The Federal Public Health Response.(to the prevention and treatment of sexually transmitted diseases)

The federal government has been involved in efforts to control the spread of STDs since the early 1900s. (64) The formal program of providing grants to states to carry out screening and other activities was established in 1938 with passage of the National Venereal Disease Control Act. Also in the 1930s, partner notification (or contact tracing) became a basic strategy of the campaign against sexually transmitted infections. (1)

Today, the national effort to combat the spread of STDs is led by the Centers for Disease Control and Prevention (CDC), an arm of the U.S. Public Health Service established in 1946 to assist states in tracking and preventing disease. (65) Chiefly through the Division of STD/HIV Prevention in its National Center for Prevention Services (NCPS), the CDC provides financial and technical assistance to state and local agencies to support STD and HIV screening partner notification; disease surveillance; risk reduction education; epidemiological, operations and behavior research; training; and program evaluation. The NCPS also develops guidelines for diagnosis and treatment of STDs. The agency generally does not pay for treatment of STDs, however; state and local health departments and other local providers are expected to cover these costs. (*)

Although the CDC's STD and HTV programs are administered by the same division, they are funded separately by Congress and have different approaches.

The CDC's STD Program

The STD program is primarily a disease control program--what health officials call secondary prevention--rather than a primary prevention program. It focuses on controlling the spread of STDs through screening, treatment of infected individuals (usually paid for with state and local funds) and notification of their partners, who may be unaware of their exposure to an STD, (+) rather than on preventing the behaviors that place individuals at risk of infection in the first place. The program relies heavily on disease intervention specialists--formerly known as contact tracers--to interview people who test positive for an STD to obtain the names of their sexual contacts, so those individuals can be notified of their risk and referred for screening and treatment, if needed.

In part, the emphasis on secondary prevention reflects the program's historic focus on bacterial diseases, which can be cured with antibiotics, rather than on incurable, viral diseases (such as herpes and HPV), for which the only alternative is to avoid infection in the first place. Indeed, measures aimed at primary prevention, including advocacy of condom use, have often received little attention in STD clinics. (67)

Under the legislation authorizing the federal STD program, most funding goes to state and local health departments; however, the CDC can award grants to other public and nonprofit agencies to support demonstration projects, research, education programs and training. (68) Health departments have broad discretion over how their CDC funds are used; they can, for example, allocate funds to other agencies as away of expanding access to STD services. In practice, however most CDC support for STD screening is directed to categorical STD clinics operated by state and local health departments. (69,70)