee's proposed system is founded on the simple infectious disease prevention model of (a) preventing exposure to infection, (b) preventing acquisition of infection when exposed, and (c) preventing transmission to others once infected. In this system, there are multiple points at which to intervene and multiple approaches or interventions at both the individual and the community levels. Programs that focus only on preventing exposure, acquisition, or transmission are unlikely to succeed because no single intervention is totally effective in isolation. Although existing interventions are not perfect, they can have an additive impact in reducing the risk of STDs in the population (Cates, 1996). Therefore,
