Rural Center for AIDS/STD Prevention: Newsletter (6)

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Rural Prevention Report
(Fall 1996, Vol. 3, No. 2)

National Attack Urged to Reduce the Hidden STD Epidemic

A daring national effort is needed to combat the tremendous heath and economic effects of sexually transmitted diseases (STDs) in the United States, according to a new report from a committee of the Institute of Medicine. The report--The Hidden Epidemic: Confronting Sexually Transmitted Diseases--states that the STDs remain hidden as their scope, impact, and consequences are under recognized by the public and health care professionals. The report calls for an ambitious national effort to prevent these diseases.

The STDs account for five of the top 10 infections in the United States and 56 million people have had them at some point in their lives, says the report. Also, 12 million people a year get them, including 3 million teenagers. Although most STDs are preventable, each year they lead to thousands of deaths and can cause cancer and other serious heath problems. The annual costs of selected STDs are approximately $10 billion, and $17 billion when HIV infection is included.

The report suggests four major strategies for public and private policymakers at the local, state, and national levels:

Overcome barriers to adoption of healthy sexual behaviors. One of the primary obstacles is the nation's reluctance to openly confront issues related to sexuality and STDs. Failure to acknowledge and discuss sexuality impedes STD education programs. A new social norm of healthy sexual behavior should be the basis for long term STD prevention.
Develop strong leadership, strengthen investment, and improve information systems for STD prevention. The current national public investment in STD prevention is not commensurate with the health and economic costs of STDs. The committee estimates that only $1 is invested in STD prevention for every $43 spent on the STD-associated costs every year.
Design and implement essential STD-related services in innovative ways for adolescents and underserved populations. Adolescents and underserved populations require special emphasis in an effective national system for STD prevention because they are at high risk for STDs and they do not have adequate access to STD-related services.
Ensure access to and quality of essential clinical services for STDs. Public and private clinical services for STDs are fragmented, inadequate, and, sometimes, poor quality.

Because of the significance of the report, highlights from two of its chapters are presented on page 2 of this newsletter.

Copies of the report can be obtained from the National Academy Press: (800) 624-6242, (202) 334-3313. The executive summary is available on the National Academy of Sciences' web site.

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1997 RCAP Conference at Indiana University

The RCAP will conduct its third annual conference, "HIV/STD in Rural Areas: Prevention Issues," on Friday, April 18, 1997 at the Indiana University Memorial Union, on the Bloomington campus. Debra W. Haffner, MPH, will present a keynote address "Facing the Facts of Adolescents: HIV Prevention and Sexual Health." Ms. Haffner is the President of the Sexuality Information and Education Council of the United States, and is widely regarded as an expert in sexuality and HIV/AIDS education. She has published more than forty articles, monographs, and public education materials. She has provided speeches, trainings, and workshops to more than 35,000 professionals.

The conference will also feature presentations of RCAP projects and an opportunity for participants to present brief summaries of their own work or ideas concerning HIV/STD prevention in rural areas. The program and registration form will be mailed in February 1997. For more information contact the RCAP.

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Personal and Social Factors Contribute to Hidden STD Epidemic

STDs are behavior-linked diseases that result from risky sexual practices, and behavioral, biological and social factors contribute to contracting an STD. These factors are described in the chapter,"Factors that Contribute to the Hidden Epidemic," in the new report of the Institute of Medicine, The Hidden Epidemic: Confronting Sexually Transmitted Diseases.

Biological factors include the lack of signs and symptoms in infected persons, the long lag time from initial infection until signs of severe complications, and the proclivity for STDs to more easily infect women than men.

Social factors include poverty, inadequate health care, lack of health insurance, substance abuse, and sexual abuse. Sex workers, the homeless, persons in detention facilities, and migrant workers, and other disenfranchised persons represent "core" transmitters of STDs.

Sexuality and STD-related issues are not discussed openly. This secrecy impedes HIV/STD and sexuality education programs for adolescents, open discussion between sex partners and children and their parents, healthy messages from media, education and counseling activities of health care professionals, and community activism.

Young adults are becoming increasingly sexually active, magnifying the need for a coordinated program to improve knowledge and health decision-making.

Copies of the report can be obtained from the National Academy Press: (800) 624-6242, (202) 334-3313. The executive summary is available on the National Academy of Sciences' web site.

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Interventions Can Have Striking Impact on STD Hidden Epidemic

Available interventions could have a rapid and dramatic impact on the prevalence of STDs in the United States, according to the chapter "Prevention of STDs" in the new Institute of Medicine report, The Hidden Epidemic: Confronting the Sexually Transmitted Diseases. The chapter states that there are many effective and efficient behavioral and biomedical interventions that could have a substantial impact on the risk of acquiring and spreading STDs.

Interventions can prevent the spread of an STD within a population by reducing the rate of exposure to an STD, lowering the rate of partner exchange, reducing the efficiency of transmission, or shortening the duration of infectiousness for that STD. Sustained interventions can eliminate an STD in the entire population.

Promotion of correct condom use is a fundamental strategy for preventing STDs. Given the level of STDs among adolescents, school-based prevention programs and mass media campaigns should be enhanced.

Effective clinical methods include prophylaxis, partner notification and treatment, and early diagnosis and treatment of infected persons through screening programs. Health care and health-seeking behavior need to be increased.

Copies of the report can be obtained from the National Academy Press: (800) 624-6242, (202) 334-3313. The executive summary is available on the National Academy of Sciences' web site.

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RCAP Gets Awards, Recognition, and Continued Funding

The national satellite video conference AIDS in Rural Communities: Education for Prevention, broadcast by the RCAP in September, 1995, was recently honored by the professional organization, Agricultural Communicators in Education. Tom Luba, executive producer of the video conference, received the Silver Award for educational production in the Distance Education and Instructional Design Category. Luba is the coordinator of distance education and informational technology in the School of Agriculture at Purdue University.

Shobia Pais, a former doctoral student in the Department of Child Development and Family Studies at Purdue University, received two awards for her dissertation research, which was supported by the RCAP. Her study, "When Do Marriage and Family Therapists Tell: An Investigation of Factors Related to Therapists' Breaking Confidence When Clients Disclose High Risks-to-HIV/AIDS Sexual Behaviors," received the national 1996 Dissertation/Thesis Award from the American Association for Marriage and Family Therapy and the 1995 Student Research Award from the Indiana Association for Marriage and Family Therapy. Pais studied under Fred Piercy, director of the Purdue University family therapy doctoral program.

A feature article about the RCAP appeared in the November 15, 1996, issue of The Chronicle of Higher Education, a weekly newspaper for colleges and universities. The Chronicle has 100,000 subscribers and over 500,000 readers worldwide.

RCAP also received continued funding for fiscal year 1997.

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New Name for Rural Center

As you may have noticed from our masthead, the directors of the Center recently established a new name for the Center, effective immediately. In wanting to simplify our name, it was shortened to the Rural Center for AIDS/STD prevention, or RCAP. Our mission and goals remain the same.

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STDs Account for 87% of Top Ten Reportable Infectious Diseases

In 1995, STDs represented 87% of all cases of the 10 most frequently reported infectious diseases in the United States, federal researchers report. The diseases were, in descending order: chlamydia, gonorrhea, HIV/AIDS, salmonellosis, hepatitis A, shigellosis, tuberculosis (TB), syphilis, Lyme disease, and hepatitis B.

Although 1995 was the first year Chlamydia trachomatis was nationally notifiable, this condition was the most commonly reported disease for 1995. Most cases were reported among women. Rates for AIDS and TB were substantially higher among males than females. The rate of AIDS reported among men was more than four times that for women, and for TB, nearly twice that for women.

Among children aged 5-14 years, gonorrhea and shigellosis were the most frequently reported diseases. Gonorrhea remained the most common disease reported among persons 15-24 years, and rates for both gonorrhea and AIDS were high among persons aged 25-44 years and persons aged 45-64 years.

SOURCE
Centers for Disease Control and Prevention (1996). Ten Leading Nationally Notifiable Diseases--United States, 1995. Morbidity and Mortality Weekly Report 45(41).

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Research Indicates that Some Adolescent Virgins at Risk for STDs

Some adolescents who have never had vaginal intercourse still have sexual experiences that can lead to HIV infection and other STDs, according to a recent study reported in the November 1996 issue of the American Journal of Public Health.

Data were collected via an anonymous, self-administered survey of 2026 urban students in 9th through 12th grades. The survey covered sexual behaviors, condom use, and nonsexual risk behaviors.

Forty-seven percent of adolescents were virgins (42% of male adolescents and 53% of female adolescents). Of those who were virgins, 29% and 31% reported that, during the prior year, they had engaged in heterosexual masturbation of a partner and masturbation by a partner, respectively. The corresponding rates for heterosexual fellatio with ejaculation, cunnilingus, and anal intercourse were 9%, 10%, and 1%. Homosexual sexual activities and condom use for fellatio were rare. Level of risk of virgins' sexual activities was associated with illicit substance use and other nonsexual risk behaviors.

The authors concluded that some of the reported sexual activities can transmit STDs, indicating a need for education and counseling about sexual decision making, risk, and prevention.

SOURCES
chuster, M.A., Bell, R.M., & Kanouse, D.E. (1996). The sexual practices of adolescent virgins: Genital sexual activities of high school students who have never had vaginal intercourse. American Journal of Public Health, 86, 1570-1576.

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In the Literature

Combating the Illusion of Adolescent Invincibility to HIV/AIDS. R. A. Crosby. Journal of School Health 66 (May 1996): 186-190.

Adolescent illusions of invulnerability to the AIDS virus influences all efforts for intervention. Deflating this illusion is a central challenge facing those charged with administering prevention education. The patterns of the 20 years of the AIDS pandemic were used as a guide for developing a five-stage model for overcoming perceived invulnerability: facts and figures, initial dissonance, uncovering hidden realities, the transitional event, and new dissonance.

Syphilis in the South: Rural Rates Surpass Urban Rates in North Carolina. J.C. Thomas, A.L. Kulik, & V.J. Schoenbach, American Journal of Public Health 85 (August 1995): 1119-1122.

Primary and secondary syphilis rates in North Carolina were examined for 1985 through 1993. Syphilis rates rose dramatically during the 9-year period, with most of the increase occurring among women, non-Whites, and rural counties. The rural rates recently surpassed urban rates. The exchange of sex for drugs and rural poverty may be fueling these trends.

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Promising STD/HIV/AIDS Prevention Programs Cited

Thirty programs that have demonstrated salutary impact on teen STD/HIV/AIDS-related behaviors and fertility have been selected by a scientist expert panel from Sociometrics Incorporated. The program, the Program Archive on Sexuality, Health and Adolescence (PASHA), aims to promote the dissemination, adaptation, and evaluation of the programs in schools, clinics, and community-based organizations. Sociometrics is developing a package containing everything needed to replicate or adapt the promising program.

Sociometrics will be evaluating other programs for possible future inclusion in PASHA.

For more information contact Sociometrics at (415) 949-3282.

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Journal Features HIV Prevention

An entire recent issue of the Public Health Reports (Vol. III, Supplement I, 1996) focused on the importance of behavioral science for HIV prevention. The issue, which has 22 articles describing prevention strategies for several target audiences, can be obtained by calling (617) 565-1440.

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National Hotlines

National AIDS Hotline