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.