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Patients who enter the KC Care Health Center in midtown Kansas City, Missouri, approach the front desk, where they’re welcomed by a staff member. At that point, some patients ask for “CATS.”
They are not seeking small furry pets, but something more urgent and much more private. At KC Care, CATS stands for counseling and testing services — more specifically, testing for sexually transmitted infections and risk prevention counseling.
Once front desk staffers know more about a patient’s specific needs, they can offer cost-free, confidential HIV, hepatitis C and syphilis testing without requiring an ID or health insurance. Patients can also speak with a counselor about their sexual health to learn more about the best time to test, what sexual protection to use and whether they should try medications like pre-exposure prophylaxis, known as PrEP, which prevents HIV infection with a daily pill.
Diagnoses for common STIs have grown rapidly in Missouri
KC Care’s efforts to expand testing and STI treatment come as a response to a rise in chlamydia, gonorrhea and syphilis rates in the state. Despite medical advances in treatment, the number of yearly infections for these three STIs has soared over the past two decades in the state of Missouri. The population of Missouri has only grown by 9% since 2000, which does not account for the increase in STI diagnoses.
While the number of HIV diagnoses for 2019 and 2020 have not been released, from 2006 until 2018 the recorded cases remained relatively stable, ranging from 456 to 588 diagnoses for those 12 years, according to the yearly Missouri Epidemiologic Profiles of HIV/AIDS.
As of 2020, the number of yearly syphilis infections had increased by more than 500% since 2000, while chlamydia infections increased by 139% and gonorrhea infections increased by 91%.
Some infections, as with chlamydia, have steadily risen since 2000, whereas with gonorrhea and syphilis, most of the increase has come since 2012. While the reason is unknown, experts say a lack of testing may play a role in the spread of these infections.
Some experts speculate that STI testing has decreased even more through the COVID-19 pandemic as patients have postponed in-person clinic visits. But Kenny Moore, the sexually transmitted diseases program manager at the Kansas City Department of Health, said it’s difficult to determine definitively that testing has decreased. The total number of STI tests often includes several tests in one visit or several visits in one year, making it hard to determine exactly how many patients are getting tested.
Part of the increase in syphilis diagnoses could also be due to more accurate testing, Moore said. With the use of new testing techniques, clinics are detecting syphilis infections that may have previously gone undetected.
Along with worries about decreased testing, the COVID-19 pandemic has also made contact tracing for STIs more difficult. Typically, the Health Department will notify patients if a test comes back positive. Staffers will even notify sexual partners if a patient feels uncomfortable or embarrassed doing so.
During the pandemic, though, contact tracers have found it more difficult to reach people when they may be out of state, in the hospital with COVID-19 or when they do not return phone calls. That said, contact tracing staff has remained stable, and the Health Department has not needed to reassign STI contact tracers for COVID-19.
Experts are using community outreach to reduce STI transmission
In an effort to expand testing, Paisley Williams, prevention manager at the KC Care Health Center, coordinates a community outreach program for rapid testing in high-risk ZIP codes.
Williams said she has recently seen an uptick in positive syphilis tests, and she often encounters patients who believe they could be carrying several different infections.
“When (clients) call me up for one of the three (STIs), they will say, ‘Well, I also need this’ or ‘I also was told this by a partner that I may have been exposed,’” Williams said. “We know the exposure is happening, and we know that people are asking more about gonorrhea and chlamydia. So that gives us some insight.”
Williams thinks the community outreach program is an important part of detecting STIs and preventing their spread. As part of this program, KC Care clinicians bring HIV and hepatitis C testing materials to public libraries and LGBTQ bars like Missie B’s and Woody’s. Patients receive results for these two tests in less than an hour.
The Kansas City Health Department also offers cost-free testing at its sexual health clinic at 24th and Troost Ave. It is one of two government-run clinics of its kind in the state of Missouri, the other being in St. Louis.
Though STI testing is critical for detecting infections before they spread, Williams said her program works mostly on risk reduction. She hopes clinicians can help clients navigate the risks associated with unprotected sex and offer tools that make certain behaviors safer if they aren’t entirely avoidable.
KC Care also offers a needle exchange program, which allows drug users to trade dirty needles for clean ones, in an effort to reduce the spread of needle-transmitted infections like HIV and hepatitis C. This form of harm reduction is not currently legal in the state of Missouri, but law enforcement allows these programs to operate at two locations in Kansas City and one in St. Louis under a formal arrangement.
Moore said the Health Department has no interest in stereotyping certain populations or making moral judgements. Its goal is simply to expand testing and ensure that everyone regularly gets tested for STIs.
Part of the department’s prevention plan is to conduct research into how to normalize testing and reduce stigma. Health professionals think those steps would make it easier to detect more STI cases and notify those who have been exposed.
Williams at KC Care also wants to move away from language that stigmatizes STIs and sexual health. Patients who feel stigmatized often avoid necessary care out of shame or fear of judgement, she said. KC Care’s goal is to help patients navigate risks and make informed decisions about how to protect themselves and their loved ones from STIs like chlamydia, gonorrhea, syphilis and HIV.
“We know these things, and all we can do is provide quality customer service and hope for the best, of course,” Williams said.
For both the Health Department and KC Care, the prevention of STIs boils down to minimizing the infection and spread of disease through informed decision-making. They accept that risky behavior will happen. Through frequent testing, risk management and medications that prevent further infection, they hope to empower patients to keep themselves and their sexual partners safe.