Guest Opinion: With skyrocketing STI rates, LGBTQ+ Californians need a pathway to equitable health care

  • by Tami Martin and Nomsa Khalfani
  • Wednesday June 8, 2022
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Guest Opinion: With skyrocketing STI rates, LGBTQ+ Californians need a pathway to equitable health care

As COVID-19 cases are back on the rise, California and the U.S. continue to face another public health epidemic that is going in the wrong direction — sexually transmitted infections. The federal Centers for Disease Control and Prevention recently released data that reported nearly 2.5 million cases of chlamydia, gonorrhea, and syphilis in 2020 nationwide. California has the most reported cases of STIs across the nation, and San Francisco has the unfortunate distinction of having the third-highest STI rate in the state.

Nearly 350,000 Californians contracted an STI in 2019 — a 30-year high. In recent years, gonorrhea rates have increased by 211% and chlamydia rates by 56%. Since 2010, there has been an alarming rise in syphilis and congenital syphilis rates, with increases of 265% and 600%, respectively. The San Francisco Department of Public Health reported that by the end of February 2022 the city's gonorrhea cases were up 55% over the same time the previous year.

When left undetected and untreated, STIs can lead to serious and long-term health complications including infertility, cancer, and blindness.

Across the country, state lawmakers and politicians have advanced a historic number of anti-LGBTQ+ bills and policies, with roughly half of them targeting transgender folks. While states move to restrict and discriminate against our LGBTQ+ communities, California has the opportunity to align with our state's values by protecting and expanding health equity for our most impacted community members.

Over the past year, California took meaningful legislative action to expand access to STI screening, testing, and treatment. Gay state Senator Scott Wiener (D-San Francisco) co-authored Senate Bill 306 with Senator Dr. Richard Pan (D-Sacramento) to expand and increase access to remote STI care for LGBTQ+ Californians. The measure passed last October and became law in January. Additionally, last year's budget significantly boosted investment in local health jurisdiction capacity to enhance STI prevention activities.

Despite this progress, we still have a long way to go to address the strain of STI rates on our public health and the disproportionate impact on LGBTQ+ Californians, which is caused by a range of factors that include economic disparities, stigma, high rates of incarceration, racial segregation, racism, and lack of access to health care and community support.

According to the California STD Control Branch, men who have sex with men (MSM) made up over 50% of reported male gonorrhea cases in 2017. MSM living with HIV are 11 times more likely to contract syphilis. The new CDC data show that rates of gonorrhea have increased over 110% since hitting a historic low in 2009, with a third of cases experienced by gay and bisexual men.

A bill introduced this session by Pan addresses this health inequity, and makes STI care more accessible for LGBTQ+ patients with low-incomes and individuals without health insurance to use STI services through the Family PACT program. It would also allow other uninsured income-eligible patients with coverage gaps and people with confidentiality concerns to obtain STI care. The measure, the STI Prevention + Treatment Fairness Act (SB 1234), recently cleared the state Senate and will be considered by the Assembly Health Committee in the coming weeks.

Family PACT has a network of more than 2,200 culturally competent, qualified providers and is a resource for high quality, nonjudgmental contraceptive and STI care for income-eligible Californians. However, the program is restricted to individuals at-risk for experiencing an unintended pregnancy. Many low-income and uninsured LGBTQ+ individuals are excluded from Family PACT services and benefits, and the state lacks an alternative program to serve LGBTQ+ patients who need no-cost STI care.

LGBTQ+ patients deserve to receive the same level of dignity and expertise of care from trusted providers. Expanding Family PACT would create a more equitable health system and maximize a program that offers a cost-effective pathway to STI coverage, rather than creating a separate program to meet the STI prevention and treatment needs of LGBTQ+ patients.

In addition to advancing SB 1234 through the legislative process, state leaders must also invest in implementation through the state budget. Our state spends approximately $1 billion annually on health costs associated with STIs.

Tami Martin is the legislative director at Equality California, the nation's largest statewide LGBTQ+ civil rights organization that works to achieve full LGBTQ+ equality by electing pro-equality leaders, passing pro-equality legislation, and fighting for LGBTQ+ civil rights and social justice in the courtroom.

Nomsa Khalfani, Ph.D., is the chief strategy and equity officer at Essential Access Health, which champions and promotes quality sexual and reproductive health care for all and leads the STI Prevention Center, a leading resource for best practices in STI testing and treatment.

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