When the Center for Disease Control (CDC) released their 2018 STD Surveillance Report, the District of Columbia stood out — and not for a great reason. Not for the first time, DC led the nation in the number of reported sexually transmitted infections. But numbers alone don’t tell the true story of what’s going on with sexually transmitted infections (STIs) in DC.
Michael Kharfen, senior deputy director of the HIV/AIDs, Hepatitis, STD, and TB (HAHSTA) in the DC Department of Health, points out that while DC once again had the highest rates of people living with HIV, those numbers have been consistently dropping over the past decade. In fact, in 2007, there were 1,374 new cases of HIV infection — which is approximately four per day. In comparison, there were 360 cases in 2018, which is fewer than one per day and a decrease of 73 percent.
When it comes to other STIs, reported gonorrhea, chlamydia, and syphilis infections were all lower than the previous year in DC, but still higher than anywhere else in the nation. And while multiple factors contribute to who gets infected with STIs — including access to testing and medical care, socioeconomic status, and a range of other social circumstances — there’s been one major shift in recent years that could be contributing to the increase: PrEP.
Pre-exposure prophylaxis (PrEP) is a medication that prevents HIV infection when taken daily. Kharfen says that one of the main focuses of the DC Department of Health in recent years has been encouraging people of all races, ages, genders, and sexualities to start taking PrEP. They’re using a range of innovative programs — including the Sexual + Being website — to pull in as many people as possible.
However, Kharfen says, getting people on PrEP has an unexpected side effect: It’s likely contributing to the increase in reported STIs. That’s because a requirement of PrEP is that you have to get screened for STIs every three months.
“One of the things about PrEP is that there’s more frequent STD screening,” Kharfen tells Sexual + Being. “The more you screen, the more you find. The more people we’re able to find and enroll on PrEP, the more they’ll be getting STD screening.”
Kharfen acknowledges that the numbers in the CDC report are “significant” but that they also reflect the fact that the Department’s efforts to connect people with testing even if they’re not showing symptoms are working. For example, chlamydia is one of the most common STIs and it people with penises almost never have symptoms of it, while people with vaginas rarely do. Chlamydia is curable, but you can’t cure it if you don’t know you have it. “The way most screening takes place is that more than 90 percent of people actually get treated — and then they’re cured,” Kharfen says.
Ultimately, while DC (and the nation) still has a way to go when it comes to reducing HIV and other STI infections, the alarming headlines when the report was released didn’t tell the whole story. The District is the leading the pack in this country, but it’s not just in reported cases. It’s also in innovative programs, community involvement, and serious outreach. And that’s something to brag about.