Minnesota Faces Crisis of Sexually Transmitted Infections


To say that Minnesota is in a state of crisis when it comes to sexually transmitted infections (STIs) is like saying sure, it gets a little cold here in the winter.  In 2009, there were 17,000 new cases of STIs, the highest-ever level in the state.  Now, we have learned that new HIV infections have risen by 13 percent, the highest level in 17 years.  These numbers are surging for all ages and races and throughout the state, but no group is more affected than the teens and young adults of Minnesota.

Much has been saidabout how the abstinence-only education policies of the Bush era has led to the recent increase in pregnancy rates across the country.  Much less has been said about how those policies have led to an increase in rates of infections for STIs, but the evidence is mounting, especially in Minnesota.  According to a newly-released study by Planned Parenthood Minnesota, chlamydia rates for young adults have tripled in the last 14 years, and teens and young adults now account for 60 percent of all gonorrhea infections in the state. 

Many of these teens and young adults came of age and went to school during the seven years during which Governor Tim Pawlenty has been governor.  Even before he began making drastic cuts in the health care budget that have become the signature of his current run for president, Pawlenty has spent years appeasing his conservative, evangelical supporters by cutting budgets for family planning, reproductive health care and sex education, instead championing abstinence-only education and providing more dollars to “positive alternative” groups that simply dealt with the resulting unwanted pregnancies by offering baby cradles and bible verses.

“Although the Minnesota State Legislature passed legislation to promote comprehensive sex education, including programs that contain information about both abstinence and risk reduction, the legislation was abandoned under threat of veto by Governor Pawlenty,” states the report from Planned Parenthood.  “This lack of comprehensive, prevention-focused sex education has resulted in a generation of young people who are at an increased risk of acquiring an STI or HIV, and who are without the information or means necessary to protect themselves.”

Planned Parenthood uses the study to call for a strategic response from legislature that includes greater funding of comprehensive sex ed programs, which they see as key to turning around the increase in STI rates. They propose that these programs be “evidence-based, culturally relevant and age-appropriate,” and include both abstinence messages and information about contraceptives and health care needs.

But does such a program have a shot when you have a governor who is running for president by moving as far to the right on fiscal and social issues as possible, as well as fearlessly waving a veto pen in front of the legislature?  And how likely are we to see “controversial” programs like evidence-based sex ed when so many legislative leaders are running for governor themselves?

“The problem we have right now is the budget deficit in the state,” said Sarah Stoesz, Chief Executive Officer of Planned Parenthood Minnesota, North Dakota, South Dakota.  “I think many of our legislative leaders would see this as an important issue to address, and would be glad to do so.  But this budget deficit and revenue stalemate has made it very difficult to advance a public policy for addressing the issue, and because of it our young people and the public health of the state has been abandoned.”

“The Minnesota Department of Health needs to acknowledge that this is a problem that must be addressed, and begin to speak out on the problem,  They need to become activly involved in studying policy alternatives and putting it out there.”

The public health community doesn’t bear the sole responsibility for beginning discussions on lowering STI rates.   Parents, teachers and others need to recognize this public health crisis directly affecting our youth, both their current health and future fertility.  “Unfortunately,” Stoez said, “because it is related to sexuality it becomes uncomfortable to talk about.”

It’s getting the conversation started that appears to be the major roadblock, as the solutions to the STI epidemic are ready to be implemented as soon as everyone is ready to start fixing broken policies like abstinence-only education and lack of contraceptive knowledge.

“These are things we can address,” according to Stoesz. “It’s not like we have to embark on a longterm study on how to treat it.  It’s all about [the] unwllingness of leaders beyond the healthcare community to grapple with this particular problem.”

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  • winningwell

     Your claims that abstinence edcuation is the cause of the epidemic of STD’s in Minnesota would be more believable if your inference was not so greatly challenged by the facts. Abstinence education is only taught in 1/3 of American Schools while 2/3rds of schools get so called Comprehensive Sex ed. So assigning all the blame to a program so disproportionately represented in the student population of Minnesota is irresponsible. This and the fact that you have no evidence to correlate the disease rates to the population recieving such programs reduces your premise to mere biased speculation. What happended to your “evidence-based” mantra in light of your unsubstantiated claims? 

  • william-smith

    Robin -

    Thanks for your post on just how dramatic STDs rates are in Minnesota and thanks to the Planned Parenthood of Minnesota, South Dakota, and North Dakota for their report as well.  Whether it is chlamydia, syphilis, gonorrhea, HIV or any other STD, what we know is that we have epidemics out of control – from coast to coast – and nearly across the board on every type of infection and things are getting worse, not better  These adverse outcomes are taking a huge toll on the health of our communities and on individuals directly affected. 

     Politics and neglect have combined for too long to advance non-evidence and non-rights-based interventions and squander the few resources at our disposal to promote sexual health, particularly when it comes to STD prevention.

     

     

    NCSD represents the interests of STD prevention and treatment health officials throughout the country and we are working to advocate for the many things you’ve outlined in your piece.  Most importantly we want to draw attention to the reality that as rates of STDs have increased, funding for preventing them has decreased.

     

     

    I would encourage all your readers to get in touch with their members of Congress (call the Capital Switchboard at 202-224-3121) and support NCSD’s request to bolster funding for STD work.

     

    Our letter is pasted below.

     

    —–Organizational Sign-On Letter —— 

     

    The undersigned organizations are writing to request that Congress adequately address this nation’s sexually transmitted disease (STD) epidemic by increasing funding to the Division of STD Prevention within the Centers for Disease Control and Prevention by $213.5 million, for a total appropriation of $367.4 million.

     

    STD programs in health departments are responsible for the direct delivery of STD prevention and control services.  These activities include providing clinical services, education and awareness efforts and monitoring disease trends through surveillance and epidemiology.  Seventy-five percent of the Division of STD Prevention’s annual funding is distributed in grants to these 65 project areas.

     

    The United States has the highest STD rates in the industrialized world, with more than 19 million new infections occurring every year.  Youth, women, gay and bisexual men and racial and ethnic minorities share a disproportionate burden of STD infections and related complications.  The sequelae of STD infection include: chronic pain, infertility, pregnancy complications, pelvic inflammatory disease, cervical cancer and birth defects. 

     

    Combating STDs is also a critical piece of addressing the domestic HIV epidemic.  For example, persons with an STD have a 2 to 5 fold increased risk of acquiring HIV if exposed to the virus through sexual contact.  Research has shown that HIV-infected persons who are co-infected with another STD are also more likely to transmit HIV through sexual contact than other HIV-infected persons.  In addition, we also know that STD surveillance can be a useful tool in forecasting where increases in HIV rates are likely to occur, but increased resources are critically needed.

     

    Profound disparities also exist in how STDs impact Americans.  African Americans and gay and bisexual men of all races experience dramatically disproportionate rates of both Syphilis and HIV/AIDS.  Throughout the 1990s, rates of syphilis steadily decreased, reaching an all-time low in 2000.  Since then, however, the syphilis rate has increased by 76%, and in 2008, 63% of all syphilis cases reported were among men who have sex with men (MSM).  Targeted efforts to reduce syphilis, through the Syphilis Elimination Effort, have been successful, yet funding has not remained consistent or been fully scaled up to eliminate this epidemic.  Research has shown that the greater a state’s per capita investment in syphilis elimination funding in a given year, the greater the decline in syphilis rates in subsequent years.  

     

    The link between HIV and syphilis is particularly troubling, as compared to other STDs.  In 2007, 48% and 60% of early syphilis cases among MSM in Massachusetts and Los Angeles, respectively, were co-infected with HIV.  In Los Angeles, nearly 25% of these new syphilis cases were diagnosed in the HIV care setting.  If left undiagnosed and untreated, the burden of STDs among HIV infected populations is a missed prevention opportunity that will continue to have a significant impact on HIV incidence.  In addition, research has shown that reductions in syphilis can have a substantial impact on reducing the cost of HIV.

     

    The most commonly reported infectious disease in the U.S.  is the sexually transmitted disease Chlamydia.  Infection is often without symptoms, but if left untreated, chlamydia  can cause severe health consequences for women, including pelvic inflammatory disease (PID), ectopic pregnancy and infertility.  The Infertility Prevention Program, which provides funding to screen low-income women for Chlamydia in STD and family planning clinics, has been highly successful.  However, funding for this program has been unable to keep pace with the increasing demand for services.  CDC estimates that 1.2 million women who are eligible for services under this program are not receiving them.  

     

    Rates of STDs have continued to rise each year, but the financial resources required to meet this public health crisis have faltered.   Federal funding for the Division of STD Prevention at the CDC has steadily declined since FY 2003.  Additionally, the current fiscal crises in state and local governments have further hampered health departments’ efforts to adequately respond to this epidemic. 

     

    The National Coalition of STD Directors recently conducted a study to assess the impact of the current economic crisis to STD programs across the nation.  NCSD found that in 2008-2009, between 30-40% of health departments were forced to reduce disease intervention services, laboratory testing, clinical services for STD care and STD testing.  In addition, between 2008-2009, 39 clinics supported by state and local STD programs closed their doors due to inadequate funding.   STD program workers are a critical part of this nation’s frontline public health defense, possessing versatile disease intervention skills which enable them to respond swiftly to non-STD related public health emergencies, such as pandemic flu.  During the H1N1 influenza outbreak of Spring 2009, more than two thirds of STD programs across the nation participated in H1N1 response activities.

     

    The economic costs of this nation’s STD epidemic are profound.   In one year, over $8.4 billion is spent to treat the symptoms and consequences of STDs, not including HIV/AIDS.  In addition, the cost of treating new cases of HIV each year that is attributable to chlamydia, gonorrhea, syphilis and genital herpes is over $1 billion per year. 

     

    Increased federal investment in STD prevention and control is critically needed.   We urge you to consider our request of a $213.5 million increase to CDC’s Division of STD Prevention to provide much needed attention to this nation’s STD epidemic.  We look forward to working with you towards this goal.

     

     

     

  • crowepps

    You are assuming that all school districts OFFER sex education of some kind and that is not accurate.  8% of school districts don’t offer either.

    “Two main forms of sex education are taught in American schools: comprehensive and abstinence-only. Comprehensive sex education covers abstinence as a positive choice, but also teaches about contraception and avoidance of STIs when sexually active. A 2002 study conducted by the Kaiser Family Foundation found that 58% of secondary school principals describe their sex education curriculum as comprehensive.

    Abstinence-only sex education tells teenagers that they should be sexually abstinent until marriage and does not provide information about contraception. In the Kaiser study, 34% of high-school principals said their school’s main message was abstinence-only.”

    http://en.wikipedia.org/wiki/Sex_education#United_States

    Then of course even if the school does offer it, the parents may choose to keep their child out of the class because they prefer they remain ignorant.

    In the last 15 years, the public provision of real sex education has been drastically curtailed in this country. In the short period from 1995 to 2002 the percentage of adolescents receiving formal instruction on birth control methods dropped from 81% to 66% for boys, and 87% to 70% for girls. This was driven by the political movement for “abstinence only” education, abetted by $1.9 billion in federal and mandatory state matching funds.

    http://familyinequality.wordpress.com/2009/11/01/whose-right-to-sex-education/

    This is not, by the way, in line with the parents’ own actual expressed preferences:

  • 95% of parents of junior high school students and 93% of parents of high school students believe that birth control and other methods of preventing pregnancy are appropriate topics for sexuality education programs in schools.
  • 100% of parents of junior high school students and 98% of parents of high school students believe sexually transmitted diseases are an appropriate topic for sexuality education programs in schools.
  • 100% of parents of junior high school students and 99% of parents of high school students believe HIV/AIDS is an appropriate topic for sexuality education programs in schools.
  • 88% of parents of junior high school students and 85% of parents of high school students believe information on how to use and where to get contraceptives is an appropriate topic for sexuality education programs in schools.
  • 83% of parents of junior high school students and 79% of parents of high school students believe information on how to put on a condom is an appropriate topic for sexuality education programs in schools.
  • 99% of parents of junior high school students and 97% of parents of high school students believe the basics of how babies are made, pregnancy, and birth is an appropriate topic for sexuality education programs in schools.
  • 97% of parents of junior high school students and 96% of parents of high school students believe information on how to get tested for HIV and other sexually transmitted diseases is an appropriate topic for sexuality education programs in schools.
  • http://www.ncsse.com/index.cfm?pageId=937
  • All too often the objections to the sex education program at the school come not from students and not from parents of students but from outside sources like local priests/pastors or ‘morality’ pressure groups that don’t believe parents should have the right to choose a truthful, accurate education for their children.

  • winningwell

    Even using your own data from the anti- abstinence Kaiser Foundation you admit that more students recieve contraceptive -based sex ed than abstinence education. And yet AE must be given the burden for all the increase in pregnancy and disease rates. Besides being a desperate attempt at diparaging AE,any honest researcher would know that such a simplistic causal relation is ludicrous. Yet you appear to be driven more by ideological bias than realistic discovery to uncover the rise in rates. Easier and more convenient to just blame AE.

    RE: what parents want and your poll statistics,I will take the same position that SIECUS took when it rejected the Zogby Poll done in 2007 commissioned by NAEA. SIECUS said it was skewed, bias and completely bogus. So sorry but we know polls just can’t be trusted. At least we agree on that.

    Now you still have not given any stats to back up the correlation of disease rate increase to abstinence programs and since you are so about being “evidenced-based” I know you must have just overlooked that pesky request for some facts. Just want to point out however that the recent Jemmott study showed that AE programs had no effect on condom use as do other AE studies.