According to the Centers for Disease Control (CDC) data, in 2013 Alabama was third behind Alaska and Louisiana in chlamydia infections and second only to Louisiana for gonorrhea.
While chlamydia had been on the rise across a ten year period, there was a slight decrease noted between 2012 and 2013 in the state. The largest infection rates were noted in a band of counties across the southern portion of the state, including Sumpter, Greene, Hale, Dallas, Wilcox, Lowndes, Perry, Montgomery, Pike and Macon counties.
- Most chlamydia cases (72.6%) were reported by women.
- Just over half the chlamydia cases (50.3%) were found in the black population.
Gonorrhea also saw a decline from 2012 to 2013 with approximately 175 cases per population of 100,000. This was a decrease of 10.8%. Similar to the chlamydia cases, the majority of gonorrhea cases were found in black women. The largest number of cases was found in Greene and Montgomery counties.
Due in large part to education efforts and cooperation between public and private agencies, syphilis infection rates have gone down.
- Primary and secondary syphilis saw a 15.6% decrease in 2013 from 2012, down to 185 cases.
- Early and latent syphilis had more encouraging news with a 56.2% decrease since 2008.
Its government has a number of statutes that direct STD health, testing and prevention including:
- 22-17-8 prohibiting a worker with a venereal disease from servicing patrons in barber, manicure or beauty shop.
- 15-23-101 requiring a person charged with rape, sodomy or sexual misconduct to be tested for sexually transmitted diseases.
- 22-11A-14 specifying all medical persons and/or facilities to report diagnosed STDs to the state board of health.
The state has taken a number of measures to educate the public in an attempt to staunch the contraction of STDs. For example, Alabama statute 22-11A-20 requires physicians to educate diagnosed patients on proper treatment and prevention of the spread of STDs. The free STD clinics also offer support for citizens with STDs.
However, STD education in its public schools is not mandatory which leaves an educational gap. Any school that does offer sex education curriculum is required to teach that:
Abstinence from sexual intercourse is the only completely effective protection against unwanted pregnancy, sexually transmitted diseases, and acquired immune deficiency syndrome (AIDS) when transmitted sexually. Section 16-40A-2 (1)
In addition, the education has to provide statistics of the efficacy of various forms contraception against HIV and AIDS. CDC studies indicate this level of education is not enough, listing Alabama as a high risk state for contracting HIV.
One service offered by the organization Thrive is a program called SMASH (Student Movement Against Stigma and Hate). It offers peer-to-peer education among high school students in the northern counties on HIV/AIDS awareness and prevention. In addition to SMASH, HIV testing and other education services, Thrive is also raising money to implement a mobile testing unit.
HIV tests and AIDS prevention methods are varied across the state. While the free clinics in each county offer testing, more notable education efforts are found in the larger cities. For example, Birmingham Aids Outreach offers education services on prevention and after diagnosis care, testing, PAWS program and an iPhone app.
While many clinics offer standard tests for a variety of STDs including HIV, chlamydia, gonorrhea, syphilis, and herpes, free testing and treatment are specifically targeted to chlamydia, gonorrhea, syphilis and HIV. There is very little mention of herpes testing on the Alabama Public Health site, with efforts being concentrated on other STDs.
Given that sexual health education is not required in the state, it is not surprising that the Alabama Public Health website indicates citizens between the ages of 15 and 29 are two times more likely to contract HIV than other residents. Similarly, other regularly tracked STDs showed similar findings as recently as the first two quarters of 2016 in Alabama’s Quarterly Surveillance Report:
- Of the 14,378 reported chlamydia cases, 88.1% were between ages 10 and 29
- Of the 41,54 gonorrhea cases, 79.5% were attributed to individuals aged 10 to 29.
- For trichomonas’s, 68.5% of the 5987 cases were aged 10 to 29.
Twice as many females (71%) in all age groups tested positive for an STD than males (29%).
In fact, the three states that rank consistently the highest in STD infections do not require sex education in their public schools.
It’s worth noting that in several studies prepared by Alabama Department of Education, several of the counties that had the highest percentage of reported STDs had the poorest rankings in school quality – including Greene, Macon and Lowndes counties. These are the same counties that have high HIV infection rates.
Both Greene and Montgomery counties, which had the highest STD reports, were underperforming in all areas (reading, math, overall student achievement, and graduation rates) when compared with all state locations combined. These numbers indicate there is a relationship between poor school performance and increased incidence of sexually transmitted diseases in school aged children.
Overall the state does not fare well when compared to other state STD statistics and educational efforts. It fails in prevention of commonly tract infections, ranking in the top three states with high numbers of chlamydia and gonorrhea. Little to no mention is giving to herpes tests. There seems to be a relationship between poor school performance and increased incidence of these STDs. (Louisiana, who had the most cases of chlamydia and gonorrhea of any state in 2013, also was ranked low with Alabama in school performance.)
The state has made strides toward furthering education and research on STDs, including efforts at University of Alabama to house an STD-HIV Prevention Training Center and their participating in the Gonococcal Isolate Surveillance Project (GISP). While there are some indication that there is a slightly downward trend in new STD cases across the state, only time will tell if their continued efforts with public education and free testing will pay off.