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.