When the US Centers for Disease Control and Prevention released its most recent data on sexually transmitted infections, the numbers once again showed bad news for St. Louis.
Chlamydia cases in the region climbed by almost 6 percent between 2010 and 2011. Gonorrhea was up 17 percent. That’s nothing new, especially in the city itself, which is consistently among the top five of infections per capita.
How do rates get so high in the first place? And how do you get them down after years above average?
Reaching those who need it
Nothing about a gray, two-story building nestled in the middle of typical St. Louis four-families in the Central West End tells you that it houses a critical cog in the effort to combat the region's high STI rates.
This is the home of the SPOT - or Supporting Positive Opportunities for Teens. Medical director Katie Plax rattles off the services available behind the door.
"They can get STD testing and HIV testing, they can get contraception and pregnancy testing, they can use a computer, they can meet with a job coach, they can meet with a substance abuse counselor or a mental health therapist," she says. Teens can see a psychiatrist on certain days, get a hot meal, or just come hang out. All of this is free to anyone who says they are between the ages of 13 and 24.
"I think the other thing is, we don't require any documentation or verification," Plax says. "The easier you make it for people to come in and do it, the more likely people are to get tested."
Reaching teens and young adults is critically important to controlling STI rates in St. Louis. There were more than 15,000 new chlamydia cases in the region in 2011. Half of those were found in patients younger than 19 - a statistic that scares city health director Pamela Walker.
"When you have most of your cases between the age of 12 and 24, we’re looking at an entire generation at risk for infertility," she says. And getting gonorrhea at such a young age makes patients more susceptible to HIV.
A web of causes
Several factors are working together to perpetuate the problem.
Like most other indicators of poor health, high STI rates are concentrated in areas of poverty. And as with most other public health problems, it comes down to resources.
"This is also a largely uninsured population," says Walker. "Medicaid in this state only covers you to age 18, and then you have to be disabled. We don’t have a lot of money to treat the diseases."
In addition, many of the free clinics that used to offer testing have changed to a fee-for-service model, or disappeared altogether, leaving people fewer places to learn their STI status.
Plax says many of her patients at the SPOT are using sex to relieve some of the stress associated with the poverty and violence in their lives.
"Because we have a higher prevalence, if you choose to do that without using safer sex strategies, you’re frankly just at higher risk to acquire an STD," she says. Also at work is the fact that the symptoms of many STI’s, especially chlamydia, don’t show up immediately. That means people don’t get tested or treated for long periods of time.
Combine that with the nature of relationships today, and you have the makings of a persistent public health problem.
"Relationships have no value anymore."
Radio personality turned social worker Shellita Dillon-Coleman says these days, she rarely hears people saying, "we went on a date."
"It's a hook-up now," she says. That's less of a problem when your dating pool is bigger. But Dillon-Coleman says that's not the case for African-Americans.
"I can pull out pictures of guys that I’ve slept with, and me and five girls, we get to talking and it’s 'oh, you know him, and you know him?' It’s that type of thing," she says.
That's part of the reason that Dillon-Coleman has made herself and a giant shopping bag full of condoms a regular fixture at a gas station just north of downtown St. Louis.
"Ain't nothing wrong with doing it, as long as it's safely done," she says.
Dillon-Coleman speaks from personal experience. She was in a long-term monogamous relationship when she found out she'd contracted two STIs, and had an HIV scare as well. That led her to make the transition to outreach work.
"I felt like there were other women like me who were in relationships and did not see themselves at risk," she says. "The church people, you have the people who make a certain income level, these are all the people that do not see themselves at risk, so the biggest part of my job is to put that mirror up and say yeah, we’re all at risk. Anyone who is having unprotected sex is at risk."
Dillon-Coleman says she knows she's been successful when people come up to her and request a specific brand of condoms. In the warmer months, social service agencies will do testing in neighborhoods with high rates of infection.
None of these efforts will ever get the number to zero. As the city’s Pamela Walker puts it, as long as sex feels good, there will be new cases.
STI rates will have to go up first as well, as more people get tested.
But all involved hope that their efforts will eventually reverse the trends that have plagued the city for so long.
Follow Rachel Lippmann on Twitter: @rlippmann