The startling spread of STDs.
With an estimated 12 million new cases of sexually transmitted diseases (STDs) each year, the United States has the highest infection rate in the industrialized world - at least 50 to 100 times higher than other industrialized nations. But despite the high prevalence, it's still taboo in many circles to openly discuss the infections, what causes them and how to prevent them.
STDs remain "hidden" because they often go undetected. Major health consequences occur years after the initial infection, lessening awareness of any link to the original disease. Public discourse on the subject also is lacking because of the related stigma.
One South Carolina policymaker is shy no more when it comes to the subject of STDs. At 74 years of age, Senator Warren Giese never thought he'd quiz his colleagues with a question like, "Do you know what the status of chlamydia is?" After participat-ing in an NCSL Public Health Advisory Panel meet-ing in October 1997, he discovered that his home state ranks third out of 50 states, the District of Columbia and U.S. territories in reported cases of chlamydia (255.7 per 100,000 population), first in gonorrhea (317.5 per 100,000) and seventh in primary and secondary syphilis (10.9 per 100,000).
Hearing those numbers "was a shock," he admitted. "I'd been in the legislature for 15 years, and it was the first time I heard that we have such a problem."
Now STDs are not only something Giese has heard of, they're also something he's working to prevent. Over the past year, he spear-headed a project to raise awareness of the need for prevention and treatment of chlamydia and other STDs and will soon take his show on the road, so to speak. After the 1997 NCSL session, Giese - along with officials from the Centers for Disease Control and Prevention (CDC), the South Carolina Department of Health and Environmental Control and NCSL - decided the best way to educate people and raise awareness was through public television.
Enter Bud Skidmore, director of scripted services for South Carolina's Educational Television Network. "We periodically take on health-related topics," said Skidmore, but the STD issue "is one of the most interesting because of the potential impact on communities and the potential cost savings, in both lives and dollars."
The 30-minute video first broadcast last May begins with an overview of the problem and the fact that while "everyone's heard of [AIDS]," no one talks about chlamydia or hepatitis B, he said. The video then profiles two ways to address the issue: a Georgia project focused on chlamydia that shows how legislative work can affect a problem and a South Carolina project that targets syphilis through door-to-door education for testing and screening. The video concludes with commentary from both legislators and CDC officials, who talk about possible solutions and provide "a starting point for dialogue" across the states, said Skidmore.
Like Giese, Georgia Representative Nan Orrock "knew about chlamydia," but didn't realize the incidence and related complications until she spoke with state epidemiologist Kathleen Toomey at a regional health meeting.
At Orrock's request, Toomey gave a presentation to the women's caucus on STDs and the incidence of chlamydia. "Women were struck by the presentation in the sense that some of us had a policy background, all consider ourselves aware and informed, but we found out that this was an epidemic," she said.
Specifically, 80 percent of women are "asymptomatic," the caucus was told. "Untreated chlamy-dia," Toomey said, "results in pelvic inflammatory disease, which can lead to sterility, ectopic pregnancy and chronic pain." Orrock notes that by the time these things happen, the damage is done.
In an effort to get the word out in her own state, Representative Orrock formed a coalition for STD prevention and set up a study committee within the legislature. It recommended a measure that requires health plans to include annual screening for women under age 30 and a bill that provides an appropriation for public health clinics to screen for and treat chlamydia. The committee also worked with the state Division of Medical Assistance to ensure that providers know that screening would be covered.
As in Giese's experience, one barrier that Orrock met early on was "the reluctance to talk in public about STDs. We pierced the veil," she said "and were willing to have frank, scientific-based discussions about it. It's not 'somebody else' that has it, it's a public health problem."
And the eventual outcome? It was "awfully tough, but we prevailed with the help of very determined legislators - both male and female - and the work of advocates for women's health," said Orrock. Both measures passed the legislature.
Given the momentum from the video project, Giese said he plans to "work very hard to make progress this year" from a policy perspective. To that end, he hopes to allocate funds for statewide screening programs in both rural and urban areas. He also expressed hope that after seeing the video, legislators in other states will take action of their own.
CDC officials are also hopeful others will follow both Orrock's and Giese's lead. Although STDs are "not on the radar screen for most [state] legislators," those who take the problem seriously can truly make a difference, agency spokeswoman Judy Lipschutz said.
For information on STD: A Public Health Crisis or to obtain a copy, contact Skidmore at (803) 737-3444.