prevention. These teens serve as peer outreach workers in schools and the community and serve as "peer experts" not only for HIV and other STDs, but for other reproductive health and general health issues as well. The program has established a close working relationship with the Young Adult Clinic and encourages teens to use the clinic for HIV and other STD testing and treatment or general health care. Part of the teens' outreach work includes conducting presentations in various high schools in a five-part series that includes topics such as HIV, STD, and pregnancy prevention, substance abuse, and violence. The program has also extended its outreach presentations to middle schools. These activities are supported by the local school council.
To coordinate an effective prevention strategy in the West Town community of Chicago, Vida/SIDA brought together community health and educational organizations in West Town to form the West Town STD/HIV Prevention Network. The network brings together many community agencies that work together to develop new, interrelated prevention programs. Working with the Young Adult Clinic, Vida/SIDA is able to refer youths to the clinic for STD-related or other services. While the program appears to be running well, peer educators report that there is a common perception in the adolescent community that STDs are "no big deal." Although the program has strong support from the community and school board, it has not been formally evaluated. Vida/SIDA is currently working in collaboration with the CDC to establish a formal evaluation process.
The West Central Health District (District 7) is composed of 16 counties with a total population of approximately 450,000, with 22 percent of residents living below the federal poverty level. The largest health clinic in the district is located in Columbus and is staffed by "expanded role" nurses who work under the standing protocols and supervision of physicians. These nurses have been specifically trained in STD-related care at the regional STD training center and also receive periodic training updates at the center. Other counties in the district have health department clinics of varying sizes that provide STD screening and treatment. In two counties that do not have physicians available to treat STDs, patients frequently have to cross county lines for STD treatment.
Contact-tracing is conducted for syphilis only, but West Central Health District staff are skeptical of the effectiveness of this service. Staff have proposed that efforts should be focused in high morbidity areas within the district. STD screening and treatment and HIV testing and counseling are also integrated into family planning services provided by the health department. The Columbus Health Department operates separate clinics for teenagers that provide comprehensive health services such as prenatal care, STD screening, and pre- and post-HIV counseling and testing. In general, the private physicians in the community