STD Prevention & Control Services: Working to Maximize Sexual Health in

San Francisco

Susan Philip, MD MPH

Director, STD Prevention and Control Services San Francisco Department of Public Health

Assistant Clinical Professor of Medicine

Division of Infectious Diseases University of California, San Francisco

10 Essential Functions of Public Health: The STD Section Does all of These!

Monitor

Diagnose & Investigate

Inform, Educate, Empower

Mobilize Community Partnerships

Develop Policies

Research

Evaluate

Assure Competent Workforce

Link to or Provide Care

Enforce

STDs in San Francisco: 2010 and 2011* 2010 2011 Change

Chlamydia 4,603 4,739 +136 (3.0% ↑)

Rectal Chlamydia 923 964 +41 (4.3% ↑)

Gonorrhea 1,943 2,242 +299 (15.4% ↑) Rectal Gonorrhea 485 624 +139 (28.7% ↑)

Early Syphilis 660 681 +21 (3.2% ↑)

*preliminary

Chlamydia and Gonorrhea Rates by Age, San Francisco 2010

357

1,991

262

534

0

500

1000

1500

2000

2500

3000

Gonorrhea Chlamydia

Case

s pe

r 10

0,00

0 pe

r ye

ar

Adolescent Adult

Adolescent gonorrhea rate is 36% higher than adult rate

Adolescent chlamydia rate is 562% higher than adult rate

Chlamydia Rates by Age and Race/Ethnicity, San Francisco 2010

1,991

9,471

471

1,484

0

880 534

1,302

194 613 484 423

0

2000

4000

6000

8000

10000

All Races African-American

Asian/PI Hispanic Native American

White

Case

s pe

r 10

0,00

0 pe

r ye

ar

Adolescent Adult

African-American adolescent CT rate 11 times higher than white peers

Gonorrhea Rates by Age and Race/Ethnicity, San Francisco 2010

357

43

169

0

171

262

657

50

291

188

295

0

200

400

600

800

1000

All Races African-American

Asian/PI Hispanic Native American

White

Case

s pe

r 10

0,00

0 pe

r ye

ar

Adolescent Adult

African-American adolescent GC rate 13 times higher than white peers

2240

Enhanced Initiatives

Maintaining the core functions: expert clinical care, surveillance, case finding, health education

I will highlight some enhanced Section initiatives designed to impact sexual health disparities in SF: especially among Adolescents gay men, bisexual men and transpersons, those in jail.

E-STD Health System: Iknowsfbay.org

Research partnership with Dr. Freya Spielberg, RTI International

Women 18-30 can request chlamydia, gonorrhea and trichomonas tests kits online, obtain a vaginal swab specimen, mail the kits back and receive a secure notification of their results and either e-prescriptions or referrals to City Clinic if from SF.

We will be able to evaluate acceptability and outcomes for SF residents

Offers a novel option for sexual health promotion in young women

E-STD Health System: Iknowsfbay.org

YUTHE

Peer Educator Model of Sexual Health Promotion Workshops, street outreach, health fairs

Youth United Through Health Education

New street intercept sexual health survey planned for assessment May 2012

SFDPH HIV Partner Services, 2011

Number of index cases interviewed: 118 Total number of partners named: 114 Proportion of named partners not known to be HIV-

infected that were HIV tested: 37% (n=42) HIV positivity among those partners: 21% (n=9) Of the 31 also tested for syphilis, 23% (n=7) were

positive Of the 28 tested for gonorrhea or chlamydia, 21%

(n=6) were positive

Those who test HIV positive are offered voluntary counseling, referrals and linkage to care. STD staff offer assistance with disclosure to partners.

LINCS Linkages, Integration, Navigation, &

Comprehensive Services In conjunction with SFDPH HIV Prevention and HIV

Surveillance Sections Increase access to Partner Services

Embed DPH staff in two HIV testing sites with high positivity

A new Field Response LINCs team will increase access for medical settings and community providers.

Provide simultaneous support for STD screening and management

The Importance of STD Screening in SF Jails

Approximately 5% of men and women screened for chlamydia or gonorrhea in jail test positive – this is higher than at City Clinic.

Previous data have shown an association of screening and treating men in the jails with a decrease in female chlamydia positivity in the community (Barry STD 2008)

Despite this, screening coverage is only 35%, and can be improved

Expanding STD Screening in SF Jails

We have been working with Jail Health Services and the Forensic AIDS Project (FAP) to increase screening

STD is providing 1.5 FTEs and training for an integrated screening team at FAP which offers testing for chlamydia, gonorrhea, HIV and hepatitis

HIV Pre Exposure Prophylaxis (PrEP) Demonstration Project

Builds on results of iPrEX study – which showed that daily Truvada™ decreased HIV infections in Gay and Bisexual Men and Transgender women

Collaboration of HIV Prevention and STD, with funds from NIH awarded through HIV Research

First in nation, two sites: San Francisco and Miami SFDPH providing national project leadership – Dr.

Stephanie Cohen (STD) and Dr. Al Liu (HIV Research)

Expected to start enrolling mid 2012

Susan.Philip@sfdph.org www.sfcityclinic.org Thanks to: •Barbara Garcia, Tomas Aragon and SFDPH Leadership •STD Prevention & Control Staff •Community Partners Groups •SFDPH Public Health Lab •HIV Prevention Section •HIV Surveillance Section •Jail Health Services •Forensic AIDS Project

Thank You!