Last week the Centers for Disease Control and Prevention reported that we are facing an escalating public health crisis in the United States: all-time high rates of sexually transmitted diseases, with more than 2.4 million reported cases of syphilis, gonorrhea and chlamydia in 2018.
Sexually transmitted disease rates soared for males and females, all racial groups, and in all regions of the U.S. Most troubling is a 40 percent increase between 2017 and 2018 of syphilis among newborns, resulting in severe health complications and deaths among newborns.
These alarming numbers — which have been steeply increasing since 2014 — are the result of attacks for more than a decade on public health services, programs, and policies that support the prevention and treatment of these reportable STDs.
And STD rates will continue to climb dramatically as a result of the renewed assault on the Title X program, the only federal grant program dedicated to funding comprehensive family planning and related sexual health services, such as STD prevention and treatment.
From 2003 to 2018, federal funding to support the CDC’s STD prevention efforts has decreased, equaling a 40 percent decline in purchasing power, according to the National Coalition of STD Directors.
Moreover, state and local STD clinics across the country, which are critical resources for prevention and treatment, particularly for low-income and uninsured patients, are closing or reducing their services due to budget restraints.
In 2012, 20 health departments reported having to close their clinics, with budget cuts affecting more than half of state and local programs, said Jonathan Mermin, director of the CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD and TB prevention, in a 2016 interview with NPR.
In July 2019, the Trump administration changed Title X rules to prohibit grants to institutions that provide abortion referrals or services, a "gag" restriction that will directly impact millions of people who receive family planning and sexual health care at Title X-funded facilities.
To put in perspective the far-reaching consequences of attacks on these centers, in 2010 more than half of all chlamydia and gonorrhea infections prevented by publicly funded care were handled by Title X centers.
This crippling of Title X is forcing providers to withdraw from the program, leaving many people without needed STD care. Planned Parenthood, an organization specifically targeted by new Title X restrictions, for example, is the only Title X grantee in Utah and the largest grantee in Alaska, Connecticut and Minnesota, according to the Kaiser Family Foundation.
State-run clinics in Hawaii, Maine, Oregon, Vermont and Washington state will also withdraw from the Title X program. Overall, more than one in five Title X facilities will no longer use program funding as the effects of this gag rule continue to roll out, a major blow to STD prevention, testing, and treatment.
While several lawsuits representing states and providers like the American Medical Association and Planned Parented are challenging Title X gag rules, a 9th Circuit Court ruling has allowed the restrictions to be implemented anyway.
This clear affront to providing comprehensive, accessible sexual and reproductive care will do much more than restrict abortion. As prevention and treatment services diminish under the Title X restrictions, this country can expect higher rates of STDs, increased transmission, and deteriorating sexual health, particularly among sub-populations at greatest risk, including those ages 18-24.
Although these STDs are preventable and treatable, inadequate funding and hostile regulation leaves us on track to see rates further skyrocket in the coming years. We must work to make health care resources and access top priorities in order to stop the spread of STDs.
The CDC and HHS announced that they are developing a Sexually Transmitted Infections Federal Action Plan (STI Plan) to address and reverse the troubling trends in STD rates. This Action Plan must include overturning the Title X gag rule and re-investing in care for sexual health, including STD prevention and treatment. Otherwise, this is just the beginning of a dire epidemic.
Samantha Garbers, Ph.D., associate professor at Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health.