The Indian Health Service provides medical services to diverse populations. Many of these communities are small and located in rural areas. STD screening, diagnosis and treatment should be managed using strict confidentiality. Perceptions of AI/AN community members include concerns related to local staff knowledge of STD testing, sexual orientation, and sexual partners and networks. These concerns should be addressed with each patient, with assurance that information regarding this medical information is not shared with staff, family members, or sexual partners. These concerns may be especially important to recognize and address in smaller communities where friends, associates, or family members may be employed by local medical facilities. National guidelines support the following recommendations. Each recommendation is referenced to an online resource. STD/HIV TESTING IN PREGNANCY Syphilis screening should be performed on all pregnant women at the first prenatal visit and at delivery. During periods of and in areas of high syphilis morbidity, an additional syphilis test should be performed during the third trimester (between 28-32 weeks gestation) and again at delivery. [2] HIV testing should be provided to all pregnant women, with re-testing in the third trimester (preferably before 36 weeks’ gestation) for high-risk women (e.g., women who use illicit drugs, have STDs during pregnancy, have multiple sex partners or have HIV-infected partners). Testing for chlamydia and gonorrhea should be performed at the first prenatal visit and repeated during pregnancy based on sexual risk. This testing should utilize nucleic acid amplification test (NAAT) on vaginal or cervical swabs or urine. Testing for hepatitis B surface antigen (HBsAg) should be performed at the first prenatal visit. Consider testing for Hepatitis C for those pregnant women at risk (e.g., current or former drug users, persons with known exposure to HCV and persons with HIV). Papanicolaou (Pap) smear testing should be performed at the first prenatal visit if none has been documented in the previous 12 months. Evaluation for bacterial vaginosis (BV) should occur only in those pregnant women who are symptomatic. STD SCREENING TESTING IN GENERAL POPULATIONS
The Indian Health Service provides medical services to diverse populations. Many of these communities are small and located in rural areas. STD screening, diagnosis and treatment should be managed using strict confidentiality. Perceptions of AI/AN community members include concerns related to local staff knowledge of STD testing, sexual orientation, and sexual partners and networks. These concerns should be addressed with each patient, with assurance that information regarding this medical information is not shared with staff, family members, or sexual partners. These concerns may be especially important to recognize and address in smaller communities where friends, associates, or family members may be employed by local medical facilities. National guidelines support the following recommendations. Each recommendation is referenced to an online resource. STD/HIV TESTING IN PREGNANCY Syphilis screening should be performed on all pregnant women at the first prenatal visit and at delivery. During periods of and in areas of high syphilis morbidity, an additional syphilis test should be performed during the third trimester (between 28-32 weeks gestation) and again at delivery. [2] HIV testing should be provided to all pregnant women, with re-testing in the third trimester (preferably before 36 weeks’ gestation) for high-risk women (e.g., women who use illicit drugs, have STDs during pregnancy, have multiple sex partners or have HIV-infected partners). Testing for chlamydia and gonorrhea should be performed at the first prenatal visit and repeated during pregnancy based on sexual risk. This testing should utilize nucleic acid amplification test (NAAT) on vaginal or cervical swabs or urine. Testing for hepatitis B surface antigen (HBsAg) should be performed at the first prenatal visit. Consider testing for Hepatitis C for those pregnant women at risk (e.g., current or former drug users, persons with known exposure to HCV and persons with HIV). Papanicolaou (Pap) smear testing should be performed at the first prenatal visit if none has been documented in the previous 12 months. Evaluation for bacterial vaginosis (BV) should occur only in those pregnant women who are symptomatic. STD SCREENING TESTING IN GENERAL POPULATIONS
1.%20Sample%20Policy_STD%20Screening%20and%20Treatment%20in%20AI-AN%20Populations.docx