Syphilis is back? HIV is still a thing? Isn’t that something IV drug users and “undercover brothers” need to be worried about? As the unprecedented HIV/syphilis cluster outbreak in Milwaukee shows, sexually transmitted infections are definitely a thing, despite misconceptions like these that refuse to go away.
Milwaukee might just be the rude awakening the country needs because the outbreak that happened there can — and will — happen anywhere.
But we have the tools to address general ignorance about sex and STIs, in particular, through comprehensive sex education in schools. Europe has pretty much figured it out: If we don’t get to students when they are a captive audience, the likelihood of receiving this life-saving information drops to — never.
This is disturbing because HIV and syphilis are preventable. Here we are in 2018 with one of the largest sexually transmitted infection outbreaks Milwaukee has ever seen. In 2016, the national syphilis infection rate was much lower than the Milwaukee the syphilis infection rate, especially among 15-29 year olds. Similarly, Milwaukee’s rate of HIV infection was much higher than the national average, particularly for males ages 13-29.
In the past year, three babies were born there with syphilis, at least 12 high school students were infected, and of at least 130 reported cases, 24 people had both infections, and 26 people couldn’t be found for testing or refused.
Wisconsin is an “abstinence-only” state where students do not receive comprehensive sex education. Eleven states require abstinence-only education, and 26 require educators to stress this option. While some people have misconceptions about it, abstinence is taught as a part of a comprehensive approach. What is also taught is skills for healthy relationship communication, decision-making and critical-thinking, avoiding manipulation, taking responsibility, body image, contraception methods and values.
Scientifically, we’re better off, too. We can now detect HIV infection 10-33 days after exposure compared with a tension-filled up to six months over a decade ago.
We now have pre-exposure prophylaxis (PrEP), a daily pill people that HIV-negative people can take that will prevent HIV by over 90 percent.
This can help support healthy intimate relations in a couple where one partner is infected. And of course, male and female condoms, prevent both HIV and other sexually transmitted infections.
But we have two problems: People are not being taught how to properly protect themselves with comprehensive sex education, and PrEP is not well advertised. It would help if politicians would stop making public health policy decisions based on their personal beliefs, instead using evidence-based science. Abstinence-only education programs do not work, and there is scientific evidence to support this. The current outbreak in Milwaukee does, too.
Truvada, the first medication for PrEP and sold by the pharmaceutical company Gilead, was FDA-approved in 2012. Yet, they only started advertising in 2016. There has been very little advertisement for PrEP, and most of what is out there is from nonprofits and local government agencies. There was concern that PrEP would increase risky sexual behaviors, but no evidence supports that claim. In fact, to take PrEP, patients must see a doctor regularly, which increased access to medical care and regular discussions about safe sexual practices and testing.
PrEP is by no means a silver bullet, nor should it be. It should be used in combination with other prevention methods, such as condoms and testing. But people who are eligible for PrEP should at least be aware it is an option and know how and where to access PrEP, condoms and testing services.
Science is the enemy of politicians making moral decisions that affect the rest of us.
We need to stand up to them so outbreaks such as the one in Milwaukee don’t get worse and don’t happen again. The science shows: We actually know better.
Liesl Nydegger, PhD, MPH, a Public Voices Fellow, is an assistant professor in health behavior & education at The University of Texas at Austin