“Monkeypox is inundating these programs and it is interrupting our ability to diagnose and treat other STIs,” said David Harvey, the executive director of the National Coalition of STD Directors. “It’s shining a bright light on the fact that safety net clinics who provide essential services are in desperate need of federal support.”
Public health officials warn their scarce resources could be further strained and outbreaks could proliferate if a Texas lawsuit succeeds in eliminating Obamacare’s requirement that insurance cover services like STD tests and HIV prevention drugs.
Leandro Mena, the director of the CDC’s Division of STD Prevention, told POLITICO that chronic underfunding of public health programs is largely to blame.
“Over two decades of level funding, when you account for inflation and population changes, have effectively decreased the buying power of public health dollars and resulted in the reduction of STI services at the local level,” Mena said. “That reduction in screening, treatment and partner services likely contributed to these STI increases.”
Additionally, opioid and methamphetamine use — which increased significantly during the pandemic — is both leading to more HIV and hepatitis infections among people who share needles and to the spread of other STDs as more people trade sex for drugs and engage in unprotected sex.
Also fueling the rising rates, Mena said, are decreases in condom usage, particularly among young people, and taboos around sex that deter people from talking to their primary care doctors about STD prevention and treatment.
The CDC data found total infections in 2021 beat the record number of STIs documented in the U.S. in 2020 — increasing from 2.4 to 2.5 million.
Gonorrhea increased 2.8 percent — reaching almost 700,000 infections in 2021. Chlamydia, which had declined in 2020, increased 3 percent last year.
And rates of congenital syphilis — babies who contract the condition in the womb — climbed 24 percent. More than 2,600 babies were born with syphilis in 2021, up from 529 in 2000 when the country seemed on the verge of eliminating the condition.
Meanwhile, progress on preventing new HIV infections, which are tracked separately, slowed during the pandemic, and some parts of the country including San Francisco are even seeing HIV rates increase for the first time in nearly a decade. Officials warn that without significantly more funding, the U.S. may not reach its goal of ending the spread of the virus by 2030.
The surge in these preventable infections is alarming public health workers who had hoped the Covid-19 pandemic would convince lawmakers to invest more in testing, vaccines, treatments and outreach to at-risk groups in order to protect the broader population.
But that hasn’t happened.
Instead, Covid’s disruption exacerbated problems brought about by years of budget cuts to STD programs and the pervasive stigmatization of poor people of color and LGBTQ communities where infection rates tend to be higher, according to health experts and government officials.
When Covid hit, many testing clinics closed their doors or cut back hours, and many patients stopped getting regular checkups out of fear of catching the virus. Workers who had been contact-tracing for STDs were reassigned to Covid, meaning fewer people were notified that they had been exposed. For months, basic testing supplies like glass vials and swabs were scarce.
While many services have been restored and medical supply chains have been fixed, federal funding remains stagnant. Earlier this year, Congress approved far less funding than health departments requested for Title X family planning clinics that provide STI testing to uninsured and low-income patients. And Republican lawmakers are voicing opposition to new pleas from the administration for $4.5 billion to combat monkeypox — which Harvey and other health leaders say would alleviate some of the strain on STI clinics that are distributing the vaccine and testing for the virus.
“It isn’t a question of money; you have been given astonishing amounts of money,” North Carolina Sen. Richard Burr (R-N.C.), the top Republican on the Health, Education, Labor and Pensions Committee told Biden administration public health leaders during a hearing Wednesday.
Sen. Richard Shelby (R-Ala.), the top Republican in charge of appropriations, agreed.
“I don’t know that there’s an epidemic out there and that we’ve just got to have all this money all at once,” he told reporters earlier this week.
More challenges loom. In particular, health workers and government officials fear a lawsuit backed by former Trump administration officials could make the STD crisis worse still.
A federal judge in Texas ruled last week that the government advisers who decide what minimum services insurance has to cover under the Affordable Care Act lack the authority to do so, and that requiring coverage of things like the HIV prevention drug PrEP violates the religious rights of employers.
The judge has not yet indicated if his ruling will apply just to the conservative business owners who brought the lawsuit, to all of Texas, or to the entire country, and has requested additional briefings by Friday. If applied nationally, the ruling has the potential to strip insurance coverage for preventive care services like STD tests from nearly 170 million Americans.
Democratic policymakers and advocates see the case as a potential cataclysm, warning it could drive up health insurance premiums, bring back high out-of-pocket costs that deter people from seeking STD testing and treatment, and unwind progress on treating both chronic and infectious diseases.
“Picking and choosing what type of basic care is included in an employer-sponsored plan both discriminates against individuals who need important health care and is antithetical to the way health care insurance works, where everybody shares all the costs,” Bobby Scott (D-Va.), chair of the Education and Labor Committee that has jurisdiction over health policy, told reporters on a recent call. “What if someone objects to out-of-marriage births for example and asks why they should pay for half of all births as part of the costs they have to share?”
“If you can pick and choose, it’s no longer insurance,” he added.
Krista Mahr contributed to this report.