SF Readies Condom Campaigns to Reduce STDs

Use a condom messaging is again being rolled out in San Francisco.

But unlike during the early days of the AIDS epidemic, when condoms were the main focus of safe sex campaigns aimed at preventing HIV, the prophylactics are returning as a way to combat rising rates of other sexually transmitted diseases.

"What we are hearing is the community wants to see messages about condom use, what the data says about STD rates, and how to incorporate that into a sexual health message," said Tracey Packer, director of community health equity and promotion in the Population Health Division?at the San Francisco Department of Public Health.

For the last decade San Francisco has seen a relentless rise in STDs. And 2015 was no exception, with rates of gonorrhea, chlamydia, and syphilis all spiking.

It is a trend that has been growing across California and the U.S., particularly as more gay and bisexual men abandon condoms for other HIV prevention methods, such as taking PrEP and/or serosorting their sexual partners, and sexual practices, based on HIV status.

While that has led to a reduction of new HIV cases both in the city and across the state, the tools many men are using to protect themselves from becoming HIV-positive, or passing on the virus to their sexual partners, do not stop the spread of STDs.

"Reportable STD cases are going up everywhere. We are not facing this in isolation, multiple factors throughout the country are contributing to this," said Deputy Health Officer Dr. Susan Philip, the director of SFDPH's Disease Prevention and Control?Population Health Division. "In San Francisco we are seeing large numbers of STD cases. At the same time, we are happy to see declines in HIV infections. Those things are connected."

According to the health department's preliminary year-end 2015 data on reportable STDs, chlamydia increased by 21.2 percent between 2014 and 2015, from 5,972 to 7,239 cases. Male rectal chlamydia increased from 1,408 to 1,788 cases, a 27 percent annual increase, according to the initial reports.

Gonorrhea increased by 30.3 percent from 3,278 in 2014 to 4,270 cases last year, noted the health department's monthly STD report published February 4. It also pointed out that, compared to a 10 percent increase seen in 2014, rectal gonorrhea among men increased steeply in 2015, by 30.4 percent, from 874 to 1,140 cases.

And early syphilis cases, those that are infectious, increased 9.5 percent from 1,114 to 1,220 cases.

"We have to expect STD rates are not going to go down presently," said Philip. "We need to find new approaches to engage people and allow people to have every single possible tool to make sure people are able to be sexually healthy."

Condoms are at the top of that list. As the STD monthly report noted, the health department "is planning approaches to improve sexual health and reduce rates of STDs, including expanding access to STD/HIV screening and supporting condoms as one effective option for STD/HIV prevention."

Philip, on behalf of the health department, recently wrote a letter to the city's school district endorsing its proposed policy to hand out condoms to middle school students. She pointed to the data from last year that showed the proportionate increases in STDs by age group were greater among 15-25 year-olds than those 26 and over.

Among 15-25 year-olds in 2015, compared to 2014, there were 2,360 cases of chlamydia (a 12 percent increase), 863 gonorrhea cases (22 percent), and 103 early syphilis cases (17 percent), stated the report.

Increases among those ages 26 and over were similar or smaller in 2015 compared to 2014: 4,852 chlamydia cases (26.6 percent increase), 3,400 gonorrhea cases (32.6 percent), and 1,116 early syphilis cases (9 percent), according to the report.

"We know comprehensive sex education improves overall health. Understanding and having access to condoms is part of that," she said. "Ideally, people will have an understanding or familiarity with condoms before they become sexually active, whether they have partners who are men, women, or both."

The health department will "drill down" further into the 2015 data on STD cases, said Philip, to determine if the increases are being driven among young gay and bisexual men or heterosexual adolescents. In past years nearly 90 percent of the city's STD cases have been attributed to men who have sex with men.

With the 2015 data on the younger age bracket, Philip said, "Our impression is it will be the case it is both gay men and heterosexual transmission." Though she cautioned, "It may not be an even split."

She is also looking to hire a sexual behavioral health expert to consult with the health department as it develops strategies to reduce STD rates in the city.

New campaigns

Last summer the STD control section hosted two town halls to hear directly from men who have sex with men what their ideas are for stopping the spread of syphilis, gonorrhea, and chlamydia. More recently DPH has convened focus groups to assist it as it develops new social marketing campaigns that will debut this spring and in early summer.

The first ads are expected to premiere in April, which is STD Awareness Month, on cable networks during shows with large gay audiences. The $5,000 worth of public service announcements will feature a message about how PrEP does not prevent STDs and encourages men who have sex with men to use condoms and get screened for STDs every three months.

This summer the health department will roll out a similar campaign focused on men of color and transgender women. It will address "sexual health in a broad way," explained Packer, "incorporating info about PrEP as well as STD prevention."

It has been eight years since DPH created its last public campaign focused on STDs, said Jacqueline McCright, the deputy director of the community health equity and promotion branch. That campaign was titled "Every Three For Me" and encouraged sexually active gay and bisexual men to get screened for STDs every three to six months.

Past campaigns from the health department tended to focus separately on HIV and STDs, as there were different sections tasked with preventing either HIV or STDs. But after a recent reorganization of the department, those staffs are now grouped together and working more collaboratively.

Thus, the new public messaging will also be broader in scope.

"The campaigns we do need to address sexual health overall," said Packer.