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Reversing the course of the sexually transmitted infection epidemic

by Andria Apostolou, PhD, MPH, National STD Program Lead and Senior Epidemiologist, Division of Epidemiology and Disease Prevention, Indian Health Service

STD Awareness Week Exit Disclaimer: You Are Leaving , observed this year from April 11-17, provides an opportunity to bring awareness to the impacts of sexually transmitted infections. Recent data from the Centers for Disease Control and Prevention Exit Disclaimer: You Are Leaving  estimate that on any given day in 2018, one in five people had an STI – totaling nearly 68 million infections. Of the 26 million new infections in that same year, almost half were among youth aged 15-24. While many STIs are asymptomatic, if left untreated, some infections can increase the risk of HIV and cause chronic pelvic pain, pelvic inflammatory disease, infertility, and/or severe pregnancy and newborn complications.

In December 2020, the U.S. Department of Health and Human Services released the STI National Strategic Plan Exit Disclaimer: You Are Leaving , a groundbreaking, first-ever five year plan to address the public health crisis of STIs in the United States. These alarming increases in the rates of STIs call for urgent, coordinated, and targeted action from us all. The COVID-19 pandemic has compounded many challenges worsening pre-existing disparities in health care and prevention access. Many health care facilities and medical personnel, as well as public health services, have been greatly burdened with responding to the pandemic. Access to preventive and routine care services were impacted, likely delaying patients from receiving timely screening and treatment of STIs.

This action plan is extremely relevant to American Indian and Alaska Native communities. Rates of chlamydia, gonorrhea, primary and secondary syphilis, and congenital syphilis are disproportionately higher among Native populations.

For American Indians and Alaska Natives:

  • the rate of reported chlamydia cases was 3.7 times the rate among whites;
  • the rate of reported gonorrhea cases was 4.6 times the rate among whites;
  • the rate of reported primary and secondary syphilis cases was 2.6 times that rate among whites;
  • and the rate of congenital syphilis cases was 5.9 times the rate among whites.

The STI National Strategic Plan lays out a clear vision for reducing STIs in our communities and our nation:

The United States will be a place where sexually transmitted infections are prevented and where every person has high-quality STI prevention, care, and treatment while living free from stigma and discrimination. This vision includes all people, regardless of age, sex, gender identity, sexual orientation, race, ethnicity, religion, disability, geographic location, or socioeconomic circumstance.

The plan offers clear objectives and strategies to achieve that vision. It includes indicators with targets through 2030 to measure progress toward these goals. This roadmap will help a broad range of stakeholders to develop and implement STI prevention, treatment, and care programs at the local, state, tribal, and national levels over the next five years.

As a health care and public health services delivery system, this plan will help guide the IHS on how and where to best focus our efforts and resources to achieve results with the highest impact. With it, we hope to reverse the course of this STI epidemic that disproportionately affects the communities we serve.

The IHS National STD Program is convening diverse stakeholders from the health care, public health and community sectors to discuss STI prevention activities among Native populations, as well as how to work collaboratively in developing culturally driven approaches, resources and interventions that align with the STI National Strategic Plan. If you are interested in participating in the National American Indian and Alaska Native STI Prevention Workgroup, please reach out to

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Andria Apostolou, PhD, MPH, National STD Program Lead and Senior Epidemiologist, Division of Epidemiology and Disease Prevention, Indian Health Service

Dr. Andria Apostolou is the IHS National STD Program lead for the Division of Epidemiology and Disease Prevention at IHS headquarters. She also functions as a senior epidemiologist supporting activities in infectious disease surveillance, including the COVID-19 response and supporting the National Immunization Program.