act as primary care providers, referring plan enrollees to other plan services as needed.

An example of an effort to promote collaboration at the national level is the CDC's National Partnership to Prevent STD-Related Infertility, which is intended to prevent infertility and other serious complications of chlamydial and gonococcal infections. The partnership seeks to prevent these infections through collaborations with a variety of traditional and nontraditional stakeholders in STD prevention. The action plan for the partnership focuses on coordination and integration of STD-related services, public education, health professional education, quality assurance for diagnosis and treatment, community-level behavior change, and surveillance and program evaluation (CDC, DSTD/HIVP, 1995). In addition, the demonstration projects cosponsored by the CDC and the Office of Population Affairs are increasing collaboration among dedicated public STD clinics, family planning clinics, and public laboratories. The committee believes that these types of collaborative approaches should be expanded to all STDs.

Concluding Statement

STDs are hidden epidemics of tremendous health and economic consequence in the United States. They are hidden because many Americans are reluctant to address sexual health issues in an open way and because of the biologic and social characteristics of these diseases. STDs are diseases of national and global importance that have a dramatic impact on local communities. All Americans have an interest in STD prevention because all communities are impacted by STDs, and all individuals directly or indirectly pay for the costs of these diseases. STDs are public health problems that lack easy solutions because they are rooted in human behavior and fundamental societal problems. Indeed, there are many obstacles to effective prevention efforts. The first hurdle will be to confront the reluctance of American society to openly address issues surrounding sexuality and STDs. Despite the barriers, there are existing individual- and community-based interventions that are effective and can be implemented immediately. Although these interventions are not perfect, they can have a synergistic, positive impact in reducing the risk of STDs in the population. That is why a multifaceted approach is necessary at both the individual and community levels. Populations at high risk, such as adolescents and disenfranchised persons, will need special attention.

An effective system of STD prevention in the United States will have to be developed at the local, state, and national levels, with full participation of both the public and private sectors. Many of the essential components of an effective system already exist, but they need to be integrated or coordinated, particularly at the local level. Many of these components also need to be improved and redesigned in order to maximize effectiveness and optimize resources. This means that many stakeholders need to redefine their mission, refocus their efforts, modify

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