private and public sectors. Advocacy by the above public and private organizations is important because, unlike many other health problems, there are virtually no patient-based constituent groups for STDs other than HIV infection. As discussed in Chapter 3, this is because having an STD is still perceived as socially unacceptable.

Traditionally, public health agencies have led the efforts to improve STD-related services and have assumed most of the responsibility for STD prevention because private sector clinicians refused or were reluctant to provide STD-related services. The committee believes that the private sector needs to assume more responsibility and leadership (Showstack et al., 1996), and that the organizational norms of some private sector organizations regarding responsibility for STD prevention need to change. This is because, although the public sector must continue to play a major role in preventing STDs, the public sector does not have the resources or the organizational reach to fully implement a national system of STD-related services. Developing leadership in the private sector may be a challenge, given the heterogeneity of the organizations potentially involved in STD prevention. As mentioned previously, independent private nonprofit organizations, such as foundations, may be key in bringing these disparate organizations together.

Therefore, the committee makes the following recommendation:

• Private sector organizations and clinicians should assume more leadership and responsibility for STD prevention. The committee proposes the following major responsibilities in STD prevention for private sector organizations and clinicians:

1. Health Plans and Clinicians. Provide confidential, comprehensive, high-quality STD-related clinical services to enrollees/patients and their sex partners; implement clinical practice guidelines for management of STDs; and ensure complete and accurate reporting of surveillance information.
2. Employers and Purchasers of Health Services. Ensure that comprehensive STD-related services are available to employees/beneficiaries and their sex partners.
3. Health Plan Accrediting Organizations. Develop and promote health plan performance measures for STD-related services.
4. Mass Media Companies, Commercial Sponsors, and Advertisers. Improve public awareness and knowledge of STDs and promote healthy sexual behaviors.
5. Health Professional Membership Organizations. Improve awareness and