Dear Zak,
I read with interest your Dec. 5 Wespeak, 2008, “Univ. STD testing should be FREE” (Volume CXLIV, Number 23). Thank you for your interest in the issue of sexually transmitted infection (STI) testing on campus. It is a topic of great importance to Wesleyan’s Davison Health Center (DHC) and one on which we spend significant time and energy. We offer a wide array of sexual health services ranging from counseling to cryotherapy of genital warts to state of the art screening strategies and do so as cost effectively as possible.
I would like to specifically address three components of your comments: confidentiality, cost and modernity.
Confidentiality is a subject of high priority to us. It has long been our practice to bill STI testing charges to the student account as “miscellaneous lab fees,” just as we do for strep tests, mono tests, urinalyses, etc. Some students prefer to pay at the time of testing.
DHC has worked very hard to keep our testing cost-effective. Office visits with clinicians, counseling and exams are covered by tuition and there is no cap on number of visits. With regard to laboratory tests, we bargain aggressively with our lab services provider, Quest Diagnostics, to control costs because insurance companies characteristically do not pay for screening tests. We have negotiated steep discounts in fees (on the order of 60 percent) for tests we send to them. Where possible, we seek to provide other, cheaper options. For several years we have provided support services to a campus group, AIDS and Sexual Health Awareness (ASHA), which has organized a free HIV and other STI testing day in cooperation with the Connecticut Department of Public Health. We are currently in planning meetings with a Hartford-based organization with a grant to provide HIV testing for queer-identified students on campus for $20 or a nominal donation. We have also had meetings with local leaders to resurrect Middletown’s STI clinic. We applaud the recent Wesleying posting regarding free HIV testing at the Oasis center.
Over the years we have worked very hard to make the services we offer as up to date, as minimally invasive and as timely as possible. For example, until several years ago the only way to test for chlamydia and gonorrhea in males was via a urethral swab. DHC was an early adopter of urine-based screening. Based on results of a national survey I coordinate for the American College Health Association (ACHA), we discontinued routine gonorrhea screening because its rarity made such testing non-cost effective for most students. We were also early adopters of rapid HIV testing that provides results in 20 minutes and in one visit as opposed to the previous two weeks and two visits. Per Centers for Disease Control guidelines, we recommend this test annually for all students. As Chair of ACHA’s STI Taskforce, subsequently renamed the Sexual Health Education and Clinical Care Coalition, I worked to disseminate to other college health centers nationwide the latest evidence-based recommendations for routine STI screening and management.
In summary, STI testing is something we feel is very important and work very hard to do well, compassionately, confidentially and cheaply. The tests are expensive. Because Wesleyan students are so admirably attentive to sexual health, we do about $20,000 worth of testing a year. We would like to charge students less or nothing, but do not have the capacity to change it at this time. We welcome the involvement of you and other interested students in groups such as the Student Health Advisory Committee or ASHA. We are always interested in new ideas and energy to help make our work better and more cost-effective. Finally, I would be delighted to meet with you individually and review your input as well as share a few ideas of my own I haven’t yet had time to pursue.
With respect and appreciation for your interest and motivation,
Davis Smith, M.D.
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