12th International AIDS Conference


Geneva, Switzerland - June 28-July 3, 1998

[Title] STD control for HIV prevention in the US: is there likely to be an impact?

[Author] Kassler W; Irwin KL; Kamb ML; Weinstock H; Steketee RW; St Louis M; Wasserheit J: CDC, Atlanta, GA 30333, USA

XII International Conference on AIDS, June 28-July 3, 1998; Geneva, Switzerland

Background: Although enhanced diagnosis and treatment of STD have been shown to reduce HIV transmission by 40% in Tanzania, the impact of STD control as an HIV prevention strategy in the US remains uncertain because US populations may experience lower HIV and STD prevalences, less heterosexual HIV transmission, and better access to quality STD care.

Methods: To assess concurrence of STD and HIV morbidity and quality of STD care in the US, we reviewed national and local surveys on HIV and STD morbidity and service delivery from 1990-97.

Results: Prevalences of gonorrhea (4%) and chlamydia (3-9%) in some US women age 15-24 are similar to those in African women. In many US STD clinics. HIV incidence exceeds 0.5/100 person-years. US regions with the highest HIV rates in child-bearing women also have the highest gonorrhea and syphilis rates. STD services are often lacking in populations at high risk for HIV and STD, e.g., < 50% of jails routinely screen inmates for STD. Only 50% of local health departments provide on-site STD care and many lack evening or weekend services. 90% of STD clinics in areas with high syphilis morbidity turn away clients due to limited resources. Private providers (who provide 60% of STD care in the US) are less likely than public providers to take sexual histories, to screen young, single women for STDs, and to provide prenatal syphilis screening and treatment.

Conclusions: Given the substantial STD and HIV comorbidity and suboptimal access to high quality STD services in some areas, enhanced STD diagnosis and treatment may be effective HIV prevention strategies in the US. Studies to compare the impact and cost-effectiveness of STD control with other HIV prevention strategies are needed to better allocate prevention resources.

Presented by: Kassler W; CDC, Atlanta, GA 30333, USA.

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525-33238

Copyright © 1998 - International AIDS Society (IAS). Reproduction of this abstract (other than one copy for personal reference) must be cleared through the IAS.