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fair to characterize the Federal public education response as virtually absent.

The CDC's approach to sexually transmitted diseases so far has really been a very traditional one. It's been based on individuals: You find an individual, you test them, you treat them, and then you try to find their sexual contacts.

The situation that we have today, though, is very clearly different than that which has existed, which the CDC follows and has followed since the introduction of antibiotics. They are different for two reasons. One is that like AIDS, there are a number of untreatable sexually transmitted diseases-I'm referring primarily to the viruses such as AIDS and herpes. The second reason is the unprecedented magnitude of the number of people who get these diseases. And I think clearly that calls for a different kind of response.

In the last fiscal year, the CDC funded only two sexually transmitted disease public education projects. One was assistance to the VD National Hotline, which the American Social Health Association now subsidizes heavily, and the second was a $12,000 continuation grant.

One of the remarkable things that have happened in the last few months is that we have made remarkable strides in our ability to educate the public about STD problems. Specifically I am referring to the fact that condom advertisements are now openly permitted on network television, that condom advertising appears in major national magazines, that safe sex messages are commonly seen in public.

The private sector and voluntary groups have brought about much of this progress, and that has been helped, certainly, by the Surgeon General's report and the report of the National Academy of Sciences.

I think the areas of education, a couple of them have been underscored fairly heavily in testimony referred to earlier. I would only like to add to those the need for education for teenagers, which has been discussed earlier, that we need to include older adults in those, and particularly health professionals.

I don't want people to forget that 2.5 million teenagers in this country every year get a sexually transmitted disease and about 1 million teenagers become pregnant. So to advocate abstinence or marital monogamy is the only preventive measures for young people is, I think, to put our heads in the sand. In fact, it is easier to change behavior than it is morality.

The second group, though, is older adults, and I don't want us to forget that it is not only the teenagers we need to get to, it is older adults or parents who not only need to know how to talk to younger people but a lot of those older people find themselves single again after years of having been married, and it is important that they not be overlooked in these messages.

The third component of education is also one that has been referred to but I think deserves a little greater attention, and that is professional education. Our efforts at professional education, I think, are one of the cornerstones which need to be examined. There was a study in the Journal of the American Medical Association a few years back in which 127 medical schools were surveyed in the United States and Canada. Of those, 54 percent had no sexu

ally transmitted disease clinic available for teaching, 69 percent offered no clinical training in sexually transmitted diseases to medical students, and 76 percent offered no training to residents.

The report also showed that instruction in sexually transmitted diseases within schools had actually declined over the previous 15

years.

I think there is another compelling reason for public education. That is what I referred to earlier. Fourteen million people in this country every year get sexually transmitted diseases. Like AIDS, some of those, in fact, all of them can be transmitted sexually and passed on to newborns.

Syphilis in women and congenital syphilis are increasing, and you might refer to the charts which I have included with my testimony. Since 1979, cases of gonorrhea which are resistant to antibiotic have increased thirtyfold. In fact, they have increased 90 percent just in the past year. There are 4.5 million new cases of chlamydia every year, which, like gonorrhea, can lead to pelvic inflammatory disease or ectopic pregnancy.

Herpes and human papiloma viruses affect millions of women and millions of men. Approximately 110,000 women are left sterile in the country each year from sexually transmitted diseases. I believe that if we had had effective public education programs for sexually transmitted diseases in the past, we would likely have prevented at least some of those sexually transmitted diseases, and I include AIDS, in that category.

At this point I think it is clear that the Government needs to make a clear commitment to public education for AIDS as well as other sexually transmitted diseases. The private sector has set the stage, the public health leaders have provided the script, the American public awaits in the audience, the curtain is up, and at this point we are all waiting for the action to begin.

I thank you for the opportunity to express our views.

AMERICAN

SOCIAL
HEALTH

ASSOCIATION

National Headquarters: 260 Sheridan Avenue, Palo Alto, CA 94306 • (415) 321-5134
Regional Offices: Atlanta, GA Columbus, OH Washington, DC

Reply to: 3701 Massachusetts Avenue, N.W., Washington, DC 20016 • (202) 362-2349

TESTIMONY

BEFORE THE

SUBCOMMITTEE ON INTERGOVERNMENTAL RELATIONS

AND HUMAN RESOURCES

OF THE

HOUSE GOVERNMENT OPERATIONS COMMITTEE

by

Michael J. Rosenberg, MD, MPH

Executive Director

March 16, 1987

VENEREAL DISEASES RESEARCH FUND VD NATIONAL HOTLINE HERPES RESOURCE CENTER (formerly HELP)

Mr. Chairman, my name is Michael Rosenberg, and I am

Executive Director of the American Social Health Association as well as a practicing physician and researcher. The American Social Health Association is one of the oldest non-profit organizations in the country. Our programs, which focus exclusively on sexually transmitted diseases, include the National AIDS Hotline, the National VD Hotline, the Herpes Resource Center, the Sexually Transmitted Diseases Research Fund, and a variety of public and school-based education programs.

We have operated the National AIDS Hotline for two months,

and with little advertising we receive an average of 800 calls each day. We have gained some insight about the public's need for AIDS information. A lack of information and a preponderance of misinformation have led to concern, some of which approaches hysteria. A strong need exists for very basic information about the disease itself-what causes it, how it is transmitted, how it can be diagnosed. People also need to know how to access services in their communities, such as where testing is available, counselling and support groups, hospice care, and other services. The Hotline can only help meet some of the needs, but it is just a drop in the ocean. Thus far, however, it is one of the few AIDS education projects funded by the federal government.

We are dismayed that six years into this epidemic the

Administration's long-promised plan for AIDS education has still not materialized. The fiscal year is almost half over, but funds appropriated

2

Although

The Centers for Disease Control's track record on public education regarding sexually transmitted diseases is a poor one. project grants to the states for sexually transmitted disease control include a component for public education, there is little monitoring of the projects, and no evaluation of their effectiveness. A few pilot studies have been conducted regarding education, but there has been no effort to institute these programs on a wider scale. Although 14 million Americans acquire a sexually transmitted disease each year, I think it is fair to characterize the federal public educational response as virtually absent.

CDC's approach to sexually transmitted diseases has been directed at individuals: testing them, treating them, and finding their sexual contacts. This strategy has been used since the introduction of antibiotics for the control of the classical sexually transmitted diseases, syphilis and gonorrhea. But the problems today are different and of unprecedented magnitude that sexually transmitted diseases, including AIDS, must be considered from a larger perspective. There are other sexually transmitted diseases, such as chlamydia, herpes, and human papilloma viruses, which are far more prevalent than syphilis and gonorrhea, but CDC has never initiated national education programs. In fact, in FY 1986 CDC funded only 2 sexually transmitted disease public education projectsassistance to the VD National Hotline and a $12,000 continuation grant.

We cannot cure AIDS, we can only prevent it. Education is the most important tool we possess. In the past few months remarkable strides have been made in our ability to communicate preventive messages regarding

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