Worsening STD Crisis To Come With Title X Cuts

Worsening STD Crisis To Come With Title X Cuts

When Dr. Jami­la Per­ritt was at a Wash­ing­ton, D.C. clin­ic recent­ly, she saw a 17-year-old girl come in for test­ing and birth con­trol bills. Per­ritt said the teenag­er was pay­ing out of pock­et for every­thing because she didn’t feel com­fort­able using her par­ents’ insurance.

Per­ritt, who is an Amer­i­can Col­lege of Obste­tri­cians and Gyne­col­o­gists mem­ber, said this isn’t the first case of a teenag­er seek­ing out STD/STI treat­ment with­out parental knowl­edge. Many teenagers want to ensure their health is kept confidential. 

Perritt’s patient want­ed to be test­ed for STDs but also get birth con­trol pills. How­ev­er, she was unable to afford both options. 

Birth con­trol can cost between $20 and $50 a pack or more if pay­ing out of pock­et. How­ev­er, the Planned Par­ent­hood clin­ic where the young girl came to was able to reduce her 30-day pack of birth con­trol pills to $12. The cost can be sig­nif­i­cant­ly high­er in oth­er places – some places charge up to $200 while oth­ers are test­ed for free thanks to the Afford­able Care Act.

When the woman opt­ed for the pills only, the clin­ic worked with her and got her screened. They were able to do this through the Title X pro­gram funds, which finan­cial­ly assists with fam­i­ly plan­ning and oth­er pre­ven­ta­tive health ser­vices for under­in­sured and unin­sured individuals.

Per­ritt said patients often go with­out any care because of cost con­cerns includ­ing low-income peo­ple, peo­ple of col­or, young peo­ple and peo­ple who are unin­sured or under­in­sured. She said these are also the same groups that tend to have high­er STD rates such as chlamy­dia and gon­or­rhea. The rise in STIs, as seen across the nation, is main­ly cen­tered on these pop­u­la­tions. She attrib­ut­es the prob­lem to costs and care access.

Based on infor­ma­tion from the Cen­ters for Dis­ease Con­trol and Pre­ven­tion, the U.S. had over two mil­lion new cas­es of gon­or­rhea, chlamy­dia and syphilis in 2017. Over 1.7 mil­lion of those cas­es were for chlamy­dia, with anoth­er 555,608 cas­es being gon­or­rhea and more than 30,000 syphilis cas­es (pri­ma­ry and secondary).

Cuts to Title X Is Mak­ing Things Worse

Per­ritt said it takes a large group of peo­ple and effort to ensure that one per­son gets the care they want and deserve. 

If the Trump Admin­is­tra­tion goes ahead with its Title X changes, clin­ics like Planned Par­ent­hood will not be able to offer this kind of care at a low­er cost.

Title X fam­i­ly plan­ning clin­ics have an impor­tant role in mak­ing sure peo­ple have access to an array of fam­i­ly plan­ning and pre­ven­ta­tive care ser­vices. The U.S. Depart­ment of Health and Human Ser­vices, funds are nec­es­sary for edu­ca­tion, coun­sel­ing and on-site test­ing services.

Nation­al Asso­ci­a­tion of Coun­ty and City Health Offi­cials Senior Ana­lyst Rebekah Horowitz said fund­ing for the above ser­vices has declined sig­nif­i­cant­ly in the last 15 years, lead­ing to a drop in health depart­ments offer­ing STI-relat­ed services.

She said it’s putting pres­sure on peo­ple get­ting insur­ance so they can get the med­ical care they need from providers. Horowitz said there is a stig­ma cen­tered on sex­u­al health issues that make it hard­er for patients to talk to their doc­tors. She said any move­ment that push­es peo­ple toward pri­vate providers means many will stop seek­ing out care for the services.

Health depart­ments are the key providers for these ser­vices, pro­vid­ing treat­ment to those who test­ed pos­i­tive for STI, as well as their part­ners and oth­ers who engage in risky behav­ior that can lead to an STI. Horowitz said the process for these part­ner ser­vices includes inter­views with the infect­ed peo­ple and oth­er peo­ple they could have infect­ed and bring them in to be test­ed, diag­nosed and treat­ed if positive.

For exam­ple:

The New York City Depart­ment of Health has eight sex health clin­ics open to peo­ple 12 and old­er. They can walk in with­out an appoint­ment and get test­ed for STIs for lit­tle to no mon­ey. Immi­gra­tion sta­tus and par­ent con­sent are not need­ed, and the results can be retrieved online.

The Bal­ti­more City Health Depart­ment has a clin­ic and out­reach social media pro­gram called Your Health is Your Pow­er” for STI test­ing and con­dom use. Posts reg­u­lar­ly remind peo­ple to get test­ed for STIs and receive con­doms. Patients are eli­gi­ble for test­ing ser­vices via their insur­ance be it Medicare, Med­ic­aid or pri­vate insurance.

Seat­tle pedi­a­tri­cian Dr. Cora Bre­uner said most patients are unaware of their insur­ance company’s deductibles. And, if the deductible is too high, most under­stand that the tests are not cov­ered by their com­pa­ny until the deductible is met. A state or fed­er­al insur­ance plan often waives deductibles for testing.

Peo­ple who are unable to afford the care or can’t see their fam­i­ly doc­tor often come to Planned Par­ent­hood clin­ics thanks to their low-cost or free test­ing ser­vices and pri­vate results.

New Jersey’s Planned Par­ent­hood Com­mu­ni­ca­tions Man­ag­er Casey Olesko said 56 per­cent of the Planned Par­ent­hood health cen­ters are a pri­ma­ry health care source, espe­cial­ly those in med­ical­ly under­served, rur­al or health pro­fes­sion­al short­age loca­tions. If there is no Planned Par­ent­hood in these places, peo­ple may not have any place to turn to for their healthcare.

New Jer­sey is also not immune from the rise in STDs and has 17 clin­ics that pro­vide free test­ing for HIV, chlamy­dia and gon­or­rhea. The state is see­ing an increase due in part to for­mer Gov. Chris Christie’s defund­ing of Planned Par­ent­hood and oth­er pre­ven­tive health care ser­vices. Christie’s vetoes have led to a $50 mil­lion loss in fam­i­ly plan­ning ser­vices. Six of 58 clin­ics have closed around the state, with 14 oth­ers scal­ing back their hours.

Back in May, the Trump Admin­is­tra­tion sug­gest­ed a domes­tic gag rule lim­it­ing patients’ access to these ser­vices and stop abor­tion providers. If it were imple­ment­ed, it would keep mil­lions of patients from get­ting the birth con­trol and STD test­ing and treat­ment they need­ed that Planned Par­ent­hood now pro­vides. Planned Par­ent­hood ser­vices 41 per­cent of Title X patients.

Planned Par­ent­hood Fed­er­a­tion of Amer­i­can Senior Direc­tor of Med­ical Ser­vices Dr. Gillian Dean said the Trump/​Pence admin­is­tra­tion is mak­ing it hard­er for peo­ple to get the care they need that Planned Par­ent­hood has to offer. She said it doesn’t mat­ter where a per­son lives or who they are; they have the right to get result STD test­ing, treat­ment and edu­ca­tion in a non-judg­men­tal location.

Per­ritt said it’s dan­ger­ous to have law­mak­ers decide what kind of health care women can have and who they can see. It’s also dis­heart­en­ing to see them take away pro­grams that are help­ing peo­ple who can­not oth­er­wise afford to pay for these ser­vices. The most vul­ner­a­ble are at risk for hav­ing these ser­vices tak­en away by politicians. 

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