Most people refused to talk to Shirlene Lightsey Manuel when she first appeared on their church steps a couple of years ago. The pastors, first ladies and deaconesses didn’t want to talk about HIV, the human immunodeficiency virus that causes AIDS.
They would tell her the disease wasn’t a problem in their congregations. But statistics said otherwise: While the rate of new HIV infections has dropped considerably since the 1990s, it continues to hit Black communities particularly hard. Black Americans made up more than 40% of new HIV diagnoses in 2019 — and new federal statistics show most sexually transmitted diseases have the same disparities.
Now, more than two years into the COVID pandemic, Lightsey Manuel’s efforts to raise awareness about HIV/AIDS through church congregations has gotten a little easier. With growing public interest in racial disparities in health, faith leaders are more open to hearing the HIV facts she brings with her, some allowing her to give out condoms.
“Something shifted in January,” said Lightsey Manuel, a community liaison for a health nonprofit in Florida. “People are willing to talk about it, willing to know about it. I told my boss that I needed someone just to handle my social calendar because now I’m getting invited to events.”
Growing attention to health disparities could create a timely opportunity to raise awareness about sexually transmitted diseases, which saw a concerning increase during the pandemic, according to a recently released CDC report.
After a decline in the first months of the coronavirus pandemic, STD cases rose by the end of 2020. Reported cases of gonorrhea and primary and secondary syphilis increased by 10% and 7%, respectively, since 2019, the data shows. And since 2016, gonorrhea cases have increased by 45%. Black Americans have the highest rates of each of these STDs across racial groups.
Chlamydia was the only reported infection for which case rates declined, though experts say that is likely due to a decline in screening during the pandemic. The decline was 1%.
While the report did not include the latest HIV numbers, Lightsey Manuel and other health experts suspect new diagnoses have increased during the COVID-19 pandemic.
“There were moments in 2020 when it felt like the world was standing still, but STDs weren’t,” said Dr. Jonathan Mermin, director of the CDC’s National Center for HIV, Viral Hepatitis, STD, and TB Prevention. “The unrelenting momentum of the STD epidemic continued even as STD prevention services were disrupted.”
There was a slight decline in reported cases early in 2020, likely due to the diversion of public health resources to address the pandemic, lapses in insurance coverage due to unemployment, the reduction of in-person routine health visits, and a shortage of STD labs, according to the CDC. Those factors complicated STD testing and treatment, which are critical to reducing the spread. And with a lack of testing early on, the data lags.
Black women are the hardest hit by chlamydia cases, and Black men face a disproportionately high rate of gonorrhea and syphilis cases. The chlamydia cases are largely driven by young adults ages 15 to 24, the data shows. Among gonorrhea cases, men account for more cases than women.
Like other health disparities, experts say the inequities in sexual health are driven by factors like access to quality health care and comprehensive sex education.
“A lot of the time people don’t have access,” said Shemeka Thorpe, a University of Kentucky researcher who focuses on the sexual well-being of Black women. “People don’t have access to testing. People don’t have access to condoms.”
Access to information is also important, said Thorpe. “Black people are less likely to have access to comprehensive sex ed,” she said, partially due to their concentration in Southern states, which tend to teach abstinence only.
People are often unaware of how often to get tested for STDs, said Thorpe, or mistakenly believe infections are always visible. Myths about the prevalence of STDs are pervasive, she said, such as the belief that syphilis is an “old STI.”
Yet the rates of syphilis, according to the CDC, are up more than 50% since 2016 and over 230% for cases passed from mother to infant.
Increased education, testing, use of barriers methods to STD prevention and open, honest communication between partners are crucial to reducing the spread, said Thorpe.
“It’s important to know your partner’s status,” and understand which infections are treatable, she said. “Just because you have an STI doesn’t mean the world is over.” Herpes, for example, is treatable, though not curable. “It also isn’t life and death.”
Condoms and dental dams, regardless of sexuality and the sex of your partner, are important to reducing transmission, experts say.
But condom negotiation can be difficult, said Rasheeta Chandler, an assistant professor at Emory University’s School of Nursing. Among the women she’s engaged with in her research, some have expressed a sense of distrust within their relationships when asking their partner to use a condom.
In Thorpe’s work, she’s found couples often trust their partner enough to not test regularly or use condoms. The STD rates are “an outcome of people trying to have pleasure,” she said.
Larger, systemic barriers to testing and treatment are also persistent.
“Transportation can sometimes be a huge barrier,” said Chandler. In some ways, the COVID-19 pandemic helped expand access to testing in new ways, she said. “More health care institutions should consider more innovative ways of meeting people where they are.”
Engaging communities — like the work Lightsey Manuel is doing in Florida — must be done in a way that’s not stigmatizing, particularly for Black communities, said Chandler.
“We understand sex is a part of life,” said Chandler. “We want to make sure people are informed, educated and can make healthy decisions for themselves.”
Lightsey Manuel, who represents Metro Inclusive Health — a health and wellness nonprofit that provides services for the LGBTQ community in the Tampa Bay region — said she’s seen a significant difference in awareness during her 30 years working with HIV patients.
In the 1980s, a positive test meant funeral information came tucked into the information packet, and patients took 35 pills a day from the hospital’s speciality unit. With advances in technology, one pill a day can now keep the virus from spreading when patients know their status.
The journey spanning three decades has been rewarding, said Lightsey Manuel. She’s never thought about why she’s stayed in all these years, but she knows it feels good to be a voice of reason and hope for individuals who face devastating diagnoses.
“I think back to some of the clients that I had back when I first started, to know that if they had the services or the medication or the resources that we have now, they probably would still be with us,” she said. “I can’t wait to see what the future holds. I’m hoping for a cure.”