A new analysis by the Centers for Disease Control and Prevention (CDC) documents the dangerous intersection of HIV and other sexually transmitted diseases (STDs) in many U.S. communities and finds a gap in health services that may be contributing to the spread of HIV infection in the United States. This analysis concludes that improved STD treatment is likely to have an impact on HIV prevention.
The analysis, presented by CDC researcher William Kassler, M.D., at the 12th World AIDS Conference, examines data from 1990 to 1997 to identify areas dually impacted by both the STD and HIV epidemics. In areas where rates of HIV and STD are highest, Kassler explores the availability of STD treatment services. The analysis illustrates the importance of eliminating barriers to obtaining high quality testing and treatment for STDs, especially for people with HIV and those at greatest risk for infection.
Because the presence of other STDs greatly increases the risk of sexual infection with HIV, CDC believes improved STD treatment could greatly slow the spread of the HIV epidemic. Improved STD treatment in Tanzania was shown to reduce HIV transmission by 40 percent. While the potential impact of such a program in the U.S. cannot be precisely quantified until implemented, the rates of STDs among certain groups at high risk for HIV suggests that the impact could be significant.
Kassler and colleagues found that the combined impact of HIV, syphilis, and gonorrhea is greatest in the Southern region of the U.S. In some Southern communities, 4 percent of young women 15 to 24 years of age were infected with gonorrhea, and the prevalence of chlamydia was almost 10 percent.
Rates of certain STDs in some young women in the U.S. mirror rates found in African women," commented Helene Gayle, M.D., M.P.H., Director of CDC's National Center for HIV, STD and TB Prevention. "Given the impact STD treatment has had in reducing HIV infection in Tanzania, we believe STD treatment may reduce the sexual spread of HIV in our own country." But CDC researchers find numerous barriers to effective STD treatment that must be overcome to truly impact the HIV epidemic. Kassler and colleagues find that STD services are often lacking for populations at high risk.
A review of national STD services finds that only 50 percent of local health departments provide any STD treatment services at all, and many lack evening or weekend services. Ninety percent of clinics in areas with high STD rates have to turn clients away due to limited resources.
Too many people at risk for STDs are being turned away from needed services and care," said Kassler. "The tragedy is that we have the tools to treat, cure and suppress most common STDs, but many cannot or do not access them."
In addition to extending public services, CDC points to the need for private health care providers to play a greater role. "While more than half of people treated for STDs seek care from private providers, private providers are much less likely to take sexual histories and screen young women for common STDs," stressed Kassler.
CDC is working to expand public and private sector partnerships to combat the STD epidemic. By identifying the areas where STD treatment can have the greatest impact on reducing the toll of STDs and HIV infection among women, the agency hopes to jumpstart efforts in these communities. "CDC is committed to improving programs to reach individuals at highest risk for STDs and HIV," said Gayle, "But the public sector cannot combat these epidemics alone. Every citizen, health care and public health providers, community leaders, and educators all have a role to play."