Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #121287

Sevgi O. Aral, PhD, Division of STD Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop E02, Atlanta, GA 30333, (404) 639-8259, soa1@cdc.gov

The distribution of sexually transmitted infections (STIs), including HV infection, across individuals and subgroups within societies and across populations still preoccupies scientists of multiple disciplinary backgrounds. Systematic observation of how such distributions change over time in the presence and absence of preventive interventions underscores the complex, almost mysterious, multilevel multifactorial causation of the epidemiological profile of STIs. The importance of attention to both the individual- and population-level factors that cause and prevent chronic and communicable diseases is obvious.

Development and implementation of effective intervention packages necessitates careful attention to sometimes surprising findings of intervention research. Direct and indirect effects of interventions lead to both intended and unintended consequences creating unexpected challenges at the biological, behavioral and structural levels. For example, in sex partner recruitment sorting by HIV serostatus may lead to outbreaks of syphilis while decreasing HIV transmission; sorting by age group may decrease or increase STI transmission depending on the additional behavioral changes it gives rise to. Use of effective hormonal pregnancy prevention may lead to increased STI due to condom migration. Expanded screening for gonorrhea may lead to declines in the volume of much needed screening for chlamydial infections.

Disinhibition, selective adherence and structural interactions are important components to be taken into consideration in the development of all STD prevention strategies and public health policy.

Learning Objectives:

• The participants will find out about the major unintended consequences of explicit and implicit public health policies in the STD arena in recent years including the unintended consequences of antiretroviral therapy for HIV/AIDS; urban renewal; and expanded screening for gonorrhea.

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.