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School- and University-Based Settings
School-based health clinics in elementary and high schools and student health services on university and college campuses often provide STD-related services for their students. The number of school-based health centers has dramatically increased in recent years, from 40 in 1985 to 607 in 1994, in an effort to improve access to primary health services for children (Schlitt et al., 1995). The School Health Services and Policies Study examined school health services and HIV infection policies on a state and school district basis nationwide in 1994 (Leavy Small, et al., 1995). Approximately 60 percent of states fund school-based or -linked clinics, and 12 percent of all school districts have at least one school-based or -linked clinic. Diagnostic and treatment services for STDs were available for 16 percent of all middle and junior high schools and for 20 percent of all senior high schools. School health services are supported in part by state funds and in part by federal funds, primarily through the CDC, the Health Care Financing Administration, and the Health Resources and Services Administration (Leavy Small et al., 1995; Schlitt et al., 1995). Most school-based clinic services are provided by registered school health nurses (Igoe, 1994). For example, in one study, 31 percent of adolescents surveyed cited fear of parental discovery as their reason for not utilizing available health services at family planning clinics (Zabin et al., 1991).
Students at universities and colleges are at high risk for STDs (DeBuono et al., 1990; Reinisch et al., 1995). Recent national data on the scope and quality of STD-related clinical services among university health services are not available. Anecdotal evidence, however, suggests that university student health services at a minimum provide confidential STD diagnosis and treatment services to students (Cindy Launchbaugh, American College Health Association, personal communication, April 1996). Several universities have published descriptions of prevention activities for STDs that generally focus on HIV prevention (McLean, 1994; Turner et al, 1994; Keeling, 1995). Several have shown that specific interventions were successful in improving knowledge and promoting safer sex behavior (McLean, 1994; Turner et al., 1994).
Private Sector Settings
Many private sector health care providers, including private physician offices, health plans, private clinics, and private hospital emergency rooms, provide some STD-related services. Most cases of STDs are diagnosed by private sector health care professionals (Berg, 1990). However, very little is known about the volume, extent, disease prevalence, or spectrum of STDs encountered in private sector settings compared to either dedicated public STD clinics or community-based clinics. Accurate estimates of STD morbidity seen in private sector settings are lacking as a result of underreporting from clinicians in these settings. Nonetheless,