Adolescents and underserved populations require special emphasis in an effective national system for STD prevention because they are at high risk for STDs and they do not have adequate access to STD-related services. Innovative methods for delivering STD-related services to such populations should immediately be designed and implemented because these groups are difficult to reach through traditional clinical settings and approaches.
A national strategy for STDs should emphasize prevention because averting illness is desirable, many STDs are incurable, and STD-related complications may be irreversible. Effective prevention programs are usually the result of extensive research and evaluation and continuous quality improvement. They should be regularly modified based on the epidemiology of STDs and continuous evaluation of programs. Prevention-related research allows program managers and policymakers to maximize the effectiveness of interventions and available resources. Areas of prevention-related research that should be emphasized include determinants of sexual behavior and sustained behavior change; determinants of initiation of sexual intercourse among adolescents; influence of social and other community-related factors on risk of STDs; interventions to improve condom use and reduce high-risk behaviors; effectiveness of sexual risk behavior assessment and counseling; biomedical interventions that do not rely primarily on individual behavior, such as vaccines; female-controlled prevention methods; cost-effectiveness of interventions; methods for preventing STDs among disenfranchised populations; interventions for preventing STDs among persons of all sexual orientations; and methods to assess prevention program effectiveness.
With respect to the above issues, the committee makes the following recommendations: