This article is published in partnership with the National Coalition of STD Directors (NCSD) as part of our joint series on STD Awareness.
Sexually transmitted diseases (STDs) remain a major epidemic in the United States. Each year, there are approximately 19 million new cases of STDs, approximately half of which go undiagnosed and untreated, making the United States the country with the highest STD rate in the industrialized world. STDs cost the U.S. health care system $17 billion every year — and that number doesn’t even take into account the costs to individuals of STDs, the short-term and long-term consequences, including infertility, increased risk of acquiring HIV, and certain cancers.
And it is because of this, I am here to make the case for increased funding for the Division of STD Prevention (DSTDP) at the Centers for Disease Control and Prevention (CDC).
Now I am not an advocate who lives under a rock. I know these are fiscally-challenging times, to put it mildly. I know that when a congressional staffer says (as I did when I worked for a Member of Congress), “Flat funding is the new increase” that he or she speaks the truth.
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Yet, these statements chafe me. It is not the factual basis of this statement that I take issue with, but the idea that this is something we should all accept. Investments in our country’s public health are investments in our country’s healthy future. These investments are crucial not only for maintaining healthy individuals, but these are the investments in the infrastructure that we rely on when there is an outbreak or an unforeseen disaster. And I refuse to believe that we live in a county where it’s okay to let people fall through the cracks. Because in 2009, African Americans had 20 times the reported gonorrhea rates than whites. And that is just one alarming statistic. I could list many, many more that highlight the sexual health disparities in this country.
Funding for the Division of STD Prevention (DSTDP) is important because DSTDP guides national efforts to prevent and control STDs and invests most of its resources in state, territorial, and large city health departments. Additional federal resources are necessary to reverse the alarming and costly trends of STDs. And I make this case for two main reasons: STD prevention is also HIV prevention, and the increasing likelihood of an STD “superbug.” [HIV is an infection that is often sexually-transmitted.]
STD Prevention is ALSO HIV Prevention
Research indicates that there is a strong link between HIV and other sexually-transmitted infections. Having one or more STDs increases the likelihood of contracting HIV, and in turn, having HIV also increases the likelihood of contracting and spreading STDs. Investments in STD prevention and treatment furthers the National HIV/AIDS Strategy’s goal of reducing new infections.
Individuals who are infected with STDs are at least two to five times more likely than uninfected individuals to acquire HIV infection if they are exposed to the virus through sexual contact. In addition, if an HIV-infected individual is also infected with another STD, that person is more likely to transmit HIV through sexual contact than other HIV-infected persons. Co-infection of those with STDs and HIV is frequent; according to 2010 CDC STD surveillance data, between 25-54 percent of those with primary or secondary syphilis were also HIV positive.
For many communities, HIV and other STDs are syndemic — overlapping epidemics. STDs and HIV affect the same communities disproportionately — communities of color and men who have sex with men (MSM). Data released by the CDC indicates that the overall number of new HIV infections has remained fairly stable over the last five years, however that is not true among MSM — the only population in which new HIV infections have been increasing steadily since the nineties.
The MSM community is also a community of particular concern for STDs, partly because their screening needs for STDs are not being met. For those in this community, testing needs to be done not only in genital sites and through urine, but also in the throat or the rectum, referred to as “extra-genital sites.” Studies have found that more than 60 percent of gonorrhea infections and more than 50 percent of chlamydia infections are extra- genital, serving as reservoirs of infection and increasing the likelihood of further transmission.
And certain types of STD infections increase the likelihood of HIV infection — further underscoring the connection between HIV and other STDs: having a rectal chlamydia or gonorrhea infection was associated with a two times greater risk of becoming newly HIV-infected in the following two years. In addition, MSM infected with rectal chlamydia or gonorrhea with a history of two prior infections have an eight-fold increased risk of HIV infection.
Increasing STD Drug Resistance
The incidence of antibiotic-resistance has been rapidly increasing. This is a pattern the public health system is seeing in many areas, and STDs are no exception. We are on the verge of a highly untreatable gonorrhea epidemic. A case exhibiting high resistance to this last line of defense was reported in Hawaii last year; increasing resistance is being reported throughout the country. Gonorrhea has developed resistance to every class of antibiotics; we are now on our last line of defense to treat this disease that is a major cause of pelvic inflammatory disease, ectopic pregnancy, and infertility and can facilitate HIV transmission.
To directly quote the CDC report from last summer that outlined gonorrhea’s growing resistance to antibiotics:
In light of the past inability to prevent emergence of resistance and of diminished resources available to STD control programs, the eventual emergence of …resistance appears inevitable. Actions undertaken now could delay the spread of…resistant strains and mitigate the public health consequences.
While the CDC is currently collaborating with NIH on a clinical trial investigating the efficacy of two different antimicrobial combinations, the fact is that if gonorrhea develops resistance to this last class of antibiotics, there is nothing in the immediate pipeline for patients to turn to when diagnosed with gonorrhea. We will have no definitive treatment options for gonorrhea. Should this occur, we will be facing a gonorrhea “superbug” that could never be cleared.
Beyond the scary “always-infectious” reality, untreated gonorrhea is a disaster for public health and HIV prevention. According to the CDC, seven years after the onset of antimicrobial resistance, there would be almost six million new cases of gonorrhea which would add an estimated $780 million dollars to our health care system.
Increased resources are needed for surveillance to get a handle on where the resistance is occurring. The Gonococcal Isolate Surveillance Project (GISP) is a national sentinel surveillance system that monitors trends in antimicrobial resistance in the United States. GISP is supported by the Division of STD Prevention — increases in DSTDP funding can help monitor growing gonococcal resistance. We need increased resources now for surveillance and testing so we can catch resistant strains quickly and they are not spread through the population.
NCSD is working with a number of coalition partners to ensure that these points are made to decision makers that hold the federal purse strings in both Congress and the Administration. These investments are cost-effective and the correct role of our government. While we do know that any funding increase in this environment is a heavy lift, these are not concerns we can just ignore and hope they will go away. We have the tools to make changes—let’s just hope we can find the will as well.
Click here to view NCSD’s two-page fact sheet on the need for increased STD prevention funding in FY13.