Invoking, monitoring, and relinquishing a public health power: the health hold order.
OBJECTIVE
To describe a quarter-century's use of a public health power (Health Hold Orders) as an adjunct to noncoercive sexually transmitted disease (STD) control efforts in a middle-American city.


METHODS
Persons arrested for prostitution were involuntarily detained for up to 72 hours if they had not been tested for STD within 30 days of arrest. Such persons were mandatorily tested/treated for STD and voluntarily tested for HIV by health department providers in Colorado Springs from mid-1970 through 1994.


RESULTS
Prostitutes viewed temporary detention as inconvenient, but not as inappropriate. Over the 25-year interval, 4,965 examinations in prostitutes yielded 818 positive gonorrhea tests; the 1,564 tests performed under the health-hold order yielded 218 positive results. Positivity rates among prostitutes locally for reportable STD/HIV declined substantially during the period of observation, providing support for termination of the involuntary detention system.


CONCLUSIONS
The involuntary detention system contributed to observed communitywide declines in STD/HIV prevalence. Our experience demonstrates the importance of surveillance and empiric validation in public health practice.
El Paso County Department of Health and Environment, Colorado Springs, Colorado, USA.
J J
JJ
Potterat
R B
RB
Rothenberg
J B
JB
Muth
D E
DE
Woodhouse
S Q
SQ
Muth
D015492:AIDS Serodiagnosis; D002690:Chlamydia Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control; D003120:Colorado; D003140:Communicable Disease Control / Q000331:legislation & jurisprudence*; D005260:Female; D006069:Gonorrhea / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control; D006291:Health Policy / Q000331:legislation & jurisprudence*; D006801:Humans; D008297:Male; D018580:Mandatory Testing / Q000331:legislation & jurisprudence*; D016495:Police; D011477:Sex Work; D012749:Sexually Transmitted Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control*; D013587:Syphilis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control