While COVID-19 has taken center stage over the past year, another public health crisis has been looming since before the pandemic began. Last week, the Centers for Disease Control and Prevention reported that the United States beat its own record for rates of sexually transmitted infections in 2019 for the sixth consecutive year. This follows another report from earlier this year which revealed that in 2018, one in five people across the country had a STI.
California has some of the highest rates in the nation, particularly when it comes to syphilis. The state ranks second highest for syphilis cases, and fifth highest for congenital syphilis — when a pregnant person passes on the infection to their baby. Between 2008 and 2018, syphilis rates rose by 743 percent among women of reproductive age in California. In 2018, the state also saw over 300 babies born with congenital syphilis — and heartbreakingly — 20 associated stillbirths.
Within California, Kern County has consistently ranked among the counties with the highest rates in the state. In 2018, Kern had the second highest rates of congenital syphilis, third highest rates of chlamydia, fourth highest rates of gonorrhea, and sixth highest rates of syphilis.
Early data for 2020 suggests a decline in rates, seemingly breaking the trend. However, experts warn that the numbers don’t tell the full story. Clinic closures, lack of testing, a shortage of supplies, and fear of stigma during the COVID era have likely caused infections to go largely undetected.
The COVID-19 crisis has also exacerbated pre-existing barriers to care for the most impacted populations. Black, indigenous and people of color, LGBTQ+ communities, and rural Californians already experience a range of systemic challenges when accessing care, including unequal access to culturally competent and affordable health services, housing insecurity, and lack of transportation.
Such inequities have caused these communities to experience disproportionately high rates of STIs — rates of congenital syphilis among the Latinx population are three times higher than their white counterparts, and roughly two times higher for chlamydia and gonorrhea. Coverage gaps must also be addressed — currently, low-income and uninsured LGBTQ+ individuals have no pathway to no-cost STI services.
While all STIs are either treatable or curable, untreated they can cause serious long-term health issues, including infertility, cancer, blindness and increased risk for contracting HIV.
Complacency is no longer an option. We need bold action. State leaders must strengthen the ability of local health jurisdictions to implement STI prevention strategies that meet the needs of their region, and integrate the voices and experiences of community members most impacted.
A bill introduced this session by Sen. Dr. Richard Pan offers a comprehensive approach to curbing the tide on rising STI rates. If enacted, the measure would ensure that LGBTQ+ patients can get no-cost STI services, provide health insurance coverage for STI-tests administered at home, and expand syphilis screening requirements to the third trimester. The bill also seeks to enhance evidence-based prevention practices, like streamlining the process for giving patients that test positive for an STI treatment to bring to their partners, if their partners are unable or unlikely to go to a health provider to get treated on their own.
In addition to these policy goals, providers must be trained in client-centered best practices for STI screening and care. Outreach interventions must be culturally and linguistically appropriate to effectively reduce persisting health disparities. Parents and educators need tools to talk about STIs in a medically accurate and inclusive manner. Youth need comprehensive prevention education and links to local, non-judgmental care.
We know what works. Now we need the political will and public investment to make sure that all Californians can get the STI care they want — when and where they need it. This isn’t just about health. It’s about equity. Continuing to ignore the problem is no longer an option.
Nomsa Khalfani, Ph.D., is chief strategy and equity officer at Essential Access Health.