How to Stop STDs? The Answers Lie in SDoH

STD transmission remains one of the top public health crises in the United States. While efforts to reduce STDs have historically focused on individual behavior, recent programs such as CARS (Community-based Approaches to Reducing STDs) find that focusing instead on SDoH through community programs yield greater results in reduction and prevention. 

When thinking of public health crises in the United States, what comes to mind? Most Americans agree that COVID-19, obesity, and mental health are just a few of the health problems our nation faces, but one that is often overlooked—though potentially just as catastrophic—is sexual health. 

A NATION IN CRISIS 

The CDC reports sexually transmitted diseases (STDs)among the top ten current public health crises that the United States is facing1. STDs can cause infertility, severe lifelong complications, and in extreme cases newborn death during childbirth2. STD cases are on the rise, leaving many health professionals at a loss over how to stop this epidemic. 

There are many reasons for this climb in STD cases. Societal factors, such as shame and secrecy surrounding sexual health, prevent many from seeking help and even lead them to unknowingly spread disease. Others may have limited access to proper resources, such as condoms, contraceptives, and adequate healthcare. 

While traditional prevention techniques focus on changing individual behavior, recent developments have led professionals to take a more systemic approach to handling the STD crisis3. By addressing how well environments are addressing the social determinants of health (SDoH) for those most at-risk for STDs, communities are beginning to see positive changes in sexual health. 

HOW SDoH INFORM SEXUAL HEALTH 

STDs do not impact all communities equally. While racial/ethnic and sexual minorities are the populations most at risk for contracting HIV or other STDs, the prevalence is not caused by ethnicity, heritage, or sexual orientation. Rather, these communities are historically underserved; economic factors such as poverty, unemployment, and low education levels make it difficult for people to stay sexually healthy4. 

These factors, known as social determinants of health, can inform us on how to serve these at-risk populations. By looking at the environmental needs of communities—such as access to testing and economic relief from health costs—instead of individual behavior, programs have found better success in reducing STDs. 

 PROGRAMS IN ACTION 

One of the leading programs that uses SDoH for STD prevention is the CDC’s Community-based Approaches to Reducing STDS (CARS) initiative5. This program focuses on identifying the SDoH most at risk, in each area and then using a community-centered approach to implementing interventions to reduce STDs. 

Notably, CARS does not advocate for a one-size-fits-all-solution. Instead, it focuses on crafting responses made for the individual community while recognizing realistic barriers and goals. In doing so, the initiative puts power and trust in the community, ultimately leading to more successful outcomes. 

The CARS initiative provides several case studies of successful implementation, including: 

1. Baltimore, MD6
   Focusing on STD identification and reduction among youth ages 15-24, CARS successfully implemented 11 interventions in underserved neighborhoods. It also began a community-led program specifically designed to test youth for chlamydia and gonorrhea. 
2. Philadelphia, PA7
   Philadelphia CARS built a youth-led program to address the stigma of sexual health among teens and built a design around recruitment, incentives, and leadership development. They reported a 7% increase in condom usage, among other successes. 
3. Chicago, IL8
   Chicago’s initiative focused on STD prevention in young women of color. By creating a social media campaign and expanding treatment, the youth-led program successfully conducted over 2,000 screenings. 

CARS attributes their successful campaigns to shifting towards addressing SDoH. As programs like these move to community-wide issues—as well as community-wide solutions—they are likely to see greater engagement and better implementation. 

IMPLEMENTING SDoH INTO INTIATIVES 

In analyzing the success of CARS initiatives, experts agree on ten critical elements of community engagement9. These elements are not exclusive to the CARS program and can be established in a variety of ways across a range of programs. They include: 

1. Commitment to Engagement 
2. Partner Flexibility 
3. Talented and Trusted Leadership 
4. Participation of Diverse Sectors 
5. Establishment of Vision and Mission 
6. Open Communication 
7. Reducing Power Differentials 
8. Working Through Conflict 
9. Identifying and Leveraging Resources 
10. Building a Shared History 

By cultivating these factors with the aim of strengthening SDoH for communities, STD prevention is likely to increase. While responses to SDoH often require more effort and preparation, the results can be astounding—some community health workers report an almost 150% return by addressing these factors.  

More than anything, efforts to address the STD epidemic in the U.S. show that the future of public health and long-term solutions lie in understanding and addressing the SDoH of each community.  

SOURCES 

1. https://www.beckershospitalreview.com/care-coordination/cdc-10-most-important-public-health-problems-and-concerns.html 
2. https://www.cdc.gov/nchhstp/newsroom/2019/2018-STD-surveillance-report-press-release.html#:~:text=New%20CDC%20Report%3A%20STDs%20Continue%20to%20Rise%20in%20the%20U.S.&text=Combined%20cases%20of%20syphilis%2C%20gonorrhea,Control%20and%20Prevention%20(CDC). 
3. https://www.nursesinaidscare.org/files/USCA%20Social%20Determinates%20of%20Health.pdf  
4. https://www.cdc.gov/std/health-disparities/cars-toolkit-2020.pdf 
5. https://www.cdc.gov/std/health-disparities/cars.htm 
6. https://www.cdc.gov/std/health-disparities/cars-case-baltimore.htm 
7. https://www.cdc.gov/std/health-disparities/cars-case-philadelphia.htm  
8. https://www.cdc.gov/std/health-disparities/cars-case-chicago.htm