Addressing STDs, Tuberculosis in America

Addressing STDs, Tuberculosis in America


Kim Krisberg

Hazel Dean, Sc.D., is the deputy director of the Centers for Disease Control and Prevention’s (CDC) National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention. Dean is widely recognized for her work in addressing disparities in HIV and sexually transmitted disease rates and is the recipient of a number of honors, including the Presidential Rank Honor Award for Distinguished Service, the nation’s highest civil service award. With continuing disease challenges on the horizon, Dean recently spoke about her top priorities, new prevention opportunities and why social media is a critical public health communication tool.

Your CDC center oversees a wide range of health issues, from multidrug-resistant TB to continuing disparities in HIV infection. What have been the most significant accomplishments?

Hazel Dean: Six particularly remarkable accomplishments, among many, come to mind. First, highly effective antiretroviral therapy has greatly extended life expectancy among people living with HIV and resulted in a dramatic drop in AIDS deaths. Additionally, consistent pre-exposure prophylaxis use now reduces HIV transmission, and considerable progress has been made in other highly effective interventions, such as male circumcision, STD treatments, antiretrovirals and vaccines. For hepatitis C, advances in antiviral treatments have helped cure infection, reduce transmission and prevent deaths. For STDs, better testing, treatments and partner management have reduced syphilis by 22 percent and gonorrhea by 34 percent among blacks. Finally, annual tuberculosis cases in the United States have reached an all-time low.

Despite these accomplishments, however, our center still has many urgent priorities, not the least of which are limiting antibiotic-resistant gonorrhea and reducing STDs among young people. We cannot claim victory yet over tuberculosis and must continue to take steps toward its elimination. While improved treatments for hepatitis C are a major step forward, there is still a great need for more widespread testing to make people aware of their infection so that they can benefit from new life-saving treatments. Progress in HIV prevention has been uneven, and gay and bisexual men and blacks continue to be most affected. We must ensure that all prevention strategies reach all populations equally.

In November, CDC reported that rates of gonorrhea, chlamydia and syphilis had risen for the first time since 2006. What are the drivers behind this?

To clarify, 2014 was the first time since 2006 that all three diseases increased in the same year. Nevertheless, this trend is particularly concerning because these complex diseases are being influenced by multiple factors. Increased implementation of STD screening recommendations—particularly screening and testing at least annually among all sexually active men who have sex with men—might be increasing chlamydia and gonorrhea detection.

For both primary and secondary syphilis, cases have been increasing among men who have sex with men since at least 2000. In 2014, men accounted for 91 percent of all syphilis cases, and among men for whom the sex of their partner was known, 83 percent were men who have sex with men. In 2014, syphilis cases also increased among women and heterosexual men. Some men have sex partners in both men-who-have-sex-with-men and heterosexual networks, which might account for syphilis rate increases among these additional populations. Compounding the challenge is a lack of resources in certain health jurisdictions for contact tracing and other services for new syphilis patients.

Because STDs are preventable, significant reductions in new infections are not only possible, they are urgently needed. CDC is working to provide resources to state and local health departments to support prevention efforts in communities. People should talk openly about their risk behaviors, get tested and increase safe sex behaviors. Finally, we encourage doctors to discuss STDs with patients and to prescribe screening, prophylaxis and treatments recommended by CDC and the U.S. Preventive Services Task Force.

Another recent CDC report found a third of health care providers are unaware of pre-exposure prophylaxis (PrEP), the daily pill that can prevent HIV infection. How can we raise awareness?

As with any new health intervention, health-care providers and patients need time to learn about and accept PrEP. CDC is working to help inform and educate clinicians about PrEP, including issuing guidelines, offering charts and checklists and supporting a telephone hotline that provides free expert advice on PrEP.

PrEP can dramatically alter the course of the HIV epidemic. When taken daily by persons who are HIV-negative, it can reduce the risk for sexually acquired HIV by 90 percent. Daily PrEP can also reduce the risk for HIV infection among people who inject drugs by 70 percent. But PrEP alone is not enough. Thirteen percent of those who are HIV-infected do not know their status. Early linkage to care and treatment can serve the dual purpose of enabling those with HIV to have longer, healthier lives and be less infectious.

You’re an avid user of Twitter, with thousands of fans following you at @DrDeanCDC. As a public health practitioner, do you think it’s particularly important to be a savvy social media user?

Social media provides an opportunity and an obligation, both of which I strongly embrace. Through social media, I can share our center’s messages with diverse audiences. For example, some of what I share is targeted to providers, who in turn touch thousands of lives through their practice. It’s my hope—and belief—that the messages I share through Twitter will influence clinicians to think about HIV, STDs, viral hepatitis and tuberculosis when talking with their patients. We encourage both clinicians and patients to be open and honest in sharing information about sexual behaviors and substance abuse and their consequences. That helps everyone.

Along with these opportunities, we also have an obligation to provide the most current, accurate data and scientific findings to demonstrate that our advice is not merely opinion, but grounded in objective facts. This provides a level of depth far beyond the initial message we provide through social media. I believe that we can always do better at meeting this obligation to clearly communicate important messages, explanations and good reasons to act, and I strive to do this daily.

You often speak and tweet about the importance of working toward health equity. What kinds of insights can we glean from the history of HIV, STD and TB prevention work that are particularly relevant to the public health movement to achieve health equity?

Disparities in HIV, viral hepatitis, STDs and TB exist across gender, age, race or ethnicity, education, income, disability, geographic location and sexual orientation. We know from history that these diseases do not affect all populations equally. Social determinants of health, including poverty, unequal access to health care, limited education, stigma and discrimination, are all linked to these health disparities.

History has taught us that health disparities can be substantially reduced or eliminated through a combination of preventive services for everyone and preventive services that target the greatest needs of disadvantaged populations with sufficient resources to address those needs.

Reprinted with permission from The Nation’s Health, APHA