Synopses & Reviews
The end of the twentieth century has brought a new understanding about opportunities and challenges in public health, personal health and primary care in the United States and globally. (1, 2) The opportunities and challenges in the prevention of sexually transmitted infections (STIs) including Human Immune Deficiency Virus (HIV) are similar. The central barrier to effective prevention of STI/HIV is not the lack of efficacious interventions. Difficulties encountered in large scale implementation of such interventions; maintenance of intervention fidelity and quality over time; appropriate targeting of subpopulations central to spread of infections; monitoring of intervention implementation and resultant continuous quality improvement are among the factors that affect achievement of public health impact, despite the existence of efficacious interventions. In the context of increasingly scarce financial resources, these barriers assume even greater significance. A recent review of research on interventions for prevention of sexually transmitted infections including HIV concluded that although many interventions were found to be effective against STIs and HIV, few had been replicated, widely implemented or carefully evaluated for effectiveness in other settings. (3) A large majority of reviewed interventions were individual level, single modality interventions that aimed to prevent acquisition of infection in uninfected individuals. At this juncture, it is crucial that the public health discourse in general and the STI/HIV prevention discourse in particular evolve to include strategic approaches to epidemiology and prevention. A better understanding of the changing and interactive role of social determinants and the community in the spread of ill health; the central role of health systems, their structure and functioning in the implementation of prevention interventions; and all the parameters that bridge the gap between efficacious prevention in study subjects and public health impact reflected in declining morbidity, is called for. Such integrated understanding may indeed form the basis for the formulation of strategic approaches to the study of STI/IHIV epidemiology and the creation of realistic, feasible and cost effective prevention plans.
Synopsis
This book advances the argument that the public health discourse in general and the STI/HIV prevention discourse in particular must evolve and expand to include strategic approaches to epidemiology and prevention.
Synopsis
Despite effective approaches to prevention, STD and HIV infection rates remain fairly constant. Targeting, implementation, and monitoring of interventions have posed widespread problems, and the recent spate of cuts to prevention budgets has made these roadblocks even more challenging. It is clear that working in sexual health requires both a deeper understanding of STI/HIV epidemiology and an ongoing quest for up-to-date, realistic prevention strategies. The New Public Health and STD/HIV Prevention offers readers leading-edge access to both. Focusing on social determinants of sexual health, at-risk populations, critical factors in approaches to prevention, and reviews of new research, this authoritative volume explores areas as varied as HPV prevention, technology-based interventions, migration as a factor in disease transmission, and competencies key to effective leadership in the field. Dispatches from the frontlines of theory, research, and practice in the U.S. and abroad include: Personal risk, public impact: balancing individual rights and STD/HIV prevention.Distribution of prevention resources and its impact on sexual health.Prevention measures in diverse populations of women.Toward a better approach to preventive interventions with men who have sex with men.Adolescent sexual health and STIs.Reducing disparities in sexual health: lessons from the campaign to eliminate infectious syphilis.
About the Author
Sevgi O. Aral is Associate Director for Science in the Division of STD Prevention at the National Centers for HIV, STD and TB Prevention, which is part of the Centers for Disease Control and Prevention. In 2006 she received the American Sexually Transmitted Disease Association's Life Time Achievement Award. She previously co-edited the Springer book, Behavioral Interventions for Prevention and Control of Sexually Transmitted Diseases. Kevin A. Fenton is Director of the National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, at the Centers for Disease Control and Prevention. He has previously served as Chief of the US Syphilis Elimination Effort, as well as Director of the HIV/STI Department of the Health Protection Agency.
Table of Contents
Part I: Overview and Purpose.- Part II: Introduction.- Social Structure and its Impact on Sexual Health.- Social Determinants of Sexual Health.- Health Systems and Their Impact on Sexual Health.- Distribution of Resources and its Impact on Sexual Health.- Epidemiology of STI and HIV: An Overview of Concentration and Dispersion.- Evolving Paradigms of Health: Personal and Public Health, Patient Care, Prevention, and Health Protection.- Part III: Populations.- Adolescents.- Women.- Minorities.- MSM.- IDUs.- Commercial Sex Workers.- Part IV: Societal and Supra-Societal Determinants and Influences.- Personal and Public Risk Behaviors.- The Importance of Mixing Patterns and Sexual Networks.- Autonomous Dynamics of Change and Intervention Impact.- Impact of Migration.- Impact of New Technologies.- Impact of Globalization.- Part V: Public Health Approach to Prevention.- Efficacy, Effectiveness, and Impact of Interventions.- Evaluating Public Health Interventions.- Targeting, Scale-Up and Coverage.- Choosing the Intervention Mix.- Translation of Prevention Interventions: From the Bench to the Community.- Leadership Development and Capacity Building: Core Skills and Competences.- Part VI: Critical Reviews of Recent Prevention Programs.- Preventing HIV/AIDS 1980 to 2007 in the United States.- Eliminating Racial and Ethnic Disparities in Sexual Health: Syphilis Control in the United States.- Prevention of Human Papillomavirus and Cervical Cancer in the United States.- Preventing Infertility: A Comparative Review of the US and UK.- The Health of a Nation: England's Sexual Health and HIV Strategy.- A National Strategic Approach to Improving the Health of Gay and Bisexual Men: Experience in Australia.- Part VII: Conclusion.