Moving Away from “Silos” and Toward an Integrated Model of Sexual Health


This article is published in partnership with the National Coalition of STD Directors (NCSD) as part of our joint series on STD Awareness

There’s been a lot of talk at the National Coalition of STD Directors’ (NCSD) office about STD awareness month. Our staff is extremely busy creating op-eds, resolutions for state legislators, blogs and much more in preparation for a big push this month to highlight the importance of STD prevention. It’s important work. People need to know that some STDs, like HIV, can have life-long consequences. And it’s equally important for folks to know that we have the power to stop these awful illnesses. But sometimes I wonder if we are not missing the larger picture. Perhaps instead of talking about preventing STDs and treating an illness, maybe we could talk in terms of promoting sexual health.

Sexual health is a big idea — so big that it took the World Health Organization (WHO) to give us a decent definition of the phrase. The WHO says:

“sexual health is more than the absence of disease, but that it’s the state of physical, emotional, and mental well-being in relation to sexuality.”

I still have trouble wrapping my head around the WHO definition, but here’s what I make of it. Yes, sexual health is more than the dearth of illnesses like STDs, and it’s more than preventing teen pregnancy and sexual violence. Albeit I think those things are important for the overall sexual health of a community. Sexual health is about making sure that a community has all the resources it needs to stay healthy and feel good about the choices they make about sex and relationships.

Unfortunately I think we as public health practitioners have some improvement in working towards achieving community sexual health. Too often we focus on merely preventing disease. Moreover, the way we prevent diseases and poor sexual outcomes is frequently fairly disconnected and “silo-ed.” The independent and disease/problem-specific approach taken by local and state programs often prevents HIV, STD, teen pregnancy, and adolescent health programs from talking to each other. Programs often focus on their specific disease or health outcome without working alongside programs that deal with interrelated health issues. If these programs aren’t talking to one another they have less of a chance of leveraging their combined resources, let alone engage in the high-level thinking and program planning that is needed to implement a sexual health promotion model.  

Some states are on board with such a model and are actively promoting sexual health. Oregon, for example, is in its third year of implementing a state-wide sexual health plan for youth. The plan integrates the work of state HIV, STD, teen pregnancy, and Division of Adolescent and School Health programs. But that program integration is not what makes the plan exceptional. The plan is special because it recognizes the multiple factors that affect someone’s sexual health. For instance, the plan recognizes that programs can’t simply work with one another to prevent, test for and treat disease. Instead they must also work along-side other organizations to build a community where youth have access to stabling housing, nurturing families, quality education, livable wages, quality social support systems and an environment that fosters good mental health.

That’s a tall order to fill, but it’s an order that must be filled if we are to achieve community sexual health. We can talk to community members ad nauseam about the importance of using condoms and getting tested regularly for HIV, but what does that message mean to the a young gay man who just got kicked out of his parent’s home because they found out about his boyfriend? These kids sometimes trade sex in return for housing and food. Using a condom and getting tested are going to be low on their priority list if they are hungry and in the cold. Oregon’s plan is sensitive to those kinds of questions and works to advance sexual health from all angles.

NCSD is in the process of developing a program that helps other states emulate the work that Oregon is doing. We truly believe that the integrated sexual health model is the way of the future. A recent informal survey conducted by NCSD and the CDC highlighted that fact that many states and localities are in the process of creating sexual health plans. If you are involved in those efforts in your area, we want to hear from you. We can connect you with other states engaged in similar work. Regardless of what efforts are taking place in your state, I think we should all work to make this STD Awareness Month the first of many months where we leave behind our “siloed” approach and move towards a sexual health model.

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