regarding prevention during their clinic visit (Roter et al., 1990). Several states mandate counseling of patients, using a prescribed content outline, before to HIV testing; however, there is no method for ensuring that these regulations are followed.

Data on the specific types of STD-related services provided by local health departments through public STD clinics are limited. The Alan Guttmacher Institute, with support from the CDC, however, has recently conducted a survey to provide national estimates describing the STD-related activities of local public health agencies in the United States (Box 5-1).

BOX 5-1 STD-Related Services Among Local Health Agencies, 1995

A stratified, random sample of 800 local health departments that were identified as providing STD treatment were sent a questionnaire in September 1995 regarding various characteristics of their programs and policies related to STD-related clinical services. Approximately 77 percent of the eligible agencies responded.

Results indicate that 50 percent of 2,888 local health departments provide treatment for STDs. Of these providers, 74 percent integrate STD-related services with HIV/AIDS-related services; 21 percent offer STD- and HIV-related services in separate programs; and 5 percent provide STD-related services but do not provide HIV screening or testing. Almost half (49 percent) of the local health departments that offer services for STDs offer both dedicated STD sessions and sessions where such services are integrated with other services, such as family planning. An additional 37 percent always integrate STD sessions with other clinic services such as family planning, and 14 percent provide only STD-related services in dedicated sessions. Only 23 percent of agencies offered services after 6 p.m. and only 5 percent had weekend hours.

Regarding testing and treatment services for chlamydial infection, gonorrhea, and syphilis, a greater percentage of agencies reported treating chlamydial infection (97 percent) than testing for it at all or some sites (82 percent). The percentages of agencies testing and treating for gonorrhea and syphilis at all sites were all over 98 percent.

Agencies were also asked to report what type of client history, risk assessment, and educational/counseling services they routinely provide patients making an initial STD visit (Table below). More than 90 percent of agencies reported routinely collecting information on a client's sexual, STD, and contraceptive history. A smaller proportion of agencies routinely query patients regarding any history of substance abuse (78 percent). While approximately 97 percent of STD agencies reported routinely providing educational services regarding risk factors of STDs and HIV, far smaller percentages of agencies reported routinely providing services on how to use contraceptive methods effectively or how to negotiate condom use (66-70 percent). Although more than 70 percent of health departments that provide services for STDs in integrated sessions reported routinely providing education and counseling regarding contraceptive use, less than half (47 percent) of agencies that only provide services in separate sessions provide this service.

It should be noted that the survey results represent only health departments that offered treatment for STDs and that the quality and consistency of services provided were not evaluated. In addition, most agencies that reported integration of STD-related services with other services were in nonmetropolitan areas with relatively low caseloads.

Distribution of Local Health Agencies Providing STD Risk Assessment and Educational and Counseling Services by Type of Service, 1995

Type of Service

Total No. of Agencies

Routinely Provided (%)

Provided Only on Indication or Request

Not Provided (%) (%)

Client history

 

 

 

 

Client sexual history

575

98.9

1.1

0.0

Client contraceptive history

579

93.9

5.9

0.2

Client/partner substance use history

575

77.8

18.6

3.6

Client/partner STD history

578

97.3

2.1

0.6

 

Education/counseling services

 

 

 

 

How to use contraceptive method effectivelya

577

69.6

26.0

4.4

Risk factors for STDs-HIV

580

97.4

2.6

0.0

Condom negotiation skills

576

66.4

29.6

4.0

a This question was generally worded and may have been interpreted by respondents to mean education and counseling regarding contraceptive use generally or to prevent STDs only, or both.

SOURCE: Landry DJ, Forrest JD. Public health departments providing sexually transmitted disease services. Fam Plann Perspect 1996;28:261-6.



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