Decentralizing STD Surveillance: Toward Better Informed Sexual Consent
Mary D. Fan
University of Washington - School of Law
February 1, 2012
Yale Journal of Health Policy, Law, and Ethics, Vol. 12, No. 1, 2012
University of Washington School of Law Research Paper No. 2011-30
Historically, sexually transmitted diseases have been treated as an affliction of the morally degenerate Other and the consequence of deviation from the dominant sexual culture. Sexual culture and our national sexual health have, however, evolved. Sexually transmitted diseases (STDs, also referred to as STIs) are widespread and spreading. Transmission is facilitated by social, cultural and technological shifts. These social shifts strain our STD surveillance polices and laws, which remain strongly shaped by the inherited paradigm of the past. Information and power is centralized in the state, which receives, stores, and sometimes acts -- albeit with increasing infrequency in a time of severe budgetary strain -- on information reluctantly reported by health care providers. Because of targeted intervention and concentrated surveillance in low-income health settings, socially and economically marginalized groups continue to bear the heaviest burden of surveillance. Sexual culture shifts and the resulting health ramifications,however, cut across traditional social categories such as class, age, sexual orientation, and race.
This article explores how public health policies can respond to changing sexual culture and the need for more reliable information sharing by facilitating voluntary test results sharing and priority flagging of actors most in need of intervention. The Article advocates for utilizing the better vantage of doctors to identify potentially problematic actors based on reports by patients, in the privacy of the doctor’s office, about individuals who endangered their health. In a time when budget-strapped public health authorities are in triage mode and unable to engage in contact-tracing for all cases, a priority flag approach would be more efficient in identifying potentially problematic actors in need of stronger surveillance and educational intervention. This method of identification is also salutary because it relies on accounts of behavior warranting concern, rather than on heuristics about who is high-risk that may reinforce old stigmas and stereotypes.
Number of Pages in PDF File: 39
Keywords: STD Surveillance, Contact Tracing, Budget Cuts, Public Health Departments, Physician Reporting, Serial STD Spreaders, Informed Consent to Sex, Sexual Health
Date posted: February 2, 2012 ; Last revised: February 24, 2012