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provide essential, age-appropriate STD-related services, including health education, access to condoms, and readily accessible and available clinical services, such as school-based clinical services, to prevent STDs.
All health plans, clinicians, and publicly sponsored health clinics should provide or arrange for hepatitis B immunizations for their infant, adolescent, and adult patients according to the Advisory Committee on Immunization Practices (ACIP) guidelines. Given the difficulty in reaching adolescents in health care settings, public health officials should ensure that adolescents who are not immunized in health care settings are immunized through school-based or other community programs.
Establishing New Venues for Interventions
Although services for disenfranchised groups, including substance users, sex workers, the homeless, prisoners, and migrant workers, do not have popular support, these populations represent reservoirs of infection for the entire community. Innovative methods and alternate venues for intervention are needed because these groups are difficult to reach through traditional health care settings. Nontraditional venues for delivering STD-related services, such as prisons, drug treatment clinics, the streets, and other sites where high-risk persons gather, are appropriate sites for preventive services. Health departments should establish linkages with programs that serve populations at high risk for STDs, and government agencies should coordinate their various STD-related programs, because the lack of coordination and unevenness of services have resulted in critical gaps in service coverage. To contain persisting epidemics of STDs among disenfranchised persons, new biomedical, epidemiological, and behavioral tools should be developed collaboratively by the public and private sector.
With respect to the above issues, the committee makes the following recommendations:
Federal, state, and local agencies should focus on reducing STDs among disenfranchised populations (e.g., substance users, persons in detention facilities, sex workers, the homeless, migrant workers).
Prisons and other detention facilities should provide comprehensive STD-related services, including STD prevention counseling and education, screening, diagnosis and treatment, partner notification and treatment, and methods for reducing unprotected sexual intercourse and drug use among prisoners.
The National Institutes of Health, the Food and Drug Administration, and the CDC should work with pharmaceutical and biotechnology companies to develop improved STD diagnostic tools (e.g., rapid saliva and urine tests) that are suitable for use in nontraditional health care settings (e.g., prisons, mobile clinics, the streets).