In Hamilton, reported cases of chlamydia and hepatitis b and c rose 44 percent and 67 percent, respectively, in the past decade. Middletown reported an 48 percent increase of hepatitis b and c.
Health officials said much of that is tied to lack of resources for education and the closing of free STD clinics. The clinics were funded by the state and provided free testing and treatment anonymously — even for minors. But in 2008, the Ohio Department of Health cut funding and the clinics closed, said Kay Farrar, public health nursing administrator for the Hamilton Health Department.
“The biggest disconnect is we were an anonymous site,” she said. “It makes it a bit more complicated to have to take the person’s information and bill their insurance.”
Since then, local health departments were directed to focus their resources on more “high risk” communicable diseases such as bacterial meningitis and measles, said Jackie Phillips, Middletown health commissioner.
“STDs are on the bottom line of communicable diseases,” Phillips said. “They won’t make a lot of people sick or kill people. But chlamydia — left untreated —can lead to infertility.”
Comparably, Hamilton County has a “mini-epidemic” of sexually-transmitted diseases, according to a report gauging the region’s health.
That county’s rate of syphilis is almost nine times higher than the nation’s, while gonorrhea and chlamydia rates are double and triple, respectively, the national rates, according to the report, “Indicators of Healthy Communities.”
The cost
Testing can be costly, especially for the uninsured. Primary Health Solutions, a community health center in both communities, helps fill the void but is not a free clinic. It offers testing but people must make an appointment. Payment is based on a sliding scale and those with insurance will be billed. Some testing may be paid by the state, but that varies by the age of the patient and the community, said Marc Bellisario, the center’s chief executive.
At the Cincinnati STD Clinic, testing can cost from $10 to $500 depending on the disease. Treatment is much more reasonable, as the clinic will charge $1 to $5 for medication. Farrar said health departments will often work with pharmacies to find which will offer prescriptions for free or $4 if someone is uninsured.
But with the loss of free, anonymous treatment locally, health officials said there could be many more people who have an STD but have not sought treatment, therefore it goes unreported.
Also, many people never experience STD symptoms. In the case of chlamydia, the federal Centers for Disease Control and Prevention reported 75 percent of women and 50 percent of men will never experience symptoms.
What health departments report only represents a fraction of STDs. The CDC only collects statistics for chlamydia, gonorrhea and syphilis and the state no longer tracks some diseases such as genital herpes.
Prevention
For the most part, health departments are left with “doing the backside” of disease treatment. Farrar said the health department makes follow-up calls to educate residents about how to treat and prevent.
Not much STD education is offered in schools because “a lot of times parents don’t want us to talk about sexually transmitted diseases. They don’t want to believe their kids are sexually active yet so it gets difficult,” Farrar said.
“But we can’t continue on this trend because it will become epidemic,” she added.
The reporting of “Class A” communicable diseases, such as botulism and plague, must be reported within three hours as mandated by federal law. This often takes priority, as Farrar said in Hamilton health department staff will “cancel everything else” to report, educate and treat such diseases to reduce the risk of infection to the public.
Such mandates often are unfunded — meaning the state does not provide money to support these programs. Health departments must carve out their own funding to pay for added reporting costs and treatment when necessary — which can be an issue as cities cut funding.
In 2011, Hamilton City Council cut the health department’s budget by 15 percent. The Middletown health department will see its budget slashed by $115,000 next year, pushing Phillips to pursue a 0.5-mill property tax levy this November to fund operations.
“The health department is supposed to promote, detect and prevent,” Phillips said. “It gets hard when you don’t have the money and you don’t have the staff and you have to prioritize what you do and what the state mandates.”
The Associated Press contributed to this story. Contact this reporter at (513) 705-2843 or jheffner@coxohio.com.
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