Chicago LGBTQ center increases STD testing, infection disparities persist

A Chicago LGBTQ health center dramatically increased STD screening over 5 years, but many of its patients are still disproportionately burdened by STDs, according to a recent epidemiology report.

In the report, researchers assessed the extent and results of testing for HIV, syphilis, gonorrhea and chlamydia from 2012 to 2016 at Howard Brown Health — the largest LGBTQ health center in the Midwest.

“Howard Brown observed that HIV and STDs continue to disproportionately impact men who have sex with men, transgender women, youth and persons of color,” they wrote. “Several of Howard Brown’s trends mirror data reported in Chicago, including the increase in syphilis, small increases in gonorrhea and chlamydia positivity, a decline or plateau in HIV infections and demographic groups that experience disproportionate disease prevalence and incidence.”

Howard Brown operates clinics throughout Chicago and provides medical, social and behavioral care to more than 26,000 people each year, according to the report. Over the 5-year period, nearly 46,000 unique patients were screened, the health center said. Services included 63,889 tests for HIV, 74,018 for syphilis, 70,430 for gonorrhea and 70,290 for chlamydia.

Screening for gonorrhea and chlamydia increased, on average, 29% over that period, the report said. In addition, overall STD screening that included extragenital sites rose from 20% in 2012 to 69% in 2016.

The report added that, over the 5 years, 3,384 people started pre-exposure prophylaxis (PrEP) for HIV. Moreover, in 2015 and 2016, researchers estimated that PrEP use avoided 44 new HIV infections, saving about $10 million in lifetime medical costs.

In the same 2 years, almost 30% of patients diagnosed with HIV were additionally diagnosed with gonorrhea or chlamydia on the same day.

“This frequency of same-day STD coinfections emphasizes the importance of full STD screening panels,” the researchers said.

Although the increases in screening may be encouraging, they also reveal the extent of the STD epidemic and its impact on LGBTQ clients. New primary and secondary syphilis cases at Howard Brown increased by 28% from 2015 to 2016.

Although the rates of chlamydia and gonorrhea infection have risen only slightly in Chicago overall, Howard Brown has seen a much larger increase among those who come to the center to be screened. There, chlamydia increased by 51% and gonorrhea by 68% from 2015 to 2016.

The Howard Brown report also included infection rates among patients of various gender identities. They included cisgender and transgender men and women, genderqueer (those who identify with neither or both genders), patients who identified as “something else” and those who declined to report a gender identity.

Among those who did not identify as “something else” or who declined to identify, rates of HIV infection in 2015 and 2016 were highest among transgender women, at 1.61%, followed by cisgender men at 1.02%. The rate was 2.34% among those who declined to identify.

From 2012 to 2016, among those reporting a gender identity, the infection rates of gonorrhea, chlamydia and syphilis were highest among cisgender men, at 10.74%, 10% and 1.58%, respectively. The rate of chlamydia infection was higher, however, among those who identified as “something else,” at 10.75%. In addition, those who declined to identify had the second highest rate of gonorrhea infection, at 7.93%.

Of those patients reporting a race or ethnicity, the HIV infection rate in 2015 and 2016 was greatest among blacks, at 1.42%, followed by Latinos at 1.25%. Native Americans had the highest rate of gonorrhea infection, at 9.48%, followed closely by whites at 9.47% and blacks at 9.4%.

From 2012 to 2016, Native Americans also had the highest rates of chlamydia and syphilis, at 10.08% and 2.83%, respectively. Blacks had the second highest rate of chlamydia, at 10.02%, whereas Latinos had the second-highest syphilis rate, at 1.88%. – by Joe Green

Reference:

Howard Brown Health. 2017 Epidemiology Report. https://howardbrown.org/wp-content/uploads/2017/09/HBH_EpidemiologyReport16.pdf. 2017. Accessed September 7, 2017.