STD Quarterly

Study eyes states' STD prevention spending — Can improvements be made in current climate?

Study: States invest less than 25¢ per capita for STD prevention

The burden of sexually transmitted infections (STIs) in the United States is high. Public health officials estimate there are 36 new STD infections every minute, with half of those among people ages 15-24.1 The annual cost to treat those infections? The estimate is $14.7 billion.1

When left untreated, STIs can result in severe consequences including infertility, tubal pregnancy, chronic pain, cancer, prematurity, low birth-weight, congenital infections in newborns, and even death.2 However, a new study by the American Social Health Association (ASHA) shows that states invest on average just $0.23 per capita for prevention of sexually transmitted diseases (STDs).3 The federal government invests $0.60 per capita for such services.4

"We believe investments in STI prevention programs are cost-effective and are hopeful policy-makers will utilize the findings from this research as they consider the specific resources needed for STI control in their own states," says Lynn Barclay, ASHA president and CEO.

Get an overview

To perform the study, researchers gathered state financial data from state laboratory directors and directors of state STD, hepatitis, and immunization programs. ASHA hosted a survey web site, with the response rate enhanced by follow-up telephone and e-mail contacts.

The report used the following indicators of state STD funding:

  • percentage of state funding in STD prevention budget, calculated as the percent of state funding in the total state STD prevention budget;
  • per capita state STD prevention funding, calculated by dividing the amount of reported state funding for STD prevention by the state population;
  • per capita state public health funding, calculated by dividing the reported state public health funding by the state population;
  • percentage of state public health funding directed toward STD prevention, calculated by dividing reported STD prevention funding by the state public health funding, and multiplied by 100.

Who pays for prevention?

When it comes to funding for STD prevention, the federal government carries the load, contributing $181,319,992 in 2007. The report analysis shows that just nine states — Louisiana, Hawaii, Rhode Island, Connecticut, Alabama, Arkansas, New Hampshire, Florida, and Michigan — reported sharing at least 50% of the financial responsibility for STD prevention in their jurisdictions. When looking at the percentage of state public health spending directed toward STD prevention, the leading states were Louisiana (3.68%), Connecticut (2.04%), Arkansas (1.96%), Mississippi (1.93%), and Rhode Island (1.53%).

How are STD-related vaccines funded in your state? The report shows that while several states purchased such vaccines with state funding, just 12 states distributed funding specifically earmarked for this purpose. They are California, Connecticut, Illinois, Louisiana, Missouri, New York, North Dakota, Ohio, Oklahoma, Pennsylvania, Texas, and Virginia. Five states noted such funding for the first time in the last two years, perhaps reflecting an emerging policy priority for such financing.3

Most of the funding went toward hepatitis B vaccination for adults and those children not eligible for the federal Vaccines for Children program. Two states, Texas and Virginia, directed almost all their earmarked funding for purchase of the human papillomavirus (HPV) vaccine.

What's the overall climate when it comes to state policies for STD prevention? Report researchers devised a list of 11 policies that enhance STD prevention, such as prenatal STD screening, electronic laboratory reporting for STDs and related conditions, opt out for written consent for HIV testing in STD clinics, expedited partner therapy, and insurance coverage (public and private) for HIV/STD screening. Looking at the report analysis, states have work to do when it comes to improving the climate for STD prevention.

Twenty-five states indicate they have policies that call for prenatal screening, and 22 states say they have electronic laboratory reporting capabilities. Only 14 states have expedited partner therapy policies.

When looking at all 11 policies, just seven states — California, Hawaii, Illinois, Louisiana, Minnesota, Alabama, and Missouri — reported the existence of at least five policies in their state operations. Policies most often cited include insurance coverage for HIV/STD screening, prenatal STD screening, electronic lab reporting, mandates for specific vaccines, and mandates or policies requiring the storage of vaccine data in a state immunization registry.3

Some states are moving forward with prevention policies not found in the report. For instance, California, Louisiana, Maryland, Missouri, and New Hampshire mandate that minors have access to STD diagnosis and treatment without parental consent, with Maryland requiring that such services be free.3

Funding on way?

What's the forecast on funding? State health department budgets are shrinking, according to a recent survey of state and territorial health agencies, conducted by the Association of State and Territorial Health Officials (ASTHO) in Arlington, VA.

According to the ASTHO survey, nearly 30% of states' FY '08 health department budgets were cut below their FY '07 level. About two-thirds of state health departments said they expected FY '09 budgets to be cut below their previous year's level. All health departments that experienced reductions in 2008 said they looked to further cuts in the coming year; 22% of health departments said they look to at least a 10% reduction for 2009.5

In light of current federal/state financial belt-tightening, why is it so important that spending be stepped up for STD prevention?

Times are really tough for states, and even more so for public health generally, says Beth Meyerson, PhD, MDiv, co-author of the report, and president of Policy Resource Group, a health policy research organization in McCordsville, IN. Preventative services often get short shrift, even in good financial times, she notes.

What states have yet to realize is that with STD prevention, the situation is a "pay-now-or-pay-much-more-later" scenario, notes Meyerson. "Nationally reported costs of treatment for STIs and their sequelae are indicators that we are missing many opportunities to prevent them in the first place and spending much more than necessary because we don't invest in prevention," she says. "We want states to connect the dots so that they can invest in the prevention side and save money — and lives and health issues — in the long run."


  1. Centers for Disease Control and Prevention. Trends in Reportable Sexually Transmitted Diseases in the United States, 2006 — National Surveillance Data for Chlamydia, Gonorrhea, and Syphilis. Accessed at
  2. STD Prevention Partnership. Critical Components of STD Prevention and Control. Position statement. Accessed at
  3. American Social Health Association. Show Me the Money: State Investment in STD Prevention, FY2007. Accessed at
  4. American Social Health Association. Talking Points for ASHA's Study on State Investment in STD Prevention. Accessed at
  5. Association of State and Territorial Health Officials. State Budget Cuts Jeopardize America's Health. Press release. Dec. 22, 2008. Accessed at


To access a free version of Show Me the Money: State Investment in STD Prevention, FY2007, go to the American Social Health Association,, and click on "Study examines state level investment in STD prevention." A link to the report is on the following page.