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Post-COVID: Why Aren’t We Addressing Sexual Health Testing with a Similar Urgency?

Photo: Person holding vials of medication

50% of sexually active people will have at least one sexually transmitted infection by the age of 25. The frequency and severity of the infection, including the probability of it developing into an STD as well as the likelihood that the patient will receive care, vary drastically across demographic lines. While usually only an inconvenience when treated properly, STDs have the potential to cause infertility, increase the risks of developing various cancers, or can themselves develop into dangerous conditions like HIV. Typically, the financial burdens associated with sexual health services, including paying for the service and accessing the necessary transportation, pose the largest obstacle to patients. As a result, accessibility to these services is severely limited within rural and minority communities, whose already-high rates of poverty have only been exacerbated by the ongoing COVID-19 pandemic. Recognizing the renewed federal focus on access to health care and the effectiveness of ongoing COVID-19 prevention and treatment efforts in various locations, it’s imperative that the federal government advance policy changes that increase access to sexual health testing for minorities and individuals in rural communities. 

Rural communities, especially those of the Midwest and South, are less likely to have private health insurance largely because they’re often denied health benefits through their jobs. People of color and LGBTQ+ individuals, regardless of location, similarly lack access to private health insurance and sexual health coverage. In place of private medical services, patients often rely on publicly-funded clinics, sites that offer sexual health services to the general public through the use of public funds received under Title X, Medicaid, or the federally qualified health center program. These clinics aren’t adequately present near rural or minority communities, however, placing a heavy burden on those without the necessary time or resources to travel. Rural communities also tend to lack an adequate number of primary care physicians, meaning that the few available publicly-funded clinics and sexual health resources are often understaffed and inefficient. 

Rather than expand the number of available clinics, many of the conservative politicians representing these rural communities have instead advocated for a reduction in publicly funded clinics nationwide due to their opposition to Planned Parenthood. While many publicly-funded clinics focus on sexual health services outside of abortion, these politicians have made no such distinction in their legislation. Consequently, they have limited access to all public health services. Such actions have continued even amidst the alarming increase in the number of STDs being reported in southern states and research showing that minorities are up to 20% more likely to be diagnosed. Looking at HIV specifically, the southern states of Alabama, Arkansas, Kentucky, Mississippi, Missouri, Oklahoma, and South Carolina are all disproportionately represented in the U.S.’ total cases and host to many of its rural and minority populations.

Conservative politicians and interest groups have instead attempted to subsidize crisis pregnancy centers (CPCs), which are often funded by religious institutions, have no medical staff or services onsite, and offer only faith-based counseling or information aimed at dissuading individuals from visiting publicly-funded clinics. They offer no sexual health testing or treatment. These centers have little regulation, are inaccessible to LGBTQ+ individuals as a result of their religious foundations, and still lack both the quality and quantity necessary to address the sexual health crises present in vulnerable communities. 

The most effective method of addressing this issue would involve increasing Title X funding and implementing legislation that ensures more equitable access to publicly-funded clinics. The Title X Family Planning Program is a federal grant program that allows low-income patients to receive family planning and reproductive health services at reduced or no patient cost. Funding for this program has declined by more than $31 million since 2010, and so a simple congressional appropriations change restoring Title X funding effectively ensures that millions of uninsured and low-income individuals can continue to access sexual health services. Dedicating funding to grants for innovative community-based sexual health programs or services would also benefit disadvantaged populations while allowing local communities to uniquely assess and treat their demographics. Centers in Atlanta, Chicago, or Columbus, for example, incorporate community teen-outreach programs, comprehensive care and counseling, as well as community health fairs and events. They’re effective at establishing community trust and dispelling social stigma by familiarizing younger persons with the process and allowing them to be tested during routine exams. These programs are funded through Title X funding, state funds, private donations, local university contributions, and grants received from local or national foundations.

A more comprehensive legislative policy could then implement official federal guidelines mandating an appropriate number of publicly-funded clinics at specific locations within each state, along with policies ensuring a similar quality of treatment. This “federal override” would most effectively address the confusion patients frequently experience when seeking sexual healthcare and would secure options for patients in the face of limiting statewide policies. Such legislation could be implemented at once, or in smaller increments attached to larger public-health bills depending on the political objectives of the residing government. Were the federal government less politically-divided or healthcare policies less controversial, efforts to expand Medicaid coverage to currently-uninsured communities or increased protections for publicly-funded clinics like Planned Parenthood would also greatly reduce these present inequalities in sexual health service accessibility. 

Lastly, it’s essential to address socio-cultural stigmas detrimental to those seeking sexual health services, especially in vulnerable communities, in tangent with inclusive legislative policy, as it’s important that, should these services be adequately available, persons of all backgrounds feel comfortable taking advantage of them. Considering that the overwhelming majority of STIs are contracted by people aged 15 to 24, university health services and local clinics must increase accessibility to younger demographics. UC Berkeley’s Tang Center offers same-day STI-screening, a Sexual Health Education Program (SHEP) to answer student questions, and free first-come, first-serve rapid HIV antibody tests.

While it’s true that any policies seeking to expand access to these services will inevitably cost a significant sum of money, research shows that STIs and their complications alone total around $16 billion annually in direct medical costs. Early sexual health treatment results in a net-benefit for the federal healthcare system long-term, as more serious conditions that would be costlier and more time-consuming to heal are instead treated at their onset. 

In recent years, the Democratic Party has made federally-organized healthcare a foundational part of their political platform and, as a result, could implement smaller, more specific changes such as these to illustrate their commitment to long-term changes. While the lack of a sizable Democratic majority in Congress limits the opportunity for large-scale legislation to be passed, smaller policies like the expansion of Title X funding or guidelines ensuring a minimal amount of publicly-funded in outlined regions could be feasibly implemented if they had politicians’ attention. Regardless, both parties are currently witnessing a surge in populist ideals under popular politicians such as Donald Trump, Bernie Sanders, and Alexandria Ocasio-Cortez, all of whom have illustrated that politicians across the political spectrum have incentives to appeal to increased healthcare accessibility for rural and lower-income minority populations. While the topic of sexual health is often uncomfortable and controversial to discuss publicly, the government must extend its renewed focus on public health towards meaningful protections for publicly-funded sexual health services.

Image: Photo via Unsplash (Kendal)