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STI rates in Black Hawk already state's highest, continue to rise

Waterloo-Cedar Falls Courier - 4/30/2017

April 30--WATERLOO -- To recognize sexually transmitted disease awareness month, the Iowa Department of Public Health released some new stats from 2016. It isn't pretty.

There's been a 75 percent increase in gonorrhea cases from 2013 to 2016.

Syphilis had been steady for years but is now on the rise in the state, surging 450 percent between 2011 and 2013.

A total of 13,000 cases of chlamydia, the most common reportable condition in Iowa, were reported in the state in 2016.

The early indications from Black Hawk County aren't any better, said Public Health Director Nafissa Cisse Egbuonye.

After recent decreases, preliminary data for 2016 show the county has joined the state and the nation in seeing an uptick in rates for chlamydia and gonorrhea.

That's discouraging news. Black Hawk County long has had the highest rates of those infections in the state per capita.

In 2015, the most recent data available, the county's rates of chlamydia and gonorrhea per 100,000 were 631 cases and 204 cases, respectively; the next closest counties were Webster with 587 cases of chlamydia and Woodbury with 160 cases of gonorrhea.

"It's been a problem in Black Hawk County for a little over a decade, and probably going on two decades, so it's not new news, but it's still a concern that strategically still affects us," said former Black Hawk County Public Health Director Bruce Meisinger.

But a long-standing STI Coalition in the county is working with Cisse Egbuonye, who has been director for about eight months, to tackle the issue anew.

The data

Cisse Egbuonye said the health department will use the 2016 data to figure out what caused rates to rise and to better target their efforts.

"We are doing more rigorous data analysis to be able to target very defined groups that are having these high rates and what are the interventions that need to be set in place so that they can get tested and receive treatment," Cisse Egbuonye said.

She wants to deepen relationships with the Iowa Department of Public Health and University of Northern Iowa to break down the data on sexually transmitted infections.

Cisse Egbuonye favors a systemwide approach to public health issues, looking at social determinants likely to lead to negative health outcomes.

The County Health Rankings and Roadmaps looks at factors like educational attainment, access to physical activity, poverty rates and dozens of other things to assess likely health outcomes in communities across the country.

This sort of deep numbers dive has worked before in the county, particularly in reducing teen pregnancies. The Together for Youth coalition initially formed three decades ago to reduce teen birth rates.

In 1995, the county led the state with 264 births to teen mothers, about one in five births in the county. In 2015, that number was down to 79, about one in 20 births.

The coalition soon expanded to look into the disparate rates at which youths of color faced teen pregnancies and STIs, and it began looking at county STI data in general. The coalition expanded to include the county health department.

"When we work together, we're just so much stronger," said Joni Spencer, who heads Together for Youth, part of Allen Women's Health.

Simple solutions

There's no silver bullet. But both Cisse Egbuonye and Spencer see ways the STI numbers could move downward more quickly.

Cisse Egbuonye said often when people come in with symptoms, they are not disclosing all of their sex partners.

She stresses disclosure is critical -- and confidential. Clinicians make follow-up calls to partners recommend testing without naming the person with symptoms.

"I think it's important to take the approach that 'I might be scared, but the overall outcome is that I am also saving someone's life,'" Cisse Egbuonye said. "Anger or frustration will eventually fade, but if the person doesn't receive treatment, they can possibly have really dire consequences to their health."

Spencer said another simple solution is to make condoms widely available. An informal survey found many convenience and grocery stores lock up condoms, which may intimidate people, especially youths, from buying protection. Since then Allen Women's Health has made condoms more accessible through its facility.

STD rates are highest among people 15 to 24. The Centers for Disease Control and Prevention's Youth Risk Behavior Surveillance from 2015 found about 41 percent of high schoolers nationwide have had sexual intercourse.

Both Cisse Egbuonye and Spencer say STI testing should be routine, like other tests people receive to ensure they're healthy. Spencer said testing has recently been down, even as county STI rates spiked.

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Information about where to get low- or no-cost testing is available at https://gettested.cdc.gov/.

Education is also important. Together for Youth health educators make nearly 1,000 presentations annually in Black Hawk County and surrounding areas.

"We can educate and educate and educate, but if we don't link young people to the services and resources that they need, we're not doing our job," Spencer said. "While adults talk about it and argue about it, young people are experiencing pregnancy, unintended pregnancy and STIs. So we can't argue about it anymore. We have to be able to empower them with the information that they need ... to keep themselves safe and to reach their goals."

STI coalition leaders fear budget cuts will adversely impact efforts.

"Of course, we want to empower people with information, we want to have condoms more accessible, we want to increase testing and screening, but we need to have the maintenance of our core programs to do that," Spencer said.

National epidemic

It isn't just a local problem. Rates are rising in the state and nationally as well.

Amanda Jovaag, rankings team director for County Health Rankings and Roadmaps, notes 2015 had the highest reported rates of STIs in the country, and rates have been rising for the past decade.

The CDC states this is the second year in a row all three reportable STIs -- chlamydia, gonorrhea and syphilis -- have increased substantially. The infections are curable.

But the increasing numbers, according to the CDC, suggest many Americans are not getting the preventative services that they need.

According to the CDC, an effective national response requires providers, the public, parents, teachers and state and local health departments to be at the table to begin to tackle the "epidemic."

Through the partners involved in the STI coalition, Black Hawk County has already brought many of the players to the table.

"I think we have everything that we need here. We just have to have a system in place," Cisse Egbuonye said.

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