The Persistence of Syphilis and Issues of Health Equity in America

Published: April 25, 2011

April is STD Awareness month.  This article is one in a series published by RH Reality Check in partnership with the National Coalition of STD Directors, focused on aspects of STD prevention, treatment and funding and the public health implications of neglecting STDs.
Syphilis elimination, a term that may now seem inappropriate for a period of fiscal constraint, was launched in October of 1999 at a time when syphilis rates were low and over half of all incident cases where located in 28 counties nationally. In concept, it served a purpose in galvanizing attention to the inequities surrounding syphilis rates in the United States. Jeffrey Kaplan, the then-director for the CDC said so himself:
“This disease, like others, serves as a sentinel for broader health and societal problems that we need to address. People who live in poverty, lack employment, and who lack access to quality health care are vulnerable to this and other diseases. So, as we target our efforts and work at strengthening and involving the state and local health departments, community groups, and communities of faith, we should see a difference not just in syphilis rates, but in a range of other health conditions that go hand in hand with it.” [1]  
The disparities of this historically endemic disease were and still are tied to poverty, the lack of guaranteed access to medical care, the continued stain of racism, and the contextual factors that contribute to the many non-sexual health inequities we see in our society.[2] Still, throughout much of the Southern United States, the Syphilis Elimination Effort brought the rates for heterosexually-transmitted disease to new historic lows — only to now see overall disease rates rise again across the US and with a newer, more narrowed population.
The current epidemic is a different one, but one that still most adversely affects those so often marginalized in our society. This twenty first century epidemic shifted from one of primarily heterosexual transmission to one that affects men who have sex with men (MSM) in ever-higher numbers. While heterosexual transmission reached historic lows, congenital syphilis increased by 23 percent from 2005 to 2008. Most of this increase occurred among infants born to black mothers in the South.  Syphilis elimination had a setback in the two outcomes that mattered most, HIV and congenital syphilis.
From the start, we knew an approach that was primarily “medical” could never eliminate a pathogen whose existence is so tied to societal inequities.  We knew it then, but we lacked the political will to address the underlying factors that contributed to the persistence of this centuries old scourge.   We may hold out that health care reform might indeed lift all boats, but even the politicization of that effort underscores the sad news that this courage is still profoundly wanting and when demonstrated, splits our nation in two.  All the while, syphilis continues its ravenous onslaught.

Full text of article available at link below –

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