of STD clinical management. The U.S. Preventive Services Task Force and other professional organizations have recommended that all primary care providers counsel patients regarding the avoidance of high-risk sexual behaviors as part of the periodic health examination. The committee believes that although the ability of clinician counseling in primary care settings to change behavior is unproven, focused counseling in both specialized and general clinical settings has great potential for changing behaviors related to the transmission of STDs. The effectiveness of client-centered counseling for STD prevention in a randomized behavioral intervention trial (Project RESPECT) was mentioned in Chapter 4. Thus, counseling is most likely to be highly effective when it is tailored to the individual and is provided in the context of, and reinforced by, other individual-focused and community-based interventions. The experience of STD infection presents an important opportunity to motivate behavior change.

Counseling and education are especially important for adolescents and other groups at high risk of STDs. Major barriers described in Chapters 4 and 5 that hinder clinicians from providing counseling are primarily lack of training and skills in counseling, lack of time allocated for counseling, and lack of reimbursement for such services. To maximize the time available for individualized counseling, new methods of providing information, such as interactive computer software programs and use of other clinic-based counseling staff, should be used to supplement person-to-person counseling by time-constrained clinicians. It is important to develop and evaluate such innovative approaches to counseling and education because some clinicians may be unable, for various reasons, to provide comprehensive preventive services in all the primary care areas that are expected from them. These approaches not only reinforce prevention messages delivered directly by clinicians, but also allow clinicians an opportunity to provide more effective, individually tailored prevention messages.

Therefore, the committee makes the following recommendation:

• All health care professionals should counsel their patients during routine and other appropriate clinical encounters regarding the risk of STDs and methods for preventing high-risk behaviors. Counseling for STDs, including HIV infection, should be reimbursed without copayments or other financial disincentives by Medicaid programs, managed care organizations, and other health plans. The recommendations of the U.S. Preventive Services Task Force regarding counseling for high-risk sexual behaviors should be implemented. Clinical encounters, such as the new diagnosis of an STD or unintended pregnancy, evaluation for HIV infection, or the prescribing of contraceptives, present unique teaching opportunities, when patients may be particularly receptive to health education and counseling; these opportunities should be utilized.