Economic crisis impacts health department capacity to address rising STD rates

Amid the mounting toll of budget cuts across the country, a new study from the National Coalition of STD Directors (NCSD) shows just how much an impact the economic crisis is having on sexually transmitted disease (STD) programs and in turn, having more broadly on public health infrastructure.

"These cuts threaten our national ability to control both STDs and our entire public health infrastructure," said Dr. William Wong, lead author of the study, NCSD Board member, and STD Program Director for the Chicago Department of Public Health.

The new study is based on a recent survey of states, large U.S. cities, and U.S. territories and documents the struggle of health departments across the nation to sustain the severe cuts in state and local funding enacted over the past few years. These cuts, coupled with the long-term effects of flat or declining federal resources, have severely hampered the ability of STD programs to maintain an adequate workforce and to keep pace with the increasing demand for STD testing and treatment services and the rising rates of STDs.

The majority of STD programs surveyed (69%) experienced funding cuts between 2008 and 2009 and such cuts are taking a toll. For example, the study shows that between 2008 and 2009, thirty-nine clinics supported by state and local STD programs closed their doors due to inadequate funding. And STD programs are not alone. A recent survey of state HIV programs, conducted by the National Alliance of State and Territorial AIDS Directors (NASTAD), found that in Fiscal Year 2009, 74% of sister HIV programs experienced cuts to prevention activities as a result of state funding cuts.

The NCSD study also documents that over the past decade, demands on STD programs have increased while programs' capacity to provide essential services such as STD screening, treatment, and partner services have diminished, leaving the most vulnerable populations and communities at-risk for the consequences of untreated STDs and HIV.

In one specific case, the number of Disease Intervention Specialists, the frontline public health workers comprising nearly half of the STD program workforce in health departments, declined nationwide by 20% over the last decade. Such reductions in workforce capacity have been widespread in health departments across the nation. In addition, 69% of STD programs nationwide that receive funding from state and local governments have experienced salary freezes or reductions and 27% have experienced layoffs.

"These workers are the real soldiers in our fight against STDs, flu outbreaks, tuberculosis, and other communicable diseases," said Wong. "We can't afford any more troop cutbacks," he added.

Diminished capacity and resources for core STD work have occurred at the same time that STD programs have been playing a key role in the nation's public health readiness; more than two-thirds of STD programs directly participated in H1N1 influenza outbreak activities in Spring 2009, and almost three-quarters of STD programs anticipate participation in H1N1 response during the 2009-10 influenza season.

The NCSD study comes on the heels of new data released today by the Centers for Disease Control and Prevention (CDC) showing persistent and staggeringly high rates of STDs, as well as a disproportionate burden of infections on youth, minorities, women and men who have sex with men (MSM). In 2008, more than 1.2 million chlamydia cases were reported in the United States which represents the largest number of disease cases ever reported for any condition. African Americans remain highly impacted by STDs, accounting for 71% of all gonorrhea cases, and 48% of all chlamydia cases. Syphilis increased 18% between 2007 and 2008, with 63% of all syphilis cases reported among men who have sex with men (MSM). The consequences of untreated STDs include infertility, pregnancy complications, cervical cancer, pelvic inflammatory disease, birth defects and an increased risk of HIV transmission.

"Both the NCSD study and the new data released by the CDC underscore the immediate and real need for increased federal resources," said Suzanne Miller, Health Policy Manager for NCSD. While STD rates have consistently increased, funding has declined in recent years. Funding for the Division of STD Prevention at CDC has decreased by $6 million since Fiscal Year 2004. NCSD supports an increase of $299 million in FY 2010 for the Division of STD Prevention.

Ms. Miller continued, "As Congress works to finalize a comprehensive health reform package, the investments in prevention and public health must be robust, including rebuilding the public health infrastructure, addressing workforce capacity and working to eliminate health disparities."