Sexually Transmitted Infections Adopting a Sexual Health Paradigm (2021) / Chapter Skim
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1 Addressing STI Epidemics: Integrating Sexual Health, Intersectionality, and Social Determinants
1 Addressing STI Epidemics: Integrating Sexual Health, Intersectionality, and Social Determinants
Pages 21-52
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1 Addressing STI Epidemics: Integrating Sexual Health, Intersectionality, and Social Determinants Chapter Contents Introduction Urgency of Addressing STIs Committee's Approach • Ethical Principles Guiding This Report • Sexual Health • Evolution of Sexual Health Paradigms • Report Conceptual Framework • Moving from a Narrow View of STIs to a Broader Sexual Health Approach Changes in the STI Landscape in the Past 20 Years • Recent STI-Related Reports Study Process and Report Overview • Report Terminology • Methodology • Report Overview Concluding Observations 21
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Asymp tomatic individuals may not know they are infected, yet they can still transmit an infection to their sexual partners or offspring. • Congenital syphilis is passed to a fetus with severe and often fatal conse quences for newborns.
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The Institute of Medicine released a report, The Hidden Epidemic: Confronting Sexually Transmitted Diseases, more than 20 years ago (in 1997) , yet the problems and barriers described there persist today.
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These three conditions produce significant morbidity and are nationally reportable conditions for which both diagnostic tools and therapeutics are currently available, and there are current national efforts to reduce the FIGURE 1-1 Snapshot of reportable sexually transmitted infections in 2017. SOURCE: Bolan, 2019.
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FIGURE 1-2 Notifiable sexually transmitted infections -- rates of reported cases per 100,000 population (per 100,000 live births for congenital syphilis) , United States, 1999–2018.
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The committee will provide direction for future public health programs, poli cy, and research in STI prevention and control and make recommendations* as appropriate.
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. Centering health inequities and structural factors is critical when approaching most health concerns, and the committee discusses and assesses this throughout this report.
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The committee concludes that efforts to eliminate STIs need to be expanded from interventions in the private and public health domains to encompass a productive policy-making sexual health discourse at the local, state, and federal levels that leads to legal protections and opportunities regardless of socioeconomic status, race and ethnicity, gender, sexual orientation, or ability to pay for care. Addressing sexual injustice requires the affirmation of sexual rights as basic human rights that are enjoyed by all.
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6. Right to freedom of All persons have the right to exercise freedom of thought, opinion, thought, opinion, and expression regarding ideas on and expression; sexuality, sexual orientation, gender identity, and sexual right to association.
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, sexual health is a critical frame when approaching STI prevention and control. This section provides a brief historical overview of sexual health in the United States and includes important considerations for moving forward.
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STI policies. Evolution of Sexual Health Paradigms In parallel, the scientific study of human sexuality and function developed as an interdisciplinary specialty, sexology, encompassing the medical, psychological, and cultural aspects of sexual development and relationships throughout the life span.
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. Furthermore,"Self-determination, consent, safety, privacy, confidence and the ability to communicate and negotiate sexual relations are key enabling factors for pleasure to contribute to sexual health and wellbeing." Finally, "The experiences of human sexual pleasure are diverse and sexual rights ensure that pleasure is a positive experience for all concerned and not obtained by violating other people's human rights and well-being" (Ford et al., 2019; WAS, 2019)
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support their potential. In promoting a sexual health discourse to inform the STI prevention agenda, it is important to ensure that the sexual health of all people is addressed, especially marginalized populations that are often disproportionally affected by STIs, including LGBTQ+ populations; Black people; Latino/a people; AI/AN people; sex workers; immigrants; incarcerated populations; and people affected by mental health and substance use BOX 1-3 Definitions of Sexual Health World Health Organization definition: "Sexual health is a state of physical, emotional, mental, and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction, or infirmity.
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. Report Conceptual Framework: A Modified Social Ecological Framework of Sexual Health and STI Prevention, Control, and Treatment The conceptual framework that provides a unifying approach for the committee's report on the U.S.
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. In sum, effective STI prevention, control, and treatment needs to move beyond individual-level behavior and behavior-change models toward a comprehensive framework that understands and addresses the interconnected and mutually reinforcing social and structural determinants of health and health inequities.
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that not only addresses STIs as discrete health outcomes but also addresses the social and structural determinants that influence STI risk, prevention, health care access, delivery, and treatment (see Chapter 2 for a detailed description of the core elements in the conceptual framework)
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For example, promoting sexual health in a manner that facilitates STI prevention, diagnosis, and treatment does not constrain faith communities from teaching about sexual responsibility and sexual health in a way that is consistent with their own faith traditions and ethical frameworks. The committee holds an inclusive vision of respect and appreciation for diversity in religious belief, culture, gender, and sexual orientation.
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• Social media and other interpersonal digital communications (e.g., dating apps) • Patient–provider interactions and communication Institutional Factors That Facilitate or Hinder STI Prevention, Health Care Access, Delivery, and Treatment • Health care practices that promote well-being or conversely reinforce stigma and bias CHANGES IN THE STI LANDSCAPE IN THE PAST 20 YEARS The committee is completing its work as the nation and the world continue to grapple with the COVID-19 pandemic and its associated disruptions in economic activity.
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• Community-level indicators of STI transmission (e.g., prevalence of STIs within neighborhoods) Structural Factors, Including Societal Values, Policies, and Practices at Local, State, and Federal Levels That Determine STI Prevention, Health Care Access, Health Care Delivery, and Treatment • Social advocacy that promotes health equity and inclusion • Social policies and laws that address structural inequities (e.g., structural sexism, anti-LGBTQ+ structural stigma)
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This report also comes more than two decades after the release of the foundational report The Hidden Epidemic: Confronting Sexually Transmitted Disease (IOM, 1997)
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, which can also indirectly lead to more STIs by practice of high-risk behavior. A key factor affecting the challenges and opportunities for addressing STIs is Internet usage.
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There are too few vaccines and both a weak pipeline for new therapeutics and growing concerns over drug resistance to existing therapies, especially for gonorrhea. STI prevention, care, and research remain dramatically underfunded at the federal level in relation to their public health burden, and state and local funding is nonexistent or miniscule in most U.S.
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The national response to the STI crisis needs to recognize that the nation's collective efforts will be most successful if funding and programs prioritize health equity and address broader factors that are associated with an increased STI risk (such as racism, discrimination, unemployment, income insecurity, poverty, and unstable housing) while also increasing access to comprehensive STI health services.
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Similarly, the committee has chosen "Latino/Latina" for consistency to refer to persons with cultural connections to Latin America, recognizing that some people may prefer "Hispanic," "Latinx," or another term. Societal understanding of gender identity is rapidly evolving.
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The committee notes throughout the report where this is the case and where more BOX 1-5 Sexually Transmitted Diseases or Sexually Transmitted Infections? The term "sexually transmitted infection" (STI)
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Embrace Innovation and Policy Change to Improve Sexual Health These themes are explored in detail in the following chapters. Chapters 1–5 provide background and address the first two components of the committee's charge, and Chapters 6–12 address the third component of the charge -- advice on future public health programs, policies, and research in STI prevention and control (some of these chapters provide conclusions, and others provide conclusions and recommendations for action)
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Stronger leadership and coordination of national STI prevention and control efforts are also needed to improve STI prevention and control. Furthermore, because the committee's primary focus was on providing clear policy guidance and a framework for action, it does not uniformly offer specific implementation steps or metrics for each recommendation.
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Presentation to the Committee on Preven tion and Control of Sexually Transmitted Infections in the United States, Meet ing 1 (August 26)
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2021. The estimated direct lifetime medical costs of sexually transmitted infections acquired in the United States in 2018.
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2018. The impact of sexually transmitted diseases on the United States: Still hidden, getting worse, can be controlled.
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2017. Sexually transmitted infections: Challenges ahead.
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