Rates of syphilis and other sexually transmitted infections (STIs) in D.C. did not return to pre-pandemic levels in 2022, according to a recent analysis released by the District. This persistent increase in new cases is primarily attributed to ongoing challenges caused by the COVID-19 pandemic.
The report suggests that the upward trend in STIs reflects the continued impact of service interruptions when clinics were temporarily closed and people avoided healthcare settings. These disruptions have hindered access to testing and treatment, leading to an increase in new cases.
Additionally, the District is facing a nationwide staffing shortage of culturally competent professionals who can effectively screen, test, and treat residents. This shortage has further exacerbated the barriers to healthcare access, particularly for marginalized communities and individuals experiencing increased homelessness.
Clover Barnes, senior deputy director for D.C. Health’s HIV/AIDS, Hepatitis, STD, and TB Administration, highlights the link between homelessness and reduced prioritization of HIV testing. When someone is uncertain about their living situation, their focus shifts away from preventive measures like HIV testing.
While there has been a slight decrease in new cases of HIV compared to previous years, syphilis cases among women and their babies have been on the rise in 2022. However, District public health experts believe that the tide may turn and the numbers may decrease in the future.
The impact of the pandemic on the availability and accessibility of disease screening, prevention, and care services is still apparent. Care-seeking behaviors, especially those related to preventive measures, are lagging behind pre-pandemic levels.
To address the challenges, public health officials are striving to improve access to care, particularly for Black residents who are disproportionately affected. This includes engaging with the community at events, recruiting artists to spread messages about prevention and treatment, and meeting people where they are.
Unfortunately, the District’s federally qualified health centers and community-based organizations are grappling with the staffing shortfall, hindering their efforts to recruit culturally sensitive public health workers.
According to Barnes, the District’s capacity to provide healthcare services has been significantly reduced compared to pre-pandemic times. This issue further highlights the importance of addressing the staffing shortage in order to effectively combat the spread of STIs.
Less testing has resulted in more cases, particularly regarding new HIV diagnoses. However, the numbers have been decreasing over time. The report states that there were 210 new HIV diagnoses in 2022, down from 224 in 2021 and 274 in 2019. This is still a significant improvement compared to the peak of 1,374 cases in 2007.
The report also reveals that about 1.7% of the D.C. population, or 11,747 people, are living with HIV. Alarmingly, Black individuals account for approximately 70% of HIV cases, despite comprising only 44% of the population.
The Centers for Disease Control and Prevention (CDC) has set goals for D.C. and other cities to reduce new HIV diagnoses to fewer than 21 per year by 2030. However, Barnes acknowledges that these numbers may be revised in the future.
While the District has not reported any babies born with HIV since 2019, there has been an increase in cases of syphilis in babies in 2022. This alarming trend aligns with the overall uptick in syphilis cases. Three out of five people diagnosed with syphilis in 2022 were Black, highlighting the disparities in infection rates.
Efforts to combat congenital syphilis have shown some improvement, particularly in understanding the needs of women with the infection, which is often linked to substance abuse. Doctors are encouraged to test at-risk women throughout their pregnancy, but effective treatment can be challenging when screening occurs late in pregnancy or when access to prenatal care is limited.
Public health officials have worked on improving the treatment of men who may have transmitted the infection to their female partners as part of their efforts to combat syphilis.
In 2022, public health officials experimented with various strategies to spread hopeful messages and practical information. Celebrations for World AIDS Day, for example, included residents who have been living full lives with HIV, showcasing their experiences on social media in collaboration with go-go bands.
The District has also focused on making testing more accessible, with options like walk-in LabCorp facilities, city workers embedded at healthcare clinics, and free HIV and STI tests provided by community health providers. These innovations, which were introduced during the pandemic, have remained popular, with thousands of monthly requests for tests.
An interesting feature of the testing process is that test takers can scan a QR code to receive their HIV results. Negative results are accompanied by information on maintaining their status using methods such as pre-exposure prophylaxis (PrEP), a once-a-day pill that helps protect against HIV infection. For positive results, individuals are provided with resources for help and treatment.
The District has also seen success with a federally funded pilot program that supports up to eight residents on PrEP. The program covers their housing costs for one year while also providing intensive case management and employment training. This initiative aims to promote independent living and may be expanded to include transgender women in addition to men who have sex with men.
Looking ahead, it is crucial to address the ongoing challenges caused by the COVID-19 pandemic and the staffing shortage in order to effectively combat the spread of STIs. Building a culturally sensitive and well-staffed public health infrastructure will be key to reducing the impact of these infections on marginalized communities.
Recommended measures include increasing awareness through community engagement, leveraging social media and artistic platforms for health promotion, expanding access to testing and treatment facilities, and ensuring