Across Idaho, the number of people tested for sexually transmitted infections and HIV has become crater. The Department of Health and Wellbeing screens far fewer people than it did last year, and many community organizations conducting rapid HIV tests dropped out when the state’s home stayer went into effect on March 25.
“Those things have kind of stopped,” said Kevin Brinegar, an HIV prevention program specialist in the Idaho Department of Health and Welfare. “That is worrying.”
The number of sexually transmitted infections in the United States has risen steadily in recent years, with syphilis, gonorrhea and chlamydia that are one ever high in 2018. With COVID-19 attracting the majority of public health resources, local health departments fear they will lose even more ground.
“Once the dust settles on the coronavirus, we will learn about all the public health issues that we have been unable to address, and how big a problem they have got, as they are under the radar,” says Adriane Casalotti , head of government and public affairs with the National Association of County and City Health Officials (NACCHO).
The NACCHO examined local health departments across the country to see how their HIV, STD, and viral hepatitis programs were impacted by the efforts of COVID-19. Health departments reported that they had to cut or discontinue some services, and fear that those reversals will lead to the outbreak of diseases such as syphilis, HIV and chlamydia. The number of clusters has already increased in some jurisdictions.
Due to the pandemic, the STI and HIV programs have limited hours for testing and treatment clinics. “One of the most important things in the STI world is making sure you can do open test hours,” says Casalotti. “If you feel sick or not, you can come in, know your status, and get going. You can’t really do that anymore in this world of social distance. Clinics are also sending personal protective equipment to the front lines of the COVID-19 response.
In response, health departments are restructuring their priorities. Some reported that they were no longer able to start people on pre-exposure prophylaxis (PrEP) medications that can prevent HIV. “Individuals who have expressed an interest in PrEP will be lost for concern or [will] have been exposed to HIV by the time we can provide them with PrEP services, ‘said one department in their survey response.
Michigan county health departments have cut some of their services, says Kristine Tuinier, manager of the Department of HIV and STD Programs at the Michigan Department of Health and Human Services. “I don’t think anyone is running at full speed,” she says. Most focus on working with people who have positive STI test results or symptoms of an infection, and they may not screen people who are feeling well.
Clinicians perform a more robust assessment of each person who comes in for testing and treatment, she says, checking whether a physical exam is needed or whether they can be treated without that much contact. Clinics also use oral medications instead of shots (which require physical contact with clinicians) to treat STIs such as gonorrhea.
Many people in public health departments who usually work on STIs and HIV are also attracted to work on the COVID-19 response. Managing STDs in communities uses some of the same methods used in the COVID-19 response, namely contact tracking, the process of finding out who may have been exposed to a disease.
In Michigan, specialists divide their schedules, spend half their time on STD work, and half their time on contact tracking with COVID-19. Most health departments in Idaho don’t have researchers specifically dealing with STDs to begin with – their experts are all working on multiple diseases – but they now have less time to devote to that response.
“If you add something like that to the mix, it really gets on the priority list,” says Brinegar. “They keep up to date with their HIV and syphilis studies, but the way they do it and the time investment is more tailored.”
Those priorities remain skewed until the COVID-19 pandemic is better controlled and it is unclear how long it can take. “It’s not just that these people are being deducted from their day-to-day work in the STI room. It’s that they got it done and we can’t when they can get back to that job,” says Casalotti.
It is not clear what the long-term impact of the new cuts in the coronavirus can be for people at risk of various STIs. “We know that when we don’t pay attention to things, they bubble up and remind us,” says Casalotti. “That’s what could happen at the end of the coronavirus response.”
Many sexually transmitted infections can be asymptomatic, so it can take time for communities to realize they have an outbreak. If left untreated, they can also cause serious complications – so any undetected spread can have long-term consequences.
“Say you have one decrease in even the availability of condoms, ”says Brinegar. “If people rely on these clinic spaces to routinely pick up free condoms, then it suddenly shuts down – what will that translate to?”
However, the challenges ensure that health departments innovate in the way they provide care. Idaho’s health departments are examining test kits for several STIs at home. Michigan tries to be more agile in their work. “It has changed the way we look at everything,” says Gardener. “I think we have some important skills in how we do our job in the future.”
also the proposed extension of COVID-19 contact detection personnel could also benefit from STD and HIV programs in the future. The coronavirus pandemic has brought new attention to disease research experts.
“My hope is that when we can get back into our normal daily routine, there will be a community level awareness of who these people are – that they are not the sex police, they are just trying to ensure public health,” says Gardener. “I have the feeling that this will be a good outcome of all this. ”