Deneshun Graves, a disease intervention specialist with the Houston Health Department, walks to a client’s residence for a visit in Houston on Thursday, Oct. 26, 2023. “When you have a mother who didn’t know (she had syphilis), it can be very emotional trying to explain … it could have been prevented if we could have caught it before,” says Graves. (AP Photo/Michael Wyke)The Associated Press
State and local health departments across the U.S found out in June they’d be losing the final two years of a $1 billion investment to strengthen the ranks of people who track and try to prevent sexually transmitted diseases — especially the rapid increase of syphilis cases.
The fallout was quick: Nevada, which saw a 44 percentage-point jump in congenital syphilis from 2021 to 2022, was supposed to get more than $10 million to bolster its STD program budget. Instead, the state’s STD prevention budget went down by more than 75%, reducing its capacity to respond to syphilis, according to Dawn Cribb at the Nevada Division of Public and Behavioral Health.
Several states told The Associated Press that the biggest impact from having the program canceled in the national debt ceiling deal is that they're struggling to expand their disease intervention specialist workforce. These people do contact tracing and outreach, and are a key piece of trying to stop the spread of syphilis, which reached a low point in the U.S. in 2000 but has increased almost every year since. In 2021, there were 176,713 cases — up 31% from the prior year.
“It was devastating, really, because we had worked so hard to shore up our workforce and also implement new activities,” said Sam Burgess, the STD/HIV program director for the Louisiana Department of Health. His state was slated to receive more than $14 million overall, but instead got $8.6 million that must be spent by January 2026. "And we're still scrambling to try to figure out how we can plug some of those funding gaps.”
While men who have sex with men are disproportionately impacted by syphilis, the U.S. Centers for Disease Control and Prevention and health officials across the country also point to the increase in pregnant women who are passing syphilis to their babies. It can cause serious health issues for infants, including blindness and bone damage, or lead to stillbirths. In 2021, there were 77.9 cases of congenital syphilis per 100,000 live births.
Disease intervention specialists often link infected mothers and their partners with care for syphilis, which has mild symptoms for adults, like fever and sores. Doing so in a timely manner can prevent congenital syphilis. The specialists also can help pregnant patients find prenatal care.
“When you have a mother who didn’t know (she had syphilis), it can be very emotional trying to explain … it could have been prevented if we could have caught it before,” said Deneshun Graves, a public health investigator with the Houston Health Department.
Lupita Thornton, a public health investigator manager in the health department, said she is worried about being able to treat pregnant syphilis patients “before 30 days of delivery, for the baby’s sake.”
The Houston Health Department is in the midst of what it calls a “rapid community outreach response” because of syphilis cases increased by 128% among women from 2019 to 2022, and congenital syphilis cases went from 16 in 2019 to 151 in 2021.
Its STD/HIV bureau was set to receive a total of $10.7 million from the federal grant, but will end up with about 75% of that.
The department has used the money to hire disease intervention specialists and epidemiologists — including Graves. But Thornton said she could use “double of everything," and had planned to bring down the caseload for her investigators by hiring even more people.
It would help Graves, who deals with more than 70 cases at a time.
“You got people that don't want to go in and get treatment. You have people that don't want to answer the phone, so you got to continue to call," Graves said.
Mississippi is also seeing an uptick in congenital syphilis cases, which a recently published study showed rose tenfold between 2016 and 2022. Health officials said a combination of funding shortages and poor access to prenatal care compounds their ability to stop the spread of syphilis.
The Mississippi State Department of Health was supposed to get more than $9 million in federal grant money over five years to expand its disease intervention workforce. Agency head Dr. Dan Edney said one of his top priorities now is finding money from other parts of the state's health budget.
He said the state has been “challenged because of limited state funding” and will need to "cannibalize resources from every program we can so that we can increase our diagnostic rates or treatment rates, and then close the loop with our investigations.”
Arizona has the highest rate of congenital syphilis in the nation: 232.3 cases per 100,000 live births. The federal money helped the state Department of Health Services clear out a backlog of several thousands of non-syphilis STD investigations that had been stalled for years, said Rebecca Scranton, the deputy bureau chief of infectious disease and services.
“We were finally at the point where we were able to breathe again,” Scranton said, “and start really kind of tackling it.”
Scranton acknowledges syphilis will take awhile to fully address, and will look to preserve some of the unspent grant money for what lies ahead.
“You don’t know what challenges are going to come. You know they’re going to come, and you just keep getting creative because our job is really to get services to the folks,” she said. “And that doesn’t change just because you get a funding cut.”
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