Sexually Transmitted Infections
Why It Matters
Acquiring any sexually transmitted infection (STI) increases the likelihood of HIV acquisition. Therefore, prompt diagnosis and complete treatment of people with STIs is very important. This prevents the long-term health consequences of STIs and reduces the risk of acquiring HIV or other STIs.
Given how common STIs other than HIV currently are, we cannot stop HIV in Iowa unless STIs are reduced.
Where We Stand Today
There is substantial overlap in populations at increased risk of acquiring HIV and those at increased risk of other STIs. Co-infection is common. It is also common for people to acquire an STI and later acquire HIV. In 2020, 38% of Iowan’s newly diagnosed with HIV were co-infected with another STI within the same year.
Bacterial STIs, like chlamydia, gonorrhea, and syphilis, are more common than HIV. The opportunity exists to increase HIV testing among individuals who present for STI testing, as well as offering HIV prevention strategies for those who test negative for HIV.
STIs are at all time highs in Iowa with gonorrhea more than doubling in the state in 5 years and syphilis increasing by more than 75% in the past year.
What We're Doing Now
Community-Based Screening Services
Community-Based Screening Services (CBSS) are a safety net program to provide chlamydia and gonorrhea testing. Syphilis, HIV, hepatitis, and herpes testing are also available.
CBSS primarily provides services to individuals that are uninsured, underinsured, or seek confidential services.
There are 60 CBSS sites located throughout the state of Iowa. They include family planning, local health departments, corrections, drug treatment, and student health centers.
CBSS sites provide an average of 30,000 tests each year!
IDPH Treatment Medications Program
This program provides free medications to safety net providers for patients diagnosed with chlamydia, gonorrhea, and syphilis, as well as their sexual partners.
Approximately 13,000 doses of these medications are provided each year.
Expedited Partner Therapy
Expedited Partner Therapy (EPT) is the practice of treating partners of people diagnosed with chlamydia or gonorrhea without first examining the partners.
Additional medications are given to the patient to deliver to their partners and thereby reducing re-infections.
In 2020, more than 1,400 doses of medication were given for EPT through safety net clinics.
Disease Intervention Specialists (DIS) work directly with persons diagnosed or at risk of acquiring HIV and other STIs.
The goals of DIS include:
Ensure connection to medical and other services
Conduct risk reduction counseling
Confidentially notify sex and needle-sharing partners of exposure and refer for testing and treatment.
Work with clinicians and other community partners
DIS work directly with medical providers and other community partners. They provide testing and treatment recommendations as well as information on other best practices. Additionally, DIS provide guidance and assistance related to reporting to the IDPH.
Gaps, Barriers, & Challenges
STI screening and testing guidelines are not widely followed.
Providers are not discussing patient’s complete sexual histories.
Barriers & Challenges
Concurrent/comprehensive testing. HIV, syphilis, chlamydia, and gonorrhea are all primarily transmitted via sex, yet testing for these conditions is often thought of and conducted separately (e.g., some are tested for and not others).
Concerns about who will pay for this testing often overrides the public health good.
Free or reduced cost STI testing and treatment is not widely available.
Systemic & Societal Challenges
Social determinants of health
STIs are often not a person’s top concern. There may be issues or situations in someone's life that need more immediate attention. These include other health issues (like drug use or mental health), housing, transportation, incarceration, and/or language barriers.
Stigma around STIs
Stigma related to STIs is present in both the general public and among health providers
Some providers expressing their patients don’t get STIs, despite being sexually active
Perceptions that people who get STIs are “dirty”
Currently, folks are not empowered to seek regular testing. People should be praised for being proactive about their health (and public health), not mocked or vilified.
It's very uncommon for individuals to disclose they’ve had an STI, for fear of judgment.
To stop HIV in Iowa by 2030, this focus area must:
Increase HIV testing among individuals already presenting for STI testing.
Increase access to fast, free, and convenient testing and treatment options.
Improve provider best practices related to sexual history taking.
Improve provider best practices related to testing and treatment.
Engage with and learn from disproportionately impacted and other prioritized communities to inform our larger direction and strategies.
Address STI stigma.
Process for Community Engagement
This focus area will work with partners across the state to understand barriers related to addressing STIs and define potential improvement opportunities.
What we learn will inform and support our work towards the following goals:
Diagnose & treat persons for STIs earlier
To help reduce transmission and improve health outcomes.
Expand Disease Intervention Specialist (DIS) infrastructure
To ensure persons diagnosed with or exposed to HIV and other STIs are equipped to navigate the health system and receive recommended care.
Decrease transmission of STIs, including HIV
To improve individuals' sexual health and prevent the negative outcomes associated with untreated infection.
This focus area will seek input from the following stakeholders and communities. A variety of methods will be used to collect input, including surveys, key informant interviews, and focus groups. A concerted effort will be made to include both rural and urban populations.
Urgent care & Emergency Department
Federally Qualified Health Centers (FQHC)
Adolescents & young adults
Does an STI Diagnosis Spur Subsequent HIV Testing Among Adolescents?
The American Journal of Managed Care, 2020