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



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--> 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

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-->    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

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-->    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

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-->    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

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--> 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

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-->    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

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--> 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

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-->    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

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-->    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

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--> 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

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--> 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

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--> 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

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-->    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

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--> 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

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-->    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

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-->    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

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--> 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

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-->    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

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-->    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

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--> 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

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-->    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

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--> 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