As federal and state officials begin to implement health care reform, they will experiment with coordinated care. In this "whole patient" approach to medicine, specialists communicate with each other and primary care providers serve as figurative medical homes, managing a patient's varied health care needs. But in the area of sexual health, a longstanding divide between STD prevention and pregnancy prevention may inhibit a coordinated approach.
Along with Alcohol Awareness Month and Irritable Bowel Syndrome Awareness Month, April is also STD Awareness Month, making this the perfect time of year to consider the most effective way to reduce the 19 million new STDs occurring annually in the US. Like many health problems, STDs are more common in non-white and poor communities, but risky behavior is also high among the mostly white women who rely on oral contraceptives to prevent pregnancy. (Dual use of condoms and the pill is highest among young African Americans.)
Counseling and services for protection against STDs (including HIV) and unwanted pregnancy are often decoupled -- a silo approach reflecting the separate priorities of different funding sources, according to Bill Smith, executive director of the (curiously named) National Coalition of STD Directors. The Department of Health and Human Services' Office of Population Affairs supports publicly funded family planning services while the Center for Disease Control's (CDC) National Center for Chronic Disease Prevention and Health Promotion handles clinics that deal only with STDs. This division poses a problem for coordinated care, often meaning that STD clinics lack resources and expertise on pregnancy prevention.