STD Awareness Week, observed April 11-17 this year, provides an opportunity to raise awareness about sexually transmitted diseases and how they impact our lives; reduce STD-related stigma, fear, and discrimination; and ensure that people have the tools and knowledge to prevent, test for, and get treatment for STDs. It is also an important opportunity for us to revisit how STD and HIV programs can further strengthen collaborations to better support prevention, diagnosis, care, and treatment of both.
For years, the U.S. has been battling steep, sustained increases in STDs. A recent report estimates that about 20 percent of the U.S. population—approximately one in five people in the U.S.—had an STD on any given day in 2018, and STDs acquired that year cost the American health care system nearly $16 billion in health care costs alone. CDC’s latest STD Surveillance Report, released this week, shows that STDs increased for the sixth consecutive year—reaching a new, all-time high in 2019. From 2015 to 2019, the rates of reported cases of syphilis, congenital syphilis, gonorrhea, and chlamydia rose 74%, 279%, 56%, and 19%, respectively. In addition, human papillomavirus (HPV) is the most common sexually transmitted infection (STI) with about 43 million HPV infections in 2018, many among people in their late teens and early 20s. These trends have serious implications for our national response to HIV as well since the presence of STDs increases the risk of transmitting or acquiring HIV.
HIV & STI National Strategic Plans Call for Enhanced Coordination of Efforts
The recently released STI National Strategic Plan (STI Plan) and HIV National Strategic Plan were developed concurrently with the Viral Hepatitis National Strategic Plan and each calls for a more integrated approach to addressing the syndemic of HIV, STIs, viral hepatitis, and substance use and mental health disorders. Together, these three plans aim to enhance coordination of the activities of federal agencies and diverse community stakeholders to reduce morbidity and mortality, stigma, discrimination, health inequities, and disparities; improve outcomes; and fortify the public health and health care infrastructure to support prevention, diagnosis, care, and treatment across these infectious diseases. As federal agencies begin work to develop implementation plans for each of these five-year plans, we will explore opportunities to enhance integration of prevention, care, and treatment of STIs, HIV, viral hepatitis, and behavioral health issues by leveraging capacity and infrastructure across the domains and breaking down operational and funding silos.
Such silos result in missed opportunities every day to test people for multiple infections and to scale up services in settings where people at risk receive other services. These missed opportunities translate directly into lost time and resources and may result in harm to people who remain undiagnosed, untreated, and at risk of severe outcomes or of transmitting HIV, an STI, or viral hepatitis to others. A reciprocal, integrated approach in our responses to infectious diseases and substance use and mental health disorders that puts patients first through a status-neutral and no-wrong-door approach will maximize their ability to access services that meet their health needs.
For example, HIV testing, prevention, and care programs can identify opportunities to screen for other STIs, viral hepatitis, and behavioral health issues and provide treatment and/or linkage to appropriate services. Current CDC PrEP guidelines recommend STI screening as part of PrEP care and the HHS HIV Treatment Guidelines provide information on screening, treatment, and prevention of herpes and syphilis.
Similarly, STD clinic patients represent a population at increased risk for HIV; so STD specialty clinics play a vital role in reaching people at risk for HIV who are not engaged in HIV prevention programs or other health care services, including those who are uninsured and those who seek confidential services. In addition, STD specialty clinics serve a high proportion of racial and ethnic minorities, gay and bisexual men, and transgender people so are ideally positioned to reach these populations disproportionately affected by HIV who could benefit from PrEP or PEP or reach people with HIV who are either unaware of their status or are not virally suppressed and could benefit from linkage to or reengagement in care.
New National Academies Report Recommends Actions to Improve STI Prevention and Control
A March 2021 report from the National Academies of Sciences, Engineering, and Medicine, Sexually Transmitted Infections: Adopting a Sexual Health Paradigm, also encourages more integrated, collaborative and holistic efforts among federal agencies, state and local health departments, practitioners and stakeholders not traditionally involved in care delivery, parents and guardians, and other stakeholders to create opportunities to improve sexual health outcomes and prevent and treat STIs. The report, developed by an independent panel of experts, observes that currently the U.S. has a narrow view of STIs and how to address them and it calls for a new sexual health paradigm in which sexual health cannot be addressed separately from physical, mental, and emotional health. Other recommendations from this report also are consistent with the STI Plan, including focusing on the most impacted populations to better address STI-related health disparities and inequities.
What You Can Do
During STD Awareness Week, we encourage our partners at the local, state, and federal levels to:
- Learn more about STDs, how to prevent them, and whether you should talk to your health care provider about getting tested.
- Share what you know and encourage others. These CDC campaigns provide messages and tools you may wish to use:
- GYT: Get Yourself Tested is a campaign encouraging young people to get tested and treated for STDs and HIV to protect their health and that of their partners.
- Talk. Test. Treat. is a campaign that encourages individuals and health care providers to take three simple actions – Talk. Test. Treat. – to protect their health, the health of their partners, and that of their patients. The campaign reinforces that all STDs are preventable and treatable, and most are curable.
- Syphilis Strikes Back is a campaign devoted exclusively to promoting the prevention, diagnosis, and treatment of syphilis with audience-specific information for two disproportionately affected populations: gay and bisexual men and women and newborns.
- Consider what your agency or organization could do to strengthen the integration of STD and HIV prevention, testing, and treatment in your community, organization, or program and make that part of your own plan to support implementation of the STI and HIV national strategic plans.
Appreciation for State and Local STD Partners
Finally, we extend our sincere appreciation to the state and local public health staff working in STD programs, especially for their creative but challenging work over the last year during the pandemic to maintain the availability of services in communities across the country. We look forward to working with them as we collaborate across programs to further strengthen services and reduce transmission of both STDs and HIV through improved screening and prompt linkage to treatment and partner services.