detention facilities varies with the characteristics of the facility and population. At a minimum, all persons entering detention facilities should be screened and treated for STDs. As reviewed in Chapter 3, in addition to having high rates of STDs upon entry, some inmates continue to have high rates of unprotected sex and drug use while in prison. Therefore, diagnostic and treatment services, risk reduction, and other prevention programs for prisoners are needed. Prevention, early detection, and treatment are appropriate even for long-term prisoners because such a strategy is more cost-effective for the correctional system than treating the severe long-term complications of STDs.

Few correctional facilities currently provide access to condoms. Although condoms can be used as weapons or to conceal contraband, as cited in Chapter 3, the experience of correctional systems with condom availability programs indicates that such programs do not increase these problems. Given the circumstances under which sexual intercourse occurs among prisoners, research regarding the effectiveness of condom availability programs and other methods for reducing the prevalence of unprotected sexual intercourse within correctional facilities is indicated and should be supported by the Department of Justice and the Department of Health and Human Services.

Sex workers, runaways, and the homeless are at high risk of STDs and almost always lack health insurance and are difficult to reach. These populations, however, may be more accessible through nontraditional venues and mobile clinics. Examples of effective approaches to reach these groups are cited in Chapters 3 and 4. Migrant workers need access to STD-related services in an environment that minimizes cultural and language barriers. Because of the lack of education of most migrant workers, health education for STDs must begin at the most basic level. To address cultural and language barriers, peer educators may be effective in reaching many migrants and other groups.

Nontraditional venues for delivering STD-related services, such as detention facilities, drug treatment clinics, alcohol treatment facilities, and other sites where disenfranchised persons can be found, are appropriate sites for prevention activities. Most nontraditional venues for STD prevention have not been targeted by STD program staff, and there are many problems that may arise in implementing STD-related services in such settings. Appropriately trained staff and tools that are suitable for such situations are essential. For example, outreach workers commonly need multiple language and cultural sensitivity skills in order to effectively deliver services to these ethnically and culturally diverse groups. Despite the barriers that make delivery of services in these settings challenging, it is critical that STD-related services be provided in places where persons at high risk for STDs are frequently encountered. Such services may either be furnished by staff of these facilities or supplied through partnerships with local health departments, health plans, and other organizations. Given the evolving epidemiology of STDs, health officials need to continually monitor and reassess the most appropriate and effective community-based venues for prevention.

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