Published in "Sexually Transmitted Diseases", Editors: King K. Holmes, P. Frederick Sparling, Per-Anders Mårdh, Stanley M Lemon, Walter E. Stamm, Peter Piot, Judith N. Wasserheit, McGraw-Hill, 1999, pp 3-11.

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Sexually transmitted diseases are painful and sometimes deadly. However, the same is true of many other diseases and also of pollution, crime, poverty, traffic accidents and armed conflict. Governments in all countries, and especially in the poorest countries of the world, must struggle to fulfill a multitude of important roles with extremely limited resources. Should the prevention and control of sexually transmitted diseases be one of the short list of activities that are part of the irreducible core of government responsibility?

Some people would argue that sexually transmitted diseases (STDs) should not be on the short list. Starting from the premise that sexual activity is almost always a voluntary activity subject to individual control, many would argue that the individual should take responsibility for his or her own actions and should pay the penalty in health cost if poor luck leads to an STD. This chapter takes the contrary view. It shows how individual choices made with full information about risks and consequences can nevertheless lead to a socially undesirable outcome. For reasons not unlike the "tragedy of the commons" that exacerbates pollution problems, individually optimal decisions about risky sexual contacts lead to a higher prevalence of STDs than the individuals would choose. The implication is that some government intervention to prevent and control STDs is socially desirable.