Frequently coming from families where visits to doctors were rare and from communities where drug and alcohol abuse are common, juvenile offenders may suffer from long-untreated chronic illnesses such as asthma and diabetes. Some of the new challenges facing health care providers at juvenile facilities include previous drug use, AIDS/HIV, an increasing number of young women in correctional facilities, and the dramatic increase in the use of psychotropic drugs for behavioral disorders. Challenges in diagnosis and treatment are the reliability of inmate self- reporting on health problems and previous treatment and the slight increase in the female population among juvenile offenders. Young women who have spent several years on the street before arriving in a corrections facility tend to have had multiple sex partners and suffer from sexually transmitted diseases at higher rates than male inmates. This means the females are also at higher risk for HIV infection. Citing its findings of high-risk behaviors among youthful offenders, the National Commission of Correctional Health Care is moving to implement universal standards for juvenile facilities with fewer than 50 beds (most juvenile centers). Another factor that is impacting the delivery of health care at juvenile facilities is the increasing use of private companies to provide managed health care on site.