A rise in sexually transmitted infections is an urgent call for action for Monroe County, William Valenti M.D. believes.
Valenti, co-founder, chief of innovation and staff physician at Trillium Health, recently authored a report titled “Sexual Health in Rochester/Monroe County.” Key findings of the ACT Rochester and Trillium Health report are sobering. In the first nine months of 2020, Monroe Country had 55 new HIV diagnoses—as many as in each of the previous four years. Cases of gonorrhea grew 77 percent last year, compared with 2019.
A mix of factors could explain the increase, Valenti says. They range from social determinants of health such as access to care, income and education, to limited funding for services that focus on sexual health. Increased screening, changing transmission patterns, and decreased condom use also account for some of the reported increases.
“State funding for sexually transmitted infections as either been flat or decreased, Valenti says. “In other words, we’re not putting the money into the kinds of services that people need to stay healthy. The ideal situation is to try and prevent infections whenever possible.”
The COVID-19 pandemic also has had an impact, he believes.
“In fact, because people have been inside more often doesn’t necessarily mean they’re not having sex (and they) may connect with people they might not know very well and don’t know about their (sexual) history,” Valenti notes. “And the other part of that is that during the pandemic, a lot of people have put off accessing health care, for one reason or another. They’ve stayed away from health care and have not been able to take care of some of those health problems that they would have gone (for) ordinarily.”
For a while, Trillium had switched to telehealth visits. Its Trillium At Home program sent kits to patients to collect their own specimens for sexually transmitted diseases. Patients were also able to perform an HIV test at home.
The report, funded by the LGBT+ Giving Circle of Rochester Area Community Foundation, found that more than half of sexually transmitted infections were among people younger than 26 years old. Non-Hispanic Black individuals, and gay, bisexual, and other men who have sex with men are at the highest risk for STIs.
Beyond demographics, “people tend to underestimate—and sometimes even deny—their risk for STIs in general and HIV specifically,” the report states. “This has been shown in younger people and adults older than 50 who fail to appreciate their risk for either STIs or HIV. The concepts of infection transmission are not well understood by many, which could lead to the disconnect in perceived vs. real risk of HIV or STIs overall.”
Ann Johnson, executive director of ACT Rochester, says people also tend not to report such infections, given the stigma associated with it.
“That’s a big part of the report, that we think things are underreported,” she says. “We also know that the Department of Health folks that normally are on these diseases and infections, they’ve been pulled away onto COVID.”
In addition, individuals who haven’t lived through the crisis of the HIV epidemic may not understand the gravity of a spike in infection rates and the need to pay attention to sexual health.
“Since HIV has become more manageable because of advances in treatment, in some ways it’s off the radar, and not a part of our consciousness or our discussion on a regular basis,” Valenti says. “So, our successes with HIV (put) the whole sexual health and sexually transmitted infection discussion on the back burner. During the height of the HIV pandemic, it was something that we discussed every day. And it was part of our day-to-day thinking, as opposed to today where it’s less so.”
The report makes a few key recommendations, urging providers to ask each patient details about their sexual history and drug use as a way to inform screening, treatment, prevention and education as part of a health care plan. Screening for STIs and HIV in all sexually active people and offering pre- and post-exposure to prevent HIV along with safe sex techniques to reduce exposure are among other suggestions. Educating the public is also vital.
A recent poll by the Kaiser Family Foundation found that large majorities of the public are unaware how common STIs are among U.S. adults. The Centers for Disease Control recently estimated that on any given day in 2018 (the year used for data), one in five people in the U.S. had a sexually transmitted infection. It translated into nearly $16 billion in direct lifetime medical costs resulting from the infections acquired that year.
The local data has made Valenti think about Trillium’s programs and how it can help the community adopt a preventive stance.
“What are we missing as a community, as health care providers, health educators, as parents?” he says. “We continue to evaluate our programs, how we communicate with people and try (to) get ahead of it. In other words, really trying to develop programs that are high-impact prevention.”
Smriti Jacob is Rochester Beacon managing editor.