Earlier this week, the Centers for Disease Control and Prevention released its annual report on STDs in the United States, announcing that, in 2018, the total number of cases of gonorrhea, chlamydia, and syphilis reached an all-time high of 2.4 million. Its the fifth consecutive year of record STD rates. In the report’s foreword, Gail Bolan, director of the CDC’s division of STD prevention, noted that it wasn’t long ago that “gonorrhea rates were at historic lows, [and] syphilis was close to elimination.”
“That progress has since unraveled,” Bolan wrote.
CDC officials say one factor contributing to the ballooning STD rates is a lack of access to preventative healthcare services. Therefore, curbing the spread of STDs requires federal, state, and local programs to expand access and promote “sexual, reproductive, maternal, and infant health,” according to the report.
Yet a recently implemented federal family-planning policy is doing just the opposite, experts say. The Trump administration’s revised Title X rule has not only forced hundreds of clinics that provide comprehensive reproductive healthcare to forego federal funding—pushing at least two of them to shutter so far—but it’s also allowed that money to go to organizations that are openly opposed to evidence-based methods of preventing STIs and unintended pregnancy, namely condoms and birth control.
Reproductive health advocates say the combination of these two phenomena could make STI rates worse.
“Scaling back services really affects the ability of people to know their [STI] status and receive treatment,” said Usha Ranji, associate director for women’s health policy at the Kaiser Family Foundation. “STIs are also disproportionate among young people and in some cases they’re also higher among low-income populations: Those are the people who use Title X programs, and whom the program serves.”
Until Planned Parenthood was forced to leave the federal family-planning program, the organization served roughly 40 percent of the four million patients in the U.S. who received care through Title X—that’s 1.6 million patients.
"STIs such as chlamydia, gonorrhea, and syphilis often don’t have symptoms, which is why it’s so critical that people get tested and know their status, so that they can seek treatment and stay healthy,” Courtney Benedict, associate director of medical standards implementation at Planned Parenthood Federation of America, said in a statement. “Yet the Trump administration is doubling down on its agenda to attack health care providers like Planned Parenthood—making STI testing and treatment increasingly out of reach."
Obria Medical Clinics, a chain of Christian health centers, is one of the groups that has received government funding—in the amount of $1.7 million, and as much as $5.1 million over three years—through the new Title X policy. The organization has said it will comply with the CDC guidelines for STD prevention; however, Obria refuses to provide or even promote the use of condoms, bucking CDC recommendations. Instead, Obria’s staff advocates for abstinence as the sole form of STD prevention.
“By reducing sexual risk, you would have less women getting sick with STDs and [cervical] cancer and pregnancies,” Obria CEO Kathleen Bravo said in a 2018 statement. “In other words, teach them to not even go down that path.”
Obria did not respond to VICE’s request for comment.
Debra Hauser, the president of Advocates for Youth, an organization dedicated to promoting sexual health among young people, said Obria’s abstinence-only approach has long been discredited.
“We’ve known for decades that the best way to prepare young people to protect their health is to provide honest, complete sex education that gives them the tools they need to prevent unintended pregnancy and STDs,” Hauser said.
In addition to denying young people the resources they need to have safe sex, groups like Obria are also heaping shame onto the very idea of sex, Hauser said, which can discourage them from seeking out help and education elsewhere.
“It’s propagating stigma and misinformation while doing nothing to help prevent STDs,” Hauser continued. “If we want young people to protect themselves from STDs, we have a responsibility to give them the information and skills they need, as well as providing reproductive and sexual healthcare services and making sure condoms are available.”
Whereas Title X once helped establish a standard of care among family planning providers, experts say that has become more lax under the new rule, allowing groups room to promote their own agendas.
The CDC and the Office of Population Affairs’ official recommendations for providing Quality Family Planning (QFP) services—which encourage healthcare providers to offer a range of STD services and birth control methods—are no longer incorporated in the new Title X policy.
“The new final regulations define family planning as including abstinence, natural family methods, and effective contraceptive methods, but exclude abortion services,” reads a Kaiser Family Foundation report following the policy change. “The regulations do not incorporate any of the other elements of CDC and OPA recommendations.”
Brittni Frederiksen, one of the authors of the KFF report and a senior policy analyst at the foundation, argues that this is an overlooked consequence of the new Title X rules: It’s not just that the Trump administration’s new guidelines reduce access to care; the guidelines also diminish the quality of care.
“These recommendations became the gold standard,” Frederiksen said. “When you no longer have the standards established by Title X, the quality of services could differ based on what clinic you go to.”
And, in some places, that could mean patients wont even receive condoms.
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