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Health

Important lessons Covid testing can teach us about STI testing (and vice versa)

By Maya Khamala

As vaccination programs continue their roll out, many of us in the western world are starting to feel emboldened enough to leap back into what we see as “normal.” But, a) the pandemic ain’t over yet, and b) there are incredibly important lessons to be learned from Covid before we go back to doing things the way we did them before. Take STI testing, for instance. Although the connections may not be immediately obvious, the parallels between STI and Covid testing strategies are worth learning from.

Just as shortcomings in pre-pandemic STI testing might have taught us how to better cope with Covid, the failings of Covid testing can teach us how to pick the thread back up and launch an effective STI testing strategy. Goddess knows it’s badly needed—especially since the realities of Covid-19 led to a situation where most people dealing with non-Covid health issues were left to fend for themselves. Testing for chlamydia and gonorrhea fell 30%-50% in the spring of 2020 compared to the previous year as Covid sapped needed staff and resources—in spite of the fact that STI outbreaks had been rising steadily for five years, hitting record numbers in 2018. Officials attribute this rise to increases in unstable housing, drug use and social stigma, along with cuts to sex ed and public health budgets.

As Covid-19 has raged across the US, government has struggled to contain it. Questions around testing everyone versus only those with symptoms; making masks mandatory or not; the best way to track infections; and engaging marginalized communities effectively have been at the forefront. Fact: these and other questions are similar to those that have characterized the struggle for effective STI testing for years as advocates have worked to bring down the rates of infection for HIV, syphilis, gonorrhea and chlamydia—to name a few.

How Covid can help us improve STI testing

While coping with Covid and STIs are very different experiences, Covid infection cycles are quite similar to patterns long observed in HIV and tuberculosis, where a successful suppression of infection is promptly followed by funding cuts (and the abandonment of the poor communities of color most deeply affected). The result: infection rates increase again, big surprise.

But as CDC consultant Dr. Hilary Reno puts it, “To have our resources taken and diverted to COVID makes it especially important that we come back now and say: ‘If you’re sexually active, you should be tested.’”

Here are a few key lessons we can learn from Covid to improve strategies to curb STIs moving forward:

1. Shame and fear are ineffective

Julia Marcus, an assistant professor at Harvard Medical School, points out that resistance to wearing condoms and resistance to wearing masks are fueled by some of the same misinformation pertaining to ‘manliness.' California’s health department addresses some of the reasons people resist masks—from worries that it projects weakness, to issues like glasses fogging up, or the challenge of reading facial expressions. Effective STI prevention campaigns and mask-wearing campaigns alike should be focused on the protection that wearing the thing provides both the wearer and those close to them (in the case of STIs, those very close to them). There have, after all, been successful HIV prevention campaigns which appealed to people’s desire to protect not only themselves but their partners. More of that.

2. Promoting abstinence doesn’t work either

Abstinence-only ‘education’ has never worked. Why? Because sexual desire is natural, and any effort to get people to ignore or dismiss it is likely to work against itself. Former Surgeon General Joycelyn Elders advocated for teaching about masturbation in sex ed classes as a safer way of exploring sex while reducing STIs and unwanted pregnancies, but she was fired for it. Go America. Just as strict quarantines and social isolation haven’t worked all that well (in this part of the world, anyway), making the need for safe, albeit less strict ways of navigating the pandemic ultra necessary, people need to be educated on safer ways of having sex. Otherwise, people will just believe whatever’s most convenient for them personally. If the pandemic has taught us one overarching thing, it’s that strong, clear, concise, and coherent messaging is integral to any popular education initiative.

3. Testing must be free and readily accessible

In the US, Covid testing has known many failures, from straight-up supply shortages, to surprise medical bills, to all but nonexistent efforts to test people without symptoms. These failures, which contributed to the spread of the virus, could have been avoided if testing was 100% free, convenient, and accessible to people with or without symptoms. As it turns out, most people with STIs are asymptomatic too. Getting ahead of the curve (remember all that early pandemic talk of ‘flattening the curve’?) involves identifying those at highest risk, and catering to them with regular screenings and routine testing. In 2014, the CDC recommended that all sexually active women under 25 be screened annually for chlamydia; this broad-based approach has met with success, but STIs like syphilis, without routine testing, have developed into full blown epidemics. In the spirit of making testing as convenient as possible, cues we can take from some of the more successful Covid testing initiatives include mobile van testing for vulnerable neighborhoods, as well as at-home testing kits. The latter are becoming more available, and instant at-home tests are in the works as well.

4. Testing needs to cater to disproportionately affected populations

It bears repeating. Much Like STIs, Covid is far more common among marginalized groups, including communities of color and the poor. Lack of trust in a system that abuses and or disregards them creates whole swaths of the population that would rather forgo testing than go in and engage with said system. A lack of consultation with marginalized groups in the development of vaccines translates to those who need it most going unvaccinated. An Axios poll from August 2020 found that 72% of Black Americans would not get vaccinated, compared to 49% of white Americans. As physician and HIV expert Jeanne Marrazzo puts it, “The only way you’re going to get something that works for people is to involve them in the research from the beginning,” she said. “We learned that the hard way with sexual health and we’re making the same mistakes again now.” Moral of the story: efforts to make STI testing inclusive need to be redoubled. Let’s face it: meaningful inclusivity has always been the only way.

Bottom line: the lessons here really do go both ways. Just as we might glean invaluable lessons from Covid testing efforts which can be applied to STI testing initiatives, the opposite is also true. If one thing’s for certain which wasn’t before the pandemic, it’s that the question, “have you been tested/vaxxed?” has joined the ranks of new lover vetting questions; “getting tested” isn’t just about STIs anymore—one might say our vetting is becoming more holistic, by necessity. Personally, in spite of my distrust of the system at large, I try to stay STI and Covid free, so I advocate for getting vaccinated and/or routinely testing as needed (since you can still catch the virus once vaccinated). Y’know, all that sexy stuff. <3

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