print media) (EDK Associates, 1994). In an effort to address the lack of accurate information regarding STDs in the mass media, the STD Communications Roundtable was formed in 1995. This ad hoc committee of public health experts, communications professionals, and mass media executives met to discuss ways of assisting the mass media in producing and incorporating messages supporting healthy sexual behavior. Building on these discussions, they recently produced a resource guide for media executives (STD Communications Roundtable, 1996). This roundtable, however, does not have plans to reconvene. In addition, the Media Project2 has been working with television producers and writers to improve the content of sexual messages in television shows and to increase the promotion of healthy sexual behaviors. A coalition of organizations with an interest in sexuality education, the National Coalition to Support Sexuality Education, recently issued a consensus statement and suggested guidelines for incorporating information regarding healthy sexual behavior and STDs into the mass media (Box 3-2).
STD-related risk assessment and counseling are not routinely performed by most primary care clinicians. A 1994 nationwide survey of 450 physicians and 514 other primary care providers showed that 60 percent of physicians and 51 percent of other primary care providers do not routinely evaluate all or most new adult patients for STDs (ARHP and ANPRH, 1995). In addition, only 30 percent of physicians and 34 percent of other primary care providers reported collecting information regarding their patients' sexual activity.
Health care providers have two major hurdles to effective communication with their patients regarding sexuality issues. One is their own comfort level in talking about sex and sexual health issues, and the other is reserving time in their schedule to do it. The reluctance to discuss sexual health issues with patients can be partially attributed to the discomfort and embarrassment of some health care professionals in discussing these issues (Risen, 1995). A physician survey found that embarrassment was perceived to be a major reason physicians did not take sexual histories (Merrill et al., 1990). If clinicians are not comfortable talking to their patients about STDs, assessing their patients' risk behavior, and providing information on STD prevention, patients may detect this discomfort and decide not to raise questions or concerns regarding sex with their health care provider. The reluctance of clinicians to discuss sexual health issues may be especially problematic among older clinicians and gay patients (Matthews et al., 1986; Lewis and Freeman, 1987; Lewis and Montgomery, 1990). In order to address