What's Behind A Rash of HIV and STD Outbreaks?

Recently there has been a spate of reports about rising STD rates in certain cities or states. Rhode Island, Palm Beach County and Nashua have all reported higher rates of HIV and other infectious diseases, but each locale has cited different causes for the spikes.

According to the Palm Beach Post, rates of HIV and hepatitis are significantly higher than they were this time last year: local Hep B cases are up 60 percent and Hep C cases are up 73.5 percent. Meanwhile, stats for Florida as a whole show HIV cases have risen 27 percent over three years.

Palm Beach County Health Department Director Dr. Alina Alonso told The Post she is confident the increase reflects a greater focus on testing, siting a surveillance grant in place since 2012, new practices by labs to notify the state of new cases and recent ads for new hepatitis C drugs which have pushed people to get tested.

“I think we are going to need to give this a little more time,” Alonso said. “We don’t think there is an epidemic going on.”

Hoping to examine this statement by comparing Palm Beach County’s stats to those statewide, The Post requested this information from the Florida Department of Health; which refused their request to release its statewide data.

Apparently Centers for Disease Control and Prevention  has asked Palm Beach County to notify them of suspected clusters of recent HIV or hepatitis C infections. But, The Post reports, the Palm Beach County Health Department has not sent such notification. Alonso says that’s because she is confident the numbers simply reflect more testing.

Meanwhile Nashau in Southern New Hampshire is actively looking for HIV and Hep C outbreaks, in light of the state’s high intravenous drug use. According to the New Hampshire Partnership for Successful Living  “There have been over 300 drug-related deaths in New Hampshire this year.  Nashua alone has reported 144 deaths due to overdoses, as compared to 48 in 2014.”

And Rhode Island officials blame a number of factors—including use of social media sites like Tinder—for that state’s rise in STDS.

The Rhode Island Department of Health (nicknamed HEALTH) felt compelled to “alert Rhode Islanders of the epidemic of sexually transmitted diseases," and released data showing increasing rates of STDs including: 

• Infectious syphilis cases increased by 79 percent between 2013 and 2014
• Gonorrhea cases increased by 30 percent in that same period.
• Newly-identified HIV cases increased by nearly 33 percent.

HEALTH also noted that new cases of HIV and AIDS and infectious syphilis continued to increase among gay, bisexual, and other men who have sex with men at a faster rate than in other populations.

They also found that infection rates of all STDs continued to have a greater impact on the African-American, Hispanic, and young adult populations.

"These data send a clear signal that despite the progress we have made in reducing STDs and HIV over the years, there is more work to do," said Nicole Alexander-Scott, MD, MPH, Director Designee at HEALTH in a written statement. "We are fortunate in Rhode Island to have great partnerships among state agencies, community-based organizations, and healthcare providers to continue to educate, test, and treat for sexually transmitted diseases. This trend reminds us that we cannot become complacent."

The Rhode Island Health Department promotes free and low-cost HIV and STD testing services throughout the state and provides “a variety of resources for clinicians to test, treat, and counsel patients and their sexual partners.”

The recent uptick in STDs in Rhode Island follows a national trend, HEALTH experts argue. They blame the increase on both increased testing and high-risk behaviors: using social media to arrange casual and often anonymous sexual encounters, having sex without a condom, having multiple sex partners, and having sex while under the influence of drugs or alcohol.

While HEALTH does not connect the use of intravenous drugs with the increase in HIV and STDs, the health department had earlier reported 212 apparent accidental drug overdose deaths in 2014. The state does have a distribution network for free Narcan, the antidote to overdoses as well as a needle-exchange program.

The Rhode Island Department of Education (RIDE) works under a federal grant to “make sexual health education more accessible to high school students, to increase awareness of and education about STDs [and] to correct misinformation among young people that may put them at higher risk of getting an STD,” according to the HEALTH report.

"These new data underscore the importance of encouraging young people to begin talking to a doctor, nurse, or health educator about sexual health before becoming sexually active and especially after becoming sexually active," said Rosemary Reilly-Chammat, EdD, RIDE HIV/AIDS Sexuality Specialist in a statement. "It's never too early to learn about making HIV and STD testing part of routine healthcare. Doctors and nurses are trained to discuss sensitive topics like sex, and conversations with them are confidential. Health educators at schools or community health centers are great resources too."

RIDE also promotes “evidence-based prevention practices, including abstinence.”

The HEALTH report includes a list of STD vectors and notes that “Anyone who is sexually active can stop the spread of STDs and HIV.” To do so, they recommend practicing safer sex (including the use of condoms and dental dams), getting tested regularly for STDs and HIV (routine testing is recommended for anyone age 13 and older); knowing your partner(s)' sexual health status and, if you've been diagnosed with an STD, taking the medication as prescribed and not having sex with anyone until your healthcare provider says it is safe to do so.

So what is behind the increase in HIV and STDs? It depends on where you are. If you are in Indiana or Nashau, New Hampshire, the explanation is intravenous drug use. If you are Rhode Island the problem boils down to risking sexual behaviors including using social media apps like Tinder to hook-up. And if you are in Palm Beach County? Any increase is due to changes in reporting and nothing more.