Objective: To describe a quarter-century's use of a public health power (He
alth 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 test
ed 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 prostitute
s yielded 818 positive gonorrhea tests; the 1,564 tests performed under the
health-hold order yielded 218 positive results. Positivity rates among pro
stitutes locally for reportable STD/HIV declined substantially during the p
eriod of observation, providing support for termination of the involuntary
detention system.
Conclusions: The involuntary detention system contributed to observed commu
nitywide declines in STD/HIV prevalence. Our experience demonstrates the im
portance of surveillance and empiric validation in public health practice.