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Suggested Citation:"INDEX." Institute of Medicine. 1997. The Hidden Epidemic: Confronting Sexually Transmitted Diseases. Washington, DC: The National Academies Press. doi: 10.17226/5284.
×

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

Suggested Citation:"INDEX." Institute of Medicine. 1997. The Hidden Epidemic: Confronting Sexually Transmitted Diseases. Washington, DC: The National Academies Press. doi: 10.17226/5284.
×

   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

Suggested Citation:"INDEX." Institute of Medicine. 1997. The Hidden Epidemic: Confronting Sexually Transmitted Diseases. Washington, DC: The National Academies Press. doi: 10.17226/5284.
×

   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

Suggested Citation:"INDEX." Institute of Medicine. 1997. The Hidden Epidemic: Confronting Sexually Transmitted Diseases. Washington, DC: The National Academies Press. doi: 10.17226/5284.
×

   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

Suggested Citation:"INDEX." Institute of Medicine. 1997. The Hidden Epidemic: Confronting Sexually Transmitted Diseases. Washington, DC: The National Academies Press. doi: 10.17226/5284.
×

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

Suggested Citation:"INDEX." Institute of Medicine. 1997. The Hidden Epidemic: Confronting Sexually Transmitted Diseases. Washington, DC: The National Academies Press. doi: 10.17226/5284.
×

   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

Suggested Citation:"INDEX." Institute of Medicine. 1997. The Hidden Epidemic: Confronting Sexually Transmitted Diseases. Washington, DC: The National Academies Press. doi: 10.17226/5284.
×

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

Suggested Citation:"INDEX." Institute of Medicine. 1997. The Hidden Epidemic: Confronting Sexually Transmitted Diseases. Washington, DC: The National Academies Press. doi: 10.17226/5284.
×

   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

Suggested Citation:"INDEX." Institute of Medicine. 1997. The Hidden Epidemic: Confronting Sexually Transmitted Diseases. Washington, DC: The National Academies Press. doi: 10.17226/5284.
×

   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

Suggested Citation:"INDEX." Institute of Medicine. 1997. The Hidden Epidemic: Confronting Sexually Transmitted Diseases. Washington, DC: The National Academies Press. doi: 10.17226/5284.
×

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

Suggested Citation:"INDEX." Institute of Medicine. 1997. The Hidden Epidemic: Confronting Sexually Transmitted Diseases. Washington, DC: The National Academies Press. doi: 10.17226/5284.
×

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

Suggested Citation:"INDEX." Institute of Medicine. 1997. The Hidden Epidemic: Confronting Sexually Transmitted Diseases. Washington, DC: The National Academies Press. doi: 10.17226/5284.
×

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

Suggested Citation:"INDEX." Institute of Medicine. 1997. The Hidden Epidemic: Confronting Sexually Transmitted Diseases. Washington, DC: The National Academies Press. doi: 10.17226/5284.
×

   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

Suggested Citation:"INDEX." Institute of Medicine. 1997. The Hidden Epidemic: Confronting Sexually Transmitted Diseases. Washington, DC: The National Academies Press. doi: 10.17226/5284.
×

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

Suggested Citation:"INDEX." Institute of Medicine. 1997. The Hidden Epidemic: Confronting Sexually Transmitted Diseases. Washington, DC: The National Academies Press. doi: 10.17226/5284.
×

   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

Suggested Citation:"INDEX." Institute of Medicine. 1997. The Hidden Epidemic: Confronting Sexually Transmitted Diseases. Washington, DC: The National Academies Press. doi: 10.17226/5284.
×

   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

Suggested Citation:"INDEX." Institute of Medicine. 1997. The Hidden Epidemic: Confronting Sexually Transmitted Diseases. Washington, DC: The National Academies Press. doi: 10.17226/5284.
×

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

Suggested Citation:"INDEX." Institute of Medicine. 1997. The Hidden Epidemic: Confronting Sexually Transmitted Diseases. Washington, DC: The National Academies Press. doi: 10.17226/5284.
×

   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

Suggested Citation:"INDEX." Institute of Medicine. 1997. The Hidden Epidemic: Confronting Sexually Transmitted Diseases. Washington, DC: The National Academies Press. doi: 10.17226/5284.
×

   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

Suggested Citation:"INDEX." Institute of Medicine. 1997. The Hidden Epidemic: Confronting Sexually Transmitted Diseases. Washington, DC: The National Academies Press. doi: 10.17226/5284.
×

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

Suggested Citation:"INDEX." Institute of Medicine. 1997. The Hidden Epidemic: Confronting Sexually Transmitted Diseases. Washington, DC: The National Academies Press. doi: 10.17226/5284.
×

   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

Suggested Citation:"INDEX." Institute of Medicine. 1997. The Hidden Epidemic: Confronting Sexually Transmitted Diseases. Washington, DC: The National Academies Press. doi: 10.17226/5284.
×

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

Suggested Citation:"INDEX." Institute of Medicine. 1997. The Hidden Epidemic: Confronting Sexually Transmitted Diseases. Washington, DC: The National Academies Press. doi: 10.17226/5284.
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Suggested Citation:"INDEX." Institute of Medicine. 1997. The Hidden Epidemic: Confronting Sexually Transmitted Diseases. Washington, DC: The National Academies Press. doi: 10.17226/5284.
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Suggested Citation:"INDEX." Institute of Medicine. 1997. The Hidden Epidemic: Confronting Sexually Transmitted Diseases. Washington, DC: The National Academies Press. doi: 10.17226/5284.
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Suggested Citation:"INDEX." Institute of Medicine. 1997. The Hidden Epidemic: Confronting Sexually Transmitted Diseases. Washington, DC: The National Academies Press. doi: 10.17226/5284.
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Suggested Citation:"INDEX." Institute of Medicine. 1997. The Hidden Epidemic: Confronting Sexually Transmitted Diseases. Washington, DC: The National Academies Press. doi: 10.17226/5284.
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Suggested Citation:"INDEX." Institute of Medicine. 1997. The Hidden Epidemic: Confronting Sexually Transmitted Diseases. Washington, DC: The National Academies Press. doi: 10.17226/5284.
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The Hidden Epidemic: Confronting Sexually Transmitted Diseases Get This Book
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The United States has the dubious distinction of leading the industrialized world in overall rates of sexually transmitted diseases (STDs), with 12 million new cases annually. About 3 million teenagers contract an STD each year, and many will have long-term health problems as a result. Women and adolescents are particularly vulnerable to these diseases and their health consequences. In addition, STDs increase the risk of HIV transmission.

The Hidden Epidemic examines the scope of sexually transmitted infections in the United States and provides a critical assessment of the nation's response to this public health crisis. The book identifies the components of an effective national STD prevention and control strategy and provides direction for an appropriate response to the epidemic. Recommendations for improving public awareness and education, reaching women and adolescents, integrating public health programs, training health care professionals, modifying messages from the mass media, and supporting future research are included.

The book documents the epidemiological dimensions and the economic and social costs of STDs, describing them as "a secret epidemic" with tremendous consequences. The committee frankly discusses the confusing and often hypocritical nature of how Americans deal with issues regarding sexuality—the conflicting messages conveyed in the mass media, the reluctance to promote condom use, the controversy over sex education for teenagers, and the issue of personal blame.

The Hidden Epidemic identifies key elements of effective, culturally appropriate programs to promote healthy behavior by adolescents and adults. It examines the problem of fragmentation in STD services and provides examples of communities that have formed partnerships between stakeholders to develop integrated approaches.

The committee's recommendations provide a practical foundation on which to build an integrated national program to help young people and adults develop habits of healthy sexuality.

The Hidden Epidemic was written for both health care professionals and people without a medical background and will be indispensable to anyone concerned about preventing and controlling STDs.

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