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The STD Epidemic in America

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The STD Epidemic in America A Report by a Panel of the NATIONAL ACADEMY OF PUBLIC ADMINISTRATION for the National Coalition of STD Directors The STD Epidemic in America: The Frontline Struggle ay 2017 NOVEMBER 2019 ABOUT THE ACADEMY The National Academy of Public Administration is an independent, non-profit, and non-partisan organization established in 1967 and chartered by Congress in 1984. It provides expert advice to government leaders in building more effective, efficient, accountable, and transparent organizations. To carry out this mission, the Academy draws on the knowledge and experience of its over 900 Fellows— including former cabinet officers, Members of Congress, governors, mayors, and state legislators, as well as prominent scholars, business executives, and public administrators. The Academy helps public institutions address their most critical governance and management challenges through in-depth studies and analyses, advisory services and technical assistance, congressional testimony, forums and conferences, and online stakeholder engagement. Learn more about the Academy and its work at www.NAPAwash.org. This page is intentionally blank iii A Report by a Panel of the NATIONAL ACADEMY OF PUBLIC ADMINISTRATION November 2019 The STD Epidemic in America: The Frontline Struggle PANEL OF FELLOWS Georges C. Benjamin (Chair)* Kenneth W. Kizer* Gregg Pane* William Gimson* Shoshanna Sofaer* *Academy Fellow Officers of the Academy Jeffrey Neal, Chair of the Board Norton Bonaparte, Vice Chair Teresa W. Gerton, President and Chief Executive Officer Jane Fountain, Secretary Jonathan Fiechter, Treasurer Study Team Brenna Isman, Director of Academy Studies Cynthia Heckmann*, Project Director Kate Connor, Research Analyst Richard Pezzella, Research Associate Elise Johnson, Research Associate *Academy Fellow National Academy of Public Administration 1600 K Street, N.W. Suite 400 Washington, DC 20006 www.napawash.org November 2019 Printed in the United States of America Academy Project Number: 2229 i Foreword The National Coalition of STD Directors (NCSD) advocates on behalf of state and local public health entities across the United States to fulfill their vision of, in their words, “a nation without STDs.” NCSD represents their members before Capitol Hill and other federal interests; partners with the Centers for Disease Control and Prevention (CDC) on the design and implementation of sexually transmitted disease response grants; provides technical assistance for members participating in CDC grant programs; and offers coordination services between public health groups. The state and local public health entities that comprise the membership of NCSD carry out the vital, front-line work that contributes to the wellbeing of communities nationwide. NCSD contracted with the National Academy of Public Administration (the Academy) to undertake a two-part study. The first, Phase I, explored the STD landscape across the United States, examining the scope of the epidemic, intersecting factors that complicate efforts to address STDs, public policy solutions, and federal programs involved in STD prevention and control. The results are presented in the Academy’s report, “The Impact of Sexually Transmitted Diseases in the United States: Still Hidden, Getting Worse, Can Be Controlled,” issued in December 2018. Phase II, the focus of this report, was to document the challenges experienced by state and local public health entities at the frontline of STD prevention and control. Like Phase I, this is a report of a Panel of five Academy Fellows. It provides the results of extensive information collection and analysis based on research and interviews conducted over the period of April to October 2019, and builds on Phase I, leveraging research and data. It describes the challenges and burdens—including the intergovernmental obstacles—confronting state and local public health entities in their efforts to address the STD epidemic within their communities. As a congressionally chartered non-partisan, non-profit organization with over 900 distinguished Fellows, the Academy brings nationally recognized public administration experts together to help organizations like NCSD address the challenges that define our time. We are pleased to have had the opportunity to work with NCSD and its members to conduct this study and to contribute to their ongoing efforts to end STDs in America. I extend my thanks to the Academy Panel, all experts who offered their invaluable insight and keen analysis, and to the professional study team that provided critical support throughout the project. I expect this report will further inform new efforts by the federal government and state and local health departments to tackle the continuing epidemic and improve the health of millions of people. Teresa W. Gerton President and Chief Executive Officer, National Academy of Public Administration ii This page is intentionally blank iii Table of Contents Foreword ................................................................................................................................................................... i Table of Contents ..................................................................................................................................................iii Acronyms, Abbreviations, and Definitions .............................................................................................. viii Executive Summary ........................................................................................................................................... xiv Actions for Consideration ........................................................................................................xvii Introduction ............................................................................................................................................................ 1 What Has Changed Since Phase I ............................................................................................... 3 Results in Brief ............................................................................................................................ 5 Methodology ............................................................................................................................... 8 Organization of Report ............................................................................................................... 9 Section I: State and Local Governance of STD Prevention and Control .......................................... 12 Section 2: Funding Streams ............................................................................................................................. 20 Federal Funding Streams .......................................................................................................... 20 Centers for Disease Control and Prevention ............................................................................ 22 Strengthening STD Preventing and Control for Health Departments (PCHD) ............. 23 STD Surveillance Network (SSuN) .................................................................................. 26 National Network of STD Clinical Prevention Training Centers Grants (NNPTC) ....... 27 Community Approaches to Reducing STDs (CARS)........................................................ 30 National Network to Enhance Capacity of State and Local Sexually Transmitted Disease Prevention Programs (NNECS) .......................................................................... 31 Division of HIV/AIDS Prevention (DHAP) ....................................................................... 31 Health Resources and Services Administration ....................................................................... 35 Ryan White HIV/AIDS Program ..................................................................................... 35 iv Health Center Program .................................................................................................... 42 340B Drug Pricing Program ........................................................................................... 45 Maternal and Child Health Services Block Grant ........................................................... 47 HHS ........................................................................................................................................... 51 Title X Family Planning Services ...................................................................................... 51 Sexual Health-Related Education Grants ................................................................................. 56 DASH Cooperative Agreements to Promote Adolescent Health through School-Based HIV/STD Prevention and School-Based Surveillance .................................................... 56 Personal Responsibility Education Program (PREP) ..................................................... 58 Title V Sexual Risk Avoidance Education Program – Competitive Grants .................... 59 Sexual Risk Avoidance Education (SRAE) Program ....................................................... 60 Teen Pregnancy Prevention Program (TPP) .................................................................... 61 Substance Abuse and Mental Health Services Administration (SAMHSA) ............................. 65 Targeted Capacity Expansion-HIV (TCE-HIV) Program: ............................................. 65 Prevention Navigator Program: ....................................................................................
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