This week, the National Coalition of STD Directors (NCSD) and the Centers for Disease Control and Prevention (CDC) have both released new information about the sad state of affairs in our country when it comes to sexually transmitted diseases (STDs).
Let’s begin with the newly published CDC 2008 Sexually Transmitted Diseases Surveillance Report since it underscores the scope of the STD epidemic in this country. Each year, CDC collects and releases data on the three different STDs that are reportable to health officials: chlamydia, gonorrhea, and syphilis. For 2008, the news on this trifecta of diseases that undermines sexual and reproductive health is not good.
Chlamydia and gonorrhea are two of the most commonly reported diseases and together, added up to more than 1.5 million cases in 2008. These diseases are both preventable and curable with appropriate treatment, but unfortunately, often go undiagnosed resulting in serious health consequences. According to the CDC, an estimated 10-20% of undiagnosed infections in women will result in long term consequences for reproductive health such as ectopic pregnancies, chronic pelvic pain, pelvic inflammatory disease, and infertility. Each year, an estimated 24,000 women in the United States will become infertile due to STDs left untreated.
The situation with syphilis is even more troubling. It was not so long ago that syphilis was on the verge of being eliminated from the United States. Yes…eliminated. But in 2008, our country saw an 18 percent increase in cases of syphilis from 2007 totaling more than 13,500 cases.
Keep in mind that these are just the cases reported and gathered through health department STD programs. Since STDs commonly have no symptoms whatsoever, the majority of cases go undiagnosed and unreported. The CDC actually estimates that more than 19 million new infections occur in the U.S. each year. What is presented in the disease statistics is only the “tip of the iceberg” of the silent epidemic of STDs in this nation. Behind the topline numbers, however, one finds additionally disturbing evidence of how our efforts to combat these illnesses are falling disastrously short. For example, racial disparities in how these diseases are affecting African-Americans are shocking and unacceptable. Gonorrhea rates are 20 times higher among African-Americans than they are among whites. African-Americans represent only 12 percent of the population, yet they made up for 71 percent of reported gonorrhea cases, 48 percent of chlamydia cases, and 49 percent of syphilis cases in 2008 according to the CDC report. This racial disparity has further widened in some parts of the country as people continue to lose their health insurance along with their jobs and their access to medical care in the current economic recession.
Youth also continue to be disproportionately affected, particularly adolescent girls. Half of the estimated 19 million new STD infections each year occur among youth 15 to 24 years old. In 2008, however, nearly a third of the new chlamydia and gonorrhea cases occurred among girls ages 15-19 years old followed by 20-24 year old girls in close second.
Finally on the CDC data, the increase in syphilis cases is particularly worrisome because the epidemic continues to expand among men who have sex with men (MSM). Since syphilis can facilitate the transmission of HIV, the control of the HIV epidemic in this country is being undermined by the rising rate of syphilis. With the CDC also indicating that HIV is on the rise among MSM, we have a profound recipe for a public health disaster if we cannot get a handle on the current situation.
So, for those of us on the frontline combating STDs – like I am in Chicago – the news from the CDC is sobering, but not a surprise: we see this every day in our clinics and programs across our city. But the CDC data presents only half the picture, because what I and other colleagues have also been witnessing across the country is a cut to the resources we need to tackle STDs, including HIV. In particular, budget cuts by state and local jurisdictions, and flat or declining federal resources to tackle STDs, were everywhere apparent, but we needed to determine the actual impact.
So earlier this year NCSD set out to conduct a study on how the budget cuts were affecting the operation of programs that are designed to prevent, diagnose, and treat STDs. Our survey of states, large U.S. cities, and the territories is as equally sobering as the scale of the STD epidemic itself.
Our research found:
● 69 percent of STD programs experienced funding cuts from 2008 to 2009;
● 39 clinics supported by state and local STD programs closed due to lack of funding over the past year;
● 20 percent of the frontline STD program workforce – known as Disease Intervention Specialists – have disappeared over the past decade, and;
● 69 percent of STD programs supported by state and local dollars have experienced salary freezes and 29% have experiences layoffs.
In other words, the burden of STDs is becoming worse in this country at the same time that the resources we need to fight these illnesses continue to shrink. None of this bodes well for the future health of our nation and our communities.
NCSD is working to ensure that STDs are not lost in the shuffle. Of course, the current debate over healthcare reform provides an opportunity to address these issues, but taking STDs seriously will require additional targeted resources for prevention, diagnosis and treatment. What we know for certain is that without more resources, the situation will grow still worse and as a nation, that is an outcome we simply cannot afford.
To access a fact sheet on the NCSD study, go to www.ncsddc.org