• services. In addition, universities and colleges should ensure that their student health services provide the above services.
  • All health plans, clinicians, and publicly sponsored health clinics should provide or arrange for hepatitis B immunizations for their infant, adolescent, and adult patients according to the Advisory Committee on Immunization Practices (ACIP) guidelines. Given the difficulty in reaching adolescents in health care settings, public health officials should ensure that adolescents who are not immunized in health care settings are immunized through school-based or other community programs. Additional infrastructure and programs for vaccinating adolescents and adults at risk for hepatitis B virus infection, through settings such as public STD clinics, should be developed and implemented. This infrastructure may also be used when vaccines against other STDs become available. In addition, communities should consider including hepatitis B immunization for adolescents and children in the local immunization campaigns that have traditionally focused only on vaccines for young children.

Establishing New Venues for Interventions

The risk of STDs among disenfranchised groups can be significantly reduced through appropriate innovative interventions. Venues for intervention need to be expanded because these groups are difficult to reach through traditional health care settings. Health services for disenfranchised persons do not have popular support; as a result, such services have been marginalized and underfunded. However, because these groups represent reservoirs of infection for the community, and for other reasons, it is important that they receive appropriate STD-related services.

Currently, knowledge of sociocultural factors related to transmission of STDs is not sufficient to fully explain why some ethnic and racial groups in the United States have higher STD rates than the general population. As discussed in Chapter 2, poverty and sexual behavior do not entirely explain the higher rates of STDs in some groups. Other potential explanations, discussed in Chapter 3, that are associated with increased risk of STDs and their associated complications are known to vary across racial or ethnic groups. These explanations include inadequate access to health care, lack of awareness and knowledge of STDs, and substance use behaviors. Further research is needed to evaluate the role of sociocultural and other factors in STD transmission among different ethnic and racial groups.

It is important to recognize that the underlying cause of STDs is high-risk sexual behavior that is common among all racial and ethnic groups in the United States. Therefore, in this report, the committee proposes an approach to STD prevention that is focused on the specific behaviors and ecological factors that



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