Capitalizing on Missed Opportunities for Sexual Health Workforce Development by Adoption of a Sexual Health Paradigm

STIs remain a major cause of morbidity, dis-proportionately affecting younger persons and having lifelong consequences.1,2 Reportable STI rates have increased since 1997, and the latest data reflectan all-time high.3 Estimates suggest that approximately one in five people in the United States had an STI on any given day in 20184 Although the STI burden is increasing across all population groups, adolescents and young adults, women, men who have sex with men, and other groups underserved by mainstream health and public health systems remain disproportionately affected. [...]the dire need for increased public health attention and resources for addressing the "hidden epidemic" of STIs persists today.1,2 The lack of progress in STI prevention and control is owing to longstanding underinvestment in the broader public health system and its workforce, as highlighted during the COVID-19 pandemic. [...]recognition of sexual health as an integral component of broader health and well-being creates opportunities for using additional resources and partnerships (e.g., in education, family services, community health) to supplement STI-specific funding and infrastructure and a STIspecific workforce. [...]additional practitioners across clinical health care and public health, most notably primary care providers, can be used if a well-being-focused sexual health paradigm is adopted and applied to workforce development. [...]the committee identifies a wide range of professionals and stakeholders as part of the sexual health workforce. The committee therefore recommends that clinical practice guidelines and training curricula for health care generalists define a minimum set of sexual health competencies, more heavily emphasizing the importance of the consistent delivery of recommended sexual health services, such as sexual histories, STI screening, and vaccination.2 As first-line providers trained to deliver most aspects of sexual health promotion, STI prevention, and STI management and as the largest segment of the health care workforce, nurses are particularly well positioned to increase the reach of sexual health services.2 The committee encourages a broader scope of nursing practice in sexual health services as meaningful for strengthening the sexual health workforce and reducing STI disparities- guidance aligned with the vision outlined in the National Academy of Medicine's The Future of Nursing 2020-2030 report to use nurses for addressing social determinants of health and population health in the United States.8 Given that about 90% of the US population lives within two miles of a community pharmacy, pharmacists can serve as convenient entry points into the health care system, including for sexual health services.2 The committee therefore highlights the utility of incorporating pharmacists into the sexual health workforce, particularly for STI testing using point-of-care tests.

Reconsidering Assumptions of Adolescent and Young Adult Severe Acute Respiratory Syndrome Coronavirus 2 Transmission Dynamics.

Evidence regarding the important role of adolescents and young adults (AYA) in accelerating and sustaining coronavirus disease 2019 (COVID-19) outbreaks is growing. Furthermore, data suggest that 2 known factors that contribute to high severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmissibility-presymptomatic transmission and asymptomatic case presentations-may be amplified in AYA. However, AYA have not been prioritized as a key population in the public health response to the COVID-19 pandemic. Policy decisions that limit public health attention to AYA and are driven by the assumption of insignificant forward transmission from AYA pose a risk of inadvertent reinvigoration of local transmission dynamics. In this viewpoint, we highlight evidence regarding the increased potential of AYA to transmit SARS-CoV-2 that, to date, has received little attention, discuss adolescent and young adult-specific considerations for future COVID-19 control measures, and provide applied programmatic suggestions.

Nurses at the frontline of public health emergency preparedness and response: lessons learned from the HIV/AIDS pandemic and emerging infectious disease outbreaks.

The years 2020-21, designated by WHO as the International Year of the Nurse and Midwife, are characterised by unprecedented global efforts to contain and mitigate the COVID-19 pandemic. Lessons learned from successful pandemic response efforts in the past and present have implications for future efforts to leverage the global health-care workforce in response to outbreaks of emerging infectious diseases such as COVID-19. Given its scale, reach, and effectiveness, the response to the HIV/AIDS pandemic provides one such valuable example, particularly with respect to the pivotal, although largely overlooked, contributions of nurses and midwives. This Personal View argues that impressive achievements in the global fight against HIV/AIDS would not have been attained without the contributions of nurses. We discuss how these contributions uniquely position nurses to improve the scale, reach, and effectiveness of response efforts to emerging infectious diseases with pandemic potential; provide examples from the responses to COVID-19, Zika virus disease, and Ebola virus disease; and discuss implications for current and future efforts to strengthen pandemic preparedness and response.

Risk for COVID-19 infection and death among Latinos in the United States: examining heterogeneity in transmission dynamics.

PURPOSE: The purpose of this study was to ascertain COVID-19 transmission dynamics among Latino communities nationally. METHODS: We compared predictors of COVID-19 cases and deaths between disproportionally Latino counties (≥17.8% Latino population) and all other counties through May 11, 2020. Adjusted rate ratios (aRRs) were estimated using COVID-19 cases and deaths via zero-inflated binomial regression models. RESULTS: COVID-19 diagnoses rates were greater in Latino counties nationally (90.9 vs. 82.0 per 100,000). In multivariable analysis, COVID-19 cases were greater in Northeastern and Midwestern Latino counties (aRR: 1.42, 95% CI: 1.11-1.84, and aRR: 1.70, 95% CI: 1.57-1.85, respectively). COVID-19 deaths were greater in Midwestern Latino counties (aRR: 1.17, 95% CI: 1.04-1.34). COVID-19 diagnoses were associated with counties with greater monolingual Spanish speakers, employment rates, heart disease deaths, less social distancing, and days since the first reported case. COVID-19 deaths were associated with household occupancy density, air pollution, employment, days since the first reported case, and age (fewer <35 yo). CONCLUSIONS: COVID-19 risks and deaths among Latino populations differ by region. Structural factors place Latino populations and particularly monolingual Spanish speakers at elevated risk for COVID-19 acquisition.