to promote healthy sexual behavior need to be complemented by access to clinical services, training and education of health professionals, surveillance and research, and community-based programs. Many prevention efforts, such as community- and school-based programs, remain underfunded and weak because of social and political constraints. The committee believes that population-based interventions should be objectively evaluated for funding and implementation based on their scientific merit and potential public health impact.

Prevention programs must address the roles of both men and women in transmitting infection. Many screening programs are appropriately targeted toward women and conducted in facilities exclusively providing services to women. In order to interrupt the transmission cycle of STDs, however, infections among men also need to be addressed. STD prevention efforts should include both screening programs for asymptomatic men and male-specific behavioral interventions, such as promotion of responsibility for condom use. In addition, programs providing health services to women should ensure that sex partners are appropriately evaluated and treated.

Expanding Prevention-Related Research

New research may be used to develop effective prevention programs, but such programs need to be modified regularly based on continuous evaluation of existing programs and changes in the epidemiology of STDs and the health care environment. Prevention-related research allows program managers to maximize the effectiveness of interventions and policymakers to maximize available resources. Professionals responsible for STD prevention efforts should ensure that regular program evaluation and quality improvement activities are integral parts of their programs.

There are many available interventions for STD prevention, but some have not been fully evaluated, and new interventions need to be developed. Wasserheit and Hitchcock (1992), in their assessment of future directions in STD prevention research, concluded that a multidisciplinary approach to research is necessary; prevention research should be given top priority; the long-term sequelae of STDs should be given greater emphasis; and communication and coordination within the research infrastructure should be improved. A recent panel charged to evaluate the social, behavioral, and prevention research areas for the National Institutes of Health found that only 3.4 percent of the total National Institutes of Health budget for research on AIDS was devoted to prevention and intervention research in the behavioral and social sciences (NIH, 1996). The panel recommended the following: intervention and behavioral research be given the highest priority and coordinated with biomedical research; a paradigm shift to develop models that are domain-specific with regard to sexuality (and drug use) and recognition that risk behavior is embedded within personal, interpersonal, and situational contexts; research on individual differences in human sexuality (and

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