By Rebecca Bowers

EXECUTIVE SUMMARY

A new review by the National Academy of Public Administration makes a convincing case to act against skyrocketing sexually transmitted disease rates.

  • Contracted by the National Coalition of STD Directors to compile the report, the nonpartisan group formed an expert panel and a professional study team to collect and review available information concerning STD trends. Experts also analyzed prevention and control efforts for chlamydia, gonorrhea, and syphilis.
  • The expert panel developed six “Actions for Consideration” that will help stakeholders in the STD community inform a national action strategy for reducing STD transmission rates and improving public health.

Back in 1997, the title from the groundbreaking report, “The Hidden Epidemic,” provided the perfect description of the limited degree of public awareness about sexually transmitted diseases (STDs) in the United States.1 Fast forward to today, and the phrase still accurately depicts the STD landscape in the United States, according to a new review by the National Academy of Public Administration.2

Although STDs are preventable and treatable, rates of known infections of diseases such as chlamydia and gonorrhea are rising at alarming rates, the report states. Since 2013, chlamydia rates have jumped 22%, while gonorrhea rates have soared 67%. Rates for syphilis also have increased 76%, while congenital syphilis rates have risen 154%.3

With STD rates increasing year after year and investment in prevention lagging, the public health field is “in crisis,” says David Harvey, MSW, executive director of the National Coalition of STD Directors. The Coalition contracted with the non-partisan, congressionally-chartered National Academy of Public Administration to undertake the comprehensive study.

“We must work collaboratively at all levels of government to prioritize increasing investments in public health,” said Michael Fraser, PhD, CAE, FCPP, chief executive officer of the Association of State and Territorial Health Officials, in a press statement. “Limited resources for too long have significantly impacted state and local STD programs, leaving our nation with the highest infection rates in the industrialized world.”

Six Actions Outlined

To develop the report, the academy formed an expert panel and a professional study team to collect and review available information concerning STD trends, as well as to analyze prevention and control efforts for chlamydia, gonorrhea, and syphilis. The principal focus rested on federally funded intervention programs and current funding mechanisms.

The expert panel developed six “Actions for Consideration” that will help stakeholders in the STD community inform a national action strategy for reducing STD transmission rates and improving public health.

The first item on the list calls for designating a national STD “champion” to coordinate federal, state, and local efforts to develop and implement a national STD strategy.

Previous public health leadership appointments related to disease eradication or control have resulted in naming a “czar,” such as the AIDS Czar, the Bird Flu Czar, and the Ebola Czar, the report notes. Although the expert panel does not advocate an STD czar, it does recommend the appointment of an individual who can unify and harmonize policy across the disparate agencies that play a role in STD prevention and control. Such an individual should be empowered to align efforts, advocate for funding, and promote research and innovation across all sectors.2 Such authority is needed to reach across federal, state, and local government agencies, as well as different nongovernmental partners, to develop effective programs.

Secondly, the panel calls for changing the STD narrative. Sexual health needs to be reframed as an important dimension of health and wellness, with STDs seen as detrimental to health, with financial impacts on both individuals and society at large. Social stigma currently prevents some individuals from seeking STD treatment, and some medical professionals from screening for disease. In a national survey of men and women ages 15-44, just 47% of women and 23% of men with a history of recent sexual activity said they had received a sexual risk assessment from a doctor or other medical care provider in the past year.4

Unifying the Field

The third “Action for Consideration” calls for unifying the STD field. Steps are already under way, as a national STD action plan may be on the horizon, the report states. The Office of the Assistant Secretary for Health is spearheading a planning effort to develop a national STD action plan by early 2020. An interagency working group is forming, with outreach to state and local entities and nongovernmental operations. Federal, state, local, and territorial agencies/jurisdictions, nonprofits, and academic institutions must be included to develop such a plan.

In a field where numbers tell the story, the fourth “Action for Consideration” calls for improved data and further evaluation. Currently, STD reporting is dictated by state laws that call for local authorities to report to state public health entities, who then forward the data to the Centers for Disease Control and Prevention (CDC). The report terms this as an “unwieldy system” that requires the federal agency to rely on the ability of local entities to report cases. Because the data reported need to be standardized, so should the systems by which those data are shared and disseminated, the report states.2

The CDC is involved in a major program to upgrade the National Notifiable Disease Surveillance System, which collects information from states and territories for all notifiable diseases, including STDs. The project is aimed at strengthening and modernizing the infrastructure, as well as developing more efficient systems to put data to use.

Time to Raise Awareness

Not only is public awareness needed regarding STD prevention and treatment, but more training should be offered to clinicians about current guidelines. Currently, medical school curricula do not provide a suitable amount of education about STDs or sexual health, outside of obstetrics, gynecology, and other fields relevant to diseases like HIV, notes the report. Providers may not be considering STD screenings for high-risk patients or discussing risk factors and symptoms with them, as a result of such limited education, the report states.2

“Providers must be adequately informed on STD symptoms and risk factors and how best to ask about them to be proactive with their patients’ health,” the report states. “[The] CDC’s planned effort to make the guidelines for STD screening readily available to medical providers through electronic health record applications is a positive step for expanding awareness among the medical community.”

Increase Funding — STAT

The last “Action for Consideration” calls for expanded funding and resources, given the breadth of the national epidemic.

Local health departments play a critical role in the fight against STDs, says Lori Tremmel Freeman, chief executive officer of the National Association of County and City Health Officials. Freeman’s organization surveyed its HIV, STI and Viral Hepatitis Sentinel Network in 2017 to assess the impact of existing or potential budget cuts. A total of 62% of agencies responded, representing varying jurisdictional sizes, geographic locations, and settings.

Most local health departments participating in the survey reported stagnant or declining funds for HIV, STIs, and viral hepatitis services. Although the survey was not nationally representative, local departments reporting funding cuts noted that the services they reduced were most likely to affect disease surveillance and STI partner services, as well as HIV testing and hepatitis B vaccination. Almost half (43%) reported reductions in HIV, STI, and/or viral hepatitis program staffing levels. Public health nurses represented the greatest loss in staffing.2

“It’s easy to see at the local level that, as with so many things, the brunt of the STD epidemic is borne by people already sidelined by society,” noted Freeman in a press statement. “The report is clear — for the sake of public health and health equity, we need to do more to invest in STD prevention to address this epidemic.”

REFERENCES

  1. Institute of Medicine. The Hidden Epidemic: Confronting Sexually Transmitted Diseases. Washington, DC: The National Academies Press; 1997.
  2. National Academy of Public Administration. The Impact of Sexually Transmitted Diseases on the United States: Still Hidden, Getting Worse, Can Be Controlled. 2018. December 2018. Available at: https://bit.ly/2GYvGV5. Accessed Jan. 21, 2019.
  3. Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2017. Atlanta: U.S. Department of Health and Human Services; 2018.
  4. Copen CE. Receipt of a sexual risk assessment from a doctor or medical care provider in the past year among women and men aged 15-44 with recent sexual activity. Natl Health Stat Report 2018;110:1-12.