As part of our month-long effort to educate LGBTQ people and allies about the steps we can take to take care of ourselves, our partners, and our community, HRC turned to one of the leading experts in the world of Sexually Transmitted Diseases (STD) prevention: the National Coalition of STD Directors (NCSD). We recently sat down with NCSD's Jessica and Stephen to discuss what you need to know about preventing the spread of STDs, including HIV.
STD rates are on the rise, especially among young people. Why is that, and how concerned should LGBTQ people and allies be about this latest rate increase?
The good news is that very effective strategies have emerged for preventing HIV and unwanted pregnancy that give people more options to exercise choice in their sex lives. Pre-exposure Prophylaxis (PrEP), for example, has revolutionized HIV prevention, and there is a waterfall of evidence that points to the fact that having an undetectable viral load makes it virtually impossible to transmit HIV to someone else. Additionally, there are many birth control options in addition to condoms that are easier to use than ever before, including some methods that can provide protection for several years.
The challenge for our work is that none of these options prevent the spread of other STDs. Condoms are still the main tool we have in this fight, and not everyone uses them or wants to use them. This decline in condom use is occurring at the exact time STD prevention resources across the nation are stretched thin, as noted by the Centers for Disease Control and Prevention. Now we are seeing the highest rates in STDs in 20 years, with the starkest increases in syphilis and gonorrhea among gay, bisexual, and other men who have sex with men.
To what extent, if any, does stigma play a role in the spread of STDs? How does that stigma play out in the lives of LGBTQ people? Take healthcare for example.
As is described in a toolkit we co-developed with our partners at NASTAD, stigma is the "Bar Before the Bars" in the continuum of HIV care that looks at the path between diagnosis and viral suppression. You can think about other STDs the same way. Fear of, or experience with stigma prevents LGBTQ people and allies from accessing care, from being out to their providers, or from sharing information about the types of sex they're having, which is critical to figuring out which STD tests one might need. Stigma can also get in the way of providers giving their LGBTQ patients the health care or services they deserve.
There have been several changes in recent years to the ways we prevent and treat HIV. Is the same true of other STDs? If so, what changes should our readers know about?
There are vaccines for HPV, Hepatitis A, and Hepatitis B. Gay, bisexual, and other men who have sex with men should ask their provider about the meningitis vaccine, since there have been some outbreaks in the last few years. At NCSD, we're worried about antibiotic-resistant gonorrhea though prevalence remains low. The pipeline for new treatment is pretty empty, but there is some funding going toward finding the next treatment options.
What can LGBTQ people and allies do both individually and collectively to prevent the spread of STDs? How can we support NCSD's work to promote sexual health?
Take action to maintain your own sexual health and that of others. We recommend people use condoms since they remain one of the most effective tools we have for preventing STDs and unwanted pregnancy. That said, it's important to respect each person's decision to use condoms (or not). No one should be made to feel ashamed or embarrassed because of how they choose to have sex.
We also recommend getting tested every 3-6 months for STDs, especially if you aren't using condoms. Make sure you are getting the right kinds of tests to match the types of sex that you're having. For example, you may need an oral and/or anal swab in addition to a urine sample -- be sure to ask about your provider if you're unsure. Finally, try to find a provider who treats you like a whole person (i.e., with kindness, dignity, and respect). If you don't have one, use GetTested.cdc.gov to find STD and HIV testing sites based near you. Ultimately, we want everyone to have fun, stay healthy, as well as take care of yourselves and each other.
Jessica Frasure-Williams is director of programs and partnerships at the National Coalition of STD Directors. Stephen Hicks is the health equity and capacity building manager.
Additional Resources From NCSD
Additional Resources From HRC