Public health departments providing sexually transmitted disease services

Abstract

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 care 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.

PIP: In 1995, the Alan Guttmacher Institute surveyed 1437 local public health departments that provide sexually transmitted disease (STD) services to determine the range of STD services. They had around 2 million clients annually. These agencies comprised 50% of all local public health departments in the US. Further analysis was limited to 587 randomly selected agencies. The health department clients tended to have incomes less than 250% of the poverty level (83%) and to be women (60%) and non-Hispanic Whites or Blacks (55% and 35%, respectively). 36% of clients were teenagers. 30% were 20-24 years old. Among clients screened for STDs, 23% had chlamydia, 13% had gonorrhea, 3% had early-stage syphilis, 18% had another STD, and 43% had no STD. 99% and 93% of all public STD control programs provided testing and treatment for gonorrhea and syphilis, respectively. 97% treated chlamydia but only 82% tested for chlamydia. 14% of all agencies always provided STD services in separate sessions. They tended to be in metropolitan areas, to serve many clients, to see about as many men as women, and to provide little contraceptive care. 37% of all agencies always integrated STD services and other health care. They tend to have small STD caseloads, to provide STD services mostly to women, and to offer contraceptive methods other than male condoms. 49% used a mix of separate STD sessions and sessions in which STD services were integrated with other services. Individuals in need of STD testing and/or treatment who lived in sparsely populated areas appeared to have a limited choice of accessible clinic-based or private providers.