Setting the Context: Understanding the Numbers, Vulnerable Populations and Federal Public Health Policy

Transcription

1 Setting the Context: Understanding the Numbers, Vulnerable Populations and Federal Public Health Policy David B. Johnson STD Disparities Coordinator, Division of STD Prevention National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention Centers for Disease Control and Prevention Council of State Governments 30 Years On: Innovations in HIV and Sexual Health Policy July 16, 2011 National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Division of STD Prevention

2 Outline Vulnerable populations impacted by STIs Burden of disease in Southern States Unfair burden on young and minority populations STI prevention challenges and strategies to address them Test, treat, vaccinate Partnerships with community, academia, and national organizations

3 BURDEN OF DISEASE IN SOUTHERN STATES

4 Chlamydia Rates by State, United States and Outlying Areas, 2009 Guam VT NH MA RI CT NJ DE MD DC Rate per 100,000 population ,107 <300.0 (n = 10) (n = 21) 468 Puerto Rico 185 Virgin Islands >400.0 (n = 23) NOTE: The total rate of chlamydia for the United States and outlying areas (Guam, Puerto Rico, and Virgin Islands) was per 100,000 population.

5 Gonorrhea Rates by State, United States and Outlying Areas, 2009 Guam VT NH MA RI CT NJ DE MD DC Rate per 100,000 population <19.0 (n = 8) (n = 24) 49.0 Puerto Rico 5.8 Virgin Islands >100.0 (n = 22) NOTE: The total rate of gonorrhea for the United States and outlying areas (Guam, Puerto Rico, and Virgin Islands) was 97.8 per 100,000 population.

6 Primary and Secondary Syphilis Rates by State, United States and Outlying Areas, 2009 Guam VT NH MA RI CT NJ DE MD DC Rate per 100,000 population <0.2 (n = 5) (n = 19) 2.6 Puerto Rico 5.7 Virgin Islands >2.2 (n = 30) NOTE: The total rate of primary and secondary syphilis for the United States and outlying areas (Guam, Puerto Rico, and Virgin Islands) was 4.6 per 100,000 population.

7 UNFAIR BURDEN ON YOUNG AND MINORITY POPULATIONS

8 Prevalence, % 8 Burden of Infection Highest Among Sexually Active Adolescents and Young Adults Sexually active people aged have about 3x the chlamydia prevalence of sexually active adults aged NHANES, National Health and Nutrition Examination Survey, Sexual activity = yes response to Have you ever had sex? Sex = vaginal, anal, or oral sex Age group (years)

9 9 Prevalence, % Chlamydia Prevalence in Sexually Active Females Aged in the United States NHANES, National Health and Nutrition Examination Survey, Sexual activity = yes response to Have you ever had sex? Sex = vaginal, anal, or oral sex

10 Chlamydia Rates by Race/Ethnicity and Sex, United States, 2009 Men Rate (per 100,000 population) Women Race/ 2,500 2,000 1,500 1, Ethnicity ,000 1,500 2,000 2, AI/AN* 1, A/PI* Blacks 2, Hispanics Whites Total * AI/AN = American Indians/Alaska Natives; A/PI = Asians/Pacific Islanders.

11 Gonorrhea Rates by Race/Ethnicity and Sex, United States, 2009 Men Rate (per 100,000 population) Women Race/ Ethnicity AI/AN* A/PI* Blacks Hispanics Whites Total * AI/AN = American Indians/Alaska Natives; A/PI = Asians/Pacific Islanders.

12 Primary and Secondary Syphilis Rates by Race/Ethnicity and Sex, United States, 2009 Men Rate (per 100,000 population) Women Race/ Ethnicity AI/AN* A/PI* Blacks Hispanics Whites Total 1.4 * AI/AN = American Indians/Alaska Natives; A/PI = Asians/Pacific Islanders.

13 Circumstances that make people vulnerable to poor health State Black % of Incarcerated Population % High Graduation for Black Males 2008 Black Males aged years 2009 Gonorrhea Ratio (B:W) Black Male to Female Ratio for Gonorrhea (M:F) Black Unemployment nd Qtr Alabama 61.9% (26%) 42% 17.4:1 0.8:1 10.8% Florida 48.1%(14.6%) 37% 6.6:1 0.8:1 14.0% Georgia 61.7% (28.7%) 43% 26.9:1 0.9:1 11.7% Louisiana 72.1% (32.5%) 39% 14.3:1 0.7:1 10.4% South Carolina 67.2% (29.5%) 39% 14.7:1 0.6:1 14% Tennessee 49.0% (16.4%) 52% 9.2:1 0.8:1 20.9% *Bureau of Labor and Statistics: Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance Atlanta: U.S. Department of Health and Human Services; Incarcerated America Human Rights Watch Backgrounder April Schott Foundation for Public Education : The 2010 Schott 50 State Report on Public Education and Black Males.

14 Estimated Annual Burden and Cost of STDs in the U.S. * HIV and Hepatitis B estimates include costs of sexually-acquired cases only **US annual estimated new cases (Weinstock H, Berman S, Cates W Jr. Sexually transmitted diseases among American youth: incidence and prevalence estimates, Perspect Sex Reprod Health Jan-Feb;36(1):6-10.) Annual new HIV cases, 2008 estimate ; all other annual cases are 2004 estimates (1Hall HI, Ruiguang S, Rhodes P, et al. Estimation of HIV incidence in the United States. JAMA. 2009;300: ) Reported Cases, 2009 Estimated Annual New Cases** Estimated Annual Direct Costs (millions)*** Chlamydia 1,244, million $701 Gonorrhea 301, ,000 $138 HIV* 42,959 60,000 $8,900 Syphilis 13,997 70,000 $25 Hepatitis B* 4,033 80,000 $47 HPV NA 6.2 million $5,8 00 Genital Herpes NA 1.6 million $1,100 Trichomoniasis NA 7.4 million $198 Total 1,606, million $17 billion ***Updated to 2010 $US using medical care component of CPI. Total may differ from sum of all diseases due to rounding. Adapted from: Chesson HW, Blandford JM, Gift TL, Tao G, and Irwin KL. The estimated direct medical cost of sexually transmitted diseases among American youth, Perspectives on Sexual and Reproductive Health 2004, 36(1):

15 STI PREVENTION CHALLENGES AND STRATEGIES TO ADDRESS THEM

16 The New Industry in America: Eliminating Health Disparities Funded Centers of Excellence Diverse Business and Stakeholders Vulnerable/Underserved Communities Federal Agendas Health Care Providers Community-Based Organizations/ Consultants Professional Organizations/ Associations Health Magazines and Wellness Media Professional Journals Social Marketers Colleges and Universities Mental Health Service Providers Private Foundations Publishers Public Health Workforce Shaw-Ridley, M, Ryan, KW. The Health Disparities Industry: Is it an Ethical Conundrum? Health Promotion Practice July 2010 Vol. 11, No. 4,

17 Programmatic Initiatives (Federal Agenda) Prevention through Healthcare Partnerships and collaboration between public health and healthcare Monitor performance and quality of prevention services Promote innovative systems and health-based approaches Improving Program Collaboration and Service Integration (PCSI) A structural intervention to improve synergies between prevention programs and to provide more holistic services to clients Promoting Health Equity and Reducing Health Disparities Incorporating social and structural approaches to STD prevention such as: Community mobilization Policy interventions Promoting science on disparities

18 Prevention through Healthcare Training medical professionals Endorsing screening by professional medical associations Developing tools to facilitate office-based chlamydia screening Disseminating information Promoting quality measures to improve care of adolescents National Certification Corporation: New chlamydia screening measure for accreditation of commercial and Medicaid plans - effective in 2010 American Academy of Pediatrics, American Board of Pediatrics: Chlamydia screening quality improvement activity as part of the recertification in adolescent medicine

19 Improving Program Collaboration and Service Integration (PCSI) Collaboration b/w HIV, viral hepatitis, STD & TB to provide integrated services Opt-out HIV testing in TB programs Testing for Hepatitis C Virus (HCV) as standard care for TB patients Testing for syphilis & prevention education on STDs Testing for hepatitis at HIV counseling & testing programs

20 Promoting Health Equity and Reducing Health Disparities Incorporating social and structural approaches to STD prevention Community mobilization Community Approaches to Reducing Sexually Transmitted Diseases (CARS) funding announcement o promote sexual health, and advance community wellness using community engagement methods (e.g., community-based participatory research) and multi-sector partnerships to build local capacity to impact STD disparities Historically Black Colleges & Universities (HBCU) community outreach efforts Native Students Together Against Negative Decisions (STAND) Curriculum Policy interventions - multi-sector partnerships to build local capacity to impact STD disparities Promoting science on disparities multi-layered approach

21 Transforming the Health Disparities Industry Transformational leadership for a new era Transforming ethics of the industry Developing industry quality assurance mechanisms Moving From Illusions of Collaboration Research Individual Agendas Fragmentation Silos Physician Centered Care Physician bias Lack/weak monitoring No/weak community research Advisory boards Moving To True Collaboration Evidence-Based Practice Team Agendas Coordination Integration Patient centered/patient self-advocacy Physician responsiveness Quality Assurance Systems Strong community research Advisory boards Individual patient care Holistic Prevention Care Models Family centered care & family self-advance Shaw-Ridley, M, Ryan, KW. The Health Disparities Industry: Is it an Ethical Conundrum? Health Promotion Practice July 2010 Vol. 11, No. 4,

22 Summary of Discussion High population burden of STDs and their associated costs exist in the U.S. Health equity and disparities are a major concern Health disparities need to be addressed using multilevel approaches (individual and structural) Changes in healthcare delivery systems provide opportunities to scale-up effective interventions

23 Resources For additional information and resources visit

24 Thank you! Questions? For more information please contact Centers for Disease Control and Prevention 1600 Clifton Road NE, Atlanta, GA Telephone: CDC-INFO ( )/TTY: Web: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Division of STD Prevention