[Our resources to ensure those individuals are tested are even
more compromised in this era. Reaching the undiagnosed is even more
challenging, difficult and unlikely to happen.]
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PANDEMIC SPARKS CONCERNS ABOUT SURGING STD, HIV RATES
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Jessie Hellmann
April 23, 2020
The Hill
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_ Our resources to ensure those individuals are tested are even more
compromised in this era. Reaching the undiagnosed is even more
challenging, difficult and unlikely to happen. _
,
The pandemic that has upended life in the U.S. could lead to increased
STD rates and setbacks in the fight against HIV as public health
resources are shifted to the coronavirus response.
Access to STD and HIV testing and treatment services are dwindling as
local health departments shuffle staff to respond to COVID-19 and
clinics reduce hours or close altogether and cancel outreach programs.
“We are seeing a complete disruption to STD prevention here in the
United States,” said David Harvey, executive director of the
National Coalition of STD Directors (NCSD). “We expect to
experience even higher STD rates as a result.”
As the U.S. deals with the coronavirus pandemic, many of the 2,200
disease intervention specialists who work at local health departments
tracking STDs and other infectious diseases are being reassigned to
the COVID-19 response.
These specialists would typically contact people who have tested
positive for STDs and HIV, make sure they’re getting treatment and
interview them confidentially about who they have had sexual contact
with to ensure those individuals also get testing and treatment.
Other staff, including doctors and nurses, have also been redeployed
to the COVID-19 response. Clinics are reducing hours and limiting
appointments, no longer accepting walk-in patients, reducing services
or suspending outreach activities, according to the National
Association of City and County Health Officials. A handful of clinics
have closed.
“Where does that leave our patients? It leaves them without access
to services, leaves some of their infections untreated and it
predisposes greater forward transmission of STIs and possibly HIV,”
said Christopher Hall, an HIV care physician in Oakland, Calif., and
medical adviser to the NCSD.
The pandemic couldn’t come at a worse time in the fight against
STDs. Record-high STD rates are themselves an epidemic, experts say,
with combined cases of syphilis, gonorrhea and chlamydia increasing
for the fifth straight year in 2018. HIV and STDs disproportionately
affect black men, particularly those who have sex with other men,
because of stigma, disparities in access to health care and other
societal inequities.
Experts at the Centers for Disease Control and Prevention (CDC) have
blamed the high STD rates on an eroding public health infrastructure
that saw STD clinics close during the 2008 recession. As a result,
public health departments that often run those clinics and testing
programs are often short-staffed.
Physical distancing requirements that are needed to slow the spread of
COVID-19 make it difficult for departments to continue prevention
efforts, like STD screenings.
If people don’t know they have an STD or HIV, they could potentially
spread it to their sexual partners, and untreated HIV and STIs can
lead to serious health complications.
About 38 percent of new HIV transmissions are linked to people who
have the disease but haven’t been tested, according to the CDC.
Essentially all of the field testing done by the Baltimore City Health
Department has been suspended because of COVID-19, said Adena
Greenbaum, assistant commissioner for clinical services and HIV/STD
prevention. Baltimore already has the highest rate of STDs in the U.S.
“Myself and my colleagues really are concerned we’re going to see
increases in HIV and STI rates because of the decrease in the
prevention activities being conducted by the health department and all
of our partners,” Greenbaum said.
She said most of the staff is focused on the COVID-19 response,
limiting the work the department can do on HIV and STDs.
“We’re trying as hard as we can, but it’s certainly not at the
level as it would be otherwise if COVID wasn’t here.”
Some local health departments have already reported increases in STD
cases, according to the National Association of City and County Health
Officials.
Meanwhile, the Trump administration’s plan to end the HIV epidemic
by 2030 is essentially on pause as federal, state and local health
officials turn their focus to the coronavirus response instead.
An estimated 1.1 million people age 13 and older had HIV in 2016,
according to the CDC, and there are about 40,000 new infections every
year.
The administration’s plan largely focuses on reaching people at risk
for HIV and getting them on prevention medication while quickly
finding and treating people who are HIV positive, especially those who
are undiagnosed.
That becomes more difficult during a pandemic when clinics and health
departments are losing staff to the COVID-19 response and pulling back
on outreach programs like mobile testing sites.
“The hard cases often involve a lot of shoe-leather work, it’s
relationship building, it’s seeing people face-to-face, gaining
trust, making those connections, and that’s incredibly time- and
resource-intensive,” said Adriane Casalotti, chief of government and
public affairs at the National Association of City and County Health
Officials.
“With social distancing, that becomes incredibly, incredibly
difficult.”
There is no cure for HIV, but it is treatable with antiretroviral
therapy. Individuals who take their medicine daily can stay healthy
and achieve an undetectable viral load, meaning they effectively have
no risk of transmitting HIV to sexual partners.
These drugs are also used to prevent HIV infection in people who are
at high risk for it, including people with HIV positive partners and
gay and bisexual men.
“Efforts to ramp up HIV testing, treating and prevention are on
hold. What’s happening on the ground is people are just trying to
hold their own and make sure patients remain in care,” said Carl
Schmid, co-chair of the President’s Advisory Council on HIV/AIDS and
executive director of the HIV + Hepatitis Policy Institute.
Many clinics are pivoting to telehealth and diagnosing patients by
listening to their symptoms, a technique called syndromic management.
Some clinics are sending at-home HIV and STI testing kits to patients
and then mailing them treatments if they’re positive.
But that misses people who are HIV positive or have an STD but
aren’t showing symptoms, who in pre-pandemic times may have been
found through community outreach activities or periodic screenings for
high-risk people, including people who have had STDs in the past.
“If your care system is relying on syndromic management alone and
you’re not doing testing of asymptomatic people, which is called
screening, you’re doing to miss infections and there’s going to be
more transmission,” Hall said.
“It’s not ideal, but under the current circumstances, in which
home-based testing is not something a lot of clinics have yet, that is
all we have.”
Hall said he’s most worried about reaching undiagnosed HIV patients,
of which there are about 162,500 in the U.S., according to the CDC.
People who have HIV or an STD but don’t know it can eventually
experience serious illness without treatment, especially if they get
COVID-19.
“Our resources to ensure those individuals are tested are even more
compromised in this era,” Hall said.
“Reaching the undiagnosed is even more challenging, difficult and
unlikely to happen.”
_Jessie Hellmann is national health care reporter at The Hill_
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