Long Beach has the second highest rate of chlamydia and gonorrhea in California, and in 2017, the number of sexually transmitted diseases increased for the third consecutive year, according to data from the city’s Department of Health and Human Services.
The department on Thursday afternoon, Oct. 11, released its 2017 STD report, which showed that the rate at which residents contracted the three primary sexually transmitted diseases – excluding HIV/AIDS – shot up between 12 percent and 14 percent last year, with the densely populated areas of downtown and north Long Beach driving the increase.
Long Beach, the data show, is in many ways a microcosm of a growing public health issue both across the state and nationally: Last year, according to the Centers for Disease Control and Prevention, there were a record 2.3 million cases of chlamydia, gonorrhea and syphilis, breaking the previous high – set in 2016.
And in California, according to the state’s Department of Public Health, the rates of chlamydia and gonorrhea were the highest since the late 1980s and early 1990s.
“We are sliding backward,” Jonathan Mermin, director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention said in an August statement. “It is evident the systems that identify, treat, and ultimately prevent STDs are strained to near-breaking point.”
The reasons for the increase are not definitive, but there are several hypotheses, according to officials from the Long Beach Health Department, St. Mary’s Medical Center and the LGBT Center.
Those include attrition at the federal level of funding for STD education and prevention programs, which filter to local agencies; increasing density in urban areas and the advent of technology that makes it easier to have multiple sexual partners; and, more than three decades after the AIDS epidemic scared people into having safer sexual behaviors, a concerning rise in “condom fatigue.”
“There’s a whole bunch of stuff going on,” said Dr. Anissa Davis, Long Beach’s health officer.
And while public officials are hesitant to call the rise in STDs a full-on crisis, they do say they are increasingly concerned – particularly over the possible rise in antibiotic-resistant strains of some diseases, and the permanent disabilities that could burden children born to mothers with untreated syphilis.
It’s enough of a problem, Long Beach officials say, that the city has a team working on an action plan, a draft of which is due out early next year.
“The nation,” Davis said, “is struggling to deal with this.”
Rising rates
In Long Beach, there were 4,321 cases of chlamydia in 2017, a 12 percent increase over the previous year, and 1,690 cases of gonorrhea, a 14 percent rise.
The city had fewer syphilis cases last year than it did chlamydia or gonorrhea, but the 343 contractions – the third highest in the state – represented a 12 percent increase.
There were also eight reported cases of congenital syphilis, up from four the previous year. Congenital syphilis, passed through the placenta to an unborn fetus, can cause miscarriages and birth defects, and pass itself to the child. It was nearly eradicated in the 1990s, Davis said.
“I don’t know if it’s a crisis,” said Dr. Paul Lovely, the executive director of St. Mary’s CARE Center, an HIV program that also does STD screenings. “But it is concerning because it’s a trend that’s gone on for a number of years.”
The highest rates for most STDs, according to Health Department data, are in North Long Beach and the downtown area.
The North Long Beach ZIP code of 90805 had among the highest rates of contraction for every STD except syphilis, which was highest in the Alamitos Beach area.
The 90802 ZIP code, which includes Alamitos Beach, had among the highest rates for everything except chlamydia.
Chlamydia, Long Beach officials say, is more prominent among those aged 20 to 29, particularly men.
The reasons these two areas, separated by the length of the city and by demographics, have the highest STD rates are different, officials say – but equally challenging.
Condom fatigue
The Alamitos Beach area has long had a vibrant LGBT community, and the data show that gay men are among those driving the increasing STD rates.
But the reasons for this are not all bad, officials say.
For one, HIV/AIDS research has come a long way since the dark ages of the 1980s. There’s an increasingly common pill taken by gay men, pre-exposure prophylaxis, or PrEp, that can reduce the risk of contracting HIV by 92 percent if taken regularly.
And the rate of new HIV cases is one bit of good news from the report: the numbers have plateaued – though not decreased – since 2014.
“That’s a good thing,” said Ismael Salamanca, the director of health and wellness at the LGBT Center. “But we need to work on getting it down.”
For those living with HIV, antiretroviral drugs can make the virus virtually undetectable – and unable to be passed onto someone else.
Couple that with the relative ease of curing other STDs when caught early, and the risks of unprotected sex seem lower.
“There is condom fatigue now that we can prevent HIV in different ways,” Davis said, pivoting to STDs generally. “It feels safer. You get a shot or two and it’s taken care of.”
But it’s not simply that gay men aren’t wearing condoms as much as in the past, Salamanca and others said.
“PrEp patients are extremely proactive about their sexual health,” Lovely, of St. Mary’s, added. “Our patients get tested regularly for STDs as well.”
Salamanca placed part of the blame on medical providers who aren’t as well versed about their patients’ sexual behaviors as they should be.
At the LGBT Center and St. Mary’s, for example, the routine testing procedure is to check urine and do throat and rectal swabs. Patients have to opt out to avoid those.
“A lot of providers just do urine,” Lovely said. “But a high percent of rectal gonorrhea won’t show up on a urine exam.”
And if doctors don’t catch STDs, they can spread undetected.
Unfortunately, Salamanca said, not everyone feels comfortable sharing their sexual behaviors with their doctors.
“It’s not that they feel shame,” he said. “It’s that they don’t want their doctors to shame them.”
Some doctors, Lovely added, may not realize rectal and throat exams are necessary if it’s not part of their regular practice.
“You have to advocate for yourself,” he said.
Stigma runs deep
North Long Beach’s residents, on the other hand, are predominantly Latino and African American.
Citywide, black men and women, particularly those in their 20s, have been the most likely to be diagnosed with chlamydia and gonorrhea over the past several years – with rates of chlamydia in 2017 hitting 866.5 per 100,000 for women and 873 for men; for gonorrhea, the rates for women were 332 for women and 724 for men.
Latinos have had the highest rate of new HIV/AIDS contractions, according to city data.
Nationally, high STD rates among minorities have been linked to poverty rates, according to the CDC.
But in North Long Beach, that may not apply. That area, Councilman Rex Richardson said, has been on the upswing lately.
Even though about 24 percent of the 90805 ZIP code is below the poverty line, according to the U.S. Census Bureau, there are only a smattering of individual neighborhoods within North Long Beach where poverty is above 25 percent, according to city data – far fewer than the southwestern portion of Long Beach, where nearly every neighborhood hit that mark.
Rather, three issues may be at play, Richardson and others say: too few resources, cultural stigma and – a problem city- and nationwide – education.
“For years, the resources were centered in downtown because that’s where the need was,” Richardson said. “But that’s not where the need is anymore. It’s in North Long Beach, so we need to distribute the resources more evenly.”
Health officials deploy mobile testing centers in North Long Beach, but Salmanaca said the city could perhaps offer that resource more frequently.
But other resources are lacking. The bars in downtown Long Beach, despite condom fatigue, still have free prophylactics on hand. The bathrooms at Cal State Long Beach have bowls of condoms for students to take. The LGBT Center also offers condoms.
Those resources are not readily available in North Long Beach.
“If you’re a young man,” said Kelly Colopy, the city’s director of Health and Human Services, “and you have to go to a store to buy condoms, it may be embarrassing. They are usually behind glass and you have to ask someone.”
Then there is the stigma.
African Americans with HIV still face much greater stigma and cultural rejection that whites, according to experts and multiple studies.
“HIV-related stigma is associated with decreased likelihood of HIV testing,” several experts wrote in a 2014 article for the journal AIDS and Behavior. “African-Americans living with HIV report greater perceived stigma and more social rejection than Caucasians.”
Richardson, who represents North Long Beach, said, “We have to work to change the culture.”
Education needed
The final reason officials say North Long Beach has higher rates than other parts of the city is also true throughout the country – and possibly the key to turning around the brewing-crisis:
Education.
In 2018, President Donald Trump’s budget slashed HIV prevention and education programs by $149 million from 2016 levels and STD programs by 27 million.
Over the last two decades, according to Davis, the purchasing power of STD funding has decreased by 40 percent.
Still, the city does what it can.
Officials have developed an HIV/STD awareness campaign called KnowMore, designed to encourage people to get tested, and recently held a half-day STD training session for more than 60 local clinicians.
Officials also try to go to schools to educate people, though that can be tough: Parents, even in progressive Long Beach, aren’t always keen on having strangers talk to their children about sexual health – and there’s a host of protocols school districts have to follow.
“When we get in, the teachers are excited to have us and the students are engaged,” Davis said. “But getting in can be a challenge.”
In general, officials said, people still don’t like talking about sex – whether with their doctors, to their kids or among friends. But that makes lowering STD rates difficult, especially for those in the LGBT community, where they may not feel safe discussing their sexual behaviors, or among African American communities, where stigma still runs deep.
“Americans still don’t talk about sex,” Lovely said. “In 2018, there is less sex ed taught in schools than 10 or 20 years ago, which seems crazy.
“We don’t really do school-based education.”
