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Opioid Epidemic and Syphilis Outbreaks Complicate Trump's HIV Plan

Unless the government gets both issues under control, public health experts say President Trump will never realize his goal of eradicating HIV.

Pain in Preemies
Congenital syphilis can cause premature births,
(AP/M. Spencer Green)
America nearly eradicated congenital syphilis around 2000, but since 2012, the number of babies born with the disease has been on the rise. In some places, the outbreaks have reached crisis levels.

Public health experts largely blame the opioid epidemic for the disease's return, and unless the government gets both issues under control, they say President Trump will never realize his stated goal of eradicating HIV.

Congenital syphilis refers to the disease having been passed down from a mother to her fetus. Syphilis can cause miscarriages and stillbirth. For newborns, it can result in brain and nerve problems, bone deformities, meningitis and death in infancy.

According to the Centers for Disease Control and Prevention, cases of congenital syphilis jumped 44 percent from 2016 to 2017 (the latest numbers available) and 133 percent from 2013 to 2017.

In Arizona last year, 53 babies were born with congenital syphilis, and 10 of them died -- the most deaths the state has recorded for the disease.

Kansas City is also facing an outbreak, with cases jumping 71 percent in one year. There, the disease's comeback follows four years of significant federal, state and local budget cuts for the health department. With fewer funds, the department hasn’t been able to fill a couple of positions that would have helped manage the outbreak, according to Tiffany Wilkerson, manager of the city health department’s division of communicable disease prevention.

Health officials asked Kansas City leaders to declare a public health emergency, which would allocate additional resources. They are still waiting on final word from the city.

"Federal STD funding has seen a 40 percent decrease in purchasing power since 2003," according to a 2018 report from the National Academy of Public Administration. Most city and state health departments rely entirely or mostly on federal funding, says Matthew Prior, communications director for the National Coalition of STD Directors.

“Every case of congenital syphilis is a public health failure,” Prior says. “It’s treatable, and it’s easy to diagnose.”

 

The Opioid Epidemic's Role

Women can contract syphilis through sex or needles that have been used by people with the disease. Experts say needle transmissions have become more common as opioid use has risen to epidemic levels.

In addition to causing many congenital syphilis cases, experts say the opioid epidemic has limited health departments' ability to respond to them because there are so many resources being spent on the drug crisis. The federal government spent $500 million on the opioid epidemic in 2018 and around $120 million on STD prevention.

“There are often competing priorities in public health, and STDs haven’t risen to importance for decisionmakers in allocating resources,” says Prior.

In his State of the Union address this year, President Trump pledged to end HIV in the next decade. But Prior says that will be nearly impossible if more resources aren’t allocated to preventing the spread of other STDs, such as syphilis.

“We can’t end HIV in the next 10 years if we don’t get a handle on the skyrocketing cases of STDs,” he says. 

Kansas City's Wilkerson echoes that concern.

“Our gonorrhea and chlamydia are also above normal. We could be looking at additional HIV cases if we can’t get a handle on these diseases. We are stretched so thin, I hope we can maintain the services we do have.”

 

Responding to Outbreaks

Alabama has made some progress against congenital syphilis. After the state's cases tripled in 2016, the health department quickly expanded its education and outreach efforts, testing every single pregnant woman who came into the office and strengthening the interview process for people with syphilis to help officials notify anyone the person might have come into contact with. 

“That person might come in for one service, but we don’t want to miss an opportunity. We routinely work across county lines to draw resources from a county that might have more resources,” says Karen Landers, medical director for communicable diseases at the Alabama Department of Public Health.

Though syphilis numbers are still gradually moving up in Alabama, mirroring national trends, they have slowed down since the 2016 outbreak.

This appears in the Health newsletter. Subscribe for free.

Mattie covers all things health for Governing.

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