Clinic‐based service programs for increasing responsible sexual behavior

Abstract

Three general classes of clinic-based programs to increase responsible sexual behavior are considered: (a) clinic-based educational/counseling programs, (b) school clinic-based condom distribution programs, and (c) clinic-based STD/HIV screening programs. Consistent condom use may double in response to clinic-based counseling. However, consistent use seldom exceeds 50% of coital exposures. Extensive and personalized counseling interventions reduce incident sexually transmitted infections by 5% to 10%. Increases in responsible sexual behavior following school-based condom distribution programs is reported in some but not in all studies. Screening programs for sexually transmitted infections are associated with decreases in rates of some infections. STD/HIV screening should be considered an important aspect of healthy sexuality and an adjunct to other counseling efforts.

Chlamydia and gonorrhea screening in asymptomatic young women

“…This test is simple to perform and can be a "mail-out" specimen. 74 The test performs best in clinic populations with high prevalence rates of CT and NGC infection. The sensitivity and specificity in detection of CT infection is approximately 80% and 100%, respectively.…”

“…26,70,71,73 Thus, STI screening should be an important adjunct to risk-reduction efforts. 74 There has been a marked absence of programs and no publications describing interventions to improve client-initiated screening behaviors. This is despite the CDC's recommendations that encourage young women to (1) seek a medical evaluation promptly after having unprotected sex with someone who is suspected of having an STI; (2) seek routine STI checkups if in a non-mutually monogamous relationship, even if symptoms are not present; and (3) seek care immediately when genital symptoms appear.…”

Chlamydia Trachomatis: Common Misperceptions and Misunderstandings

“…64,100 M & M 7: Periodic urine-based CT screening is a cost-effective prevention measure It is widely recognized that for reasons ranging from denial of personal and patient risk and low health literacy to embarrassment and anxiety about the implications of an STD diagnosis and concerns about confidentiality and cost, teens, young adults, and the health care professionals who care for them, rarely engage in routine periodic STD screening. 6,17,[50][51][52][59][60][61][62][63][64][101][102][103][104][105][106][107][108] It is equally clear that the delayed diagnosis of asymptomatic chlamydial infections contributes disproportionately to the spread of this organism and the development of the costly suppurative manifestations of chlamydial infection. 1-10 Thus, the consensus in the public health community is that routine, periodic screening is key for disease control.…”

“…41-44,52-64 Thus, the concerns about infidelity raised by the diagnosis of an STD provide a unique opportunity to promote dialogue about sexual health and disease transmission and prevention between sexual partners. 2,10,27-32,36,41-44, [59][60][61][62][63][64] The optimal content and duration of such counseling is debatable and the number of relevant studies limited. 32,60,64 Nonetheless, brief (5-minute), personalized (provider-delivered-client-centered) counseling seems to be more effective than didactic groups and as effective as prolonged individualized sessions that are difficult to conduct in busy clinics.…”

A comprehensive sex education approach for HIV testing and counselling

“…HIV testing and counselling is a clinic-based form of prevention. Clinic-based service programmes for increasing responsible sexual behaviours offer advantages that complement community-based prevention programmes (Fortenberry, 2002). Clinic clients are often at higher risk than persons in the general population.…”