Coming Together to Address America’s STD Crisis

April 26, 2018 | David C. Harvey

The work of state, local, and territorial STD programs has never been more important. These programs play an essential role in the public health system in this country, serving as entry points to care and touching the lives of millions of Americans every year. Often, they and their highly skilled staff are on the frontlines of infectious disease outbreaks, including those associated with the opioid crisis.

Americans of all ages, races, genders, and sexual orientations are at risk for STDs, but too often it is women, young people, communities of color, and those who lack access to basic healthcare and sexual health services who bear the brunt of the STD burden. Shortchanging STD prevention shortchanges these already vulnerable populations.

And these infections are not benign:

• The long-term health consequences of STDs can be serious and often irreversible, especially for women and especially if not diagnosed and treated early. These include infertility, pelvic inflammatory disease, life-threatening ectopic pregnancies, chronic pelvic pain, and increased cancer risk.
• STDs are also of particular concern for people living with or at risk for HIV. In someone who is HIV positive, syphilis can advance quickly to serious and damaging stages, and someone with syphilis is up to five times more likely to acquire HIV if exposed. Rectal gonorrhea, on the brink of becoming untreatable due to drug resistance, also increases HIV risk.
• Congenital syphilis, once trending toward eradication, has roared back to the highest rates in decades with dire consequences. More than 700 cases were reported in 2016. Roughly seven times more babies are born today with congenital syphilis than with HIV, and 40 percent result in stillbirth or death very early in life. 
• Recently, reports of antibiotic resistant gonorrhea have become frequent features in the headlines. A report in the U.K. highlighted a case that was unresponsive to all antibiotics normally used to treat the disease and that ultimately was cured only following lengthy and expensive treatment. This should serve as a warning to health officials in this country: It’s not a question of if, but when similar cases will start to show up in the United States. And once they’re here, they could spread quickly.

State and local STD programs are expected to address these ever-growing and changing health threats with an ever-shrinking pool of resources. As STDs have reached and exceeded record highs, STD programs have faced cuts in resources, leading to a 40 percent reduction in purchasing power since 2003. This has meant the loss of key staff and programs, and the closure of STD clinics – over 40 percent of health departments reported a reduction in clinic hours or services in recent years. 

Clinics are vital to STD prevention, serving as keys points of access to care, particularly for the most vulnerable Americans. That is why in early April 2018, NCSD, with support of Gilead, launched the Reimagining STD Clinics for the Future initiative. This initiative aims to improve and integrate the critical STD and HIV care and prevention services that STD clinics provide and will bring together STD prevention practitioners from public and private clinics across the country to share information and resources, identify and implement best practices, and ultimately, reduce epidemic levels of STDs and HIV in this country.

Luckily, people are beginning to take notice of the STD crisis. In late March, Congress took a first crucial step toward restoring support to America’s public health and STD prevention infrastructure. Its final FY18 funding bill reverses a federal STD prevention cut of $5 million that was passed last year. NCSD applauds this action, but cautions that this restoration is a fraction of the investment needed to reverse STD trends in this country.

More federal support is needed, but it’s also critical that state and territorial health departments recognize the vital role that STD prevention—including ensuring access to STD screening and treatment for at-risk populations at public clinics—plays in promoting broader sexual and public health and health equity. That means collaboration across disciplines and between public and private sectors. This is one of the goals of STD Engage, NCSD’s annual conference, which will bring together state and local STD prevention and sexual health professionals, their community-based partners, and allies in related fields of public health practice to address the growing threat of STDs in this country. This year we welcome ASTHO as an Engaged Partner, and we hope you and your staff can join us. Now more than ever, we need to come to together to stem the rising tide of STDs in this country.