Running head: IOWA STD SCREENING AND TREATMENT PROGRAM 1

Table of Contents
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Sexually Transmitted Disease in Iowa

Prepared for Des Moines area elected officials

November 10, 2018

Contact Information:

Abby Benning

Abigail.benning@students.mchs.edu
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Table of Contents
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Sexually Transmitted Disease in Iowa

Rates of chlamydia, gonorrhea, and syphilis, all sexually transmitted diseases (STDs),

have reached epidemic levels among Iowans. In 2017 there were 11,994 cases of chlamydia,

2,579 cases of gonorrhea, and 62 cases of syphilis (CDC). As the number of cases continue to go

up every year, very little has changed to address the issue. A majority of those cases affect people

ages 15 to 24 and there is a multitude of reasons that population does not seek STD screenings.

Those reasons include: sexually transmitted diseases do not usually present with symptoms, the

stigma surrounding transmission, and lack of education regarding safe sex practices. The most

productive, effective, and efficient way to stop the rise in sexually transmitted diseases is to

actively screen the at-risk population for them. By using a program that goes into Iowa’s high

schools, colleges, and universities screening young people and providing treatment while also

educating on safe sex, Iowa would be able to get a handle on the current epidemic. Select

Louisiana and Philadelphia high schools have used similar methods and found success. This

policy brief will address the implications of a program that will identify and treat the majority of

sexually transmitted diseases by going into high schools, colleges, and universities- where people

between the ages of 15 and 24 can be reached.

I. Introduction and Background

Summary

Though largely preventable, sexually transmitted diseases affect more and more of the

population each year, especially people between the ages of 15 and 24. Over the years the

problem has turned into an epidemic and is now recognized as a major public health enemy.
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A. The STD Crisis in Iowa.

The numbers of sexually transmitted diseases have more than doubled since the year

2000 and continue to rise. The primary group of people affected are adolescents between the age

of 15 and 24. Approximately 70% of chlamydia cases affect people ages 15 to 24 and an

additional 20% if the age group included up to age 29. With gonorrhea, approximately 46% of

the cases affect people ages 15 to 24 with an additional 24% if it included people up to 29-years-

old (CDC). We see similar numbers in syphilis rates. “Because many cases of STDs go

undiagnosed… the reported cases of chlamydia, gonorrhea, and syphilis represent only a fraction

of the true burden of STDs in the United States” (Healthy).

II. Overview of Government Regulation

Summary

Despite the rising rates and seriousness of sexually transmitted diseases in Iowa, there has been

very little done to update the programs. The funding and attention paid to the problem have

proven ineffective because they aren’t reducing the prevalence of STDs.

A. Overview: Government Regulation and STDs

The state of Iowa recognizes the significance of sexually transmitted disease and has a

bureau, programs, funding, and collects data in current efforts. Most of what the sexually

transmitted disease program is devoted to the reporting and collection of information. The data

collected by them over the past years show significant increases especially in the 15 to 24 age

group. The Iowa Department of Public Health’s (IDPH) Bureau of HIV, STD, and Hepatitis has

“partnered with other groups, agencies, and organizations for the delivery of information

services” (IDPH). The physicians and laboratories are required by law to report information to
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the IDPH. The current STD program has established 65 provider sites across Iowa that provide

screening for STDs. In 2016, the CDC funded $703,615 to Iowa’s state health department for the

STD program. Though adequate funding for screenings along with community partnerships to

administer screenings, there have been no efforts implemented to make use of available

resources.

B. Legality of Screening and Consent

“In Iowa, by law, a minor can be tested and treated for a sexually transmitted disease

without parental consent”. This legislation has an unmeasurable, positive effect on who and how

many people under 18-years-old seek testing and treatment. It is unknown what percentage of the

population is aware of this legislation. This allows young people to have a say in their

reproductive health status, knowing they are making their own decisions in regard to their sexual

health. For a program to go into schools, screening people as young as 14 to be effective, it is

important our health care providers can reach all of the at-risk sexually active population. For

those 18 and older, there are no reservations for ability to give consent. Under HIPAA (health

insurance portability and accountability act), everyone’s medical records and personal health

information is private and protected. In the proposed program, there would be no exceptions in

the protection of each individuals health history or status.

III. Evaluative Criteria

This policy brief has three areas of criteria used to evaluate the proposed intervention.

A. Feasibility Criteria

“To what extent does the cost of increased oversight of the industry outweigh any

measureable improvement in [reduced STD rates], reduced health care costs, and consumer

return on investment?” (Bhattacharya). Economically, it would be an investment but it would

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undoubtedly yield results. The proposed program is socially feasibly; the public’s acceptance

would especially follow when individuals in the current target population start having families.

From a political standpoint, there would be workable solutions for government, private

industries, and academia. All three areas would benefit, though some of their resources would be

needed.

B. Evidence Based Criteria

The quantitative evidence of this alternative program would be crucial for evaluation.

Sexually transmitted disease rates at the start of implementation could be compared to the

following months and years. The process of evaluating would not be difficult. The positive STD

tests would continue to be reported to the Iowa Department of Public Health. Initially, rates

might be higher at implementation due to all of the newly recognized cases. This alternative

would not only shine a light on all of the undiscovered infections but also treat them, preventing

further spread.

C. Reports on Similar Issues

As mentioned in the executive summary, a Philadelphia high school and a couple

Louisiana high schools have implemented a program similar to the one proposed. A case study

reviewing the Louisiana screening program concluded that “there are high rates of asymptomatic

sexually transmitted diseases in the general urban school population” (Cohen). A study done on

the Philadelphia STD screening program concluded “that high-school based screening for CT

[Chlamydia] is extremely cost-effective over a 5 to 10 year time horizon” (Fisman). Iowa,

though not urban, would almost certainly find high rates of STDs in our students, high school

through grad school and those not enrolled in any school. The state would also be very capable

of implementing a state-wide, cost-effective program.

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IV. Reflection and Analysis

Summary

The two alternative interventions to reduce sexually transmitted disease rates in Iowa are

examined in this policy brief- to leave policy as is or to implement an effective program.

A. Key Law and Public Health Questions

The current STD program’s mission statement is “promoting and protecting the health of

Iowans at risk of or infected with HIV, sexually transmitted diseases, and/or viral hepatitis”

(IDPH). An option in the efforts to reduce STD rates is to leave the policies and programs as is.

A second alternative is to implement a more active sexually transmitted disease screening

program that provides treatment and prevention methods. A program that would use high

schools, colleges, and universities as the platform to reach the students, who are in the age

groups of the most affected.

B. Key Ethical and Public Health Questions

There should be a program that provides free screening, treatment, and condoms to

students. The free services would ensure there’s nothing holding people back from getting

checked. There could also be educational content given could address other reproductive health

topics such as birth control methods, intimate partner violence, and pregnancy. Knowing the

STD rates continue to rise every year, we must ask if the current protective measures are

sufficient.

C. Key Economic and Public Health Questions

It’s important to recognize the unequivocal burden STDs have on individuals and the

state. It is also important to realize there are funds currently going towards efforts to reduce STD
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rates. Those efforts have not yet seen any positive results in the past 20 years. A reallocation of

the current STD program funds would be sufficient and yield more results.

D. Key Political and Public Health Questions

The Bureau of HIV, STD, and Hepatitis does have intentions to reduce the impact of

chlamydia, gonorrhea, and syphilis. The public nature of the program would directly address the

stigma that comes with sexually transmitted diseases and show the importance of sexual and

reproductive health. Government, media, corporations, and all other interest groups would

benefit from a healthier society. It would especially appeal to the next generation of voters

knowing their best interest was being looked out for.

E. Key epidemiological and Public Health Questions

Free screening would identify the majority of the cases of chlamydia, gonorrhea, and

syphilis. Free treatment would prevent further spread of the infection from a diagnosed

individual. Along with that, we could provide condoms and educating that they’re the most

effective ways to prevent STDs. Once the majority of the at-risk population has been screened,

and individuals with positive test results have been treated, the incidence rates should

dramatically decrease. That also decreases chances of distribution. Then through routine

screening and treatments, the rates of STDs in Iowa would start to decrease.

V. Limitations

Summary

Implementing a sexually transmitted disease program that actively screens the vulnerable

population faces two main limitations.

A. Public Perception
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Iowa, a state with fairly traditional values, would most likely be cautious about this

change in sexually transmitted disease policy. A popular mindset of the citizens is “the more

exposed to sex and things related, young people are more likely to participate in sexual

activities”. Though never backed up with research, it is a concept easy to understand and accept.

Research has found that people will participate in sexual activities despite their knowledge, or

lack thereof, of reproductive health implications. It’s important that we supply the public with

knowledge and resources to keep themselves healthy, even if that means addressing the stigma

surrounding sexually transmitted disease.

B. Rural Demographic

Iowa is composed of mostly smaller towns scattered across the state. It would take a lot

of planning and organization to effectively reach all of the school districts. Any hesitation related

to the rural demographic hindering the program’s effectiveness can be addressed with the

community partnerships with the current STD program and potential partnerships made with the

proposed program. Organizing new partnerships with health care providers in communities to

implement the program would ensure its effectiveness. School health service providers would

also be included in the organization.

VI. Conclusion

There is no disputing that the state of Iowa has high rates of sexually transmitted

diseases. And as the rates continue to rise every year, we are left to either continue as is, allowing

the prevalence to increase, or to take action. Sexually transmitted disease rates are a serious crisis

in Iowa and our young people are the ones most affected. The Iowa legislature has a strong track

record of protecting our younger generation of citizens, knowing we want them to grow up

happy and healthy. It’s important we take action to encourage our youth to care about their
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sexual and reproductive health. The best way to do that is to implement a program that screens

those in the vulnerable population, treating the cases of STDs, and educating. Those measures

will save money in the long run and improve the quality of life for Iowans.
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References

Bhattacharya, D. (2013). Public Health Policy: Issues, Theories, and Advocacy. San Francisco:

Jossey-Bass

Centers for Disease Control and Prevention. (2015). Iowa- State Health Profile. Retrieved from

https://www.cdc.gov/nchhstp/stateprofiles/pdf/iowa_profile.pdf.

Cohen, D., Nsuami, M., Martin, D., & Farley, T. (1999). Repeated School-based Screening for

Sexually Transmitted Diseases. Retrieved from

http://pediatrics.aappublications.org/content/104/6/1281.short

Fisman, D., Spain, C., Salmon, M., & Martin, G. (2008). The Philadelphia High-School STD

Screening Program. Retrieved from

https://journals.lww.com/stdjournal/Fulltext/2008/11001/Cost_Effectiveness_of_Five_Str

ategies_for.11.aspx

Healthy People 2020. (2018). Sexually Transmitted Disease. Retrieved from

https://www.healthypeople.gov/2020/topics-objectives/topic/sexually-transmitted-

diseases.

Iowa Department of Public Health. (2018). Bureau of HIV, STD, and Hepatitis. Retrieved from

http://idph.iowa.gov/hivstdhep/std.