The Issue:

Though HIV is one of many STDs, prevention efforts are typically developed and conducted separately. Funding streams as well as organizational structures at local, state and federal levels have set HIV apart from other STDs. Yet, sexual behaviors that facilitate HIV transmission are the same as those for other STDs. HIV and other STDs share common risk behaviors and are amenable to common behavioral interventions. In addition, HIV infection and other STDs are linked by biological mechanisms. Other STDs increase both HIV infectiousness and susceptibility, yet STD prevention is not usually implemented as a significant HIV prevention strategy.

The Opportunities:

1. STD and HIV programmatic efforts could be integrated for several reasons:

• The affected populations greatly overlap.
• HIV and other STDs share common risk behaviors and are amenable to common behavioral interventions.
• Other STDs contribute to HIV acquisition and can potentially amplify HIV transmission.
• HIV alters the natural history and response to standard therapy of several STDs.
• As the incidence of bacterial STDs is reduced, the remaining STDs will be viral infections, the prevention of which will require strategies that more and more resemble those for HIV prevention.

2. STD/HIV integration could result in increased efficiency and more effective use of limited resources.

• The number of administrative staff needed to support an integrated program could be reduced substantially.
• Instead of having two programs target the same populations with similar services and distinct, potentially competing messages, one program would better coordinate STD/HIV activities.

3. The needs of people at risk for STDs and HIV could be better responded to because:

• STD infection could serve as a surrogate marker for changes in behavior and may predict HIV infection.
• HIV surveillance information, because it is obtained from sources beyond those used by STD programs, may help identify populations in need of services as well.
• HIV prevention programs have made significant progress in forming partnerships with community-based organizations. Although such linkages have not been a strong part of traditional STD programs, these linkages can be used to enhance efforts to prevent and treat other STDs.
• Conversely, HIV programs need to better reach and help prevent HIV in populations attending STD clinics. Some populations may be more concerned about STDs other than HIV and, therefore, be less likely to participate in a separate HIV prevention program.

The Challenges:

1. There will always be areas where STD and HIV prevention needs are different and integration is not appropriate.
2. Integration models may be different at the local, state and federal levels. Integration, for example, does not mean imposing a traditional STD model on HIV prevention nor does it mean imposing HIV prevention models on STD prevention.
3. There will be no single model of integration that will work for every community.
4. Funding streams will likely remain categorical or combine multiple health programs into one block grant.
5. Staff who have traditionally worked only in HIV prevention or only in STD prevention will be challenged to learn new approaches to their work.
6. Perceptions of the usefulness of and appropriate approach to partner notification services differ between HIV program workers and STD program workers.
7. HIV/AIDS prevention efforts tend to overshadow STD prevention. HIV programs receive almost five times more funding than STDs and attract more political and public attention than other STDs.

Recommendations:

1. STD and HIV grant proposals should include plans to integrate the two programs. Such plans should be preceded by assessment of both the STD and HIV programs to identify appropriate places for integration.
2. States should consider incorporating STD prevention plans in their HIV prevention community plan and include STD prevention advocates on their HIV prevention community planning council.
3. Workers in STD programs and workers in HIV programs should be cross-trained.