State governments routinely compete with each other for top rankings in everything from education and economic development to taxes and transportation. These days Georgia is a national leader in at least one category it would just as soon forget: sexually transmitted diseases.
Based on data compiled by the Centers for Disease Control and Prevention, Georgia has some of the worst STD rates in the country. For 2011, Georgia ranked 4th among the 50 states and the District of Columbia for syphilis, 7th or gonorrhea and 8th for Chlamydia.
To a significant degree, the STD problem appears to be regional in nature. But in many cases, Georgia’s Southeastern neighbors seem to be doing a better job of managing their STD challenges.
In the five-year period from 2007 through 2011, for example, gonorrhea rates – the number of cases per 100,000 people – fell nearly 12 percent nationally.
Georgia trimmed its rate only 9.3 percent during that period. And while several Southeastern states have higher actual gonorrhea rates than Georgia, all except North Carolina saw more improvement in their rates than Georgia. Mississippi, for instance, cut its rate by nearly a third over the five-year period; South Carolina, Tennessee and Louisiana all saw reductions of more than 20 percent, and Florida and Alabama weren’t far behind with improvements of more than 18 percent.
For that same period, Georgia’s rate for primary and secondary syphilis has essentially been flat. The state has nonetheless ranked in the worst five for each of the past five years – a dubious distinction shared only by the District of Columbia and Louisiana.
Georgia actually had some significant improvement in its Chlamydia rates for 2008 and ’09, only to see the numbers deteriorate dramatically in 2010 and ’11. For the five-year period, Georgia’s Chlamydia rate increased 24.9 percent, slightly better than the national and regional average, but not enough to get the state out of the Worst 10.
The question is: why? Explanations for elevated rates vary, but some public health officials say that fear of talking openly about sex plays a role in keeping rates high, especially when it comes to teens and young adults who account for the majority of new STD cases in Georgia.
“Public health programs to prevent STDs have always been kept on the back-burner,” said Brenda Mims, the infectious disease coordinator for the Valdosta-based South Health District. “It’s just not something that anybody wants to talk about, so we don’t have the support for additional funding or a more balanced budget in those programs.”
Public shame hinders efforts to reduce STDs, not just in the South Health District, but for the entire state, said Ms. Mims.
People diagnosed with STDs are not always honest about the number of sexual partners they have had leading up to the infection, she said. As such, it can be harder for local health departments to reach out to those who could’ve been infected and are still unknowingly spreading the disease. Georgia STD rates may be even higher than what the current statistics show, she said.
Because of the taboo nature of the subject, the state often puts STDs last on the priority list, said Jennifer Parker, women’s health coordinator for the Gainesville-based North Public Health District.
“I don’t think our politicians really acknowledge that people are having sex,” she said. As a result, STD programs are among the first to be axed when the going gets tough.
Due to the poor economy, all public health programs have been cut to a certain degree in the last few years. For the Coastal Health District, which serves 16 counties, including Savannah’s Chatham County, STD programs have been hit especially hard as the state budget has been relatively unchanged while the cost of running these programs has risen.
In 2002, the state STD program had a budget of $5.5 million; 10 years later, it had crept up to only $5.7 million, according to the Georgia Department of Public Health.
This slight increase, Ms. Mims says, was insufficient to cover inflation, let alone rising demand.
“We can’t do the same things, perform the same tests, or provide the same care with the same budget we had five or 10 years ago,” she said. “Sadly, we can no longer do everything for free.”
Patients in the South Health District must now pay a fee, a minimum of $20 on an income-based sliding scale, for syphilis screenings that were once free to them, she said. Insufficient funds have also led to staff cuts, which result in longer waits at public health departments. Ms. Mims also said she believes added costs and wait times are both disincentives to being screened and could impact STD rates for the worse for her district.
For the Coastal Health District, budget cuts have eliminated some programs that target high-risk populations, like teens and young adults ages 15-24, said Hollard Phillips, the district’s infectious disease coordinator. This age group accounts for nearly 70 percent of all new STD cases in Georgia, according to the CDC. Out of the five teen clinics in the Coastal Health District that served them, only one has been able to keep its doors open, he said.
Outside of the teen clinics, students are reliant on a state-mandated abstinence-based sex education in public schools. This makes it even harder for public health officials to get their message across, said Philips.
In fact, in 2010 the Governor’s Office of Planning and Budget received $1.8 million in federal abstinence-only funding, according to the Sexuality Information and Education Council of the United States. That’s more funding than any other sex education initiative received — more than pregnancy prevention programs and evidence-based programs that provide students with medically accurate and age-appropriate information for the prevention of unintended pregnancy, HIV/AIDS, and other sexually transmitted infection.
The Coastal Health District has additional programs such as the Teen Maze, an interactive game between students and volunteers that focuses on life-choice consequences and evidence-based sex education curriculum implementation, said Trevor Thomas, lead epidemiologist for the district. In some instances, with administrative permission, the health department may bring the maze to schools and distribute educational materials about safe-sex, he said.
But it’s misleading to refer to most abstinence programs in Georgia as strictly abstinence-only, said Marcia Papst, spokesperson for Choosing the Best (CTB), an Atlanta-based company that manufactures abstinence-centered sex educational resources and guides. This would imply that abstinence-based programs do not provide any information about contraception, which is not true, she says.
CTB, like most abstinence programs in Georgia, promotes abstinence as the healthiest choice, but Ms. Papst insists that CTB still provides information about both the benefits and limitations of contraception to protect against STDs.
“We want young people to understand that condoms can only reduce, and not eliminate, STD risk,” said Ms. Papst. “We also don’t want to relay the message that [using a condom] is equally as safe as being abstinent as it’s often implied in many contraceptive-focused programs.”
Public officials agree that it’s unfair to single out abstinence-only education as the cause for increased STD rates among teenagers and young adults. For some young people, it’s not a matter of not knowing what precautions to take, or having an abstinence-only curriculum; it’s the refusal to think it’s ever going to happen to them, said Connee Martin, infectious disease coordinator for the North Public Health District.
“We’ve seen the same thing with sexually transmitted diseases as we have with car accidents,” she said. “Just like people know to use seatbelts, they still don’t because they think it’s not going to happen to them. The same goes with condoms and STDs,” she said.
Someone in denial is not going to get tested, especially if they don’t show any symptoms of an STD, said Ms. Mims. But untreated STDs have real consequences. They not only impact an individual’s short-term health, but can also have long-term effects. Many women who do not get proper treatment put their health, or the health of a future child, at serious risk, said Nikki Mayes, spokesperson for the CDC.
“If left untreated, chlamydia and gonorrhea can impact a woman’s ability to have children, and untreated syphilis can lead to serious, long-term complications, such as damage to the brain and heart. Pregnant women with an untreated STD can cause blindness to their baby, joint and blood infections, pneumonia, and even death,” Ms. Mayes said.
The best method to combat ignorance among youth is for public health workers to cultivate relationships with school nurses, said Ms. Martin, the North Public Health District infectious disease coordinator.
“If we can’t go into the schools, we’ve seen that reaching out to school nurses and letting them know we’re available to help is the best way to reach teenagers at risk for sexually transmitted diseases,” Ms. Martin added.
Ms. Mims agrees that having relationships with school nurses is a key factor in keeping youth educated about sexual health. That way, if school nurses see more sexually transmitted diseases than normal, the public health department can step in and provide more resources for that particular school, Ms. Mims said.
One major challenge in preventing STDs is when funding is cut from overlapping programs, said Phillips. When the Coastal District saw staff cuts in HIV prevention, it placed an even heavier burden on the public health investigators in the STD arena because jobs in those two departments often overlap, he said.
“In the last year, we have seen 2,500 cases, and many of them require investigation from either department,” he said. “Communicable disease investigators play a big role in preventing the spread of infectious disease from one infected person to another.”
Ms. Mims also said her program faced considerable hardships due to cuts in total investigators from the HIV program. Because of cuts in the HIV department, her staff has been unable to take on the burden of finding people with STDs, she said.
Public health workers hope budgets will increase as the economy improves, but they doubt they will ever have the resources to do the job that needs to be done. Indeed, given the limited resources, Ms. Mims, of the South Health District, applauds the Health Department for keeping Georgia from being “completely eaten up with STDs.” But without significant change, she says, Georgia will continue to be a state with a big STD problem.