Do you know you the difference between an STD and an STI?
Probably not — because, if you're like most Americans, sex education wasn't really taught in school, as it either wasn't offered or wasn't required. (For the record, those of us who work in sexual and reproductive health, rights and justice use the term "sexually transmitted infections" — STI — instead of "sexually transmitted disease" — STD — because it emphasizes the nonpermanent nature of most of them and thereby reduces stigma, encouraging people to seek testing and treatment.)
According to the Guttmacher Institute, only slightly more than half of U.S. states (plus the District of Columbia) require both sex education and HIV education. Here's something else to know: This week, the Centers for Disease Control and Prevention reported that STD rates have reached an all-time high.
And, though it didn't say so directly, the surge is just one of the many expected negative outcomes of the Trump administration's assault on sexual and reproductive health — and there will be more to come.
Although reported STD rates are through the roof — gonorrhea infections alone have increased 82.6 percent — the reality is that the numbers are probably even higher than we know due to, in part, undiagnosed cases. In particular, the CDC’s annual Sexually Transmitted Disease Surveillance Report mentioned a spike in syphilis, gonorrhea and chlamydia. But once someone contracts one of those three infections, the most common symptom is no symptom at all because each of them are commonly asymptomatic. If symptoms like anal itching, unusual discharge or pain do show up, it can take several weeks, months or years to detect and diagnose — and any such diagnoses do not show up in the current, record-breaking numbers.
As these STD rates spike, we can also reasonably expect HIV infection rates to go up because having an STD increases the likelihood of contracting an HIV infection. Additionally, many activities that spread STDs — like sexual contact with an orifice such as the vagina or penis of someone who has an infection — can also spread HIV/AIDS.
To reduce STD and HIV rates, doctors recommend regular screening and testing: Only by detecting and treating the massive (and increasing) number of current infections can we hope to reduce the rate of infection now and in the years to come. Plus, unlike with syphilis, gonorrhea and chlamydia, HIV infections can remain undetected for up to 10 years. Yet, most Americans have never taken an HIV test, and 1 out of every 7 people living with HIV does not know their status.
Prevention should be our goal — but the Trump administration's actions are having the exact opposite effect and, in many cases, accelerating the rate of STD infections. The administration’s new policy to choke off Title X funding to health care centers that provide abortion care is forcing clinics that do not provide abortions but do provide STD testing to stop services and close their doors.
Because sexual activities that drive up STD and HIV/AIDS rates can cause pregnancies, we can also reasonably predict an increase in the number of untimed pregnancies. We could stop that, too, but Trump has decided not to. With bipartisan support, the Teen Pregnancy Prevention Program is one of the Department of Health and Human Services' most effective programs; nevertheless, the Trump administration still defunded it, only reinstating support after a court forced it to do so. Research actually shows that when you cut funding for family planning, the number of abortions go up.
As a sex educator with nearly two decades of experience, there are three obvious fixes. First, we should restore Title X funding to health care providers, even if they offer abortion services or refer patients elsewhere to get them. Title X is literally in a class of its own: There is no other federal program exclusively dedicated to providing comprehensive family planning services and preventive care.
Second, we should use strategies that have been proven to reduce STD rates, not rely on programs that appeal to political constituencies that have proven ineffective at their stated goals time and again. The Trump administration’s federal budget flooded abstinence-only programs with a 67 percent increase in funding, even though research repeatedly shows these programs do not work. We should only fund evidence-based, comprehensive sex education and training.
Lastly, the Trump administration needs to shut up. They need to stop demonstrating such a lack of understanding about sexual health by stating things like they “do not support references to ambiguous terms and expressions, such as sexual and reproductive health and rights.” Just because they don't know what the term means — they don't know what "sexual health" means? — doesn't mean that the term is ambiguous, and it makes it sound as if ignorance is something in which it is OK to take pride.
We should all be embarrassed. The all-time-high STD rates are a problem that we can easily solve, and we aren't doing it. They are proof that the American public's health is literally suffering from this administration's willful ignorance and harmful policies. In the end, that ignorance hurts us all.