By Rose Hoban
Despite the fact that fewer young people are having early sex, and pregnancy rates among teens are at historic lows, teens and people in their early 20s are nonetheless contracting sexually transmitted diseases in North Carolina.
In fact, North Carolina has some of the highest rates of chlamydia, gonorrhea and syphilis in the U.S. according to recent data from the Centers for Disease Control and Prevention.
“The North Carolina picture mirrors the national picture pretty well,” said Erika Samoff, an epidemiologist from the state Department of Health and Human Services who is the surveillance manager for HIV and STDs.
“We’ve had increases in almost everything this year and over the past few years, and I think we’re experiencing same thing as they’re seeing nationally: limited dollars on the front lines of the transmission of STDs are hampering our ability to respond.”
According to a report published by the Guttmacher Institute this summer, young people in the U.S., on average, have sex for the first time at about age 17. But between that time and the time they tend to marry in their 20s, “they may be at heightened risk for unintended pregnancy and sexually transmitted infections (STIs).”
Rates of chlamydia, gonorrhea and HIV all ticked up in North Carolina last year, while the rate for syphilis stayed flat, Samoff said.
But most disturbing to Samoff is an increase that’s small, but significant: Last year, North Carolina had 16 babies born with congenital syphilis and two babies were stillborn as a result of syphilis.
“We don’t need to have any cases of congenital syphilis,” she said. “I just want to put it out there that the screening recommendations are that women should be screened.”
Samoff noted that women can be infected with syphilis during pregnancy so while they might have been screened in their first trimester, they should also be screened in their third trimester and at delivery.
“Every baby born with syphilis represents a tragic systems failure,” said Gail Bolan, director of CDC’s Division of STD Prevention.
Syphilis makes a comeback
Samoff also expressed concern about high rates of syphilis in the community of gay, bisexual and other men who have sex with men, particularly in communities of color.
She said researchers from Emory University in Atlanta and the CDC have calculated total populations of men who have sex with men in order to calculate rates. Â When those numbers are compared to the number of those men of color who are diagnosed with HIV and syphilis, the rates are eye-popping.
“There’s data indicating that one-in-two young gay men of color will contract HIV,” Samoff said. “It’s an absolutely shocking excess of risk in young African American men.”
There’s been a lot of effort in North Carolina to address this increase, with public health workers targeting the young men who have sex with other men, particularly those men of color, said Jacquelyn Clymore, the HIV/STD/Viral Hepatitis director for DHHS.
Efforts are focused on the counties that have the highest rates: Mecklenburg, Orange, Durham, Wake, Forsyth and Guilford.
Clymore’s division runs a peer-to-peer program that’s designated for people who have HIV or are at high risk of contracting the disease.
“We hire facilitators who are from the community,” Clymore explained. “When I say that, it doesn’t automatically mean someone who’s HIV-positive, but the idea is that the facilitator is as much like the people they’re working with as possible.”
The groups discuss an entire curriculum that includes education on sexual health, “which includes STDs and spend a lot of time talking about the fact that syphilis is here, it’s never gone away, it’s pretty easy to contract and one wants to be sure one is getting tested for that if one is sexually active without condoms,” she said.
Disease Investigation Specialists also do outreach after someone has been diagnosed with HIV or syphilis.
“The DIS’s will test partners in the field. They’ll look for and diagnose more cases of syphilis and that’s a very effective outreach tool,” Clymore said. “If you can find people without having to have them go into the health department, that’s another really terrific way to make a dent in the syphilis epidemic.”
She attributed the flattening syphilis rate to this intensive outreach.
Confronting inequities
Clymore and Samoff both spoke about the need to address inequity and buried prejudice in the health care system if they really want to keep rates of sexually transmitted infections from continuing to climb.
Clymore said her division members are doing cultural competency training with health care providers who provide care for people who often face discrimination.
“We engage HIV/STD providers, from the reception desk all the way through to the exam room… anyone who touches a client or interacts with a client,” Clymore said.
She said that if providers want to get care to the people who really need it to stop the transmission of STDs, then they have to create environments that are accepting, non-judgmental and sensitive to their clientele.
“If you have a bad experience, even from the front desk, you are more unlikely to return to care,” she said. “We want to be sure that providers are culturally competent in working particularly with people of color, transgender people, young men who have sex with men, and the LGBTQ community in providing medical care.”
The training addresses the kinds of experiences that people of color might have had in the health care system that make them wary – everything from the Tuskegee syphilis experiments that were revealed in the 1960s to prejudices against transgender people today.
“In the STD world, that’s important when so many people with HIV are also living with syphilis and the two are so linked because they’re sexually transmitted,” Clymore said.
Research has shown that people with HIV who regularly take their medications can suppress the rate of virus in their blood to almost undetectable levels. At that point, a person with HIV is no longer capable of passing along the disease.
Samoff said breaking the chain of transmission isn’t possible if people are turned off because they had a bad experience.
“We’re trying to make sure our providers are culturally competent,” Samoff said. “So people aren’t pushed away from care because providers are looking down on them or treating them badly.”
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