How Do STD Programs Fare When it Comes to Providing HIV Services?

HIV, or human immunodeficiency virus, often goes hand-in-hand with other sexually transmitted diseases (STDs). Individuals with HIV are at increased risk of contracting a range of STDs, and individuals who have forms of STD other than HIV are more likely to contract HIV. Given this link, it makes sense that programs and health departments that focus on the testing and treatment of STDs would also focus on the prevention and treatment of HIV in order to curb the spread of both. But do they? Researchers at the Centers for Disease Control and Prevention (CDC) decided to find out.

The CDC staffers looked at data from 311 local health departments and 56 state health departments in the United States that offered screening or treatment for STDs, according to a 2010 National Profile of Local Health Departments survey. The researchers sent a questionnaire to each health department that asked about HIV testing, access to HIV treatment, follow-up care for infected patients, and whether the department spent time visiting HIV care providers. Close to half (47.6%) of the local health departments responded to the CDC as well as 60.7% of the state departments.

The researchers learned that roughly twice as many state health departments (94.1%) made it a practice to visit HIV care providers than did local ones (46.7%). The majority of state health departments (92.3%) indicated that they attempted to teach HIV prevention strategies to high-risk individuals compared with just 58.4% of local health departments. Nearly three-quarters (73.1%) of state health departments matched their STD case report data with data on local individuals with HIV in order to spot disease clusters and determine who might need treatment, while only 16.1% of local health departments did so. Almost two out of five (39.4%) state health departments conducted HIV field testing for their STD patients, while 25% of local health departments did likewise. Some health departments opted to fully or partially combine financial and human resources in order to target both HIV and STDs, and every health department that discovered an HIV infection during field testing linked the patient to further care.

This study highlights a disparity between the functions of the state and the local health departments surveyed, which may be partly be design. “State and local health departments often have different functions,” says Kendra Cuffe, MPH, public health analyst at the CDC and an author of the study. “It is common for STD programs at the state level to perform programmatic activities such as HIV provider site visits and surveillance activities. Usually, more hands-on services like partner and clinical services tend to be performed at the local health departmental level. These different functions also help reduce inefficiencies and duplication of services.”

Diminishing budgets, however, may thwart the efforts of any health department. “In recent years, more than half of state and local STD programs experienced budget cuts, resulting in more than 20 health department STD clinics closing in 2012 alone,” Cuffe continued. “Our ability to prevent STDs is only as strong as the public health infrastructure that exists to support it.”

Although progress has been made when it comes to diagnosing and treating HIV among the STD-infected population, the study reveals areas for improvement. Local health departments in smaller jurisdictions, for example, were less likely than those in bigger jurisdictions to provide HIV field testing. Local health departments were much less likely than state health departments to match STD and HIV case data, and they were also less likely than state health departments to offer prevention strategies to those at risk.

Laurie Saloman, MS, is a health writer with more than 20 years of experience working for both consumer and physician-focused publications. She is a graduate of Brandeis University and the Medill School of Journalism at Northwestern University. She lives in New Jersey with her family.