Testing for sexually transmitted diseases at the Southern Nevada Health District has jumped 34 percent in the last two years, and reported STD cases have been rising by double-digit percentages.
Explanations for the rise of STDs vary, from a decline in condom use to the rise of dating apps to people’s inability to visit or have an honest conversation with a doctor. But whatever the reasons, there has been an increase rate of STDs nationally.
That’s also the case in Nevada.
There has been a double-digit percentage increase in reported chlamydia and gonorrhea cases in Southern Nevada in the last year, though the health district isn’t considering this a health emergency at the moment.
“It’s something we should paying attention to though” said Marlo Tonge, a communicable disease manager with the health district. “It’s something we should be getting out in front of as much as possible.”
If there was an infection to worry about, Tonge said it would be for syphilis cases, which have also risen at a double-digit percentage rate.
“There are many complications to leaving syphilis untreated and undiagnosed,” she added. “It spreads through skin to skin contact, can cause a variety of significant health issues, including neurological issues, and even death. Women who are infected with syphilis and become pregnant can pass it to the fetus, and without proper treatment a stillbirth or deformities can occur.”
While the health district focuses on stopping the spread of disease, some working in outreach think that effort needs to more aggressive.
“If anyone should buy into the solution it should be the gaming industry,” said Gary Costa, the executive director of Golden Rainbow, which provides resources for people with HIV. “Tourists aren’t going to want to come here if it’s the chlamydia capital of the world.”
By the numbers
As STD rates have grown, funding for testing and treatment has fallen.
The Nevada Department of Health and Human Services Division of Public and Behavioral Health receives funding from the Centers for Disease Control and Prevention, which then disseminates it to various health districts and medical outreach clinics throughout the state.
In the 2017 fiscal year, the Southern Nevada Health District received $440,670, 11 percent less from the $493,925 it received in 2016.
“We were given a heads up there might be a slight decrease in the next year by 5 or 10 percent,” said Brian Parrish, manager at the Office of Public Health Investigations and Epidemiology.
But federal funding to combat STD prevention and treatment has always been unpredictable, according to Tonge.
Management supplements grants with money from the SNHD general fund, she said. “In addition, management is always looking for other grant opportunities from the state and/or CDC that aid in our abilities to do our work and keep good staff. Sometimes we have to shift and prioritize, but we have dedicated staff who really understand the importance of our work.”
The health district tested 47,028 people in 2017, which is up from 45,082 in 2016, and up substantially 35,180 in 2015.
State law requires health care providers to report positive test results – while protecting patient confidentiality – to the health district for a variety of diseases, including STIs.
Cases of chlamydia jumped from 11,364 in 2016 to 12,567 in 2017. Reported cases of gonorrhea increased to 4,592 cases in 2017, from 3,643 in 2016.
For African Americans, the rate of chlamydia is 868 per 100,000 compared to 181 per 100,000 for white people. The rates are also higher for cases of gonorrhea and syphilis.
The health district does reach out to “impacted communities,” but they don’t have any specific campaigns targeting black and brown people.
“You have to remember that our primary role is surveillance,” Tonge said. “We collect, analyze, and report data (population health specific data) to the state.”
Despite rising STD rates, there still aren’t a lot of places that offer full, or free, testing.
The health district facilities that offer full screenings are still in short supply. Only the facility on Decatur Boulevard does full testing while the East Las Vegas Health Center does partial screenings.
“We would like to offer screening services for STD’s wherever we go,” Tonge said. “It takes resources. We already leverage and move staff around to conduct STD testing in non-traditional venues at non-traditional hours when funding is available.”
There is currently more testing for HIV, which costs about $7 per test compared to about $20 for gonorrhea and chlamydia. (Funding for STD prevention, testing and treatment is separate from HIV funding, which comes from federal Ryan White HIV/AIDS Program).
The other issue is long wait times. Costa said clients have told him that they’ve had to wait hours to get testing. (The health district didn’t keep track of average wait times.)
Julia Peek, the deputy administrator of community services for Division of Public and Behavioral Health, said with Nevada’s Medicaid expansion people would be able to do screenings with health care providers.
Though private health providers submit reports, they aren’t required to track down a patient’s past partners.
There are still barriers for some to see a primary care physician.
For one, Tonge said even if people are seeing health care providers, people aren’t always honest with their providers, which might lead them to either not get tested or not get the correct test.
Some community outreach organizations and nonprofits have been trying to shoulder the efforts.
“There are providers like AIDS Healthcare Foundation that test for free later in the evening,” Tonge said. “We often partner with them on mobile efforts so we can target areas bringing screening services out into the community.”
AIDS Healthcare Foundation has been in Las Vegas since 2013 offering free standing clinics and a mobile testing unit.
It decided to add a free STD clinic in 2016. Screenings are administered on Wednesday evenings and Saturday.
“We have far exceeded our goals for testing,” said, Christopher Reynolds, program manager for AIDS Healthcare Foundation.
This doesn’t just add another full-serve clinic. Reynolds said many of his clients have expressed discomfort with the health district as a reason for not going to get tested so another option means more people are willing to get tested.
“We have found that our repeat testers don’t feel comfortable going to a government-style testing center (like the district),” he said. “It’s a barrier.”
Other than the AIDS Healthcare Foundation, other community partners include Huntridge Family Clinic, UMC Wellness Center and Care Coalition.
For the last two years, the district has also partnered with Aid for AIDS of Nevada to provide rapid HIV testing on sight.
If a person tests positive, they are sent to the health district for another test to confirm the diagnosis.
Antioco Carrillo, the organization’s executive director, said down the road he would like AFAN to be a site to do full STD testing.
However, that would require another license and additional funding.
“It would have to come out of (the organization’s) pocket,” Carrillo said. “So this won’t happen until the future.”
Andre Wade, the executive director of the Gay and Lesbian Community Center of Southern Nevada, said the nonprofit used to offer testing with the health district, then it was cut due to funding. Earlier this year, it decided to conduct its own testing for HIV.
Though Golden Rainbow provide housing assistance for those living with HIV, Costa said clients often request testing because they don’t know any other option.
“I have people who come in to get a check for their rent who ask if someone can take a look at their penis,” he added. “When it’s getting to the point where they are looking to a case manager for answers, it’s unfortunate. They don’t know where else to go.”