Beaver County has seen “notable increases” in new HIV and gonorrhea diagnoses.
However, a lack of willingness to test — combined with the potential spread of the diseases through illegal drug use — raises more questions than answers.
From 2017 through this year so far, the number of new HIV cases has increased “nearly threefold” in county residents compared to the average number of new diagnoses in previous years, according to a Pennsylvania Department of Health advisory issued earlier this month to local medical offices. The increases in HIV infection were predominantly identified in males with the risk factor of men who have sex with men. According to the state health department, four cases of HIV diagnoses were made in 2013, five in 2014 and three in 2015. Zero cases were reported in 2016, but the count may be incomplete because of reporting delays. The state has not yet shared the exact number of new diagnoses for 2017.
Individuals identified with new HIV infections also had a high rate of co-infection with other sexually transmitted diseases (STDs), such as syphilis and gonorrhea.
In nearby Allegheny County, 119 new HIV diagnoses were made in 2013, followed by 128 in 2014, 142 in 2015 and 127 in 2016. In Lawrence County, there were three new cases in 2013, five in 2014, five in 2015 and zero in 2016. The latter also may be incomplete because of reporting delays.
Stuart Fisk, a nurse practitioner and the director at the Center for Inclusion Health through Allegheny Health Network, said it’s difficult to determine how the increase impacts a specific population.
“What does that represent? And that, I don’t think we know,” Fisk said. “If that represents the beginning of the spread of HIV into the injection drug-using population, then that’s potentially an explosive spread of HIV. If it’s isolated to a small group of men who are having sex with each other, then it may not be a significant public health issue. But we don’t really know.”
Nationally, Fisk said, African-American men who have sex with men are now being infected with HIV at a higher rate than any other population. Fisk has been involved with HIV research, prevention and care for 25 years, and said there have been “pockets” of increases in certain parts of the country, including in West Virginia, Ohio and Indiana. Some of these pockets were the result of IV-sharing drug use.
The Center for Inclusion Health also operates a monthly satellite clinic in Beaver County called the Positive Health Clinic that treats individuals with HIV.
And while HIV remains a serious lifelong disease, there are more treatment methods than ever before, Fisk said, adding there is medication that can be taken by individuals who are at a high risk to HIV exposure that will prevent them from contracting the disease.
The most important thing is to be tested, which is further complicated because HIV can be asymptomatic in some individuals.
“I don’t think people need to panic about the fact that there’s been a threefold increase, and we don’t even know what the baseline number is,” Fisk said.
Stigma also can play a significant role in individuals not getting tested, said David Adkins Jr., director of Project Hope of Beaver County, an HIV awareness and advocacy prevention group that has been inactive for the past two years because of lack of funding and interest.
He had often distributed fliers and provided outreach at local shopping plazas and methadone clinics.
“People don’t want to get tested,” Adkins said.
Meanwhile, the same can be said for gonorrhea, which the county experienced increases in predominantly in young men and women, ages 15 to 24.
Dr. Frank DiCenzo, practice director at Premier Women’s Health located in Edgeworth, said it can be challenging to get women to agree to STD testing. He recently diagnosed two women, which were the first cases he has seen in about five years. He has his theories as to why the rates have gone up, but not specifically why Beaver County numbers have increased.
“I do think that young women are probably more promiscuous today. Maybe condom use has come down. I know that for teenagers, the pregnancy rate has come way down,” DiCenzo said.
He said women may have gotten the message about contraception, but he doesn’t know if they’ve gotten the message about the prevention of STDs.
“I think intrauterine devices have helped so much with prevention of pregnancy that possibly condom use has fallen,” he said. “I can’t say that for certain, but that’s a guess.”
According to health department statistics, there were 137 county residents who had gonorrhea in 2016, the latest number available, which should not be confused with the number of new diagnoses.
Gonorrhea, like HIV, also can be asymptomatic in some individuals. Women who aren’t diagnosed and treated can become infertile.
Patients also have told physicians at Premier Women’s Health that having “sex friends” or utilizing social media dating apps, such as Tinder and Snapchat, may have increased the issue. Then when individuals come to an appointment, they opt out of getting STD testing.
“I think a lot of patients maybe just don’t want a gynecological exam,” DiCenzo said.
In addition, Fisk said when patients have an STD, they risk a higher chance of contracting HIV if exposed to it. Individuals with HIV who also have another STD are at higher risk of spreading it.
“The presence of other STDs really can facilitate transmissions, so one of the things that really needs to be taken to heart is that we not only need to screen for HIV, but we really need to screen aggressively for STDs and treat them quickly,” Fisk said.