The state of Alaska's sexually transmitted disease (STDs) prevalence analysis presents a mixed picture. On the one hand, the state is topping the lists of worst-hit states in the USA for chlamydia and gonorrhea but has the lowest rates for syphilis and HIV.
However, according to the Centers for Disease Control and Prevention (CDC), a disturbing trend is observed in Alaska over the past five years: the rate of primary and secondary (P&S) syphilis has more than doubled since 2018. The numbers are startlingly high, and a somewhat similar scenario is reported for chlamydia and gonorrhea.
Since the start of the AIDS epidemic, researchers have noted a solid epidemiologic correlation between STDs and HIV/AIDS in the USA. In May 1997, the Advisory Committee for HIV and STD Prevention (ACHSP) examined the relation between curable sexually transmitted diseases (STDs) and sexual transmission of human immunodeficiency virus (HIV) risk.
The committee declared that there was enough evidence to suggest that early detection and treatment of curable STDs can effectively help in preventing sexually transmitted HIV infection. Hence, early diagnoses and treatment of common STDs must become a significant and explicit component of comprehensive STD/HIV prevention programs at national, state, and local levels.
If you don't want to get infected with HIV or get exposed to other, lifelong, drastic consequences of STDs, it is essential to get tested. This becomes particularly crucial if you are sexually active or have multiple partners. Many believe that using protection is enough to prevent sexually transmitted infection (STI), which is a misconception. A person can have an STD without detecting any signs or symptoms. That's why these are called STIs since experts claim you can have an infection without experiencing disease symptoms.
Regular screening is the only effective strategy to keep your sexual life healthy and physical health thriving. The frequency of testing depends on several factors, such as your sexual behaviors, age, and other risk factors.
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In 2018-19 Alaska reported the highest chlamydia in the country and the second-highest gonorrhea rate, revealing the most recent STD surveillance report released by the Centers for Disease Control and Prevention (CDC). Alaska reportedly had the highest per capita rates of chlamydia among all US states. This trend has been noted since 1996, though. Since October 2017, reports CDC, Alaska has been undergoing a gonorrhea outbreak. CDC reported that in 2018, there were over 6,150 chlamydia cases and around 2,247 gonorrhea cases in Alaska. The Alaska Department of Health and Social Services stated in a press release following this report that "High STD rates are not unusual news for Alaska, but they are alarming and should serve as a reminder to Alaskans to practice safe sex and get tested."
In 2017, the number of new gonorrhea cases in the state increased by a whopping 51% compared to 2016's statistics. Preliminary data suggested that Alaska ranked fourth for overall STDs rates in the USA in 2016. Still, in 2017, it recorded almost twice as many cases with gonorrhea cases exceeding 2,190 or 297/100,000 people compared to 197/100,000 people in 2016. For years, Alaskans have exceeded the national average in gonorrhea rates. Alaska is also struggling to control chlamydia rates in the state. Since 2001, the state has been topping the list of highest chlamydia rates in the country.
In 2017, under 6,000 Alaskans were diagnosed with chlamydia, and the state ranked 40th in countrywide lists, but after accounting for population variations and adjustments, the state moved up to number one for reporting at least 50% higher rates than anywhere else in the country.
In 2018, the state health department issued a warning of a syphilis outbreak as that year Alaska recorded more cases since 2013. Although the state ranks 21st nationally and its syphilis cases are lower than the national average. However, since 2017, Alaska health officials have noted a 300% increase from previous years in syphilis cases of all stages, including the most threatening primary and secondary syphilis stages. In 2018, more cases of P&S syphilis were reported than the combined number of cases reported between 2014 and 2017.
The Anchorage/Mat-Su region, including the City of Anchorage, was the worst-hit region as nearly half of all reported chlamydia cases in Alaska in 2016-17 were from this area. The Interior region, including Fairbanks, accounted for 15% of all chlamydial infections. Around two-thirds of all reported gonorrhea cases in the state were diagnosed in Anchorage area residents, whereas 85% of people diagnosed with any stage of syphilis lived in Anchorage's urban centers, Fairbanks or Juneau.
Reportedly, around 58% of all reported gonorrhea cases in 2018 in Alaska were diagnosed in people aged 29 or younger. The cases were evenly split between males and females. Southwest Alaska reported the highest rate of gonorrheal infections, followed by the Anchorage, Matanuska-Susitna, and Northern Alaska regions.
During 2018, over 114 syphilis diagnoses were reported to the Alaska Section of Epidemiology. In 2019 the number increased to 242 cases, thus marking a 112% increase in cases within a single year. At least 86% of the cases were newly acquired and classified as infectious. Out of the 207 syphilis cases in Alaska during 2018, 65% were diagnosed in males, 44% of them identified as men who have sex with men, whereas 52% were men who have sex with women.
At least 35% of the reported diagnoses were in females. 97% of the females were of childbearing age. Almost 90% of them were heterosexual, and 4% were bisexual. Around 94% lived in urban communities, and their age ranged between 15 and 85 years. It was identified that 35% of the infected people were diagnosed with at least another STD or known HIV infection.
Gonorrhea and chlamydia outbreaks have been concentrated in the Alaska Native communities residing in rural Alaska, particularly the southwestern and northern parts of the state. The latest available data on Alaska Native communities' STD prevalence is from 2010, which indicates that the southwestern region reported a gonorrhea infection rate of 1,125/100,000 people. That was ten times the national average back then. The hub city of Bethel and Yukon-Kuskokwim Delta regions were the epicenters of STDs in Alaska along with the Arctic northwest.
The chlamydia infection rates in Alaska Natives were six times higher than White Alaskans, reported the Alaska Native Tribal Health Consortium. Young people were the most at-risk group of the population in this context mainly because they are most likely to indulge in high-risk sexual behaviors.
The disproportionately low rates of diagnosis and treatment of STDs in Alaska a Native people and those living in rural Alaska seem to stem from several factors. These include factors like confidentiality/privacy concerns, scarce healthcare resources, and geographic isolation. Moreover, the use of conventional clinical methods of STD testing is also limited in rural areas. In 2011, an at-home STD testing service was launched by the Alaska Native Tribal Health Consortium (ANTHC) to address these challenges. The I Want the Kit–Alaska (IWTK–Alaska) initiative was launched in collaboration with the IWTK program of the Johns Hopkins University.
As per the guidelines of this initiative, any Alaska resident aged 14 or above can order a free STD test kit via www.iwantthekit.org. The kit allows the user to collect rectal or genital samples at home and mail them to the department to test for common STDs. John Hopkins maintains the website, and it also performs all laboratory testing and manages kit distribution. Conversely, ANTHC is responsible for marketing the service, providing phone-based risk analysis and counseling, and informs the participants about their results. Positive cases are reported to the state, and people who have tested positive are provided access to their closest treatment services.
This statewide initiative aims to compel people to get tested, especially the high-risk population groups including Alaska Natives, females, rural Alaskans, Alaska Indians, and anyone aged between 15-29.
The program has launched an extensive advertising campaign called Wrap It Up Alaska in partnership with the Alaska Division of Public Health to reach out to these groups. Wrap It Up Alaska is a state-funded social marketing campaign that yielded favorable results. The number of kits tested via IWTK-Alaska increased from 186 in 2012 to 304 in 2014, marking a 63% increase. This increment was primarily noted among high-risk populations.
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