2002 National STD Conference - Plenary and Mini-Plenary Abstracts

Opening Plenary Session, Monday, March 4, 2002, 2:00 - 3:00 PM

STD Prevention in the US: From Past to Present to Future

W Cates

Family Health International, Research Triangle Park, NC

By a decade ago, HIV had taken hold as the dominant STD in the public eye. Simultaneously, syphilis rates had climbed to the highest level in several decades. In the early 1990’s increasing recognition of the widespread nature of chlamydia and its consequences led to new resources and prevention efforts. Six years ago, the Institute of Medicine published the landmark report, The Hidden Epidemic: Confronting Sexually Transmitted Diseases, which inspired critical new thinking about how we should approach STD prevention in this country. Three years ago, the national effort to eliminate endemic syphilis from the United States was initiated, and just two years ago, an important step was taken in health services when chlamydia screening for young women was selected as one of the HEDIS measures. Yet, today, we are facing rising rates of STDs in some populations, on-going challenges to addressing widespread viral STDs, and halted declines in gonorrhea. Furthermore, a national debate about the efficacy of prevention efforts has re-emerged. This session will focus on the status and challenges in STD prevention today in a historical context, and propose strategies for the coming several years.

Plenary Session, Tuesday, March 5, 2002, 8:30 - 9:30 am

STD Prevention in Societies under Stress: A Global Perspective

L Garrett

Newsday, New York, NY

While in the past, these concerns have largely been focused on developing countries often plagued by political instability, the vulnerability to these conditions of the most sophisticated and developed nations of the world is now abundantly clear. The strength of public health infrastructures to withstand the negative influence of surrounding conditions is critical to both building and maintaining disease prevention efforts. As has been frequently pointed out in CDC’s syphilis elimination campaign in the US, basic public health functions, including surveillance and clinical and laboratory services, are critical services for success. The strong connection between HIV and other STDs supports the notion that systems supporting STD prevention will in turn support HIV prevention. Yet, the will and the resources to build strong systems to support STD prevention is not always evident. Furthermore, the same problems with public health infrastructures that can leave a society unprepared to address STIs can also lead to an inability to respond to an attack by microbes that is such a prevalent fear today.

This session will lend a historical perspective to the relationship among disease trends, current events, and public interventions to help the audience better understand the impact on health and STD rates of societies that have been under stress around the world as well as in the US. It will ultimately aim to move the audience beyond the traditional focus on STD behavioral and biomedical interventions into a recognition of a much larger context and the interventions that might impact those contextual factors thereby, helping to reduce the STD burden in societies under stress.

Mini-plenary Session, Tuesday, March 5, 2002, 10:10 - 11:40 am

New Diagnostic Tools: They’re here, but why should you care?

J Schwebke¹, A Wald², J Douglas³, G Bolan⁴

1University of Alabama, Birmingham, AL; 2University of Washington, Seattle, WA; 3Denver Health Department, Denver, CO; 4California Department of Health Services, Berkeley, CA

Societies around the world are all too familiar with conditions resulting from war, terrorism, economic instability, and pervasive poverty, all of which frequently are coupled with deteriorating public health services. The stress of these conditions affects a society’s ability to prevent and treat diseases, including those caused by sexually transmitted infections (STIs).

New tests are available to help identify T. vaginalis, herpes simplex, and human papillomavirus infections. However, clear guidelines about when to use such tools don’t exist nor is expert opinion consistent. In these circumstances, clinicians and public health officials may be quite uncertain about the indications for using these new tests. The tests, which may employ a highly sensitive culture system (trichomoniasis), type-specific serology (herpes simplex), or nucleic acid hybridization (human papillomavirus), can have many uses. These tools may assist with clinical management of patients and their partners, may have screening applications —including during pregnancy, and may have a role in preventing cervical cancer. However, decisions about implementation of tests will be based on considerations such as how helpful the test information is, how well the tests perform, and how much they cost.

In this session, these issues will be addressed by the first three presenters (Drs. Schwebke, Wald, and Douglas), who will suggest contexts in which the texts can and perhaps should be utilized. The last discussant (Dr. Bolan) will respond to these suggestions, offering her perspective as an STD program director.

Mini-plenary Session, Tuesday, March 5, 2002, 10:10 - 11:40 am

Communities involved in STD Prevention: Responding to Sexual Behaviors and Prevention Practices with Uncommon Solutions

A Johnson¹, EL White², D Wohlfeiler³

1Royal Free & University College School of Medicine, London; 2Mt. Sinai AIDS Education Project, Thomasville, NC; 3CA Dept. of Health Services, Berkeley, CA

In the field of STD prevention, sexual behaviors and prevention practices have often been used to describe a “community” or at-risk populations (e.g., high risk populations, sexually active adolescents, men who have sex with men). Understanding these practices is one important mechanism that helps identify interventions most likely to be successful. The STD prevention field has supported the notion that such interventions should be community-based, but the best approaches for success are not commonly understood or accepted. Amidst these discussions, one of the popularly discussed venues for such involvement is faith communities, especially when aiming to reach African Americans who have disproportionately high rates of STDs. Many believe that faith communities may be uniquely qualified to respond to unhealthy sexual behavior patterns, at least for some high-risk communities. However, moving beyond the concept to identification of when and how to work through faith communities with success is not clear. HIV prevention community-based programs have taught us that not all interventions work with all populations, and some interventions that may have met with success in the past, do not work in the present. Among other reasons, this change in impact may reflect a change in sexual behaviors and attitudes. In the case of STDs, bacterial (curable) infections probably demand a different type of intervention than viral (non-curable) infections. Furthermore, depending on the stage of an STD epidemic (e.g., syphilis waning to low levels; HPV steady at high levels), different community interventions may be merited.

This session will first examine the current status of sexual practices and behaviors, largely in the US and Great Britain, where similarities have been noted. Based on the sexual health practices and behaviors of communities today as well as other documented experiences, a discussion will be conducted that focuses on opportunities and challenges for faith communities in addressing STD prevention. The session will conclude with some analysis about what community interventions work when for STDs as well as potentially different intervention choices, depending on the disease and the phase of the epidemic of particular STDs.

Plenary Session, Wednesday, March 6, 2002, 8:30 - 9:30 am

STD-related Infertility Prevention in 2002 and Beyond: Bridging New Policies with Practices

C Westhoff

Columbia University, New York

Starting in the early 1990’s, STD-related infertility prevention grew from a new idea for national STD prevention efforts to its present status as an integral part of what STD programs encompass today. Targeted chlamydia screening of young women has demonstrated dramatic decreases in disease prevalence. Broad-based recognition of the high prevalence of chlamydia and its connection to infertility and ectopic pregnancies has placed chlamydia on the agenda of both policy-makers and public health officials. Yet, numerous challenges still abide. Chlamydia remains the most frequently reported infectious disease in this nation. Public funds are woefully inadequate to meet the screening needs of at-risk women. Screening programs have not moved much beyond publicly funded STD and family planning clinics. Both public and private health care systems are burdened by competing demands. Males are not routinely tested, and it is yet unclear whether male screening programs would have a positive impact. Resources are not plentiful enough to assure partners of women positive for chlamydia are receiving treatment. Guidelines abound for chlamydia screening from the U.S. Preventive Services Task Force, HEDIS, CDC, and numerous professional societies, yet clinician obstacles to following them present considerable challenges, including conflicting recommendations among the guidelines.

This session will focus on the current practices in chlamydia prevention in the public and private sectors, opportunities for addressing practice and health care system gaps, potential policies to address gaps, and recommendations for improved practice among providers and in health care systems throughout the nation.

Mini-plenary Session, Wednesday, March 6, 2002, 1:45 - 3:15 pm

Stable and Migrating Hispanic Populations: Facing the Convergence of a New Census Count and the Uncounted with STD Morbidity

B Aranda-Naranjo¹, G Lara²

1HRSA, Rockville, MD; 2Children’s Hospital of MI, Detroit, MI

While data on STD rates among populations crossing the Mexico-USA border or migrating between States are sparse, sexual health-related problems are clearly prevalent in these populations. In addition, according to the 2000 US census count, 32.8 million or 12 percent of the US population is Hispanic. And of those, one-third are under the age of 18, the highest risk age group for STDs. Concurrently, STD rates have continued at disproportionately high rates for Hispanics. For example, 2000 gonorrhea rates among Hispanics were 3 times greater than those among whites and reflected an 11.7% increase from 1999 to 2000. Other diseases demonstrated similar trends. There also are uncountable numbers of persons crossing the Mexican border into the US for work, moving between states and not remaining in any one locale long enough to establish relationships with health care or social service systems. Such instability creates systemic challenges between States as well as between nations in such areas as surveillance, access to care, different health care systems, and varying medical care practices. On an individual level, frequent mistrust of health care systems prevent needed health care seeking because of legal status of workers or cultural differences between health care providers and persons in need of their service. The stigma associated with STDs imposes an additional impediment for persons steeped in a culture that does not easily deal with risk behaviors related to STD acquisition and transmission.

This session will delineate known demographic and epidemiolgic data on Hispanics at risk for STDs in the US and crossing borders into and through the US. Focus on systemic challenges in serving migrating populations between countries and between States in the US will follow. The session will further introduce strategies that can successfully help providers and public health workers overcome barriers to STD prevention and control for this growing population. A new understanding of cultural competence and disparity among services to ethnic minority families based on a non-deficit approach will be introduced.

Mini-plenary Session, Wednesday, March 6, 2002, 1:45 - 3:15 pm

Confronting Social Vulnerability to STDs: Drug Use, Male-to-male Partnerships, Violence and Sex Work

S Aral^1, W Patten², R Stall¹, T Valente³

1CDC, Atlanta; 2US Department of Justice, Washington, DC; 3University of Southern CA, Los Angeles

Connections among sexual partnerships now emerge as an important determinant of the rate at which sexually transmitted infections spread through populations. So called core groups composed of individuals with many sex partners, who themselves have many sex partners, play a crucial role in this context. Sex work, including those who are trafficked and men who have sex with other men in exchange for money or drugs, constitute core groups that are expanding in size. Traditionally, STD prevention interventions for these groups have been focused on individual sexual behavior change or improved health care seeking. A population perspective opens up intervention options not only at the individual level but also at the community or contextual level. In this session, the theoretical basis of the role of sexual networks/core groups in STD spread will be discussed, followed by a discussion of two core groups vulnerable to STDs. The first will focus on trends and suggested interventions for men who have sex with men and exchange money or drugs for sex. The second will focus on women in sex work, including recent trends in trafficking in persons, the role of violence in sex work, economic vulnerability, and potential interventions.

Closing Plenary Session, Thursday, March 7, 2002, 10:15 - 11:30

Science, Politics, the Media, and STD Prevention in 2002: Harmony or Discord?

G Strait, Jr.

The Dr. Spock Company, Menlo Park, CA

One of the hallmarks of STD prevention, especially over the last couple of decades, has been the attention paid to connecting science with programs and policies. National conferences as well as strategic plans and reports have based themes and recommendations on this connection as critical to sound public health outcomes. Additional importance has been placed on the role of media in influencing policies, public opinion, and prevention programs. Yet, science is often at odds with beliefs of political and other opinion leaders, especially in the realm of STD prevention. Also often at odds are the media’s interpretations of this political and scientific disconnect. Questions about condom efficacy, abstinence programs, and sex education remain controversial, ebbing and flowing over the years, seemingly independent of science. Health services research has repeatedly demonstrated unequal access to health care and significant racial disparities in STD rates, but programs and policies to date have not successfully addressed these inequities.

This session will examine the challenges of interfacing science and STD prevention programs and practices in the current political environment. It will further explore untapped opportunities to use the media to influence policies that impact STD prevention along with its many challenges. Mr. Strait’s considerable experience as a public figure will provide unmatched insight to the question posed in this session, “In 2002, are science, politics, the media, and STD prevention in harmony or discord?”