Free STD Testing in District of Columbia

Why Testing Matters?

According to the senior deputy director of the HIV/AIDs, Hepatitis, STD, and TB (HAHSTA) in the District of Columbia Department of Health, Michael Kharfen, regarding STDs, the reported chlamydia, gonorrhea, and syphilis infections have dropped considerably. However, these are still higher than everywhere else in the country. Although multiple factors contribute to the spread of STDs, such as insufficient access to STD testing and medical care, and individual's socioeconomic status, and other social circumstances, it is a fact that STDs are constantly rising in this district.

Sexually transmitted infections (STIs) have been rising in the United States, as per the 2018 report released by the Centers for Disease Control (CDC). Nationwide surveillance figures indicate a concerning 67% rise in gonorrhea incidence between 2013 and 2017, a whopping 35% rise in chlamydia, and almost double the rate of syphilis during this period.

The District of Columbia (DC) reported one of the highest HIV prevalence rates across the country, while the district boasts 1.9% of the general population according to 2017 data. Sexual transmission, particularly among men who have sex with men (MSM), was a crucial driver of the HIV epidemic in the District of Columbia. That's because STIs are a well-known marker of HIV vulnerability, acquisition and transmission. A key area of focus of the DC Department of Health recently has been encouraging people of all ages, races, genders, and sexual orientations to get screened for STDs and STIs.

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STD Statistics in DC

According to CDC's 2018 STD Surveillance Report, DC stood out as one of the leading areas in the country for high STD incidences. In 2018, DC reported 1,298.2 chlamydia cases per 100,000 population compared to West Virginia, which reported over 800 cases per 100,000 people. During the same time, DC's gonorrhea incidence rate was 611.0 cases/100,000 people, significantly higher than Vermont, which reported 43.0 cases/100,000 people and Mississippi, where just over 326 cases were reported that year. The rate of primary and secondary syphilis cases in the District of Columbia was

In 2019, as per the data released by the DC Department of Health in its 2020 HIV/STD Surveillance Report, there were 9,337 chlamydia cases, 4,374 gonorrhea cases, and around 297 syphilis cases (primary and secondary) reported in DC. About 37% of the syphilis cases occurred among people living with HIV, but this rate has declined 43% since 2015.

It is worth noting that DC has observed a 70% rise in the number of gonorrhea cases as it recorded 2,579 cases in 2015, which increased to 3,485 in 2016, 4,647 in 2017, 4,256 in 2018, and 4,374 in 2019. On the other hand, DC has observed a 26% rise in chlamydia diagnoses across the region, with 7,386 cases reported in 2015, 7,879 in 2016, 9,413 in 2017, 9,013 in 2018, and 9,337 in 2019.

Age, Gender, and Ethnic Disparities

As per the CDC STD Surveillance Report 2018, half of the STD cases in the country and DC occur among people aged 15-24. This is an alarming situation as people are getting infected with a life-threatening disease at such a young age. Apart from the impact of rising STD cases on the public health and well-being of a young demographic, this is an economic drain on the overall healthcare system as STD testing and treatment costs billions to the country every year.

In its 2015 DC health profile, CDC revealed that the district reported 11.98.1 chlamydia cases and over 416 gonorrhea cases per 100,000 people. Reportedly, females were 1.3 times more likely to contract an STD as they accounted for 1337.6 cases/100,000 people compared to males with 994.2 cases/100,000 population. The rate of primary and secondary syphilis was over 26 cases per 100,000 individuals in 2011, which decreased to over 14 cases/100,000 people in 2015. The district reported four cases of congenital syphilis between 2011 and 2015.

The surveillance data released by the DC Department of Health in 2020, one congenital syphilis case was reported in DC in 2019. Among the overall 297 syphilis cases reported in 2019, nine out of ten diagnoses were males, two in three diagnoses were among men who have sex with men, one in two cases were diagnosed in African-Americans, and one in four infected individuals were aged 30-39.

Regarding gonorrhea, in 2019, two in five diagnoses were reported in people aged 20-29, and seven in ten cases were reported in males. Nearly 1.9% of DC residents aged 18-19 acquired gonorrhea in 2019. Conversely, one in five chlamydia infections were diagnosed among people aged 13-19 in DC, and one in two were aged 20-29. Moreover, 5.4% of DC residents aged 18-19 acquired chlamydia in 2019.

State Initiatives

In 2016, DC Mayor Bower released the 90/90/90/50 Plan to End the HIV Epidemic by 2020, but the expected results weren't achieved. Although there has been steady progress and the district met the plan's first goal, there is still a dire need to enhance and improve the accessibility, availability, and acceptability of STD/HIV testing and treatment services. It must be noted that the US Department of Health and Human Services launched the Ending the HIV Epidemic Initiative. The program focused on 48 counties, 7 rural states, and 2 cities, including DC and Puerto Rico.

The District of Columbia Center for AIDS Research (DC CFAR) is headquartered at the George Washington University Milken Institute School of Public Health and has received supplemental funding from the NIH (National Institutes of Health) to research ending the HIV/STD epidemic. The DC CFAR is among the 19 NIH-funded Centers established specifically for AIDS Research in the country to reduce the domestic and global STI burden.

The Sexual + Being initiative is another important step to spread awareness about the dangers of unprotected sex, HIV and STDs. It is a project from DC Health's HIV/AIDS, Hepatitis, STD and TB Administration (HAHSTA). The program offers innovative schemes to attract people to get tested for STDs and HIV. From offering free condoms to free testing and PrEP medication and other treatment options, Sexual + Being is working towards changing public perceptions about STD screening and opening up to the idea of sexual health.

References

• CDC, 2017. District of Columbia - 2015 state health profile . cdc.gov. Available at: https://www.cdc.gov/nchhstp/stateprofiles/pdf/district_of_columbia_profile.pdf
• CDC, 2019. Sexually Transmitted Disease Surveillance 2018. cdc.gov. Available at: https://www.cdc.gov/nchhstp/newsroom/2019/2018-STD-surveillance-report.html
• DC CFAR, 2021. DC CFAR awarded NIH funding to implement Administration's HIV initiative: Milken Institute SPH. publichealth.gwu.edu. Available at: https://publichealth.gwu.edu/content/dc-cfar-awarded-nih-funding-implement-administration%E2%80%99s-hiv-initiative
• DC Health and Wellness Center, 2018. Sex in DC: Sexual health: District of columbia: Sexual + being. Sex Positive. Available at: https://sexualbeing.org/sex-dc/
• District of Columbia Department of Health HIV/AIDS, Hepatitis, STD, and TB Administration (HAHSTA), 2020. Annual Epidemiology & Surveillance Report. dchealth.dc.gov. Available at: https://dchealth.dc.gov/sites/default/files/dc/sites/doh/publication/attachments/2020-HAHSTA-Annual-Surveillance-Report.pdf
• McGowan, E., 2020. The true story behind the high DC Sti Rates: The blog: Sexual + being. Sex Positive. Available at: https://sexualbeing.org/blog/the-true-story-behind-the-high-sti-rates-in-dc/
• Secco, A.A. et al., 2020. Sexually transmitted infections in persons living with HIV infection and estimated HIV transmission risk: Trends over time from the DC cohort. Sexually Transmitted Infections, 96(2), pp.89–95.