Addressing an American Epidemic
Addressing an American Epidemic
There is a growing epidemic in America. One that has historically been ignored in an effort to preserve our mythical image as a pure and moral country, free of sexual promiscuity and the consequences that may follow. Because of this deliberate blindness to the need for prevention and control of Sexually Transmitted Diseases (STDs), a problem that could be contained has, in recent decades, begun to spin out of control.
The U.S. has the highest STD rates in the industrialized world, with more than 19 million new infections reported annually. STDs affect people of all ages and backgrounds, but young people, women, gay and bisexual men and communities of color share a disproportionate burden of infections and the subsequent negative health consequences. Most alarming is that STD rates have continued to rise while federal funding for STD prevention and control efforts have decreased by 22% since FY 2003 (when adjusted for inflation).
On June 11, 2010, the National Council of Women’s Organizations partnered with leading groups in the field of women and public health to hold a Capitol Hill briefing, “Sexually Transmitted Diseases: What You Should Know and Why it Matters.” This session was organized to inform public policymakers and their staff about the dimensions of this crisis and to offer possible solutions from experts at the local, state, and nation levels.
Opening the discussion on “STDs and Sexual Health in the U.S.” was Dr. John M. Douglas, Jr., Chief Medical Officer at the National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention at the U.S. Centers for Disease Control and Prevention. In his overview, Dr. Douglas noted that populations at greatest risk for contracting STDs are:
- Youth -- nearly 50% of STDs are estimated to occur in 15-24 year olds;
- Racial/ethnic minorities;
- African-Americans, who incur 71% of Gonorrhea cases, 49% of Chlamydia cases, and 49% of syphilis cases; and
- men having sex with men, with increases in syphilis (63% of all cases), 21% of all Gonorrhea cases, and the high rates of HIV co-infection.
Moreover, Chlamydia rates have significantly increased since 1989, reaching an all time high at 1,210,623 total cases in 2008. Gonorrhea has been on a steady decrease since 1989, leveling out at 356,742 cases in 2008. Syphilis, which began a steady decline from 1989, has begun to increase in recent years, especially among men. The male-to-female rate ratio for syphilis is one case in women for every 5-6 cases in men.
The CDC has implemented a wide range of initiatives to combat STDs like the Infertility Prevention Program, which funds screening for low-income women for Chlamydia and Gonorrhea in public settings (STD, family planning clinics), partners with Title X Family Planning Clinics, and screens in schools, juvenile detention centers, and jails. By bundling messages and services, CDC hopes to enhance the efficiency and effectiveness of prevention efforts and to “normalize” the conversation regarding contributions of sexuality and sexual behavior to overall health.”
Dr. Peter Leone, Medical Director at the North Carolina HIV/STD Prevention and Care discussed “The Struggle at Home: Perspective from STD Control Programs.” Dr. Leone stressed the crisis caused by funding cuts to state and local public health foundations because the percentage of individuals being diagnosed and needing treatment in STD clinics is growing at an alarming rate. In a 2009 survey of STD program directors in 50 states and a large number of local health departments, 69% of clinics experienced funding cuts in 2008-2009, accompanied by salary freezes, furloughs, and/or shutdown days in 50% of clinics, and layoffs in 28%. In the last decade, the STD program workforce in state and local health departments decreased by 12% while STD disease intervention specialists were reduced 21%.
As a result of the cuts that many STD clinics across the country are facing, there has been a 40% decline in disease intervention, a 37% decline in STD laboratory services, a 32% decline in STD clinical care services, a 31% decline in STD screening tests, a 6% decline in hepatitis vaccinations, a 5% decline in HIV testing, and a 3% decline in HPV vaccinations.
Dr. Maria Trent of the Bloomberg School of Public Health focused on “Helping America’s Adolescents and Young Adults Achieve a Healthy Sexuality.” Because of disease prevalence, sexual networks, poverty, sexual risk-taking, and limited access to high quality sexual health services, 15 to 24-year-olds in the US are the highest “at-risk” population for both Chlamydia and Gonorrhea.
Along with poverty, infection rates are oftentimes determined in large part by an individual’s history of sexual victimization. In fact, victimized participants in Dr. Trent’s study were 1.7 times more likely to be involved in a pregnancy, and females who had been sexually victimized were 3.7 times more likely to report a history of STD infection. Instead of slashed funding, Dr. Trent emphasized the need for increased public health surveillance and outreach support, research, funding for adolescent clinical care, and provider training.
Sponsors of this Congressional briefing were the National Council of Women’s Organizations, the Partnership for Women & Families, the American Social Health Association, and the National Coalition of STD Directors.