Public Health Departments Providing Sexually Transmitted Disease Services.

Results of a 1995 survey reveal that 1,437 local health departments--half of those in the country--provide sexually transmitted disease (STD) services and receive about two million client visits each year. Their clients are predominantly individuals with incomes of less than 250% of the poverty level (83%), women (60%) and non-Hispanic whites or blacks (55% and 35%, respectively); 36% of clients are younger than 20, and 30% are aged 20-24. On average, 23% of clients tested for STDs have chlamydia, 13% have gonorrhea, 3% have early-stage syphilis, 18% have some other STD and 43% have no STD. Virtually all public STD programs offer testing and treatment for gonorrhea and syphilis; only 82% test for chlamydia, but 97% provide treatment for it. Some 14% offer services only in sessions dedicated to STD care, 37% always integrate STD and other services, such as family planning, in the same clinic sessions, and 49% offer both separate and integrated sessions. STD programs that integrate services with other health ca re typically cover nonmetropolitan areas, have small caseloads, serve mainly women and provide a variety of contraceptives. In contrast, those that offer services only in dedicated sessions generally are in metropolitan areas and have large caseloads; most of their clients are men, and few provide contraceptive methods other than the male condom.

(Family Planning Perspectives, 28:261-266, 1996)

An estimated 12 million cases of sexually transmitted diseases (STDs) are diagnosed among American men and women each year. (1) Some of these are nonviral and therefore curable, such as chlamydia (four million cases of which are estimated to occur annually), gonorrhea (800,000), syphilis (101,000) (2) and trichomoniasis (three million). (3) For viral STDs, however, there is no cure; these include human papilloma virus (between 500,000 and one million cases annually), genital herpes (200,000-500,000), sexually transmitted hepatitis B (53,000) and the human immunodeficiency virus, or HIV (which is responsible for 90,000 cases of AIDS annually). (4) STDs other than HIV have received relatively little attention, although they may have such consequences as infertility, cancer, infection of offspring and death. (5)

The federal government spent approximately $89.7 million in 1994 through the Division of STD/HIV Prevention of the Centers for Disease Control and Prevention (CDC) to control the spread of syphilis, gonorrhea, chlamydia and, to a lesser extent, other STDs not including HIM. Some $6.4 million of these funds were combined with $1.9 million from the Office of Population Affairs for targeted gonorrhea and chlamydia testing of family planning clinic clients and other women at high risk for infections leading to infertility; $11 million supported educational programs, STD surveillance, research projects and direct CDC program operations. However, most of the funding ($72.3 million) went to state and local health departments to support STD surveillance, as well as screening and notification of partners of infected clients. (6) State and local health departments are expected to cover most of the costs of STD treatment themselves, but comprehensive data on their spending levels are not available. (7)

Many public health departments offer a variety of services, such as family planning and maternal and child health care. In 1994, for example, 1,413 health departments served 2.1 million contraceptive clients at 3,124 sites. (8) Title X of the Public Health Service Act, which provides categorical funding for family planning services, requires that testing for STDs be provided to family planning clients when medically indicated. (9) In 1994, 66% of all Title X-funded agencies were public health departments; the remainder were hospitals, Planned Parenthood affiliates, community and migrant health centers and independent agencies. (10)

A good deal of information has been available about the provision of family planning services, in part because of the support for data collection and analysis within the Title X program. (11) Data from nationally representative surveys of the agencies that run family planning clinics indicate that most routinely test for at least some STDs at initial or annual visits. In 1992, 78% of health departments that offered family planning services routinely tested clients for gonorrhea, 59% for syphilis, 36% for chlamydia and 8% for herpes. Almost all other agencies tested for these STDs when it was medically indicated. About a quarter of health departments offering contraceptive services did so in sessions integrated with other medical services; most of the others offered both integrated and separate contraceptive sessions. (12)

In contrast to the detailed information available about family planning services, little is known about the breadth of STD services provided by local health departments or about the clients they serve. Instead, much of the information available has been from public health clinics whose primary purpose is to provide STD services, and it has concerned services specifically supported by the categorical STD funding administered by the CDC.