Below is a transcript of remarks delivered on February 22, 2019 by Taryn Couture for NCSD:

My name is Taryn Couture, Senior Manager of Policy and Government Relations at National Coalition of STD Directors.

I want to thank Secretary Azar, Assistant Secretary Giroir, Dr. Beckham, and other leaders at HHS for the opportunity to share ideas and recommendations for updates to the National HIV/AIDS Strategy (NHAS).

Tremendous gains have been made toward ending the HIV epidemic in the US, and a real possibility exists that we can end the epidemic within ten years However, while consistent progress has been made in decreasing the incidence of HIV, STD rates have soared to record high levels. For the second year in a row, the CDC released data showing that STDs have hit all-time highs in the US. Syphilis, gonorrhea and chlamydia have all increased more than two-fold over the past five years, trends that show no signs of slowing. These increases have critical consequences for the success of any strategy that aims to end the HIV epidemic.

A growing body of evidence shows that STDs increase the risk of HIV transmission up to five-fold, and that finding, treating and preventing STDs will reduce the spread of HIV. A recent modelling study, published in the Journal of Sexually Transmitted Diseases, reports that one-in-ten new HIV cases in gay and bisexual men are the result of gonorrhea and chlamydia infections.

Therefore, to fully address eliminating HIV in this strategy, STD screening, treatment and prevention must play a key role; fortunately, there are methods and infrastructure already in place. STD clinics continue to provide consistently high-quality and low-cost HIV testing. One study found that 10-35% of new HIV cases are actually diagnosed at STD clinics. Additionally, Disease Intervention Specialists (DIS), the public health workforce, conduct field outreach for both epidemics, responding to outbreaks, and finding sexual partners of people who test positive for an STD or HIV. Any updated strategy must include HIV testing in STD clinics as well as support these highly-trained, boots-on-the-ground public health workers to reach populations at risk for HIV.

Although over the past few years, we have improved the integration of HIV and STD services, we have a long way to go. Over the past 20 years federal funding for STDs has remained flat and the consequence are record rates of all new STDs. Financially supporting STDs can reverse the increasing rates of new gonorrhea, chlamydia, and syphilis cases which will ultimately limit the risk of HIV transmission.

With increased funding and policies to back up these additional resources STD clinics will be key access points for expanding the use of PrEP. Although this will require a concerted investment in resources, doing so can help to reach key populations who are at the highest risk for HIV. Also, implementing PrEP in STD clinics will ensure that CDC’s guidelines of testing for STDs every three months for people on PrEP are implemented.

We appreciate the opportunity to share our recommendations and look forward to working with you to update the NHAS.