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Preventing Sexually Transmitted Infections: The Money Crisis

Each April, National STD Awareness Month is observed in the United States. Led by our friends at the Centers for Disease Control and Prevention (CDC) in collaboration with many other partners, including my own organization, the National Coalition of STD Directors (NCSD), it is a time to try and inject discussions about sexually transmitted diseases (STDs) and sexual health in the nation’s discourse.

Throughout the month, NCSD and its members and partners will be contributing pieces to raise awareness of a number of important issues.

I wanted to take this opportunity to highlight what I think is the biggest obstacle to preventing the 19 million-plus STDs that occur in this country each year: MONEY. Or more aptly described, the threat that what money is being invested to prevent STDs will evaporate into thin air.

The current battles over sexual health issues in Washington are no doubt well known to most readers. Unprecedented attempts to eliminate the Title X family planning program and prohibit any federal resources from going to Planned Parenthood health care providers are indicative of just how divisive the current state of play is. Make no mistake, if the family planning infrastructure of our nation is obliterated by extremists, we’ll see not only more unintended pregnancies and abortions, but also a big rise in STDs.

But beyond Washington, public funding for sexual health services as a core component of public health, such as screening and treatment for STDs, are under enormous threat.

NCSD represents the state Sexually Transmitted Disease programs in every state and our members know all too well that state budget crises are taking a tremendous toll. Services have been cut, staff are furloughed, critical positions to protect the public’s health remain unfilled due to across the board hiring freezes, and yes, clinics have been shuttered.

I was reminded of the severity of these crises this week as the state of New Hampshire attempts to pass its own budget. The Governor of New Hampshire is a Democrat, John Lynch, and he is in his fourth term. Back in February, Gov. Lynch presented his budget for the next two fiscal years (New Hampshire passes two years of appropriations at a time as opposed to just a single year). According to a recent analysis by the Center on Budget and Policy Priorities, 44 states and the District of Columbia are projecting Fiscal Year 2012 shortfalls totaling some $112 billion. New Hampshire is among this group and the Governor’s proposed budget made tough choices and cut about 3.3 percent in state spending from 2010-2011 levels.

But while Lynch was re-elected in 2010, many of his fellow Democrats succumbed to the national wave of Republican victories and the Republicans retook firm control of both the New Hampshire House and Senate. Many of these Republicans, like their GOP compatriots in Washington, are seeking deeper cuts in government spending that have the salutary effect of circumscribing the size and role of government itself.

And so it was last week that the House passed a budget that in Governor Lynch’s words, “goes far beyond what is necessary to live within our means, risking our state’s economic strategy and the health and safety of our citizens.”

You don’t need to delve too deeply into the House-passed budget to see why Governor Lynch used such strong words. On sexual health issues, for example, the picture is awful. The budget slashes state general funds for family planning by over $750,000 over the next two years and piles on anti-choice language that hamstrings providers. And the $344,000 per year in state general funds for STD prevention? Gone.

These STD funds in New Hampshire allow the state to support a network of 20 clinics that provide a wide array of integrated STD and HIV services, including counseling, testing, and treatment (and I should note that there are no state revenues that support the HIV-specific services). Further, this network of providers is arranged such that no person needs to travel more than 1 hour to reach a clinic, including those that live in the state’s rural “north country.”

The folly of dismantling this system was done with much evidence in hand, not the least of which, are concrete numbers showing an increase in STDs in the state. From 2009 to 2010, members of the House were informed that there were: 36 additional cases of gonorrhea for a 2010 total of 146 cases; 7 additional cases of syphilis for a 2010 total of 44; and reported cases of both Chlamydia and HIV were up markedly. The latter two instances may likely be the result of increased testing, but that deliberate scale up of testing underscores that infections are being found and treated and now is not the time to bail on the entire enterprise. In the “Live Free or Die State,” eyes now turn to the state Senate with a likely verdict coming from them sometime in May.

While the situation in New Hampshire is not unique, it is the most recent and profound example of politicians using the current budget crisis to abandon support for sexual health services within public health.

If this was happening, say, in 2017 and if health-care reform achieved its full promise, I might be singing a different tune. But this is 2011, and the road to 2014 and the implementation of health-care reform is long, full of pot holes, and speckled by eager and ideological bulldozers and backhoes ready to plow the whole thing under. And, even if we find great success in ensuring a broad range of covered services for the majority of our citizens, whether they access those services is another question entirely. Add the sensitivity of sexual health-care needs to that scenario, and it becomes clear that state-funded programs such as that in New Hampshire will remain essential in many places across the country.

Every state needs to ensure the sustainability of its safety net providers for sexual health services. This is not an ideological or a partisan position, nor is it free; but it is basic public health.


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