Healthy People Consortium Meeting
"Implementing Healthy People 2010"
November 11, 2000

Summary of Breakout Group Discussion Concerning:
Sexually Transmitted Diseases

Healthy People 2010 Brief Overview and History of STD Focus Area

The IOM Report (1996) changed the strategic direction for STD prevention and treatment. It had an impact in how the Healthy People 2010 STD focus area was developed. The major strategies of the IOM Report included:

• Using media outlets to raise awareness and educate public, 
• Incorporating behavioral interventions with overall program efforts, 
• Analyzing the costs/benefits, and
• Expanding partnerships.

The STD objectives focus on Bacterial STD Illness and Disability, Viral STD Illness and Disability, STD Complications Affecting Females, STD Complications Affecting the Fetus and Newborn, Personal Behaviors, Community Protection Infrastructure, and Personal Health Services.

Healthy People 2010: Two Examples of Implementation

• Syphilis Elimination -- Guilford County Department of Health, North Carolina 
  Guilford County, NC, experienced a dramatic increase in syphilis rates in the early/mid1990s with an outbreak in 1997. In 1997, a task force was developed to address the high rates. A syphilis elimination plan was designed based on targeted grassroots prevention and three specific strategies: (1) jail screening and education, (2) intensive street outreach program, and (3) social marketing plan.
  
• Infertility Prevention Program (IPP) -- Massachusetts Department of Health
  The goal of the Massachusetts IPP is to offer chlamydia treatment and prevention services to those who would not ordinarily have access to the services. The project includes the following strategies: universal vs. algorithm testing plan, choice of testing technology and specimen type, expansion as far as possible among Title X partners, expansion to other settings (i.e., county jails, DYS facilities, schools, homeless, shelters, HIV drop-in service centers), history taking, treatment of partners, education, and advocacy.

Discussion: Implementing Healthy People 2010 STD Objectives

How do you suggest we work with local community groups in implementing the Healthy People 2010 objectives?

• Work with setting policy/legislation to mandate screening reimbursement.
• IPP is an excellent model that could be used throughout STD programs (i.e., STDs other than chlamydia); need better communication and collaboration across STD issues.
• Categorical funding creates some difficulties with regard to collaboration and integration of program efforts; collaboration varies across States and localities.
• HIV/STD collaboration oftentimes doesn't happen.
• IOM report was talking about sexual health in general; being sexually healthy is important; key focus; think about things more holistically.

What can we do to support the elimination of health disparities among racial and ethnic population groups?

• In Guilford County, NC, mixing of sexual networks with men from suburbs coming into the city.
• Stigma is an issue for STD prevention, particularly for communities heavily burdened.
• How do you target communities effectively without making them feel like they are being stigmatized? Community partners/programs get defensive; how do you do it without making the community feel like it is at fault?
• North Carolina has tried to engage the community/encourage community involvement. North Carolina is trying to do it, but it is very hard. It is much harder to do it. Syphilis cycles every 10 years. Syphilis elimination plans cycle every 30 years. Difference this time is that it is not only a biomedical effort. It is community focused.
• Concern about focus on the jails. An important component of prevention and control but one of many parts. Will syphilis come out as being something that bad people get?
• Concern expressed about language in Healthy People 2010--implications of using "responsible" (responsible sexual behavior); even that language does not lay it out in the report in a very positive way. Perhaps it should be healthy sexual behavior. Same observation came out in a previous meeting. In other focus area chapters there is not that same value-laden terminology.
• With any choice of words we will have issues and implications.
• Difficult to support from political leaders given the stigma and "silence" surrounding STDs.

How do we measure progress of Healthy People 2010 in the future? And what is progress?

• Why is it that oftentimes when we look at the data table in the chapter, it's data not available--data not collected. How do we get data on target groups?
• Take each of the goals and make them into action steps, turn them into "best practices." Measure how you got there; process information is important. 
• Need to talk about how data are analyzed. We don't all look at it in the same way.
• Tracking Healthy People 2010 is not promoted; didn't even know about the document until this meeting.
• Need to promote and publicize Tracking Healthy People 2010 so that everyone has understanding of the complexities of data and appreciates the issues surrounding interpretation.
• We have national data sets, but we don't have State and local. Many people do not always have the data resources in their agency.

How can we work more effectively with the media in implementing the Healthy People 2010 objectives?

• Timely analysis and promotion of relevant data.
• Need more concise, easy-to-relate-to messages with respect to Healthy People 2010.
• Need the data but also a story, a face, but this is difficult with STDs given the associated stigma.

Back to Consortium 2000 Table of Contents