a neutral forum is needed to maximize the range of participants and to catalyze the collaborative process.

With respect to the above issues, the committee makes the following recommendations:

• Private sector organizations and clinicians should assume more leadership and responsibility for STD prevention.
• Federal, state, and local governments, through the leadership of their respective health agencies, should ensure that all persons have access to comprehensive, high-quality STD-related services.²
• An independent, long-term national Roundtable should be established as a neutral forum for public and private sector agencies and organizations to collaboratively develop and implement a comprehensive system of STD-related services in the United States.

To establish an effective system of STD prevention, a substantially greater investment from both the public and private sectors is needed. The current national public investment in STD prevention is not commensurate with the health and economic costs of STDs. The committee estimates that only $1 is invested in STD prevention for every $43 spent on the STD-associated costs every year. Similarly, only $1 is invested in biomedical and clinical research for every $94 in STD-related costs. For every $1 spent on early detection and treatment of chlamydial infection and gonorrhea, $12 in associated costs could be saved. Investing in preventive services and research will avert substantial human suffering and save billions of dollars in treatment costs and lost productivity. Additional funding for STD prevention should come from local, state, and federal governments and from the private sector. Private health plans, in particular, need to increase support for STD-related services that benefit their enrolled population, and ultimately benefit the health plan's financial status. In addition, because STDs are emerging infections and a global public health problem, the United States has a national interest in preventing STDs worldwide. Despite the problems in the current system of categorical funding for STDs, moving to a system of block grants for STDs would have a devastating impact on STD prevention because STDs will fare poorly in competing with other more visible and "acceptable" health conditions for funding.

With respect to the above issues, the committee makes the following recommendations: