By Charlie Severance-Medaris | July 2021
A QUICK LOOK INTO IMPORTANT ISSUES OF THE DAY
Many states are seeing positive developments with certain infectious disease rates. For instance, the annual number of new HIV diagnoses decreased by 7% from 2014 to 2018. Unfortunately, at the same time, many states have seen significant increases in the rate of new cases of other infectious diseases.
Since 2015, rates of new chlamydia infections have risen 19%, gonorrhea by 56% and syphilis by 74%. This includes a 279% increase in cases of congenital syphilis, which occurs when syphilis infection is passed from a mother to the fetus during pregnancy. In the same time frame, rates of hepatitis A infection increased by an unprecedented 1,325% due in large part to outbreaks reported in 31 states among people who use drugs and people experiencing homelessness. Rates of new hepatitis B and C infections are rising as well.
These infections are not affecting all communities equally. For instance, 39.1% of new congenital syphilis cases occurred among infants with Black mothers and 31.5% occurred among infants with Hispanic mothers in 2018. The same year, gay, bisexual and other men who have sex with men accounted for 69% of all new HIV diagnoses in the United States. A lower percentage of Black and Hispanic gay and bisexual men have discussed PrEP (pre-exposure prophylaxis), a medicine people at risk for HIV can take to prevent getting HIV, with a health care provider or have used PrEP within the past year.
In addition to the toll these diseases can have on individuals, treatment is costly for states. The average lifetime treatment cost of a person with HIV is $501,000 according to the Centers for Disease Control and Prevention (CDC). The estimated cost of providing health care services to people living with hepatitis C in the United States is $15 billion annually and recent hepatitis A outbreaks have cost states at least $270 million since 2016.
The good news is that these infections, and their associated treatment costs, are preventable. Improving access to screening services, vaccines and medications like PrEP, as well as other strategies like employing comprehensive syringe services programs, can prevent further spread of these infections and address health disparities.
Many people with a communicable infection are unaware of their status. For instance, an estimated 15% of people with HIV do not have a diagnosis and 40% of new infections are transmitted by people unaware of their status. Routine screening, at least once per year for high-risk groups, can lead to early detection and greatly reduce risk of transmission.
States are supporting increased screening in various ways. West Virginia’s statutes stipulate that health care providers should recommend routine HIV testing and that high-risk patients should be encouraged to undergo HIV testing at least annually. Connecticut requires private insurers to cover screening for HIV, chlamydia, gonorrhea, HPV, hepatitis B and syphilis. Kentucky requires pregnant women to receive hepatitis C testing. Texas requires syphilis testing in the first and third trimester, and as of 2019, at delivery. Texas also created the Newborn Screening Preservation Account to help cover the costs of expanded testing.
Increasing access to prevention medications can also reduce new infections. PrEP reduces the risk of getting HIV from sex by 99%, and by 74% among people who inject drugs. California and Colorado authorize pharmacists to dispense PrEP without a prescription from a doctor. Georgia created a three-year pilot program in 2019 to provide PrEP financial assistance. Washington requires the Department of Health to increase awareness about financial support for PrEP. New Mexico appropriated $107,000 in 2019 to improve awareness of PrEP and its benefits among health care professionals.
Comprehensive syringe service programs (SSPs), sometimes referred to as syringe or needle exchanges, also provide screening for infectious diseases, referrals to treatment for infections and substance use disorders, vaccinations for hepatitis A and B and access to PrEP. SSP use is associated with a 50% decrease in the risk of HIV transmission and individuals who use SSPs are more than three times as likely as non-users to stop injecting drugs.
Kentucky allows county health departments to operate SSPs that test for infectious diseases and provide hepatitis A and B vaccinations. Florida allows county commissions to authorize SSPs that can refer individuals to substance use disorder treatment and for screening and treatment of infectious diseases. Minnesota provided a grant of $367,000 to the Rural Aids Action Network to support syringe exchange services in rural parts of the state. Georgia encourages SSPs to include harm reduction counseling.
The federal government supports state efforts to prevent and mitigate infectious diseases. The Consolidated Appropriations Act of 2018 permits funds from the Department of Health and Human Services (HHS) to support SSPs with the exception that funds may not be used to purchase syringes. States can work with the CDC to allow for the use of federal funds to support SSPs. Currently, 44 states and DC, one tribal nation and one territory are permitted to redirect federal resources to support SSPs. Additionally, the CDC has many informational resources for SSPs, including a technical package of effective design strategies and a summary of SSP effectiveness and safety.
HHS launched the Ending the HIV Epidemic (EHE) initiative in 2019. This plan aims to diagnose new HIV cases quickly and connect individuals to treatment. To achieve maximum impact, the CDC is focusing resources on communities most affected by HIV—more than 50% of new HIV diagnoses occurred in only 50 localities. Additionally, HHS launched the Ready, Set, PrEP program to provide free PrEP HIV-prevention medications to thousands of people living in the United States, including tribal lands and territories.