Trump Will Make Gonorrhea Great Again

In 2015, rural Scott County, Indiana, experienced an HIV outbreak, one that anti-choice conservatives like then-Governor Mike Pence helped usher in. Funding cuts targeting abortion providers forced the closure of Scott County’s Planned Parenthood clinic in 2013—it was the only HIV testing center in the county and did not provide abortions. In 2015, the county saw a surge in HIV infections among intravenous drug users, followed by Pence’s sluggish response to calls for a clean needle-exchange program (though he took some time to pray about it).

Now, Pence is standing just a heartbeat away from the presidency. And Donald Trump's own stance on HIV and AIDS has been so weak that six experts on the Presidential Advisory Council on HIV/AIDS (PACHA) resigned in protest in June.

HIV is just one of the many public health issues facing our country, and efforts to prevent and treat it could be hampered by the Trump administration’s constant efforts to destroy people's health insurance as well as its backwards attitudes on addiction and on sex education. To say that the stakes are high when it comes to other sexually transmitted infections would be an understatement. According to the Centers for Disease Control and Prevention’s most recent surveillance report, bacterial STI rates hit record numbers for the third year in a row.

Last year, chlamydia cases increased by 4.7 percent, gonorrhea by 18.5 percent, early syphilis by 17.6 percent, and congenital syphilis (newborns who contracted it in the womb) went up a staggering 27.6 percent. Young people ages 15 to 24 continue to make up most of the reported chlamydia and gonorrhea infections, and syphilis is also on the rise in that group. Left untreated, these diseases can have severe long-term consequences, including pelvic inflammatory disease, infertility, stillbirths, and organ damage.

While the CDC provides a very clear picture of these rising rates, they don’t analyze why it’s happening. In an emailed response, CDC spokesperson Elizabeth Davenport explains that socioeconomic factors can impact access to testing and early treatment. Physicians’ lack of awareness of syphilis, once a rare disease, is another possible contributor, she says.

Without a holistic approach, public health can also turn into a game of Whac-A-Mole: You combat one problem, but another pops up. Janeen Burlison, senior director of quality at Planned Parenthood of the Pacific Southwest, suggests that preventive treatment such as pre-exposure prophylaxis (PrEP) to combat HIV transmission and the rise of long-acting reversible contraceptives like IUDs could be leading to riskier behavior and reduced condom use. “People don’t have the same fears and concerns as they once did,” Burlison says.

Indeed, HIV diagnoses declined from 2010 to 2014, the unintended pregnancy rate is at a 30-year low, and teen births are at a record low—all while STI rates have skyrocketed. But the most vulnerable populations still face a higher risk: African-American men have the highest diagnosis rates, and though HIV is largely considered an “urban disease,” Southern states are seeing a rise in rural and suburban areas.

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So, in an ideal world, where would the government focus its efforts to halt this upward STI trend? John Santelli, professor of population and family health at the Columbia University Mailman School of Public Health, breaks it down into three parts:

Screening. “We have good tests for the common STIs and in many cases, you can diagnose it by looking at the patient.” He points to promising innovations such as home self-testing kits, extragenital testing on rectal and perianal sites, and urine-based tests that can circumvent the discomfort of a pelvic or penile examination.

Treatment. “Most bacterial STIs—gonorrhea, chlamydia, and syphilis—are treatable and curable, so on a population level, you can protect many [others] with treatment.”

Prevention. “That involves using protection and reducing the number of sexual partners.” (And teaching people how to use said protection properly.)

And yet, in the shadow of record STI rates, the Trump administration seems to be headed precisely in the wrong direction by reducing access to testing, treatment, and comprehensive sex ed at every opportunity.

It stands to reason that STI rates will increase bigly in this environment. “I think a lot of people are very worried about that,” Santelli says. “Many of the things that we’re talking about—testing, screening, diagnosis, and then using treatment as a prevention method—are threatened by government. Groups like Planned Parenthood and many of the Title X providers do a lot of prevention work, like providing the HPV vaccine, and that’s in jeopardy.”

If you're not familiar, Title X is the federal grant program that helps provide comprehensive family planning services; in May, Trump signed a bill that allows states to withhold Title X funds from clinics that provide abortions outside the cases of rape, incest, and to save the mother's life. But clinics can't use federal funds for such abortions in the first place, so this bill essentially means providers could have less money for things like birth control, Pap smears, and, yes, STD testing.

As STI numbers go up year after year, experts have pointed to budget cuts in treatment and prevention programs, and the resulting clinic closures that limited access to healthcare. The federal government helps fund state and local STI programs through the CDC and such cuts could have devastating effects. While the CDC wouldn’t speculate on cause and effect, Davenport writes that “previous research does suggest that reduced public funding can influence STD prevention services and can be associated with increasing STD rates.”

Let’s take a look at a few more backwards decisions made or proposed by the federal government that could affect STI rates, shall we?

- The Department of Health and Human Services announced it would end funding—$213.6 million, to be exact—for the Office of Adolescent Health’s teen pregnancy prevention programs and research, which include sex education, STI testing, and studies on the effectiveness of programs to reduce STIs.

- Trump’s 2018 budget proposal called for 17 percent less federal funding for STI prevention and 18 percent less for domestic HIV/AIDS prevention and research (see page 8).

- To date, the government has yet to come to an agreement to reauthorize the Children's Health Insurance Program (CHIP), which provides insurance for 9 million children and teens up to age 19 from low-income families. (Again, the majority of reported chlamydia and gonorrhea infections are in people ages 15 to 24.) CHIP funding expired on September 30. If it’s not reinstated, six states and Washington, DC, will run out of federal funding by December, and 25 additional states will run out of funding by the first quarter of 2018, according to Politico.

- Medicaid is under constant threat of being cut, despite the fact that the health insurance program covers 40 percent of low-income adults and one in five American women of reproductive age.

- The many GOP-led healthcare bills have all included some form of “defunding” of Planned Parenthood, i.e. excluding it from Medicaid. Planned Parenthood provided close to 4.3 million STI tests and treatments for men and women in 2015, including tests for HIV and treatment for HPV.

- Last, but certainly not least, Congress has added $15 million in new funding for ineffective abstinence-only-until-marriage programs, bringing the total to $90 million.

In an op-ed for the Washington Post, Santelli, the author of a recent study on this kind of sex ed, wrote, “Research about abstinence-only programs is already quite clear…They don’t work, and they don’t prepare young people for life.” (Pence said in a 2002 interview that "abstinence is the best choice for young people" and claimed that condoms have "zero preventative value" for certain STIs.) Truly, you only need to talk to someone who grew up with abstinence-only education to learn just how fruitless it can be. Lindsay B., a 31-year-old artist, recalls her high-school education in a fundamentalist church in rural Pennsylvania.

“It came up almost daily that we shouldn’t have sex, masturbate, or watch porn, but in terms of what to do, that never came up,” says Lindsay, who now lives in Baltimore. “The rhetoric was that you had sex when you got married and you had the rest of your life to figure out how to enjoy it.”

Lindsay recalls several girls in her tiny school getting pregnant (and subsequently expelled), while others went on to have unintended pregnancies soon after graduating. As for her own experience: “When I went to college, I was years behind everyone. I was embarrassed that I didn’t know how anything worked, and I just wanted to be normal.”

“Sex ed is the foundation for everything that comes later in sexual health,” says Debra Hauser, president of the Washington, DC-based Advocates for Youth. “If young people are not given honest information, we can’t expect them to make good decisions, get services, and use contraception.”

In fact, multiple studies have shown that comprehensive sex-ed programs have exactly the desired consequences: Young people are more likely to delay sexual activity, reduce their number of partners, and use protection. Studies have also shown that introducing sex ed to adolescents doesn't lead to more young people taking that as permission to have sex or increase promiscuity.

However, Hauser points out that even in a quality sex-ed program, some administrators still shy away from sharing critical information. “If they’re giving information on condoms, they don’t want to do a condom demonstration," she says. "Americans, in general, still are not comfortable with sex and sexuality, and they’re very uncomfortable with youth and sexuality.” (In Mississippi, which has the highest gonorrhea rates in the country, sex educators are actually banned from using condoms for in-class demonstrations.)

The real crux of addressing STIs is that everyone, especially public health officials, has to acknowledge the fact that as many as 41 percent of high schoolers have had sex, making them vulnerable to contracting life-altering infections. (Even adults 65 and older are engaging in risky behavior.) Because right now, the Trump administration may very well be leading us straight into a public-health crisis, or at least trying its best to make gonorrhea great again.

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