The politics of STDs. Dwindling resources for a growing problem

Although the 1920s witnessed little progress in combating sexually transmitted diseases, the staggering dimensions of the problem had nonetheless been clarified. Increased reticence, declining government commitment, and a continued insistence on solving the venereal problem through moral uplift rather than medical means all combined to ensure that these diseases reached epidemic proportions. Thus Dr. Allan Brandt, in his book No Magic Bullet: A Social History of Venereal Disease in the United States since 1880, described the post World War I era of the social hygiene movement in the United States. Today, nearly 70 years later and more than 40 years after the widespread availability of penicillin, virtually every one of the more than 30 recognized sexually transmitted diseases (STDs) still defies control in the United States. Cases of STDs are increasing at dramatic rates, at enormous societal and personal cost. The epidemic of AIDS has diverted needed funds, personnel, and other resources from the nation's programs of research, training, prevention, and control of STDs. Ironically, the epidemics of STDs, the diseases themselves and the sexual and drug-using behaviors surrounding them, are now fueling the HIV epidemic. Although it is often said that education is the only prevention for AIDS, in fact there is another important and cost-effective component of HIV prevention: the control of other STDs. STDs are not only public health concerns, but issues of biomedical research, economics, access to care, public and professional education, drug use, poverty, and last but not least politics. Their prevention and control demands new research approaches, the development of necessary expertise, and a major and sustained investment of resources.