Pioneering program launched to educate employees about STDs
Treatment costs billions yearly, and subject makes many uncomfortable
Although they represent a significant health threat and cost the United States more than $8 billion a year in direct medical expenses,1 sexually transmitted diseases, or STDs, are usually not addressed in worksite health education and prevention programs. Many corporations are now specifically targeting HIV/AIDS, but other common STDs, such as chlamydia, genital herpes, syphilis, and gonorrhea, are conspicuous by their absence. (For a breakdown of costs for individual STDs, see the box on p. 63.)
| Estimated Annual Medical Costs of Major STDs in the United States | |
| Curable STDs
Chlamydia Gonorrhea Pelvic inflammatory disease Trichomoniasis Syphilis Total Costs |
$374,600,000
$56,000,000 $1,125,200,000 $375,000,000 $43,800,000 $1,974,600,000 |
| Viral STDs
Genital herpes HPV Hepatitis B HIV Total Costs |
$208,000,000 $1,622,800,000 $51,400,000 $4,540,000,000 $6,422,200,000 |
|
Source: The Kaiser Family Foundation and the American Social Health Association. Sexually Transmitted Diseases in America: How Many Cases and at What Cost? ________________________________________ |
|
Now, all that is about to change. The Research Triangle Park, NC-based American Social Health Association (ASHA) is about to launch a nationwide worksite wellness program aimed specifically at educating employees on the causes and prevention of STDs.
These efforts have been spearheaded by Norma Singleton, MS, ASHA’s senior director of marketing and communications.
"Prior to joining ASHA, I had always targeted traditional markets, working with public health clinics and state and local colleges," she recalls. "But I felt we were only reaching a certain segment of the population. And since we were starting a Stop the Spread of Herpes’ campaign at ASHA, the question was, How do we do that in the most effective way?’"
Having worked with several companies in northern Virginia, particularly in the area of technology, Singleton was aware that a lot of attention was being paid to employee wellness. "I felt we could link these two concerns and get the word out that employees could become more aware, and understand that their lifestyle and behavior can either promote or prevent STDs," says Singleton. "Even if an STD is not life-threatening, it can affect the psychosocial health of employees."
Singleton began the process by brainstorming in specific industry segments. "The highest incidence of occurrence is in individuals aged 25 and under, and typically the technology industry employs lots of young, talented folks," she notes. So, she made "first-pass communications" with companies such as Intel, America Online, Nortel, and IBM, and was sufficiently encouraged to proceed with her project.
While not all STDs are life-threatening or incurable, like HIV/AIDS, they do represent a significant health threat for employees, notes Singleton. She cites these sobering statistics:
• One in five people in the United States has a sexually transmitted infection.
• Two-thirds of all STDs occur in people 25 years of age or younger.
• Three in five African-American women have genital herpes.
• At least 50% of sexually active men and women will acquire genital human papillomavirus (HPV) infection.
• Most HPV-infected people are totally unaware they are infected and potentially infectious to a sex partner.
• HPV is a major cause of cervical cancer in women.
• Hepatitis B is 100 times more infectious than HIV.
Health threats real
"Any time you walk into a room for a party or a dinner, take a look around — one in four of these people will have an STD," says Singleton. "Many people who have them are asymptomatic, so they can be a carrier without knowing it."
In addition, she says, new groups of employees are now at greater risk of exposure. "For example, there is a rising rate of STD occurrence in women 40 to 45 and older," she notes. "Due to the high divorce rate, these people are going back into a dating situation." These are often women raised in a different world than the one they now face, she says, and they sorely need to be educated about the potential dangers.
STDs have far-reaching health threats
The health threats of STDs are quite real, Singleton stresses. "HPV has been linked to cervical cancer in women, which accounts for 5,000 deaths a year and 16,000 diagnoses per year, yet it often doesn’t get diagnosed for 10 or 20 years — and Pap smears are only 51% accurate," she notes.
"Chlamydia can result in pelvic inflammatory disease — you can miss work, and repeated episodes can lead to infertility, and increased health care costs to the employer due to ectopic pregnancies and other adverse effects of pregnancies," notes Mark Finch, MD, acting chief medical officer of Health Net, in the HMO’s Woodland Hills, CA, regional office.
"Herpes simplex is a viral disease that can cause significant pain as well as lead to local symptoms, and it might cause a man or a woman to miss work days," he adds. "Then, of course, other STDs have long-term sequelae like syphilis or cervical cancer."
Even a less dramatic disease, such as genital herpes, can affect productivity and mental health. "It’s safe to say the effects are stronger on the psychosocial side than on the physical side, but there’s a huge emotional factor," Singleton says. "In a survey conducted for an HPV newsletter, respondents said that finding out about their diagnosis was worse than anything else that had happened in their entire lives. Being diagnosed is stressful; it can impair working relationships, and because of the fallout these people may ultimately need to seek counseling." (For more on the symptoms of the most common STDs, see the box on p. 64.)
The ASHA program will be implemented on-site in cooperation with the company wellness or human resource department. The educational sessions will be supplemented by current ASHA literature, which will be made available at an on-site fitness center or the human resource/wellness office or, ideally, given to employees as part of their orientation packets.
The employee education program, facilitated by ASHA representatives, will include interactive group discussions that address such issues as developing communication skills to enhance discussions with family, sexual partners, and health care providers. The facilitators will be individuals with an MPH or a background in public health education, or individuals who have been trained as teachers or nurses. Their presentations will be supported with ASHA resources, referrals, and educational materials. Following the sessions, a participant evaluation will be conducted, and the facilitators will make recommendations for follow-up.
ASHA will also offer a train-the-trainer program, which will include a complete handbook and instructor’s guide; assessment and outcomes instruments; syllabus; and suggested exercises and lesson plans. "They will be run by a compassionate facilitator who can teach about content and sensitivity; address cultural and diversity issues; and create interactive practice sessions, role plays, and other learning tools," Singleton explains.
Overcoming reluctance
This "sensitivity" to which Singleton refers is critical; STDs are simply something few employees are comfortable talking about.
"I’ve had conversations with people in the major insurance companies, and in some technology companies in the Research Triangle area and in northern Virginia, and they don’t know of any formal program that addresses STDs," Singleton reports. "My sense is that the people in these companies who are responsible for health and wellness programs have tried to bring employees together informally to talk about these issues, but they don’t show up. That’s why we need a special approach that depersonalizes the subject."
How do you depersonalize such a personal topic? "We need to adapt the discussion to a corporate audience, and provide general information about prevention," she says. "Or, for example, employees could come together and talk about the rise in STDs among our youth. This way, it wouldn’t be so intimidating or embarrassing. No one wants to come to a discussion about STDs and have it implied that they might have one! There’s a way to do this that’s sensitive, and we have the history to deal with emotional sensibilities."
What would such a program cost? The ASHA brochures cost 25 cents to $1.50 each, depending on the brochure and the quantity. "A half-day presentation program and discussion session would range anywhere from $1,000 to $1,500, plus travel," says Singleton. "A train-the-trainer session would be $1,500 to $2,500 a day plus travel, depending on the size of the group and the complexity of the program."
A note of caution
While recognizing the merit of educating employees about STDs, Finch urges wellness professionals to approach the topic with caution.
"It’s an idea that would be worthy of some consideration, but there are certainly some factors that have to be taken into account before deciding to launch such a program," he says. "For example, the worksite may not be the most appropriate site to deliver the program, because of its personal and confidential nature."
If a wellness professional is looking to integrate STD education into an existing program, "I would probably add it onto a more broadly offered women’s health initiative that includes appropriate family planning, reproductive health, breast cancer screening, and the treatment of menopause, perimenopause, and the prevention of osteoporosis," he advises.
And what about men? "Perhaps you could work it into a counseling program, such as that provided for drug abuse, or include it as part of an overall risk-reduction education program," he suggests.
As for employee reluctance, Finch offers a strategy similar to Singleton’s. "I would target employees who have teen children and young adult dependents, and educate them on how to teach your kids about indiscreet sexual intercourse and other sexual behavior," he advises. "I might do this as part of a family counseling employee assistance program."
As for Singleton, she is encouraged by the initial responses she has received. "The companies I have contacted have been intrigued with the idea," she says, while admitting she faces a significant challenge. "There’s a huge wellspring of interest in and support for AIDS/HIV education, and deservedly so, but there’s not as much on STDs and how prevalent they are in our society. Most companies don’t have a program in place — let alone a way that people can get the information they need in a confidential manner."
Reference
1. The Kaiser Family Foundation, American Social Health Association. Sexually Transmitted Diseases in America: How Many Cases and at What Cost? 1999.
Sources
• Mark Finch, Health Net, 155 Grand Ave., Oakland, CA 94612. Telephone: (510) 869-3019.
• Norma Singleton, American Social Health Association, P.O. Box 13827, Research Triangle Park, NC 27709. Telephone: (919) 361-4886. Fax: (919) 361-8425. Web site: www.ashastd.org.
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