JAMA: Sexual Health in America

Reproductive and sexual health morbidity in the United States continues to far exceed that of other developed nations. Calls for greater attention and new strategies to address this fact usually begin with a ceremonial nod to the numbers of associated adverse health outcomes (an estimated 50 000 new human immunodeficiency virus [HIV] infections, 20 million sexually transmitted infections [STIs], 3 million unintended pregnancies, and 1 million rapes annually).1 This morbidity has substantial national economic implications: each year STIs, including HIV infection, cost nearly $16 billion; teen childbearing an estimated $11 billion; and rape and other sexual assaults an estimated $12 billion.1 The personal and social costs of these diseases on interpersonal relationships, self-image, and mental health are often lifelong but poorly quantified. In 2010, Swartzendruber and Zenilman2 highlighted the need for change and promoting a shift from the longstanding and stigmatizing focus on morbidity toward a national sexual health–oriented strategy focused on health rather than disease. Five years later there has been little change despite steady accumulation of evidence in favor of shifting from a categorical, stigmatizing morbidity focus to a broadly integrated, health-promoting approach to sexual health. This needed shift could positively affect all levels of health care provision.

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Sexual Health in America: Improving Patient Care and Public Health