HHS Launches National Plan to Attack STI Epidemic

Alicia Ault

December 28, 2020

The US Department of Health and Human Services (HHS) has issued the first national plan to address the exploding rates of sexually transmitted infections (STIs). It is calling for an integrated approach that addresses health disparities, social determinants of health, and other factors that often occur in tandem, such as substance use disorders.

The Sexually Transmitted Infections National Strategic Plan sets five broad goals. It's the first of what is envisioned as an every-5-year plan and was developed in a little over a year, which would have been fast even without a pandemic, said Gail Bolan, MD, director of the Division of STD Prevention at the Centers for Disease Control and Prevention (CDC), in a briefing.

The plan calls for a "whole of the nation response," said Bolan. "It's about breaking down silos we've had in place for years and executing a cohesive and coordinated response to this epidemic."

CDC tracking shows that STI rates rose for 5 straight years and are on track to increase for a sixth year, said HHS Assistant Secretary for Health Admiral Brett P. Giroir, MD, during the briefing. The rate of syphilis in newborns — which increased 185% from 2014 to 2018 — is especially concerning, Giroir said.

"I am absolutely shocked and alarmed," he said, adding that "congenital syphilis is something that should be in medical history books, it should not be in the MMWR [the CDC's Morbidity and Mortality Weekly Report]."

The CDC's latest data show that 2.4 million STIs occurred in 2018, an increase of 90,000 from the previous year. Soon-to-be-released data show another big rise in 2019, Giroir said.

"The STI plan provides an actionable roadmap to develop and implement programs at the national, state, and local levels to help our nation stem and reverse the growing STI epidemic in the US," said Giroir, who spearheaded the plan's development.

Physicians and health clinic directors embraced the government's action.

The American College of Obstetricians and Gynecologists (ACOG) said it shared the concern about rising STI rates, especially among pregnant women.

"Obstetrician-gynecologists every day experience the real-life challenges of stemming the tide against STI rates, from the nationwide shortage of gonorrhea and chlamydia testing kits to vaccine hesitancy that is keeping us from meeting HPV [human papillomavirus] vaccination targets," Christopher M. Zahn, MD, ACOG's vice president for practice activities, told Medscape Medical News. "We are grateful to HHS for recognizing the need for a comprehensive approach to reducing STI rates and hope to see this initiative lead to real-life solutions to help us meet our goals."

The National Coalition of STD Directors (NCSD), which for years has sought a national plan, said it was pleased that Giroir had shepherded it through. The plan "is comprehensive and data-driven, and it rightly addresses the overlapping syndemics of STDs, HIV, and viral hepatitis," said the organization in a statement. The plan also clearly addresses stigma and social determinants of health and recognizes that "the unequal burden of STDs is the result of systemic racism, poverty, and other challenges in people's lives."

But, the NCSD said, "the plan is not enough," noting that it does not request federal funding and has not received a commitment of such funding. In addition, there are no clear implementation plans. The organization is asking the incoming Biden administration to support and champion the plan. It's also seeking $273 million for the CDC's Division of STD Prevention and an additional $500 million for increasing staffing, training, and services at the nation's STD-focused clinics.

Five Goals, 10 Years

Although it's a 5-year plan, it sets goals that may take 10 years to meet, said Carol Jimenez, JD, of the HHS Office of Infectious Disease and HIV/AIDS Policy. "We really need more than 5 years to turn the rates around," she said.

The overarching vision is to reduce STIs for every American, regardless of age, sex, gender identity, sexual orientation, race, ethnicity, religion, disability, geographic location, or socioeconomic circumstance, Jimenez said. The plan will focus initially on three groups especially at risk: adolescents and young adults; men who have sex with men; and pregnant women. Racial and ethnic minorities and those who live in the South and West are even more disproportionately affected and will also be a focus.

The five goals are to prevent new STIs; improve health by reducing adverse outcomes of STIs; accelerate progress in STI research, technology, and innovation; reduce STI-related health disparities and health inequities; and achieve integrated, coordinated efforts that address the STI epidemic.

The first goal is really about primary prevention, said Judith Steinberg, MD, MPH, the chief medical officer in Giroir's Office of the Assistant Secretary at HHS. The plan emphasizes putting in place "a nonstigmatizing, comprehensive approach to sexual health education and sexual well-being and making that the foundation," said Steinberg.

The plan also aims to increase uptake of the HPV vaccine.

Eliminating disparities was a separate goal because it's considered crucial to reducing STIs, Jimenez said.

When the draft plan was published in the Federal Register, many commenters said that one of the keys to eliminating disparities would be to train and educate healthcare professionals, Jimenez said.

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