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Justice, Fairness, Inclusion, and Performance.

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National Coalition of STD Directors (Phase II) - The STD Epidemic in America: The Frontline Struggle

The National Coalition of STD Directors (NCSD) is a nonprofit, non-partisan public health membership organization dedicated to the prevention of sexually transmitted diseases (STDs). Founded in 1996, NCSD represents health department STD directors and their support staff and community-based partners in programs across the 50 states, seven large cities/counties and eight U.S. territories that are directly funded by the Centers for Disease Control and Prevention (CDC). Providing leadership to support and advance STD prevention and control programs, NCSD advocates for effective policies, strategies, and sufficient resources for STD programs and endeavors to increase public awareness of the health and social impact of STDs. NCSD has established five operational priorities in direct support of its membership: capacity building, policy and advocacy, national leadership and strategic communications, health equity promotion, and organizational strengthening.

Following on from the Academy’s previous work with NCSD (The Impact of Sexually Transmitted Diseases on the United States: Still Hidden, Getting Worse, Can Be Controlled), this project assessed the efforts of frontline STD prevention and control programs and ascertained the burden placed upon state, local, and territorial authorities as a consequence of the intensifying STD epidemic. The Academy team attempted to trace funding streams facilitating those programs and authorities, identified and examined intergovernmental obstacles to program execution including administrative burden, conflicting policies, and funding constraints, and developed a set of Actions for Consideration and reforms to bolster efforts to reduce STD rates.

Click the button below to view the Final Report.

Final Report

Key Findings

The Academy found that many of its observations at the national level during Phase I, held true at the state and local levels. Sexually transmitted disease programs are generally underresourced, and lack sufficient capacity to keep pace with the rapidly rising level of infection being experienced nationwide. These programs utilize whatever dollars they have available to their fullest extent, and creatively employ funding to maximize impact, but are hindered by restrictions on the sharing of resources between overlapping programs (for example, HIV dollars being broadly used for STD applications). A lack of state funding to most local STD programs mean that municipalities must rely entirely on federal passthrough dollars and other grant funding, or miniscule amounts of local tax revenue, to fund STD control initiatives. The fractious nature of the American healthcare system, privacy concerns regarding private insurance, and local regulation and/or legislation, may be restrictive to the funding structures of a local STD program, preventing those entities from certain billing mechanisms, potentially preventing some demographics from being able to readily seek care through the local program.

Stigma continues to be a key obstacle to the containment of the STD epidemic, preventing awareness of sexually transmitted diseases, their symptoms, and treatments, to vulnerable groups, as well as contributing to limited attention by policymakers and subsequently insufficient resources provided to control entities. Sexual health education is variable across the nation, with some jurisdictions lacking formal lessons on the matter entirely. Often, sex education curricula are centered on abstinence, with many being abstinence-only. A lack of scientifically accurate and direct education on the topic of sexual health, particularly for youth more likely to practice risk high-risk behavors, creates an environment in which adolescents are more likely to contract disease, and practice unsafe behaviors without mitigation.

Actions for Consideration

The Academy Panel issued four Actions for Consideration, intended to guide policymakers as the Department of Health and Human Services prepares for its own STD Action Plan:

  1. Reform federal funding to enhance program agility across STD programs.
  2. Expand access to care, with a focus on delivering community-sensitive and patient-centered care.
  3. Enable more rapid data release and results of research.
  4. Implement science-based, health-centric education and awareness campaigns to reduce stigma and encourage healthy behaviors.

Study Fellows