The following HTML text is provided to enhance online
readability. Many aspects of typography translate only awkwardly to HTML.
Please use the page image
as the authoritative form to ensure accuracy.
Below are the first 10 and last 10 pages of uncorrected machine-read text (when available) of this chapter, followed by the top 30 algorithmically extracted key phrases from the chapter as a whole. Intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text on the opening pages of each chapter.
Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.
Do not use for reproduction, copying, pasting, or reading; exclusively for search engines.
OCR for page 411
-->
Index
A
Academic health centers, 179, 187, 280-281
Academy of Pediatrics, 267
Access to health services
adolescents, 9, 10, 11, 69, 76, 82, 261
and behavioral change, 163, 223
community settings, 12, 275-277
in developed countries, 100
and diagnosis and treatment of STDs, 162
disenfranchised populations, 9
managed care role, 13, 374, 375
migrant workers, 86
primary care, 275-277
and risk of STDs, 74-76, 163
sex workers, 81
uninsured patients, 13, 375
welfare reform and, 279
Accountability for services, 374
Adolescents.
See also School-based interventions
access to health care, 9, 10, 11, 69, 76, 82, 261, 265-266
behavioral interventions, 134, 391-392
behavioral research, 6, 240-241
cervical cancer, 37
chlamydial infection, 37, 82, 83, 155, 195
clinical services for, 299, 372, 389, 392-393, 395, 396
condom use, 10, 82, 83, 125, 141, 144, 146, 147-148, 268
confidentiality issue, 10, 187, 264-267, 386
counseling and education of, 16, 83, 236, 265-266, 267, 294, 371, 388-389, 390, 396
in detention, 81, 82-83, 125, 139, 266
early interventions, 264-267
family planning clinic utilization, 187
females, 37, 61, 71, 82-83
gonorrhea, 37, 82, 83
health insurance coverage for, 69, 76, 100, 265
hepatitis B immunization, 145, 268-269, 270
human papillomavirus, 37
incidence and prevalence, 1, 20, 28, 37
knowledge and awareness of STDs, 106-107, 123, 125
managed-care services for, 194, 195
and mass media messages, 4-5, 10, 135, 390-391
national system for prevention, 3, 9-11, 261, 264-270
parent/family communication on STDs, 69
parental consent issue, 142, 240-241, 265, 266, 267, 386, 392-393
risk factors, 2, 10, 36-37, 61, 81-82, 124, 236, 264
OCR for page 412
-->
runaways and homeless, 79, 81, 134, 139, 266, 272, 274
sexual behavior, 36, 69, 81, 82, 93, 102-104, 124, 132, 143, 163, 200, 264, 268
sexuality education, 4, 82, 89-90, 91, 108, 137-138, 140, 264, 265 , 386-388, 396, 398
sex workers, 83, 266
substance abuse, 37, 77, 81, 82, 392
surveillance, 200
susceptibility to infection, 28, 61, 71, 124
syphilis, 82
television portrayal of, 93
Advisory Committee on Immunization Practices, 11, 145, 270
Advocacy, 133-134, 136, 214, 242, 393
Advocates for Youth, 95, 97
Aetna U.S. Healthcare, 190
African Americans
access to services, 75
adolescents, 130-131, 391-392
clinic users, 177
condom use, 38, 130-131, 148
ectopic pregnancy deaths, 45
initiation of sexual intercourse, 105
interventions for, 391-392
perceptions of risk, 125
risk of STDs, 37-38
women, 148
Age.
See also Adolescents
and access to care, 75
and condom use, 148
discrepancy between sex partners, 80
and entry into marriage, 105
and health education, 138-139, 268
initiation of sexual intercourse, 104-105, 121, 124
and STD infection, 40, 71
U.S. Preventive Services Task Force recommended interventions by, 364-366
Agency for Health Care Policy and Research, 220, 244, 245, 248-249, 250, 292
AIDS, 28, 39.
See also HIV infection
cohort study, 51
deaths, 49, 50
lag time to development of, 71
rates, 31
research, 262
AIDS Action Council, 97
AIDS Community Demonstration Projects initiative, 136
AIDS Education and Training Centers, 207
Alabama, 82
Alan Guttmacher Institute, 98, 180
Alcohol use
by adolescents, 77, 79
and sexual behavior, 76, 79
and STDs, 76, 79
American Association of Health Plans, 195, 282, 379
American Association of Sex Educators, Counselors, and Therapists, 97
American Cancer Society, 232
American Counseling Association, 97
American Indians/Alaska Natives
hepatitis B immunization, 145
risk of STDs, 37
American Jewish Congress-Commission for Women's Equality, 97
American Medical Association, 97, 98, 290
American Orthopsychiatric Association, 98
American Psychological Association, 98
American Social Health Association, 98, 214
Anal
cancer, 32, 36, 38, 42, 43, 46, 48
gonorrhea, 204
intercourse, 32, 124
syphilis, 38
Antibiotic resistance, 34, 35, 158, 199, 312
Antibiotic therapy, 144, 145, 161, 162
Asian Americans/Pacific Islanders, risk of STDs, 37
Association for the Advancement of Health Education, 98
Association for Sex Education and Training, 98
Association of American Medical Colleges, 290
Association of Reproductive Health Professionals, 98
Association of Schools of Public Health, 212
Association of State and Territorial Health Officials, 98, 247
Association of Teachers of Preventive Medicine, 212
Asymptotic infections, 107, 151, 312, 314
chlamydial, 36, 70, 195, 312
diagnosis of, 2, 20, 158
gender and, 2, 20, 36
gonorrhea, 36, 312
hepatitis B, 70, 199
herpes simplex virus, 107, 199
HIV, 70, 153, 199
OCR for page 413
-->
and managed care, 193
public awareness and knowledge, 20, 41
surveillance, 199
Atlanta, Georgia, 298, 206, 394-395, 398-399
Australia, 29, 144, 358
AVSC, International, 98
B
Bacterial vaginosis, 31, 32, 38, 39, 47, 73, 250
Baltimore, 82
Behavior change.
See also specific interventions
access to health care and, 163
assessment questionnaire, 392
community-level interventions, 133-134, 163, 223, 391-392
delaying sexual intercourse, 132
focus of interventions, 133
funding for programs, 252
individual responsibility, 223
motivation for, 129, 131
national program for, 230
nonsexual health-risk behaviors, 133
personal skills and, 130-131, 163
risk perception and, 128-130, 163
self-efficacy beliefs and, 130, 131
Behavioral research
adolescents, 6, 392
condom use, 101
expansion of, 262-263
sexual, 4, 5-6, 100-102, 239, 240-241
Behavioral Risk Factors Surveillance Survey, 200
Bisexual women, risk of STDs, 38
Blindness, 20
Block grants, 212-214, 253, 254
Body cavity lymphomas, 39, 46
Brazil, 144, 358
Breast-feeding, 32, 42, 48
Bulgaria, 359
C
California, 155, 176, 184, 188, 194, 378
California Partnership for Adolescent Chlamydial Prevention, 195, 378
Canada, rates of STDs, 29, 30
Cancer.
See also individual sites
costs, 60, 351
lag time to, 70
prevention, 3, 231-232
STDs and, 32, 42-43, 231-232
Catholics for a Free Choice, 98
Centers for Disease Control and Prevention
cost data, 334
Division of Adolescent and School Health, 141
Division of STD Prevention, 202, 203, 208, 209, 212
funding for STD activities, 177, 187, 208, 209, 212, 231, 250
Gonococcal Isolate Surveillance Project, 34, 35
Managed Care Working Group, 379
National Partnership to Prevent STD-Related Infertility, 300
Prevention Marketing initiative, 136
public service announcements, 94
recommended role, 6, 8, 9, 11, 13, 15, 17, 231, 234, 237, 248, 256 , 273, 274, 280, 287-288, 292
research in prevention, 263
STD Treatment Guidelines, 161, 188, 292-293, 335, 384, 386
survey of STD-related services, 180-181
Youth Risk Behavior Surveillance System, 103-104, 146, 200
Cervical cancer, 20, 24, 46
causes, 32, 36, 37, 42
costs, 59, 342, 352
lag time from infection, 70
mortality, 37, 43, 50, 352
rates, 37, 48
screening, 42-43, 188, 231
and STD surveillance, 199
Cervical dysplasia, 39, 43, 278
Cervical ectopy, 73
Cervicitis, 158, 179
Chancroid
asymptomatic infections, 312
costs, 59, 312, 342, 351
deaths related to, 49
diagnosis, 179
and HIV infection, 49, 51, 312
interventions, 81
male circumcision and, 72, 124
partner notification, 153
prevention, 228
rates, 30, 31, 312
reporting of, 196
OCR for page 414
-->
sequelae and syndromes, 31, 48-49, 312
substance abuse and, 77
transmission routes, 312
treatment, 161, 312, 351
Chester, Pennsylvania, 339
Chicago, Illinois, 82, 184, 298, 299, 395-397
Children
information sources on sexuality, 90, 91
sexually abused, 79-80
Chlamydial trachomatis, 30, 312-313, 346
Chlamydial infection
adolescents, 37, 82, 83, 195, 378
asymptomatic, 36, 70, 195, 312
cervical, 51
contraceptives and, 72, 73, 126, 150
costs, 7, 59, 60, 250, 312, 338, 340, 342, 343, 346-347
deaths, 49
diagnostic tests, 160, 161, 197
ethnic/racial differences, 37, 38
gender differences in susceptibility, 71
and HIV infection, 49, 51, 52, 56
maternal-infant transmission, 47
partner notification and treatment, 151, 153, 154, 179
prevention initiatives, 186, 195, 202, 221, 225
in prisoners (adult), 83, 84
rates, 28, 31, 34, 37, 38, 40, 188, 312, 338, 346-347
reporting of, 196, 197, 346
screening, 15, 84, 155-156, 179, 195, 197, 201, 283-284, 372, 378
sequelae and syndromes, 30-31, 34, 36, 44, 47, 48-49, 155, 195, 202 , 221, 283-284, 312
treatment, 30, 34, 161-162, 312, 343
Chronic hepatitis, 33, 48
Chronic liver disease, 33, 46, 49
Chronic pelvic pain, 1, 44
Cigarette smoking, 105
CIGNA Healthcare of Southern California, 370, 371-372
Circumcision, male, 70, 71-72, 124
Cirrhosis, 33, 46, 48
Clinical interventions.
See also Diagnosis of STDs;
Partner notification and treatment;
Screening programs;
Treatment of STDs
barriers to, 162-163
early diagnosis and treatment, 25, 157
effectiveness, 123
in family planning settings, 162
historical focus, 120
prophylaxis, 25, 144, 145-146, 163
Clinical management of STDs.
See also Diagnosis of STDs;
Screening programs;
Treatment of STDs
major components, 290-291
Clinical practice guidelines, 242, 283, 288, 289, 292
Clinical services.
See also Dedicated public STD clinics;
Funding of services;
Managed care organizations
for adolescents, 269-270, 372, 389, 392-393, 395, 396
community-based, 12, 176, 185-186, 188, 202, 206, 211, 215, 220, 275-277, 394-399
components, 175
coordination of, 185, 202, 220-221, 276-277
differential treatment of women, 152
expenditures, 175
guidelines on care to gay and lesbian patients, 98
health care professionals, 176
private sector, 175, 176, 187-188, 197, 206, 221
privatization, 285-288
school-university-based, 11, 187, 190, 265-266, 269-270, 280-281, 392-393
secrecy and, 95, 98-99
settings, 175-176
training for, 21, 221
Coalition to Fight STDs, 214
Cocaine
crack, 33-34, 77-78, 100, 154, 271
and sexual behavior, 77
and STDs, 83, 271, 339
Cohort studies, HIV-STD relationship, 50, 55
Columbia Broadcasting Company, 93-94
Columbus, Georgia, 397-398
Committee charge, 21
Committee on Performance Measurement, 201
Committee on Using Performance Monitoring to Improve Community Health , 201
Communication
between clinical facilities, 185
between sex partners, 4, 89, 90-92, 108, 130, 140, 149
clinician-patient, 95, 98-99, 108, 289
parent-child, 4, 69, 89, 90, 91, 108
OCR for page 415
-->
Community Health Plan of Los Angeles, 387
Community roles and responsibilities
access to health care, 12
activism on STDs, 4, 99, 108
AIDS demonstration projects, 136
behavioral change interventions, 133-134, 163, 223
clinics and clinical services, 12, 176, 185-186, 188, 202, 206, 211 , 215, 220, 275-277, 299-300, 394-399
for disenfranchised populations, 136, 186
HIV prevention, 136
interventions, 132, 133-134, 135-137
in national prevention system, 12, 223, 224-225, 226, 229, 275-277, 299-300
recommendations, 12, 276, 277
stakeholders in STD prevention, 227
Condom use
accessibility and, 147-148
adolescents, 10, 82, 125, 141, 144, 147-148, 268
age and, 148
barriers to, 20, 71, 86, 130, 141, 142, 143, 146, 147-148
as behavioral outcome, 121
determinants of, 131, 144
by discordant partners, 146
educational level and, 148
effectiveness of interventions, 132, 135, 144, 146-147, 228
ethnic/racial differences, 38, 148
at first intercourse, 146
gender and, 148
and HIV prevention, 54, 135
mass media messages, 4-5
negotiating, 71, 92, 106, 108, 130, 133, 148-149
number of sex partners and, 124
other contraceptive use and, 149-151
and pregnancy, 126, 147
prisoners, 84-85, 272
promotion of, 81, 94, 121, 132, 134, 136, 137, 144, 163, 225, 228, 269
rates, 105, 146
research on, 101
and risk of STDs, 124, 126
school-based programs, 10, 11, 138, 139, 141-144
substance abuse and, 77, 78
training, 133
Condoms
advertisements, 94, 97
availability and distribution programs, 141-142, 268, 269, 272
female, 146-147, 263
funding for, 143
and sexual behavior, 143
Confidentiality
for adolescents, 10, 187, 264-267, 386
in billing and claims processing, 193, 266, 267
and condom use, 142
information systems and, 375
in managed care organizations, 375, 381
parental consent issue, 142, 240-241, 266, 267, 386, 392-393
partner notification and, 153
surveillance and, 203
Contra Costa County (California) Health Plan, 190, 370, 372-373
Contraceptives.
See also specific contraceptives
advertisements, 97
barriers to use, 149
dual protection, 149-150, 263
effectiveness against STDs, 124, 126-127, 149-151
implantable/injectable, 72, 124, 126
pregnancy prevention effectiveness, 126-127, 150
school-based programs, 138, 140
sexuality perception and use of, 91
Contributing factors to the epidemic
biological, 69-73
secrecy, 73-86
social, 86-100
Costs. See Economic costs of STDs
Council of State and Territorial Epidemiologists, 204
Counseling of patients, 293-294
adolescents, 16, 83, 236, 265-266, 294, 371, 388-389, 390, 396
barriers to, 16, 294
in clinics, 120, 134, 179, 180, 181
discordant couples, 135, 146
effectiveness in prevention, 120, 134
funding for, 252
Health Belief Model, 134
HIV infection, 179
mandated, 180
one-on-one, 132, 134
OCR for page 416
-->
in primary care settings, 134-135, 188, 215, 294
in prisons and detention facilities, 11, 274
professional training for, 21, 239
recommendations, 5, 11, 16, 294
reimbursement for, 294-295
sex workers, 81
sexual behavior, 4, 5, 176, 239
sexuality comfort levels and, 4, 176
Theory of Reasoned Action, 134
women, 150, 152
Crack cocaine. See Cocaine
Cultural
sensitivity of providers, 272, 374
values, and prevention of STDs, 75, 86, 148-149, 154
Curtis v. School Committee of Falmouth, 143
Cytomegalovirus, 39, 46, 47
D
Dade County, Florida, 156-157
Deaths
AIDS, 49, 50, 352
cervical cancer, 37, 43, 49, 50, 352
ectopic pregnancy, 45, 49
hepatitis, 49, 50, 352
liver disease, 49
pelvic inflammatory disease, 49, 352
from STDs, 1-2, 28, 37, 48, 49
Dedicated public STD clinics
in academic settings, 179
access issues, 74, 278-280
counseling, 120, 134, 179, 180, 181
definition, 175 n.1
education of patients, 179, 181
effectiveness, 181-182, 214-215, 277
evaluation of services, 182
federal role, 13, 182-185
funding for, 378, 379
improvement strategy, 13, 277-281
location, 178-179
partner notification activities, 152, 179
patterns of diseases, 188
privatization of, 285-288
quality of care, 179, 182, 214-215, 280, 285-288
recommendations, 13, 279-280, 281
reporting of STDs, 197
screening, 179
services, 21, 178-181
staffing, 152, 153, 154, 179, 182-184
training in, 205, 206, 286
users, 177-178, 220, 285, 286, 287
Definitions
community, 223
dedicated public STD clinic, 175 n.1
managed care, 189 n.3
prevention of STDs, 21-22 n.3, 209 n.7
sex worker, 50 n.3
sexual intercourse, 32 n.2
sexuality, 87
STDs, 1, 30
Delaying sexual intercourse, 5, 96, 132, 138, 140, 264
Denmark, 29, 100
Denver, 142
Department of Health and Human Services, 6, 8, 203, 210, 212-213, 228-229, 235, 243-244, 249, 255, 256, 272, 273
Detention
adolescents in, 81, 82-83, 139, 266
adults in, 83-85, 271-272
condom use in, 84-85, 272
data collection from, 202
drug use in, 84
screening for STDs, 84, 221, 271-272, 273
sexual activity in, 84-85
sexuality education of adolescents in, 82
STD-related services, 11, 266, 272, 274
transmission routes for STDs, 84
treatment in, 221-222, 271-272
Developing countries
deaths associated with STDs, 49
target populations for prevention, 40
Diagnosis of STDs.
See also Screening programs
antibody detection, 159-160
antigen detection, 160
barriers to, 36, 162-163, 164
chlamydial infection, 160, 161, 197
costs, 158
culturing, 159
delays in, 2
disenfranchised populations, 11, 273, 274
early, 157, 164
false-positives, 160, 161
genetic markers, 160-161
laboratory testing, 158-159
microscopy, 159
for nontraditional settings, 11, 274
syndromic, 158
specimen collection procedures, 159
OCR for page 417
-->
Diaphragms, 126, 150
Diffusion of innovation theory, 133-134, 135
Disease intervention specialists, 152, 153, 154, 179, 182-183, 184 , 198, 207, 295
Disenfranchised populations.
See also specific populations
access to care, 9, 279
clinical services for, 186, 266, 275
community-based interventions, 136, 186
condom use, 149
diagnostic tests, 11, 273
national system for prevention, 3, 9, 11, 261, 270-274
recommendations, 11, 273-274
screening programs, 273
STDs among, 24, 80-86, 107, 270-271
Drug Topics Red Book, 335
Drugs, illicit
adolescents' use of, 77, 83, 100
in prisons, 84, 274
trading sex for, 77, 81
E
Economic costs of STDs, 312, 314.
See also Funding of services
adjustments to estimates, 334-336
annual, 28, 175, 249-250, 330
cancer, 59, 60, 342, 351, 352
challenges to assessing, 332-334
chancroid, 59, 312, 342, 351
chlamydial infection, 7, 59, 60, 250, 312, 338, 340, 342, 343, 346 -347
clinical/research investments, 175
component studies, 338-341
contact tracing, 337
cost-effectiveness of interventions, 133, 146, 155, 156, 250, 336, 341, 353
data needs on, 250
diagnostic-related, 158
direct, 1, 58-60, 331, 338, 344-346
ectopic pregnancy, 337, 339, 341, 345
genital herpes, 341, 348-350
global estimates, 343
gonorrhea, 7, 59, 208, 250, 312, 336, 340, 341-346
hepatitis B virus infection, 59, 312, 342, 351-352
hepatitis C virus infection, 352
herpes simplex virus infection, 59, 312, 337, 340, 342
HIV/AIDS, 1, 58, 59, 60, 352, 354
human papillomavirus infection, 59, 312, 342, 350-351
incidence/prevalence adjustments, 335
indirect (productivity), 1, 58, 331, 352-353
infertility, 337, 341
literature on, 334, 336-341
and managed care, 376
measures of economic burden, 330-332
out-of-pocket, for patients, 333-334
outpatient expenses, 339, 341
partner notification, 153
payment sources, 60
pelvic inflammatory disease, 59, 337, 339, 340, 341, 342, 343-346, 352
prevalent (cost-of-illness), 331, 337
prevention investments, 175
purpose of assessing, 352
reporting of STDs and, 332-333
resource use categories, 335
screening, 155, 156
syphilis, 59, 88, 208, 312, 338-339, 340, 342, 347-348
total (overall), 58-59, 175, 210, 211, 336-338, 340
treatment, 88, 162, 335, 343, 347, 351
valuation of resources, 333-334
Education, sexuality
of adolescents, 89-90, 91, 137-138, 264, 269, 386-388, 396, 398
parents' pamphlet, 390
religious/personal beliefs and, 267
Education, STD-related.
See also School-based interventions;
Training and education of health professionals
of adolescents, 10-11, 163, 269, 372, 396-397
barriers to, 4, 41-42, 87-88, 91
with behavioral skills training, 130-131
cancer prevention education and, 232
in clinics, 179, 181
in detention facilities, 11, 83, 84, 274
employers/health care purchasers, 14
funding for, 252
HIV, 83, 84, 230
lack of, 20
managed care organizations, 387
national initiative, 236
of patients, 4, 179, 293-294
peer, 81, 83, 298, 391, 393, 396-397, 398
of policymakers, 381
OCR for page 418
-->
secrecy on sexuality and, 4, 87, 89-90
theater programs, 388-389
Educational level, and condom use, 148
Emergency centers, hospital-based, 188, 202
Emerging infections, 39, 40
Emory/Grady Teen Services Program, 298, 398-399
Employers/health care purchasers, role of, 8, 284-285
Epidemic occurrence of STDs, 19 n.1, 20, 40
Epidemiology
HIV infection and STDs, 49-51, 52
and prevention of STDs, 119-120
support for STD programs, 203-204
Epididymitis, 46, 48, 337, 338
Epstein-Barr virus (EBV), 42
Europe, gender differences in STD transmission, 35
European Americans
cervical cancer, 43
condom use, 148
genital herpes, 199
risk of STDs, 37, 38, 125
Evaluation of interventions
data collection, 139
factors considered, 55
health services performance measures, 201, 202, 255, 259-261
HIV prevention mass media campaigns, 358-362
information systems development, 202-203
limitations, 202
local data analysis capacity, 203-204
mathematical modeling, 56
methodologies, 139-140
monitoring, 258
outcome measures, 132, 134, 230, 358-360
performance measures, 259-261
school-based programs, 139-140
sharing of information, 381
survey tools, 389, 392
validation of self-reported behavioral changes, 134
F
Falmouth, Massachusetts, 143
Family planning services/clinics, 74, 89, 155, 162, 186, 187, 202, 211, 220, 221, 299, 344, 395-396, 398-399
Family Privacy Protection Act of 1995, 240 n.1
Federation of Behavioral, Psychological, and Cognitive Sciences, 98
Female-controlled methods for prevention, 9, 263-264
Florida, 82, 184
Food and Drug Administration, 9, 11, 147, 161, 220, 244, 245, 249, 263-264, 274
Fox Broadcasting Company, 94
France, 144, 359
Funding of services
block grant proposals, 212-214, 253, 254, 398
budget proposal for 1997, 244
categorical, 8, 210-212, 213, 215, 220, 253-256
clinics, 186, 187, 211, 378, 379
government, 177, 182-185, 186, 187, 208-210, 215, 251
information systems, 203
Performance Partnership Grants, 203, 212-213, 254
prevention, 3, 7-8, 211, 212, 235, 241, 249-256
private sector, 210-211, 251
recommendations, 8, 253, 255-256
research, 175, 210, 211, 212, 250
responsibility, 8, 251-253
sources, 381
training of health professionals, 175, 207, 212
G
The Gambia, 359
Gay and Lesbian Medical Association, 98
Gay men
condom use, 130
consequences of STD infection, 38
herpes simplex virus infection, 51
HIV-STD relationship, 51, 52, 55, 204
intervention strategies, 134, 135, 145
risk of STDs, 33, 38, 51, 79
self-identities, 130
substance abuse, 79
syphilis, 197
uncircumcised, 72
Gay movement, 130
Gender
and clinic use, 177
and condom use, 148
OCR for page 419
-->
and health consequences of STDs, 35-37, 45, 46, 48-49, 61
and susceptibility to STDs, 2, 20, 28, 37, 54, 70, 71, 128
General Social Survey, 79, 103
Genital herpes.
See also Herpes simplex virus infection
asymptomatic, 70, 312
and cesarean sections, 348-349
costs, 341, 348-350
diagnosis, 160, 161, 179
and HIV infection, 49, 312
maternal-infant transmission, 47
misperceptions about, 107
rates, 19 n.1, 30, 31, 107, 312, 333
reporting of, 333
sequelae and syndromes, 31
surveillance, 199
treatment, 161, 278, 312
Genital ulcers, 31, 33, 49-50, 51, 52, 53, 54, 78, 158, 179, 273
Geographic factors, in diagnosis and treatment of STDs, 163
Georgia, 184
Germany, rates of STDs, 29
Girls, Incorporated, 98
Gonococcal Isolate Surveillance Project, 34, 35, 199, 258
Gonorrhea
adolescents, 37, 82, 83
antibiotic-resistant strains, 34, 35, 158, 199, 312
asymptomatic infections, 36, 312
bacterial vaginosis and, 73
cervical, 51, 126
contraceptives and, 126, 150
costs, 7, 59, 208, 250, 312, 336-337, 340, 341-346
deaths related to, 49
diagnosis, 36, 159, 160, 161, 179
eradication, 157, 256
ethnic/racial differences, 37, 38
gender differences in risk, 35, 37, 71
geographic distribution, 56-57
and HIV infection, 49, 51, 52, 55, 56-57
in homeless women, 82
partner notification and treatment, 151, 153, 154, 179, 198
in pregnant women, 47, 56-57
prevention, 39, 93, 126, 202, 208, 221, 228
in prisoners (adult), 83, 84
rates, 19 n.1, 28-30, 31, 37, 38, 40, 204, 312
rectal, 204
reporting of, 196, 332, 343
screening, 84, 155, 179, 186, 372
sequelae and syndromes, 30-31, 44, 47, 48-49, 155, 221, 312, 337, 343-344
in sex workers, 81
substance abuse and, 77
transmission routes, 47, 312
treatment, 34, 161, 186, 312, 343
Group Health Cooperative of Puget Sound, 190, 195, 281, 390-392
H
Haiti, gender differences in STD transmission, 35
Harvard Pilgrim Health Care, 190, 194, 281
Harvard School of Public Health, 238
Hawaii, 105
Health Belief Model, 125, 128, 134
Health Care Financing Administration, 187, 191, 200, 209, 220, 244
, 245, 249, 287
Health Care for the Homeless programs, 186
Health care professionals.
See also Training and education of health professionals
approaches to prevention, 176
compliance with standard practices, 207
disease intervention specialists, 152, 153, 154, 179, 182-183, 198 , 207
primary care physicians, 14-15, 134-135, 188
public health advisors, 152, 182-183
risk assessment of patients, 176
sexuality comfort levels, 4, 176
Health consequences.
See also Men's health;
Reproductive health problems;
Women's health
cancer, 20, 28, 42-43
infants, 20
Health insurance.
See also Managed care organizations;
Medicaid
and access to care, 74, 162, 177, 265
adolescents, 69, 76, 265
coverage for sex partners of plan members, 193, 284, 372, 376, 386 , 387
private, 7, 14, 17, 59, 177-178, 193, 210-211
and source of services, 74-75, 285, 286
Health Insurance Association of America, 282
Health Plan Employer Data Information Set (HEDIS), 8, 192, 195, 201 , 260, 261, 374, 379
OCR for page 420
-->
Health Resources and Services Administration, 5, 187, 200, 207, 209 , 220, 231, 237, 239, 244, 245, 249, 287
Healthcare Management Alternatives, Inc., 392
Hepatitis.
See also specific types
diagnostic tests, 159-160
in infants, 46
Hepatitis A, 33
Hepatitis B virus infection
anal intercourse and, 72, 124
asymptomatic, 70, 199, 312
costs, 59, 312, 342, 351-352
deaths related to, 49, 50, 352
diagnostic tests, 160
high-risk populations, 38
immunization, 10, 11, 145-146, 231, 268-269, 270, 278
lag time to complications, 70
partner notification, 152
in prisoners (adult), 83
rates, 28, 31, 312, 352
sequelae and syndromes, 33, 42, 231, 312, 352
in sex workers, 81
transmission routes, 32, 39, 42, 47, 312, 351-352
treatment, 30, 161, 278, 312
Hepatitis C, 33, 49, 50, 352
Hepatitis D (delta), 33
Hepatocellular carcinoma, 42
Heroin, 78
Herpes simplex virus infection.
See also Genital herpes
asymptomatic, 107, 199
costs, 59, 312, 337, 340, 342
cross-immunity, 73
gender differences in risk, 35
and HIV infection, 51, 52
keratitis, 337
neonatal, 199, 337, 342, 348-350
partner notification, 152
rates, 33, 312
reporting of, 196
sequelae and syndromes, 33, 46, 47, 312
treatment, 199
transmission routes, 33, 47, 312
type2, 30, 40, 51, 52, 73, 107, 196
vaccine, 145
Heterosexual men
HIV-STD relationship, 50-51
Hetrick-Martin Institute, 98
Hispanic Americans
access to services, 75
adolescents, 143
condom use, 143, 148-149
risk of STDs, 37-38
HIV infection
anal intercourse and, 72, 124
asymptomatic period, 70, 153, 199, 314
cell-free RNA in semen, 54
clinical services, 194
contraceptives and, 72, 126, 150
costs, 1, 58, 59, 60, 352
counseling and testing, 179
deaths, 49, 314, 352
diagnostic tests, 159, 161
DNA shedding from cervix, 54
gender differences in, 48, 49
high-risk populations, 38
incidence, 55
infants, 47
male circumcision and, 71-72, 124
perceptions of risk, 125
in pregnant women, 57
in prisoners (adult), 83
progression to AIDS, 47-48
rates, 19 n.1, 31, 81, 83, 314, 323
and reactivation of STDs, 51, 54
school-based clinic policies, 187
screening for, 156, 271
STDs and, 24, 49-53, 54, 55-56
substance abuse and, 77, 78, 79, 154
susceptibility to, 51, 54
treatment, 30, 161, 278, 314
HIV infectivity, 51, 54
HIV prevention
barriers to, 130
community-based interventions, 136
conditions for, 121
condoms, 54, 135, 141
counseling of discordant couples, 135
education programs, 83, 84, 90, 94, 137
effectiveness measures, 204, 358-360
heterosexual populations, 230
mass media campaigns, 94, 144, 358-362
moralistic approach, 88-89
partner notification, 153, 179
school-based programs, 137
STD prevention and, 21, 28, 54-55, 61, 229-231
syphilis prevention and, 40
theoretical approaches, 133-134
OCR for page 421
-->
HIV testing, 134
HIV transmission
chlamydial infection and, 316-327
epidemiological evidence, 49-53
female-to-female, 38
genital shedding and, 54
heterosexual, 56
maternal-infant, 47
prevention, 3
routes, 32, 314
STDs and, 3, 55-57, 229-230
HIV-1, 39, 72
HIV-2, 39
Homeless persons, 81-82, 134, 139, 186, 266, 272, 274
Homosexual. See Gay men;
Lesbian women
Hospital Literature Index, 334
Human herpes virus type8, 39, 42
Human papillomavirus infection
adolescents, 37
asymptomatic, 70, 312
costs, 59, 312, 342, 350-351
deaths related to, 49
diagnostic tests, 159, 161
lag time to complications, 70
maternal-infant transmission, 47
oncogenic forms, 42
in prisoners, 83
rates, 31, 32, 40, 43, 312, 350-351
sequelae and syndromes, 31, 32, 36, 39, 42, 43, 48, 70, 199, 231, 312, 351
transmission routes, 312
treatment, 30, 312, 351
women who have sex with women, 38
Human Rights Campaign, 98
Human T-cell lymphotrophic virus (HTLV)
maternal-infant transmission, 47, 48
myelopathy, 46, 48
type1, 32, 39, 42, 47, 48
type2, 39
Human Health Care Chicago, 387
I
In vitro fertilization, 45
Incidence of STDs, 8, 28-30, 31, 40, 197, 312, 314
Indian Health Service, 209, 212, 220, 244, 245, 249
Indianapolis, 155
Infants.See Neonates and infants
Infectious disease prevention model, 224-225
Infectiousness of STDs
duration of, 78, 120, 164
HIV, 51, 54
reducing, 157-163, 164
Infertility
causes, 1, 20, 28, 36, 44, 45, 221, 337
costs, 337, 341
gender differences in risk, 36, 45, 46, 48
postpartum infections and, 48
prevention, 60, 155, 210, 212, 221, 300
and STD surveillance, 199
tubal-factor, 44
Information systems
confidentiality issue, 375
development, 202-203
funding, 204
provider-based, 199, 373-374, 375
recommendations, 8
software, 202, 203
Information technology, 236, 208, 289-290
Innovations in Syphilis Prevention in the United States, 212
Institute for Policy Studies, 353
International perspectives, 8, 40-41, 100, 256
Internet, 208, 236
Interventions.
See also Clinical interventions;
Evaluation of interventions;
School-based interventions;
specific programs
behavioral, 131-144, 163
biomedical, 163
community-based, 132, 133-134, 135-137, 252
couple-based, 135
goals, 163
individual-focused, 121-123, 134-135, 163
mass media, 144
partner notification and treatment, 151-154
population-level, 121-123, 163
punitive, 81
screening, 155-157
for sex workers, 81
''stages of change" models, 132, 133
steps/points for, 2, 121-123, 224-225
success determinants, 132-133, 140
theoretical approaches, 132, 133-134
U.S. Preventive Services Task Force recommendations, 364-369
Italy, 144, 359
IUDs, 126
OCR for page 422
-->
J
Japan, 359
K
Kaiser Foundation Health Plan, Inc., 388
Kaiser-Permanente Health Plan, 190, 194, 387
Kaiser-Permanente Medical Care Corporation, 388-389
Kaiser-Permanente of Southern California, 281, 370, 371, 389
Kaposi's sarcoma, 39, 42, 46
Kenya, 72
King County, Washington, 82-83
Kinshasa, 52
Kissing, 42
Knowledge and awareness of STDs
adolescents, 106-107, 123, 125
and behavioral changes, 20-21, 125, 134, 187
and condom use, 125
and diagnosis and treatment, 162
genital herpes infections, 107
health consequences of STDs, 235-236
HIV-STD linkage, 230
information sources, 69
mass media campaigns, 144
national promotion of, 235-237
and risk of exposure, 4, 223, 236
survey results, 105-107
women, 69, 105-106
L
Laboratory services, 17, 158-159, 162, 221, 257, 297-298
Lag time to complications, 20, 24, 41, 70-71
Lesbian women
risk of STD infection, 38
Ligase chain reaction, 159, 161
Liver cancer, 20, 24, 33, 46, 48, 49, 70
Los Angeles, California, 81, 83, 141, 142, 188, 195-196, 392-393
Los Angeles County Community Health Plan, 190, 370, 372, 373, 378
Louisiana, 138
Lymphogranuloma venereum, 58, 196, 354
M
Managed care organizations (MCO).
See also specific organizations
accountability for services, 374
access to care, 13, 374, 375
adolescent programs, 387
approaches, 189-190
barriers to prevention, 74-75, 282-283
confidentiality of services, 284, 287, 375, 381
coordination and integration of care, 373, 380
cultural sensitivity, 374
definition of, 189 n.3
economic issues, 376
educational outreach, 372, 387
employers/purchasers' influence, 284-285, 377
federal initiatives, 378-379
growth of, 190-191
information systems, 260, 373-374
interest and mission, 375
limitations of, 192-193, 374-376
Medicaid beneficiaries, 74-75, 190, 191, 193, 195-196, 215, 286-287, 371-372, 378, 383-393, 398
patient preferences, 376
and prevention of STDs, 13-14, 21, 23, 191-194, 370-381
preventive health emphasis, 283, 374
public health partnerships with, 14, 190, 195-196, 287-288, 370, 372-373, 378-379, 380-381
quality of care, 13-14, 192-193, 282, 374, 375
screening for STDs, 15, 372, 373, 387
services and programs, 194-195, 215, 281, 283-284, 371-372, 383-393
STD-related activities in, 383-393
strengths, 281, 373-374
training of providers, 286, 376, 381
treatment guidelines, use of, 384, 386, 387
treatment of sex partners, 193, 284, 297, 372, 376, 386, 387
variability of organizations, 189-190, 375-376
Managed Care Working Group, 195
Marital status, and risk of STDs, 125, 128
Mass media messages/campaigns
advertisements, 94, 97, 228, 237, 238
condom promotion, 134, 137, 237, 238
OCR for page 423
-->
documentary, 390-391
effectiveness, 144, 163, 265
examples, 230
HIV prevention, 144, 230, 358-362
music videos and rock music lyrics, 93
public service announcements, 94
radio broadcasting, 93-94
recommendations of National Coalition to Support Sexuality Education , 96-98
sexual behavior, 4-5, 69, 92-95, 108, 237, 238
target populations, 4-5
unbalanced messages, 92-95
Massachusetts, 141, 143-144
Maternal and Child Health block grant, 214
Mathematical model for prevention, 118-120, 121
Media Project, 95, 238
Medicaid, 17, 21, 74, 76, 145, 190, 191, 193, 195-196, 209, 211, 215, 251, 279, 378, 383-393, 398
MEDLINE, 334
Men who have sex with men. See Gay men
Men's health.
See also Heterosexual men
consequences of STDs, 48-49
syndromes and complications of STDs, 36, 46, 307-309
urethritis, 30-31
Mental retardation, 20
Mentally ill persons, 79, 134
Methodology, this study, 22-23
Mexico, 359
Migrant workers, 85-86, 186, 206, 272, 274, 279
Minnesota, 196
Minority Youth Health Project, 391-392
Mississippi, 84
Missouri, 196
Mobiluncus sp., 39
Molluscum contagiosum, 58
Mombasa, 52
Mothers Against Drunk Driving, 234
MTV, 94
Mucopurulent cervicitis, 58
Mycoplasma genitalium, 39
Mycoplasma infections, 31
N
Nairobi, 52
Nasopharyngeal carcinoma, 42
National Abortion and Reproductive Rights Action League, 98
National Abortion Federation, 98
National AIDS, STD, and National Immunization Program Hotline, 212
National Ambulatory Medical Care Survey, 199, 339
National Asian Women's Health Organization, 98
National Association of County and City Health Officials, 247
National Association of School Psychologists, 98
National Campaign to Prevent Teenage Pregnancy, 234
National Cancer Institute, 232
National Center for Health Statistics, 199, 200
National Center for Tobacco-Free Kids, 234
National Coalition to Support Sexuality Education, 95, 96-98
National Commission on Adolescent Sexual Health, 233
National Commission on Correctional Health Care, 84
National Committee for Quality Assurance, 192 n.5, 200-201, 267, 282, 374
National Communicable Disease Center, Venereal Disease Branch, 151
National Conference on Venereal Disease Control, 151
National Council of the Churches of Christ, 98
National Disease and Therapeutic Index, 199, 339, 348
National Education Association-Health Information Network, 98
National Health and Nutrition Examination Survey, 199, 259
National Health and Social Life Survey, 101, 200
National Health Survey of Physician Visits, 339
National Hospital Discharge Survey, 199, 339
National Household Survey on Drug Abuse, 77
National Information Infrastructure and High-Performance Computing
and Communication initiatives, 203
National Institute of Allergy and Infectious Diseases, 208-209
National Institutes of Health, 6, 9, 11, 101, 207, 209, 220, 232, 237, 241, 244, 245, 248, 250, 262, 263, 274, 292, 332, 351
OCR for page 424
-->
National Lesbian and Gay Health Association, 98
National Longitudinal Survey of Youth, 104
National Minority AIDS Council, 98
National Native American AIDS Prevention Center, 98
National Partnership to Prevent STD-Related Infertility, 300
National prevention system
academic health centers, 280-281
access to services, 3, 9-14, 246, 261, 265-266, 274-298
for adolescents, 3, 9-11, 16, 240-241, 261, 264-270
approaches, 261-262
barriers to, 6-7, 247
cancer prevention linked to STD prevention, 231-232
clinical management of STDs, 15-17, 265, 269, 290-298
collaboration with public-sector health programs, 247, 252, 298-299
community services and responsibilities, 12, 223, 224-225, 226, 229 , 275-277, 299-300
community stakeholders in, 223, 224, 227
components of, 223
condom programs, 268, 269, 272
confidentiality, 13, 265-267
coordination of services, 13, 230, 246, 259, 273-274, 276-277
counseling and education of patients, 16, 252, 265-266, 293-294
dedicated public STD clinics, 13, 277-281
diagnosis and treatment, 11, 15-16, 273, 292-293
for disenfranchised populations, 3, 9, 11, 266, 270-274, 275, 279
education, 4, 235-237, 246, 264, 265, 269, 272
employer/health care purchaser role, 8, 284-285
evaluation of interventions, 230, 247
federal role, 6, 228-229, 234, 243-245, 298-299
female-controlled protection methods, 9, 263-264
focus, 9, 261-274
funding, 3, 7-8, 235, 241, 246, 249-256
global prevention efforts, 256
guiding principles, 222, 224-225
health services performance measures, 8, 259-261
healthy sexual behaviors, adoption of, 3, 232-241
hepatitis B immunization, 11, 231, 268-269, 270
HIV prevention linked to STD prevention, 229-231
individual responsibilities, 224-225, 226
information systems, 241
laboratory services, 17, 297-298
leadership development, 3, 6-7, 234, 241-261
local-government role, 246-247, 252-253, 257
managed care organizations/health plans, 8, 13-14, 281-288
mass media messages, 4-5, 230, 237-238
models for, 224-226
open discussion of sexual behaviors, 4, 233-235
participants, 223-224
partner notification and treatment, 16-17, 295-297
policy and strategy formulation, 228-232
primary care, 12, 275-276, 279
prison/detention facility services, 11, 271-272
private-sector role, 6-7, 242-243, 247-248
privatization of services, 285-288
professional training and education, 13, 14-15, 238-239, 246, 276, 288-290
public-private partnerships, 6-7, 247-249, 252-253, 277
quality of services, 3, 13-14, 246, 254-255, 259-261, 278-279
reimbursement for services, 13-14, 16, 17
research, 9, 230, 262-263
roles and responsibilities in, 223, 226, 242-247
Roundtable, 247-248
school-based programs, 10-11, 252, 265, 267-270
screening programs, 15, 262, 271, 273, 291-292
sexual health behavior research, 4, 5-6, 240-241
social norms of sexual behavior, changes in, 232-235
state role, 245-246, 252-253, 254
OCR for page 425
-->
surveillance and other information systems, 3, 8, 230, 246, 256-261
surveys of sexual behavior, 240-241
university/college students, 268
vision statement, 2-3, 224
National Resource Center for Youth Services, 98
National Survey of Adolescent Males, 200, 259
National Survey of Family Growth, 103, 146, 197, 200
National Women's Law Center, 98
Neisseria gonorrhoeae, 30, 312-313
Neonates and infants
congenital syphilis, 31, 47, 153, 198, 338
deaths from STDs, 2
health consequences of STDs, 2, 20, 24, 46-48
hepatitis B immunization, 146
herpes simplex, 199, 337, 348-350
HIV progression to AIDS, 47-48
low birth weight, 28, 32, 39, 46, 60
neurological damage, 46, 47
prematurity, 32, 39, 46
syndromes and complications of STDs, 32, 39, 46, 47, 235, 309
transmission routes for STDs, 42, 47
Neurological damage, 28
Neurosyphilis, 46
New York City, 52, 84-85, 141, 142, 143, 273
New York State, 141
Non-A, non-B hepatitis, 33
North Carolina, 214
Norway, 156
Notifiable disease reporting system
limitations, 197-198, 221, 257
procedures, 196-197
validation of information from, 258
Nucleic acid amplification tests, 160
O
Oakland, California, 388-389
100% Condom Program, 137, 225, 228
Office of Population Affairs, 155, 209, 212, 220, 300
Ophthalmia neonatorum, 47, 48, 337
Oral contraceptives, 72-73, 124, 126, 148, 149
Oral intercourse, 32, 124
Oregon, 196
P
Pacific Business Group on Health, 376, 377
Panorama City, California, 389
Pap smears, 42-43, 159, 231, 278
Parental consent, 142, 240-241, 266, 267, 386, 392-393
Parental Rights and Responsibilities Act of 1995, 266 n.4
Parents, Family and Friends of Lesbians and Gays, 98
Partner notification and treatment
by clinics, 178, 179, 186, 198
confidentiality, 153
detention populations, 11
effectiveness, 151-152, 153-154
gonorrhea, 151, 153, 154, 179, 198, 337
health insurance coverage, 193, 284, 297, 371, 376, 386, 387
patient referral, 152, 154
prison inmates, 85, 274
in private settings, 188, 193, 221
provider referral (contact tracing), 152, 154
recommendations, 11, 14, 17, 296-298
reimbursement for, 14, 17, 221
surveillance and public STD programs, 198
syphilis, 151, 152, 153-154, 179, 198
techniques, 16-17, 144, 152-153, 163-164
training for, 288
Pasadena, California, 388-389
Pathogens
antibiotic-resistant strains, 34, 35, 158, 199, 312
associated disease/syndrome, 305-309
bacteria, 305-306
cross-immunity, 73
culturing, 159
ectoparasites, 307
fungi, 307
immunity from, 73
new, 28, 30, 39-40
protozoa, 307
viruses, 306-307
Patterns of STDs, 120-121, 188
Pediculosis pubis, 58
Pelvic inflammatory disease
a typical, 44
causes, 32, 34, 36, 44, 155, 337
chlamydial screening and, 155-156, 195, 283-284
contraceptives and, 72, 126
OCR for page 426
-->
costs, 59, 337, 339, 340, 341, 342, 343-346, 352
deaths, 48, 49, 352
diagnosis, 179
in homeless women, 82
partner notification, 179
payment sources for, 60
prevention, 202, 283-284
rates, 30, 31
sequelae, 44-45
silent, 44
treatment, 158, 188, 193, 206
vaginal douching and, 72, 124
Penile cancer, 42, 43, 46, 48
Performance measures, 8, 201, 202, 259-261, 374, 377
Performance Partnership Grants, 203, 212-213, 254
Philadelphia, Pennsylvania, 85, 143, 392
Philippines, 144, 359
Planned Parenthood Federation of America, 98
Planned Parenthood of the Chicago Area, 299, 395-396
Pneumonia, 47, 48
Polymerase chain reaction, 159, 161
Poverty
and condom use, 149
and risk of STDs, 73, 74-76
Precaution-Adoption Process, 133
Pregnancy and childbearing
cesarean section, 48, 348-349
complications related to STDs, 2, 20, 36, 39, 45-48
contraceptive effectiveness, 126
ectopic, 1, 28, 44-45, 46, 48, 49, 155, 337, 339, 341, 345
maternal deaths, 48, 49
maternal fever, 48
premature rupture of membranes, 46, 47
preterm delivery, 46, 47
puerperal sepsis, 46
postpartum infection, 46
screening for STDs during, 156
sexuality education programs and, 140
substance abuse and, 78
transmission of STDs during, 32, 33, 312, 314
unintended, 149, 240
U.S. Preventive Services Task Force recommended interventions during , 366-367
Presbyterians Affirming Reproductive Options, 98
Prevalence of STDs, 31, 33, 40, 43, 83-84, 312, 314
Prevention of Infertility Caused by STDs program, 212
Prevention of STDs.
See also Clinical services;
HIV prevention;
Interventions;
National prevention system
barriers to, 2, 20-21, 71, 74, 232
behavioral vs. biomedical approaches, 120-123
cancer prevention linked to, 3, 231-232
chancroid, 228
chlamydial infection, 186, 195, 202, 221, 225
clinician approaches to, 176
condoms and, 146-149
contraceptives and, 149-151
definition, 21-22 n.3, 209 n.7
dual protection, 149-150, 263
"enabling approaches" to, 137
epidemiology and, 119
expenditures on, 7, 175
feasibility, 220
female-controlled methods, 9, 263-264
funding, 211, 212
global efforts, 256
gonorrhea, 39, 93, 126, 202, 221, 228
and HIV prevention, 21, 28, 54-55, 61, 229-231
individual factors and, 123-131
issues, 23-24, 118-123
managed care role, 13-14
mathematical model, 118-120, 121
moralistic approach, 88-89
noncurative programs, 221
objectives, 202
pelvic inflammatory disease, 202
perceived risk and, 128-130
personal skills and, 130-131
primary vs. secondary, 120
reduction of exposure and transmission, 123-157
research, 9, 262-263
roles and responsibilities in, 223, 226, 242-247
sexuality education for adolescents, 89-90
syphilis, 39, 40, 55, 56, 88-89, 93, 136, 202, 208, 212, 228
in television shows, 69
OCR for page 427
-->
Preventive Health Amendments of 1992, 155, 210
Preventive Health and Health Services block grant, 214
Preventive health services, 374
Primary care
access to STD-related services in, 12, 275-276, 279
clinical management of STDs, 15
counseling of STD patients, 134-135, 289, 294
MCO coordination with, 373
practice format constraints, 15
professional training, 14-15, 205-207, 289-290
risk assessment of patients, 176, 188, 215
Prisoners/prisons.See Detention
Private sector.
See also Managed care organizations
clinical services, 175, 176, 187-188, 197, 206, 221
funding of services, 210-211, 251
health insurance, 7, 14, 17, 59, 177-178, 193, 210-211
partner notification and treatment, 188, 193
public-sector partnerships with, 6-7, 247-249, 252-253, 277
reporting of STDs, 221, 258
role in national prevention system, 6-7, 242-243, 285
Prophylaxis, 145-146
Prostatitis, 46, 48
Protective behaviors. See Behavior change
Public health advisors, 152, 182-183
Public Health Graduate Training Certification Program, 212
Public Health Service, Public Health Data Policy Coordinating Committee , 203
Public Health Service Act, 210, 243
Q
Quality of care
in clinics, 179, 182, 214-215, 280
in managed care, 13-14, 192-193, 374
monitoring and assessment, 13
performance measures/standards, 201, 202, 255, 259-261, 374
privatization of services and, 285-288
process measures, 254-255
standards, 280
R
Race/ethnicity
and access to care, 75
and condom use, 148
and risk of STDs, 37-38
and STD rates, 270-271
Rape, 79
Rates of STDs, 1, 20, 24, 28, 81, 187, 270-271, 332-333.
See also Incidence of STDs;
Prevalence of STDs
Recommendations
academic health centers, 281
access to services, 7, 12, 228, 246
adolescent interventions, 10-11, 228, 264-267, 269-270
cancer prevention linked to STD prevention, 3, 232, 245
clinical services, 228, 269-270
community services, 12, 276, 277
condom use, 238, 269
confidentiality for adolescents, 10, 264-267
coordination of services, 13, 246, 249, 273-274, 276-277
counseling and education of patients, 5, 11, 16, 294
dedicated public STD clinics, 13, 279-280, 281
diagnostic tools, 11, 274
for disenfranchised populations, 11, 228, 273-274, 279-280
education, 232, 236-237, 245, 246, 266, 269
evaluation of programs, 8, 260-261
federal role, 7, 244-245, 253
female-controlled protection methods, 9, 263-264
funding for STD prevention, 8, 228, 245, 249, 253, 255-256
global prevention efforts, 256
health-plan coverage, 284, 285
hepatitis B immunization, 270
HIV prevention, 3, 230-231, 245
information systems, 228, 260-261
laboratory services, 17, 297-298
leadership, 228, 244, 245, 246
local-government role, 12, 246-247, 253, 255-256
mass media messages, 5, 232, 238
national Campaign for healthy sexual behaviors, 3, 228, 235, 236-237
partner notification and treatment, 11, 14, 17, 296-297
OCR for page 428
-->
performance measures, 8, 255, 260-261
primary care, 12, 15, 276, 290
prison/detention populations, 11, 274
private-sector role, 7, 242-243, 249, 285
privatization of services, 287-288
quality of care, 13, 228, 246, 249, 255, 261, 280
reimbursement for services, 14, 16, 17, 286, 287
reproductive health services, 12, 276
research on prevention, 9, 245, 263
Roundtable, 7, 249
school-based programs, 269-270
screening programs, 11, 15, 292
sexual health behavior research, 6, 233, 239, 241
social norm of healthy sexual behavior, 232, 235
state role, 245-246, 253, 255-256
surveillance system, 8, 246, 255, 258-259
training and education of health professionals, 5, 13, 15, 233, 237 , 239, 245, 290
treatment of STDs, 15, 16, 292-293
U.S. Preventive Services Task Force interventions, 364-369
Reimbursement for services, 13, 16
Reinfection with STDs, 157
Reiter's Syndrome, 48
Religious Coalition for Reproductive Choice, 98
Reproductive health problems. See specific problems
Reproductive health services, 12
Research.
See also Behavioral research
funding, 175, 210, 211, 212, 249
obstacles to, 101
prevention-related, 9, 150-151, 262-263
topics, 263
Research and Evaluation Issues in Prevention of Infertility Due to
STDs program, 212
Research to Classroom Project, 141
Rhythm method, 126
Rikers Island, 83
Risk of STDs
adolescents, 2, 10, 36-37, 61, 81-82, 124, 236, 264
assessment of, 129, 176, 181, 188, 215
behaviors, 19 n.1, 124, 128-130
biological factors, 24, 69-73, 107, 124, 232
gender and, 2, 20, 28, 37, 54, 70, 71, 128
individual factors, 123-131
marital status and, 125, 128
perceptions of, 4, 124-130, 144, 162, 163, 178, 236
personal skills and, 130-131, 163
racial/ethnic group and, 19 n.1, 37-38
secrecy and, 86-107
sexual behavior and, 38, 123, 124, 163
social factors, 24, 73-86, 107, 232
Roundtable for the Development of Drugs and Vaccines Against AIDS, 248
S
Safer Sex Campaign, 390-391
Salpingitis, 126
San Francisco, 79, 82, 85, 145, 377
Scabies, 32, 58
School Health Services and Policies Study, 187
School-based interventions
abstinence-based, 138, 139
age of students, 138-139
approaches, 121, 137-139, 267-270
barriers to, 138
clinical services, 187, 190, 265-266, 269-270, 299-300, 392-393
condoms, 10, 90, 138, 141-144, 269
contraceptives, 138
court challenges to, 143-144
education, 10-11, 90, 100, 137-138, 267, 269
effectiveness, 10, 139-141, 163, 265
funding, 252
HIV, 187
legal mandates for, 137-138
parental consent requirement, 142, 143
religious/personal beliefs and, 267
and sexual behavior, 163
Screening programs.
See also Diagnosis of STDs
barriers to, 85, 273
cervical cancer, 42-43
chlamydial infection, 15, 84, 155-156, 179, 197, 201, 283-284, 372
clinical guidelines, 156, 273, 274
cost-effectiveness, 155, 156
in dedicated public STD clinics, 21, 178
disenfranchised populations, 273
funding, 186
gonorrhea, 84, 155, 179, 186, 372
HIV infection, 156, 179
OCR for page 429
-->
managed care organizations, 15, 372, 373, 387
men, 262
prisons, 85, 271-272, 273, 274
recommendations, 11, 15, 292
sex workers, 81, 100
and susceptibility of women to HIV, 54
syphilis, 15, 83, 84, 85, 156, 179, 292
women and infants, 146, 156, 262, 271
Seattle, Washington, 207, 390-392
Secrecy about sexuality
clinician-patient communication, 95, 98-99, 108
and communication between sex partners, 87, 90-92
and community activism, 99, 108
and condom use, 131
and mass media messages, 92-95
origins of, 87-88
parent-child communication, 4, 69, 89, 90, 91, 108
and prevention of STDs, 3-4, 25, 88-99, 107-108, 232
research needs, 240
and sexuality education of adolescents, 89-90, 108
Sex partners.
See also Partner notification and treatment
of adolescents, 10, 36, 69, 103
age discrepancy between, 80
college and university students, 105
communication between, 4, 87, 90-92, 130, 149
high-risk, 124
number of, 40, 69, 77, 79, 80, 105, 124, 129, 320
patterns of mixing, 119-120
rates of change, 119, 121
substance abuse and, 77, 79
Sex workers
adolescent, 83, 266
definition, 50 n.3
HIV-STD relationship, 50-51, 52, 54
interventions for, 81, 135, 137
licensed, 100
in migrant camps, 86
rates of STDs, 81
screening and treatment for STDs, 81, 100, 272, 339
trading sex for drugs, 77, 81, 154
Sexual abuse and violence, 79-80, 81, 139, 266
Sexual activity
condom promotion and, 143
in prisons, 84-85
trends in, 102-105
Sexual behavior
adolescents, 36, 69, 81, 82, 93, 102-104, 163, 236
alcohol use and, 79, 104
cocaine use and, 77
counseling, 5, 21
high-risk, for STDs, 123, 124
number of partners, 40, 69, 77, 79, 80, 105
religion and, 105
research, 5-6, 100-102
social-norm changes, 4, 133-134, 233-235
surveys, 101, 103-104, 200, 392
television portrayal of, 92-93, 95
Sexual intercourse.
See also specific types
adolescents, 10, 36, 69, 102-105, 264, 268
definition, 32 n.2
delaying sexual intercourse, 5, 96, 132, 138, 140, 264
dry sex, 72
during menses, 72
frequency of, 124
initiation of, 104-105, 121, 124, 143
mass media messages, 4-5
pain during, 44
prisons, 274
receptive rectal, 72
transmission of STDs, 32-33, 42
Victorian code of ethics, 87
Sexual networks, 119-120
Sexuality.
See also Secrecy about sexuality
definition, 87
education of adolescents, 82, 89-90, 91, 137-138, 140, 264, 388-386, 396, 398
information sources on, 265
international perspectives on, 100
mass media depiction of, 88
medical school curricula, 207
research on, 239
sociocultural taboos, 2, 86, 88
Sexuality Information and Education Council of the United States, 98
Sexually Transmitted Diseases Faculty Expansion Program, 212
Social learning theory (cognitive-behavioral theory), 128, 133, 134 , 140
Social marketing approaches, 132, 134, 136
Social Security Act, 191 n.4
OCR for page 430
-->
Social stigma of STDs, 41, 75, 86, 87, 99, 162, 177, 251
Society for the Scientific Study of Sex, 98
Solid phase immunoassay, 160
Soviet Union (former), STD rates, 40
Spermicides with nonoxynol-9, 126, 150
Spontaneous abortions, 28, 46, 47, 60
"Stages of change" theoretical models, 132, 133
STD Accelerated Prevention Campaigns, 185, 212
STD Communications Roundtable, 95, 238
STD/HIV Prevention Training Centers, 207, 212
Sterilization, 126, 148, 149, 150
Stillbirth, 28, 46, 47
Sub-Saharan Africa, deaths associated with STDs, 49
Substance Abuse and Mental Health Services Administration, 220, 244 , 245, 249, 273
Substance use and abuse.
See also specific substances
adolescents, 37, 77, 81, 82, 104, 139
parenteral transmission of STDs, 32
and risk of STDs, 24, 76-79, 271
and sexual behavior, 79, 104
STD prevention programs, 273, 392
and syphilis, 33-34
treatment programs, 202, 274
Surveillance.
See also Evaluation of interventions;
Information systems;
Notifiable disease reporting system
asymptomatic infections, 199
case definitions, 197-198
coordination of information systems, 259
data collection, 139, 200-201, 202, 255, 258
data management and utilization, 202
disease registries, 199
enhancing current system, 257-259
funding for, 175
health behavior surveys, 199-200
health services performance measures, 8, 259-261
ideal, 257-258
information technology and, 208
prenatal testing, 258
recommendations, 8, 255, 258-259
reporting guidelines, 257
sentinel systems, 34, 35, 198-199, 215, 258
sequelae monitoring, 199
serosurveys, 38, 230, 259
training for, 259
underreporting of STDs, 332-333
Surveys.
See also specific surveys
funding for, 175
Health Care for the Homeless programs, 186
knowledge and awareness of STDs, 105-107
managed care organization STD services, 383-387
sexual behavior, 101, 103-104, 240-241, 392
STD-related services, 180-181, 186, 194
Susceptibility to STD infection, 2, 20, 28, 37, 54, 70, 71
Sweden, 29, 30, 153, 157, 228, 295, 299
Switzerland, 144, 359
Syphilis
adolescents, 82
anal, 38, 197
asymptomatic infections, 312
congenital, 31, 47, 153, 198, 338, 340, 342, 347-348
costs, 59, 88, 208, 312, 338, 339, 340, 342, 347-348
deaths related to, 49
detection and treatment, 157, 159, 160, 161, 179, 339
eradication, 157, 256
ethnic/racial differences, 37
geographic distribution, 56-57, 198
heterosexual, 197
high-risk populations, 33-34, 38
and HIV infection, 40, 49, 52, 55, 56-57, 312
incubation period, 151
maternal-infant transmission, 47
partner notification and treatment, 151, 152, 153-154, 179, 198
in pregnant women, 56-57
prevention, 39, 40, 55, 56, 88-89, 93, 136, 202, 208, 212, 228
in prisoners (adult), 83, 84, 85
rates, 28-30, 31, 33, 40, 187, 197, 198, 312, 333
reporting of, 196, 333
screening, 15, 83, 84, 85, 156, 179, 273, 292
sequelae and syndromes, 31, 46, 47, 48-49, 312
in sex workers, 81, 154, 339
OCR for page 431
-->
substance abuse and, 77, 154
transmission routes, 312
treatment, 161, 186, 312, 347
T
T-cell leukemia/lymphoma, 39, 42, 46, 48
Tanzania, 55, 56, 135-136, 157
Tattooing, 84
Telemedicine, 208
Tennessee, 84
Thailand, 137, 225-225
Theory of Reasoned Action, 125, 128, 133, 134
Training and education of health professionals
academic health centers and, 280-281
adequacy of, 21, 288-289
in clinical management, 276, 280-281, 289
for counseling of patients, 239
in dedicated public STD clinics, 205, 206, 286
disease intervention specialists, 184
federal efforts, 207
focus of, 14-15, 288-290
funding for, 175, 207, 212
information technology and, 208, 289-290
initiatives, 207-208, 237
managed care organizations, 376
medical school and medical graduate education, 204-205, 207, 280-281, 289
partnerships with local health departments, 13
primary care, 205-207, 221, 289-290
in sexuality and sexual health issues, 238-239
in surveillance, 259
Transmission of STDs
chlamydial-HIV dynamics, 316-327
core groups, 119
crack cocaine and, 77-78
cycle, 118-119
female-to-female, 38
female-to-male, 35, 51
male-to-female, 35, 51
male-to-male, 38
maternal-infant, 45, 47
rate of spread, 118, 123
routes, 32-33, 39, 42, 84, 312, 314
in prisons, 84
Treatment of STDs
antibiotic resistance and, 34
availability, STD, 312, 314
chancroid, 161, 351
chlamydial infection, 30, 34, 161-162, 312, 343
compliance with standard practices, 207
costs, 88, 162, 335, 343, 347
drugs, 335
gonorrhea, 34, 161, 186, 312, 343
guidelines, 15-16, 161, 206-207, 292-293, 335, 384, 386, 387
hepatitis B virus, 30, 161, 312
herpes simplex, 199
human papillomavirus infection, 30, 312, 351
long-term, 278
pelvic inflammatory disease, 158, 188, 193, 206
prisoners/detainees, 271-272
settings for, 15
single-dose therapy, 16, 161-162, 293
syndromic, 158
syphilis, 161, 186, 347
Trenton, New Jersey, 77
Trichomoniasis
asymptomatic, 314
diagnostic tests, 161
and HIV infection, 49, 51, 52, 314
in homeless women, 82
rates, 31, 40, 314
sequelae and syndromes, 31, 314
transmission route, 314
treatment, 161, 314
Tropical spastic paraparesis, 39
Tuberculosis, 83, 204
U
Uganda, 56
Uninsured persons, 74, 75, 76, 145, 252, 279, 375
Unitarian Universalist Association, 98
United HealthCare, 190
United Kingdom, 29, 144, 359-360
United States
gender differences in STD transmission, 35
HIV prevention mass media campaign, 358
rates of STDs, 1, 29, 81
sex workers, 81
University/college students, 187, 268
University of California at San Francisco, 353
University of Pennsylvania, Graduate School of Education, 98
OCR for page 432
-->
Ureaplasma, 31
Urethral stricture, 48
Urethritis, 30-31, 38, 54, 55, 58, 136, 157, 158
diagnosis, 159
nongonococcal, 179, 197-198, 199
reporting of, 197-198
surveillance, 199
Urinary tract infections, 126, 193
U.S. Agency for International Development, 8, 256
U.S. Department of Justice, Bureau of Prisons, 220, 272
U.S. Preventive Services Task Force, 15, 134-135, 155-156, 291, 292 , 294, 364-369, 377
V
Vaccines, 120, 144, 145-146
Vaccines for Children program, 145
Vaginal
bacteriosis, 58
cancer, 36, 42, 43, 46
discharge, 31, 158, 159
douching, 70, 72, 124
flora, 126
intercourse, 32, 124
trichomoniasis, 51
Vaginitis, 193, 199
Vermont, 84
Vida/SIDA, 298, 396-397
Violence. See Sexual abuse and violence
Viral hepatitis. See specific types
Vulvar cancer, 36, 42, 43, 46
W
Warts, genital and anal, 32, 39, 199, 278, 351
Washington, D.C., 85, 141
Watts Health Foundation, 392-393
Welfare reform legislation, 279
West Central Health District, 397-398
West End Medical Centers, Inc., 394-395
West Town Neighborhood Health Center Young Adult Clinic, 298, 396
Wisconsin, 155, 225
Women's health.
See also Pregnancy and childbearing
in developing countries, 41
gonorrhea and, 35
HIV infection, 54
homelessness and, 82
impact of STDs, 1-2, 24, 34-36, 61
negotiating condom use, 71, 92, 106, 108, 142, 148-149
perceptions of risk, 125
prisoners, 83
reproductive problems, 1, 43-45
seronegative partners of HIV-seropositive men, 79
sexual abuse and violence, 79-80
susceptibility to STDs, 2, 20, 28, 37, 54, 70, 71, 150, 235
syndromes and complications of STDs, 20, 46, 308-309
traditional cultural values and, 75
Women who have sex with women. See Lesbian women
World Bank, 8, 40, 256
World Health Organization, 8, 40, 256
Y
Youth Risk Behavior Surveillance System, 103-104, 146, 200
Youth Risk Behavior Survey, 392
Z
Zaire, 54, 144, 360
Zero Population Growth, Incorporated, 98
Items in cart [0]
