Why Have STD Rates in the U.S. Continued to Rise?
Early last month, as the country stockpiled condoms in preparation for 'Hot Vax Summer,' the CDC released its 2019 STD Surveillance Report, showing a rise in STD rates for the sixth consecutive year.
The report's findings don't exactly make for sexy reading. Roughly 2.5 million cases of chlamydia, gonorrhea (which are frequently conflated) and syphilis were recorded, a figure that marks an all-time high. Young people, gay and bisexual men and Black, indigenous and Latino Americans were found to have higher rates of infection, and preliminary data released by the National Coalition of STD Directors indicates the COVID-19 pandemic, which saw sexual healthcare professionals deployed en masse in frontline relief efforts, only exacerbated the problem in 2020.
The CDC's release highlights a handful of key factors driving this rise, such as "poverty, unstable housing, drug use [and] lack of medical insurance or regular medical provider," but according to Aleece Fosnight, an experienced physician's assistant and sexual health educator in North Carolina, the sustained increase comes down to a lack of education. "There's been a huge switch in sex education," she explained, saying schools have taken a "Puritan-style approach" since the late 1990s.
This was due to the 1996 establishment of a federal program to exclusively fund "abstinence-only-until-marriage" (AOUM) programs, a victory for the Catholic Right that came after more than a decade of lobbying for classes that promoted "self-discipline and other prudent approaches to sex", according to Planned Parenthood. Funding has fluctuated over the decades, although President Trump was a supporter—his administration pumped $85 million annually into the program's funding, according to a 2016 article in the Journal of Adolescent Health.
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"In these classes, what gets left out is that people are still engaging in anal play, oral play and more," continued Fosnight, who argued this conservative approach to sex-ed treats "penis-in-vagina sex as the default."
The overrepresentation of young people, gay and bisexual men and Black, indigenous and Latino Americans can be attributed partly to this lack of sex ed, but discrimination also plays a role. Fifteen percent of LGBTQ+ respondents had postponed or avoided medical treatment due to discrimination, according to a 2020 survey by the Center for American Progress, and a 2018 article in Health Equity found that “the historical context of racism continues to shape the sexual and reproductive health of African American women.”
Some states now mandate more inclusive, evidence-based and secular alternatives to AOUM, but there are still no national guidelines. "Today, only 29 states and Washington D.C. require sex ed," said Susan Gilbert, co-director of the National Coalition for Sexual Health (NCSH), referencing data collated by nonprofit sex education organization SIECUS. "Of those 29 states, only seven require positive, inclusive content relating to gender identity and sexual orientation. Without national standards, these programs are uneven and vary significantly in content, quality and effectiveness."
This goes some way toward explaining why 61 percent of 2019 chlamydia cases were recorded by young people ages 15 to 24, as well as 42 percent of gonorrhea cases. Gilbert also pointed to a decrease in popularity of condoms. "Even with all their different sizes, flavors, shapes and textures, they are not as popular as they used to be," she said. "And trends are moving in the wrong direction, particularly among young people."
61 percent of 2019 chlamydia cases were recorded by young people ages 15 to 24.
Cost is another key barrier. According to the Kaiser Family Foundation, 28.9 million nonelderly Americans were uninsured in 2019, and recently published research by Neeta Kantamneni, Ph.D., indicates that the COVID-19 pandemic has inflated these numbers and exacerbated existing inequalities.
The full impact of the pandemic remains unclear, but Forbes last year estimated 22 million jobs lost across the country in 2020 due to the pandemic, spelling disaster for low-income families whose insurance is tied to their employment. "Without health insurance, many people can't afford to get the STD services recommended to them, such as routine screening," Gilbert explained. "These services are vital to detecting and treating the many STDs that don't have any symptoms but can lead to serious consequences."
Finally, Gilbert pointed to "funding cuts to STI services at the federal, state and local levels." In the absence of these services, she recommended in-house NCSH resources like the Take Charge Guide and the Five Action Steps to Good Sexual Health, as well as other forms of self-education.
As well as advocating for fair access to healthcare, Fosnight remains convinced that open, nonjudgmental conversations are the key to reducing STI rates. "People are having sex, it's a fact," she concluded. "[Sex] is not only evolutionary, it feels good and it's great to have that connection with somebody. People are going to do this, so we can't keep sticking our heads in the sand. We can clearly see this tactic is not working."