Last week a 17-year-old came to see Dr. Jamila Perritt at a clinic in Washington, D.C. She was interested in starting birth control and getting tested for sexually transmitted infections. 

“She didn’t feel comfortable using her parents’ health insurance so she was paying out-of-pocket,” said Perritt who routinely finds young people struggling to pay for STD/STI testing, mainly because of confidentiality issues. 

The young woman faced the dilemma of choosing between STD testing and a pack of pills, because she couldn’t afford both, said Perritt, a member of the American College of Obstetricians and Gynecologists. 

Depending on where you go, pill packs can cost from $20 to $50 or more if out of pocket. The Planned Parenthood clinic where Perritt saw her young patient is able to keep the cost down to $12 for a 30-day pack. Costs vary significantly from place to place with some people facing bills as high as $200 to others getting tested for free under the Affordable Care Act, according to health professionals.

In this case, the young woman decided she would take the pills and forego the test. To prevent her from having to make an “either-or decision” regarding her preventive health care, the clinic was able to screen her and bring the costs down so she could access both thanks to funding from the Title X program, which helps provide family planning and related preventive health service services to the uninsured and underinsured.

“We often see patients who sometimes go without care because of concerns around cost. In particular we are talking about low-income people, young people, people of color, and those who are uninsured or underinsured, most who are likely to fall in those previously mentioned categories,” Perritt told Rewire.News. “We also know that those are same folks who have higher rates overall of STDs like gonorrhea and chlamydia. The increase in the rate of STIs that we see are almost often concentrated in those populations. At lot of it has to do with access to care and costs.”

STD/STI rates are at a record high in the United States with more than two million cases of chlamydia, gonorrhea, and syphilis reported so far in 2017. More than 1.7 million of the new diagnoses are cases of chlamydia, followed by 555,608 cases of gonorrhea, and 30,644 cases of primary and secondary syphilis, according to an August report from the Centers for Disease Control and Prevention (CDC).

Title X Cuts Will Make it Worse

“It takes an entire staff of people and it takes a lot of coordinated effort to be able to make sure that this one person can get the care that they need and that they deserve,” Perritt said.

Should the Trump administration implement proposed changes to Title X, Planned Parenthood clinics like Perritt’s may not be able to provide such comprehensive care at reduced cost.

Title X family planning clinics play a critical role in ensuring access to a broad range of family planning and preventive health services. The extent of on-site testing, education, and counseling services in these clinics is based on the availability of funds, according to the U.S. Department of Health and Human Services.

Rebekah Horowitz, senior analyst at the National Association of County and City Health Officials, told Rewire.News that funding for these services has decreased at every level in the past 15 years, which has led to a decrease in health departments providing clinical STI testing.

“This means that there is additional pressure to get people insured so they can see a non-health department provider and normalize the provision of, and request for, these services from these providers. If there is a stigma from the individual and the provider around talking about sexual health issues, the movement towards using insurance and seeing private providers for these services will lead to many not receiving the services,” she said.

Health departments are often the only providers of partner services, offered to those who test positive for an STI, their partners, and to other people who are at increased risk for infection. The basic process for partner services involves interviewing infected people and others potentially involved in transmission, identifying those still at risk, and bringing them to diagnosis and treatment, Horowitz said.

The New York City Department of Health, for example, has eight sexual health clinics for patients 12 and older who can walk in without an appointment to access low- to no-cost services for sexually transmitted infections (STIs), including HIV. Parental consent and immigration status is not required, and results are available online, according to its website.

The Baltimore City Health Department clinic and outreach program around STI testing and using condoms has launched a widespread Your Health is Your Power or #YHYPBaltimore campaign on social media. Posts remind residents to show up, get tested, and use condoms.

Patients can also access testing services through their insurance—either private or Medicaid and Medicare.

Many patients are not aware of the deductibles they have in their insurance plans, said Dr. Cora Breuner, a pediatrician in Seattle and chair of the American Academy of Pediatrics Committee on Adolescence. “If they have a high-deductible plan, then clearly these tests will not be covered until the deductible is reached. However if they are on federal or state insurance plans, these deductibles may be waived,” she said.

For those who can’t got to their family physician or can’t afford care, Planned Parenthood clinics are often the choice for free or low-cost testing and confidential results.

“In many areas of the country, Planned Parenthood health centers are the main source of health care—56 percent of Planned Parenthood health centers in the United States are in health professional shortage areas, rural, or medically underserved areas—meaning that without Planned Parenthood, people might have nowhere else to go for care,” said Casey Olesko, communications manager of Planned Parenthood in New Jersey where all 17 clinics are addressing the spike in infections by offering free testing for gonorrhea, chlamydia, and HIV.

That is partly due to Planned Parenthood’s mandate for providing reproductive care across the spectrum, but also a result of centers being defunded in New Jersey thanks to former Gov. Chris Christie (R). His vetoes over seven years added up to more than $50 million in lost family planning investments, led six of 58 clinics statewide to close, and 14 others to scale back hours. Christie’s policies also led to soaring rates of sexually transmitted infections.

The Trump administration, in its effort to restrict reproductive rights, in May proposed a “domestic gag rule,“ which would limit patients’ access to medically accurate family planning information and ban abortion providers from the program. Implementing it would prevent millions of patients from accessing birth control and STD testing and treatment at Planned Parenthood health centers, which serve 41 percent of all Title X patients. 

“Even with rising rates of sexually transmitted infections, the Trump-Pence administration is doubling down on its agenda to make it more difficult for people to access preventive care at Planned Parenthood,” said Dr. Gillian Dean, senior director of medical services at Planned Parenthood Federation of America, in a statement. “No matter who you are or where you live, you should have access to regular STD screening and treatment, as well as accurate, nonjudgmental education about STDs and STD prevention.”

Lawmakers making decisions about what kind of health care she can provide in her exam room is “not just unacceptable and inappropriate, it’s dangerous,” said Dr. Perritt. “We don’t need politicians deciding what we can do when we see our health care providers and it also should not be subject to our ability to pay. Because what we find is those who are most vulnerable are also most likely to be supervised or dictated by politicians.”

The CDC recommends STI testing as a preventive health service for all sexually active persons from age 11 onwards. The GetTested section of the CDC website can help you find “free, fast, and confidential testing” at a clinic near you.