Simple Screening Instruments for Outreach for Alcohol and Other Drug Abuse and Infectious Diseases
Treatment Improvement Protocol (TIP) Series 11

An Approach to STD Prevention Education

The "Three R's of STD" (3Rs) is a versatile approach designed to meet a wide range contemporary needs for STD prevention education, while also reinforcing HIV prevention efforts. The 3Rs is a distillation of key facts and prevention behaviors related to dozens of different STDs and syndromes; these key facts and concepts are condensed for communication through nearly every conceivable medium.

The 3Rs approach works to influence health-seeking behavior among persons who eventually experience STD symptoms. The aim is both to halt further spread and more quickly treat infected others, especially women, who may not experience symptoms. The strategy is to saturate community areas where populations are at increased risk of STDs with 3Rs messages so that the contents of the training gradually become internalized and reflected in the actual behavior of infected persons.

Several features of the 3Rs approach make it practical for state, local, or community HIV or STD prevention programs.

• Clearly linkable with training approaches for HIV and complements rather than competes with such approaches. STD infection is an established cofactor in HIV transmission, and common methods are promoted to prevent sexual transmission. The messages of 3Rs also remind those who deny their risk for HIV that the incidence of STDs make that a foolhardy decision.
• Versatile. The 3Rs is straightforward and condensed to allow its presentation in multiple ways; e.g., formal presentation, "street" delivery, counseling session, school curricula, fliers, posters, pamphlets, radio, television, etc.
• Focused on behaviors that will prevent infection. Treating even a small portion of persons before they spread infection could reverse some STD trends; treating partners early, especially women, can prevent costly, life-threatening complications.
• Can be evaluated. Public STD clinics can track the health-seeking and referral behaviors of symptomatic males to measure impact of a sustained 3Rs campaign.
• Easy learning curve for staff. Education staff with no STD background can absorb and begin using the 3Rs approach with nothing more than a half-day inservice training.
• High confidence level for staff (easy to get and stay enthusiastic about). Experience has shown that the "user friendly" approach, combined with a clear purpose and complementary linkage to HIV, has produced wide acceptance.
• Simple to present. The 3Rs approach is straightforward and does not require even low level expertise in STDs; technical disease questions are referred to a clinic.
• "Catchy" and memorable. This feature of the 3Rs title makes it a hook on which to hand the prevention messages and to promote recall if STD symptoms appear.
• Usable messages by persons receiving the education. The 3Rs messages are practical, yet not overwhelming in either number or complexity.

Course Description

Title. The "Three R's of STD: Risk, Recognition, and Response" is an introductory course that offers information on prevalent sexually transmitted diseases and is designed to meet the basic training needs of health care outreach workers who work with persons at risk for HIV infection.

The 3Rs concept is designed to be taught in other health settings and used in media campaigns so that the "risk ,recognition, response" message is effective through repetition.

Eligibility. New community HIV prevention outreach workers, HIV test counselors, and health educators or those whose job descriptions include triaging STD questions of their clientele (for example, drug users, prostitutes) may apply for this course.

Class size. Variable, 10 to 50 students.

Class time. 16 hours (2 days).

Content summary. This course covers disease risk behaviors, common STD manifestations, prevention behaviors including condom use, STD clinic orientation, laboratory test principles, communication skills, and integrating STD and HIV prevention messages.

Format. Lectures, role play exercises, and class discussion. All students are required to participate in the role play exercises.

Didactics. All lectures must utilize and promote CDC's Sexually Transmitted Diseases Clinical Practice Guidelines, 1991 and Sexually Transmitted Diseases Treatment Guidelines, 1989. The following STD topics, program management topics, and role play should be incorporated:

• STD topics (2 hours each topic)
  • Risk/unsafe behaviors
  • Recognize common manifestations (sores, rash, discharge)
  • Disease complications/sequelae
  • Respond: discussion of five STD prevention behavior messages
  • Substance abuse and STDs
• Program management topics (1/2 to 1 hour each topic)
  • STD clinic orientation
  • Laboratory test principles
  • Disease intervention/test counseling overview
  • Case management
  • Integration into HIV prevention programs
  • Communication skills
  • Learning theory
  • STD/HIV and the law

Objectives. All didactics must include specific content and activities that enhance the learning outcome.

Participants will:

• Better understand why STDs must be included when conducting HIV educational outreach activities.
• State the key risk factors associated with sexually transmitted diseases.
• Know the symptoms that categorize most STDs.
• Know the five STD prevention behavior messages that are important to address in HIV educational activities.
• Describe appropriate ways for clients to respond to a suspected STD.

Evaluation. Participants must complete a course and training evaluation.

Certificate. All participants who successfully complete the course will receive a certificate of attendance that includes the number of CEUs earned.