PROJECT: In Brazil, the actions of prevention and control of STD/HIV in the community/primary health care basis have been done by the community health care workers (CHCW). There were two program carrying on their actions with the CHCW: The Community Health Care Workers Program (CHCWP) and The Family Health Program (FHP). The principal strategy of those programs are: information, education and counseling for HIV testing of all STD patients and all pregnant women; identification and referral of STD patients and their partners to the primary health care units; and home follow up of pregnant women regarding to their VDRL status. The CHCWP team is composed by one nurse and a maximum of 30 CHCW. Each CHCW follows monthly 200 to 250 families, if in rural or urban area respectively. On the present moment, in Brazil, we have 2,217 nurses and 44,532 CHCW following 6,017,339 families. The FHP team is composed by one community doctor, one nurse, two auxiliary nurses, and four CHCW. Each CHCW follows 200 families. So, on the present moment we have 969 team of FHP with means 3,876 CHCW following 775,200 families. Those programs have been expanded along the country. RESULT: With the actions above described we achieve to: break the chain transmission of STD/HIV; decrease the vertical transmission of HIV; manage adequately the STD cases by using the syndromic approach and eliminate the congenital syphilis as a public health problem. LESSONS LEARNED: The identification of actions for preventing and controlling STD/HIV by using the CHCW has the advantage of giving to the population the appropriate information/education in STD/HIV/Aids respecting their social, cultural principles and their way of communication. STD Control Research Strategy Overview Multiple studies have suggested that STDs are important cofactors in the transmission and acquisition of HIV infection. An "epidemiologic synergy" exists between STDs and HIV, and thus control of one may have beneficial effects on the control of the other. The primary hypothesis of the STD Control Scientific Committee is that interventions designed for more effective control of STDs should reduce the incidence of HIV. Results from two community randomized trials which address this hypothesis have been published. The results were contradictory - one study having positive results in decreasing HIV incidence (Mwanza), and the other study having limited or no effect on HIV incidence (Rakai). Data from a third trial (Musaka) were presented at the XIV International AIDS Conference in Barcelona; like Rakai, it found no impact. Careful analysis of the data from all three trials showed a unifying theme, namely that these studies need to be done in settings with high STD incidence and increasing HIV incidence. Effective STD control requires both targeted and more generalized strategies. Targeted interventions that reduce transmission in core groups (such as sex workers) with a high rate of partner exchange, and bridging groups (such as migrant workers, truck drivers etc), who seed new sexual networks, have led to rapid STD control in several areas (e.g., Thailand; South African mining areas; and Nairobi, Kenya). Research has shown that improved access to quality STD services for the general population alone can have a measurable impact on HIV transmission, especially in populations with growing HIV epidemics. Although the highest research priority identified within the STD Scientific Committee at its first meeting was a community randomized hybrid study combining these interventions, the HPTN has not had either site capability or funding to approve such a trial. Meanwhile, the emergence of genital herpes, especially in the context of mature HIV epidemics, highlights the evolving nature of STD epidemiology. Recent data from Rakai show a nearly five-fold association of HSV-2 with HIV-1 acquisition. Building on the extensive literature that has shown that genital ulcers are a risk factor for HIV acquisition, the HPTN is supporting HPTN 039, which examines the effect of acyclovir mediated suppression of HSV-2 infection on the acquisition of HIV. Because antiretrovirals are still out of reach of the majority of those infected with HIV, and HIV-related immunosuppression facilitates HSV-2 clinical expression, HSV-2 infection is likely to become an important cofactor in mature epidemics, and thus increase the risk of HSV transmission. What is known Targeted interventions that improve STD treatment and increase condom use in high-risk core/bridging networks may have the greatest impact on sexual transmission of curable STDs, HSV and HIV. Specific intensive STD interventions such as selective mass (presumptive) STD treatment to high-frequency transmitters can bring about rapid reductions in STD prevalence. Continuous access to improved STD services may have greater impact on HIV transmission than intermittent mass treatment in the general population and such services are important long-term elements of sustainable STD control. Treatment of asymptomatic STDs is critical to reducing STD prevalence and the often serious complications of STD. STD treatment is especially critical in populations with substantial rates of STDs and early or growing HIV epidemics. In later stages of the HIV epidemic, the contribution of STDs to the spread of HIV may be minimal. Genital ulcers are potent cofactors in both HIV transmission and acquisition, as evidenced by odds and risk ratios that are consistently higher than those for non-ulcerative STD. In addition to the curable causes of ulcers (chancroid and syphilis), HSV-2 is becoming a more important cause of ulcers in areas with mature HIV epidemics Lack of male circumcision is correlated with higher risks of HIV acquisition. Future Directions The STD Scientific Committee has focused its efforts on the successful implementation of HPTN 039 (suppressive HSV-2 therapy trial) in the field. The STD Scientific Committee continues to monitor the STD-HIV field of research for development of future study concepts. The STD Scientific Committee also plans to continue to increase the level of interaction with other working groups that are developing STD intervention studies, such as the microbicides and behavioral working groups. Guiding Principles: Any STD intervention trial designed to prevent HIV transmission/acquisition needs to be conducted in early phase epidemics with high incidence of HIV and STDs. STDs can serve as biomarkers or surrogate markers for HIV incidence. Trials must be designed in the context of the current state of HIV therapy in the community (may need to shift focus to transmission of HIV and transmission and/or STD acquisition). Wisconsin Schools Should Instruct About Birth Control And STD'sThe Wisconsin State Legislature is to be applauded for moving forward with a much-needed sex education bill. On Thursday the State Senate voted along party lines to ensure that if a public school taught sex education students must be instructed about birth control and sexually transmitted diseases. If the bill is signed into law by Governor Doyle it would take effect in the 2010 school year. The fact that we just do not mandate sex education in all public schools is still a mystery to me. Puritanical thinking controls more areas of public life than we care to admit, and the fight over this current proposal is proof of that fact. When it comes to a lack of proper sex education we are not only talking about unwanted pregnancies, but also diseases that can lead to death. It would then seem to be clear to all that sex education matters. But that does not stop many from arguing against the needed common-sense legislation. One of the reasons the bill winding through the state legislature is credible concerns the fact that 'abstinence only' is a bankrupt idea. Abstinence programs are outdated, and do not work. They have been proven to make a bad situation worse in that teenagers who pledge never to have sex until marriage fail to use condoms or other protective means when they realize the pledge is just not very practical. Unprotected sex can lead to pregnancy and STD's and therefore 'abstinence only' programs are not what the government should be promoting. Thankfully, most elected Wisconsin Democrats are not drinking the ‘abstinence only' kool-aid and are putting sound judgement and the health of young people ahead of political posturing. The fact is that teenagers have sex. Whether we want them to or not, it is going to happen. So with that as a starting point, it is vital that they be supplied with the right information, such as how to use a condom. By pretending that they will not be acting like average teenagers we only delude ourselves. By our failing to provide the necessary facts in order to help them to make sound decisions only undermines the ones we profess to care about. For Republicans to pretend that ‘abstinence only' is a practical idea, and use the ‘local control' argument as a means to fight for it, does not serve our youth. Such arguments may play well to conservative voters at election time, but fail to remedy a real need among our nation's youth. Thankfully the majority in the state legislature understood the leadership role they needed to play, and acted on behalf of the health and well-being of our state's youth when passing the sex education bill. I have long-argued that ‘abstinence only' programs were not positive ways to instill healthy thoughts about sex to our youth. Playing to those parents who nurture the idea that sex is not a positive or healthy value, and then instilling that in children, (which is the cornerstone of 'abstinence only' programs) should not be encouraged in our public schools. There are better ways to deal with teenage sexuality than pretending it does not exist, or foster negative views that will ill-serve the child long into adulthood. Sexually transmitted diseases (also known as STDs — or STIs for "sexually transmitted infections") are infectious diseases that spread from person to person through intimate contact. STDs can affect guys and girls of all ages and backgrounds who are having sex — it doesn't matter if they're rich or poor. Unfortunately, STDs have become common among teens. Because teens are more at risk for getting some STDs, it's important to learn what you can do to protect yourself. STDs are more than just an embarrassment. They're a serious health problem. If untreated, some STDs can cause permanent damage, such as infertility (the inability to have a baby) and even death (in the case of HIV/AIDS). How STDs Spread One reason STDs spread is because people think they need to have sexual intercourse to become infected. That's wrong. A person can get some STDs, like herpes or genital warts, through skin-to-skin contact with an infected area or sore. Another myth about STDs is that you can't get them if you have oral or anal sex. That's also wrong because the viruses or bacteria that cause STDs can enter the body through tiny cuts or tears in the mouth and anus, as well as the genitals. STDs also spread easily because you can't tell whether someone has an infection. In fact, some people with STDs don't even know that they have them. These people are in danger of passing an infection on to their sex partners without even realizing it. Some of the things that increase a person's chances of getting an STD are: Sexual activity at a young age. The younger a person starts having sex, the greater his or her chances of becoming infected with an STD. Lots of sex partners. People who have sexual contact — not just intercourse, but any form of intimate activity — with many different partners are more at risk than those who stay with the same partner. Unprotected sex. Latex condoms are the only form of birth control that reduce your risk of getting an STD. Spermicides, diaphragms, and other birth control methods may help prevent pregnancy, but they don't protect a person against STDs. Sexually transmitted diseases (STDs) are infections that you can get from having sex with someone who has the infection. The causes of STDs are bacteria, parasites and viruses. There are more than 20 types of STDs, including Chlamydia Gonorrhea Herpes Simplex HIV/AIDS HPV Syphilis Trichomoniasis Most STDs affect both men and women, but in many cases the health problems they cause can be more severe for women. If a pregnant woman has an STD, it can cause serious health problems for the baby. If you have an STD caused by bacteria or parasites, your health care provider can treat it with antibiotics or other medicines. If you have an STD caused by a virus, there is no cure. Sometimes medicines can keep the disease under control. Correct usage of latex condoms greatly reduces, but does not completely eliminate, the risk of catching or spreading STDs. Sexually transmitted diseases (STDs) are infections that you can get from having sex with someone who has the infection. The causes of STDs are bacteria, parasites and viruses. There are more than 20 types of STDs, including Chlamydia Gonorrhea Herpes Simplex HIV/AIDS HPV Syphilis Trichomoniasis Most STDs affect both men and women, but in many cases the health problems they cause can be more severe for women. If a pregnant woman has an STD, it can cause serious health problems for the baby.