programs. Finally, 44 percent of STD program managers stated that epidemiological support for their activities was inadequate.

Local capacity in data management and analysis is required if surveillance data are to be used as a program management tool. For example, the decline in rectal gonorrhea rates in many areas of the United States could be interpreted to be a result of the efficacy of HIV prevention activities among gay men. In order to make this assessment, however, local health districts need to have sufficient data management capacity both to collect data on gonorrhea incidence and STD-related behaviors, and to analyze data systematically.

A possible explanation for the lack of data analysis capacity is the dependency of information systems, such as STD*MIS, on state and local resources for maintenance and enhancement. The Council of State and Territorial Epidemiologists has reported that less than half of data resources at state and local levels is provided through federal resources (CSTE, 1995). The council further observed that almost one-half (46.4 percent) of all federal funding for state and local activities related to communicable disease data management was directed towards HIV/AIDS and that one-third of all federal funding was designated for HIV/AIDS. In addition, the council found that, with respect to data management, state and local governments were supporting 59 percent of funding for tuberculosis, 40.8 percent of funding for STDs, 44.2 percent of funding for vaccine-preventable diseases, and 86.7 percent of funding for all other communicable diseases.

Training and Education of Health Professionals

The spectrum of health care providers who are responsible for providing STD-related services includes physicians, nurse practitioners, nurses, physician assistants, and other professionals. The intensity and content of training and educational activities for health professionals vary considerably. Training may occur as part of the formal professional curricula or as part of continuing education activities.

Medical School and Medical Graduate Education

Two national committees in the United States have previously expressed concern regarding the adequacy of education in the area of STDs (Kampmeier, 1975; Work Group on Sexually Transmitted Disease, 1979). In addition, a 1980-1981 study indicated that medical school instruction regarding STDs was generally inadequate (Stamm et al., 1982). This survey of the infectious disease divisions of 122 U.S. medical schools and 15 Canadian medical schools collected information on preclinical and clinical training of medical students and clinical training of medical residents and other resident groups. Of the 127 infectious disease divisions responding to the survey, almost all offered preclinical training



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