There was a problem loading page R2.

This report focuses on the hidden epidemic of sexually transmitted diseases (STDs) in the United States: the reasons why it has not been controlled, and what we, as a nation, need to do differently to confront this problem. The main objective of this report is to educate health professionals, policymakers, and the public regarding the truths and consequences of STDs in the United States. This report is also a call for a bold national effort to prevent these diseases.

Through this report, we hope to improve awareness and knowledge regarding the scope and impact of STDs and demonstrate why all Americans should be concerned about these diseases. At a minimum, we hope to ignite open discussion in both private and public arenas regarding STDs and their prevention. We believe that encouraging open discussion around STD prevention will eventually lead to greater understanding, closer cooperation, improved STD-related services, and lower rates of STDs in the United States.

This report represents the collaborative efforts of many organizations and individuals, without whom this study would not have been possible. The committee extends its warm thanks to the organizations and individuals mentioned below.

The staff of the following organizations and agencies provided critical advice and data in preparing this report: Advocates for Youth (Kent Klindera), the Agency for Health Care Policy and Research (David Atkins and Carolyn DiGuiseppi), Alan Guttmacher Institute (Pat Donovan, Jackie Forrest, Lisa Kaeser, and Dave Landry), the American Academy of Pediatrics (Victor Strasburger), the American Cancer Society, the American Medical Association, the American Social Health Association (Peggy Clarke, Joan Cates, and Nikki Vagnes), Association of Reproductive Health Professionals, Association of State and Territorial Health Officers, Center for Media and Public Affairs (Dan Amundson), the Centers for Disease Control and Prevention (Susan DeLisle, Shahul Ebrahim, Alan Friedlob, Joel Greenspan, Robert Johnson, William Kassler, William Levine, Judy Lipshutz, Frank Mahoney, Eric Mast, John Miles, John Moran, Craig Shapiro, Jack Spencer, Mike St. Louis, Cathleen Walsh, Judy Wasserheit, and Gary West), East Coast Migrant Health Project (Oscar Gomez), The Henry J. Kaiser Family Foundation (Suzanne Delbanco), National Association of Nurse Practitioners in Reproductive Health (Susan Wysocki), the National Cancer Institute, the National Center for Farm Worker Health (Bobbi Ryder), the National Commission on Correctional Health Care (Ed Harrison), the National Institutes of Health, Ogilvy Adams & Rinehart, Planned Parenthood Federation of America, Sexuality Information and Education Council of the U.S. (SIECUS)

(Carolyn Patierno), State Family Planning Administrators (Lynn Peterson), and the World Health Organization (Antonio Gerbase and Kevin O'Reilly). The following colleagues also provided valuable assistance to the committee: Jane Brown, Margaret Chesney, Jim Kahn, Laura Koutsky, and Richard Rothenberg.

The following persons generously shared their knowledge with the committee through their active participation in the committee workshops: Sevgi Aral, Cornelius Baker, Bobbi Baron, Marie-Claude Boily, Stanley Borg, Robert Bragonier, Allan Brandt, Ward Cates Jr., William Darrow, Gray Davis, Frank Beadle de Palomo, Caswell Evans, Jonathan Freedman, Mindy Thompson Fullilove, Carol Glaser, James Goedert, James Haughton, William Kassler, Paul Kimsey, Janet Kirkpartick, Edward Laumann, William Levine, Steve Morin, Kevin O'Reilly, Frank Plummer, John Potterat, Gary Richwald, Tracy Rodriguez, Philip Rosenberg, Alfred Saah, Marilyn Keane Schuyler, Stanley Shapiro, Sten Vermund, and Maria Wawer.

The directors and staff of the following facilities and programs graciously hosted the committee during its site visits to Atlanta and Chicago. In Atlanta: The Center for Black Women's Wellness; DeKalb County Board of Health (Stuart Brown); Emory/Grady Teen Services Program; Fulton County Health Department STD Clinic (Ruby Lewis-Hardy and Pradnya Tambe); Georgia Department of Human Resources, Epidemiology and Prevention Branch (Jack Kirby and Mark Schrader); Grady Memorial Hospital Family Planning Program; Kaiser Permanente, Prevention and Practice Analysis Department; SisterLove, Inc., West Central Health District (Dee Cantrell); West End Medical Centers, Inc.; and Women's AIDS Project. In Chicago: Austin Community Academy Teen Health Clinic; Blue Cross Blue Shield of Illinois; Chicago Department of Public Health (John Wilhelm); Chicago STD/HIV Prevention Program (Romina Kee and Lisa Krull); Cook County Hospital HIV Primary Care Center, Smart Start Program, Women and Children HIV Program; Erie Family Health Center; Illinois Department of Public Health (John Lumpkin and Charlie Rabins); Night Ministry; Ounce of Prevention Fund, Toward Teen Health Program, Orr Adolescent Health Center; Planned Parenthood of Chicago; Stop AIDS Chicago; Vida Sida; and West Town Neighborhood Health Center, Young Adult Clinic.

The following individuals participated in the planning meeting for the study: Charles Carpenter (chair), Peggy Clarke, Jim Curran, Mary Faye Dark, Gray Davis, patsy Fleming, Helene Gayle, H. Hunter Handsfield, Maurice Hilleman, Penny Hitchcock, Mark Hounshell, James Kahn, Lawrence Lewin, Heather Miller, Constance Nathanson, Geoff Nichol, Michael Osterholm, Nancy Padian, Thomas Quinn, Mark Smith, P. Frederick Sparling, Beth Unger, Judy Wasserheit, Roy Widdus, and Zeda Rosenberg.

Of particular note, the following individuals directly contributed to the report by drafting commissioned papers in their areas of expertise. A review paper on the relationship between substance use and STDs by John Beltrami, Linda Wright-DeAguero, Mindy Thompson Fullilove, and Brian Edlin was critical to

the report, and sections of their paper were replicated in the discussion of substance use and STDs. A paper by Jeffrey Kelly provided important background for the drafting of sections regarding behavioral interventions in STD prevention. Marie-Claude Boily's important work on modeling the impact of STDs on HIV transmission is included as an appendix. In addition, Joanna Siegel's major review of the economic costs of STDs was the primary basis for the committee's cost estimates and is also included in the appendix of the report.

Numerous staff at IOM, the National Research Council, and the National Academy Press (NAP) contributed to the development, production, and dissemination of this report. Leslie Hardy served as study director during its first year; Marissa Fuller organized the committee's site visits and provided research assistance; Jennifer Holliday provided comprehensive administrative support; Mike Stoto, Karen Hein, and Ken Shine provided valuable advice and direction; Mona Brinegar handled the financial accounting of the study; Mike Edington provided editorial assistance; Claudia Carl and Janice Mehler coordinated the report review process; and Dan Quinn and Molly Galvin coordinated press activities. NAP staff included Dawn Eichenlaub (book production); Barbara Kline Pope and Brooke O'Donnell (marketing); Estelle Miller (page layout); Francesca Moghari (cover design); Terrence Randell (Internet listing); and Sally Stanfield (editor). In addition to IOM staff, we are grateful to Andrea Posner for her numerous valuable editorial contributions, to Caroline McEuen for copy-editing, to Kim Greene for assistance with the survey of managed care organizations, to Linnea Eng for proofreading, and to Mary Fielder and Ron Nelson for their research assistance.

The following agencies and organizations and key staff generously provided funding and generated support within their institutions for this study: the Centers for Disease Control and Prevention (Jim Curran [now with Emory University], Helene Gayle, Jack Spencer, and Judy Wasserheit), Glaxo Wellcome, Inc. (Gray Davis), the Henry J. Kaiser Family Foundation (Suzanne Delbanco and Mark Smith), the National Institute of Allergy and Infectious Diseases of the National Institutes of Health (NIH) (Penny Hitchcock), the Office of Research on Women's Health of NIH (Vivian Pinn and Anne Bavier), Ortho-McNeil Pharmaceutical (James Kahn), and SmithKline Beecham Pharmaceuticals (Vincent Ahonkai, Paul Blake, and Geoff Nichol). Their willingness to sponsor a study on the prevention and control of sexually transmitted diseases is no small commitment, given the sensitive and controversial nature of this public health issue. Their encouragement and support are gratefully acknowledged.