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DPH warnsSTD rates are rising; commission asks for targets, more data and six-month follow-up
Summary
San Francisco Department of Public Health reported increases in gonorrhea, chlamydia and syphilis while HIV diagnoses fall; DPH cited declining CDC STD grant funding and proposed a mix of short-term and upstream strategies. Commissioners requested disaggregated data, targets and a six-month update.
San Francisco Department of Public Health presented surveillance and programmatic information showing increases in sexually transmitted disease (STD) diagnoses even as new HIV diagnoses decline.
Susan Phillips, director of the Disease Prevention and Control branch, told the commission San Francisco is one of seven cities that receive CDC direct funding for STD prevention, but that the CDC's funding formula is reducing grant dollars (DPH cited a projected 25% decrease over the five-year grant cycle starting in 2014). Phillips said DPH has leveraged local general fund and HIV-related funds to sustain STD prevention services.
Preliminary surveillance through February 2014 indicated rising rates of gonorrhea, chlamydia and early syphilis. Phillips and staff noted that many prevention strategies that reduce HIV transmission (for example, treatment-as-prevention and biomedical approaches such as PrEP) do not prevent bacterial STDs, which rely on condom use and different clinical strategies. DPH outlined a three-pronged approach: secondary prevention (partner notification, repeat testing at three months), primary prevention (condom promotion, clinic-based services and community partnerships), and upstream efforts (focus groups, targeting priority populations and policy changes to reduce barriers to prevention).
Public commenters criticized DPH marketing and called for more positive messaging acknowledging community efforts in HIV prevention; Michael Petrellas called some past ads stigmatizing and urged recognition of community contributions. Commissioners broadly supported more and faster data; several asked for disaggregated counts by age, race and neighborhood and for measurable targets rather than only multi-year plans. The director and Phillips agreed to provide more detailed data and offered a six-month update to the community and public health committee.
DPH also described pilot ideas discussed with partners, including expedited partner therapy, mailed-home testing kits for retesting, electronic clinician consultation, and moving City Clinic to the San Francisco General campus to improve access. Phillips emphasized there was no single quick fix and that multiple clinical and upstream strategies would be needed to reverse rising STD trends.
