than by evaluating patients with acute signs or symptoms of STDs. In the past, gonorrhea screening has been funded on the basis of availability of government funds. More recently, publicly funded family planning clinics have become the focus of a national initiative on preventing chlamydial infection coordinated by the CDC. Unlike dedicated public STD clinics that provide services to a disproportionate number of men, most persons who use community-based clinics are women and children. In fact, some family planning clinics will not provide services to men even if they are sex partners of infected women seen in their facility. STD-related clinical services are often provided in the context of other regular health care, and there is often little emphasis on partner notification and treatment as part of care for infected women. These clinics presumably have a strong investment and interest in issues of STD counseling and health education. Federal funds for STD diagnosis and treatment in community-based clinic settings are often restricted to specific uses.
A 1990 survey conducted by the State Family Planning Administrators collected data regarding STD-related services in 410 Title X2 family planning clinics nationwide (SFPA, 1991). The survey showed that most family planning clinics provided STD-related services to their clients, but the scope of services varied considerably. For example, 82 percent of clinics reported capability for treating gonorrhea, but only 48 percent provided treatment for syphilis. Approximately one-third of clinics reported using staff resources to contact partners for at least one STD, and approximately 60 percent of clinics provided testing for gonorrhea. Virtually all clinics provided some preventive services, and more than 80 percent reported conducting community-based education activities. Half of the clinics surveyed shared family planning and local STD program staff in integrated service settings. Family planning clinics throughout the country have implemented special programs to reach disenfranchised populations, including substance users, inmates, the homeless, disabled persons, and non-English-speaking populations (Armstrong et al., 1992; Donovan, 1996).
Data regarding STD-related services in community-based clinics such as community health centers and clinics for the homeless and migrant workers are more limited than for family planning clinics. This is a result of the failure to collect STD-service-specific data, since such services are often provided as an integral part of primary care. However, in a 1994 survey of Health Care for the Homeless programs (Section 340 of the Public Health Services Act), 68 percent of responding programs offered screening and 67 percent offered STD treatment services directly (UCLA Center for Health Policy Research, unpublished data, 1994). The remainder offered services through parent agencies, under contracts, or did not offer services.