HIV and other sexually transmitted infections (STIs) appear to be a slowly rising tide in the Ocean State, according to the most recent data from the state health department.
STI surveillance data is reported on a lag, so the March report issued by the Rhode Island Department of Health (RIDOH) contains long- and short-term data ending in 2023, plus some tentative findings for 2024. But recent increases in infections could also be trends returning to their baseline prior to the pandemic.
“If you look at the data starting in 2020, we did see some significant declines starting with the pandemic, and that is because we were seeing less testing, less healthcare visits,” said Dr. Philip Chan, a primary care physician with Brown University Health and a medical consultant on the RIDOH report.
But people’s behavior also changed during that time, Chan added. “People were more likely to stay at home, more likely to isolate. What we were seeing on the ground was that a lot of people had a lot less sex partners, so there was just a lot less sex going on.”
The good news is that the state usually succeeds in treating HIV, with outcomes more positive than national averages and patients’ illness often stops before the virus progresses into AIDS. Less ideal are higher rates for other STIs like syphilis and gonorrhea, which climbed past pre-pandemic levels in 2023.
“From year to year, it’s tough to tell exactly what’s happening,” Chan said. “But I think that the trends the last couple years are clear that things are going up.”
Data for the more ubiquitous infections includes:
- Syphilis has increased 58% from 2014 to 2023. There were 328 cases recorded in 2021, the highest number in decades. That fell to 240 cases in 2022, and 190 in 2023 — about the same as pre-pandemic levels, which had already risen since 2014. Preliminary data for 2024 shows similar trends. From 2020 to 2023, there were also about 10 cases of congenital syphilis — the state’s first instances in about a decade, and one example of testing’s importance in early detection, Chan said.
- Gonorrhea cases rose 183.4% over the last 10 years. There were 590 cases in 2014, compared to 1,672 cases in 2023. There has not been a year with fewer than 1,000 cases since 2016. Men account for about twice as many cases as women.
- Chlamydia cases have remained more consistent since 2014, and rose 21% over the decade, from 4,349 cases in 2014 to 5,269 cases in 2023. Women ages 20-24 exhibited the highest increase over that same period, but the report notes that women access routine screenings more than men, who are often asymptomatic when infected.
“A key theme for all these STIs is that most people may not have symptoms,” Chan said. “And so the only way that you know that you may have it is to get tested, and that’s why testing is so so important.”
Chan pointed to primary care doctors and sex education as two ways people can become educated about the necessity of screening. Only 52% of adults ages 18 to 64 who had multiple sex partners received an STI test in the past year, according to 2022 data. Only 60% had ever received an HIV test.
What we were seeing on the ground was that a lot of people had a lot less sex partners, so there was just a lot less sex going on.
Demographic and geographic factors also shaped the data. Racial disparities exist: In 2023, HIV rates were four times higher among Black residents and nearly sevenfold higher among Rhode Island’s Latino population, compared to caucasian residents. New HIV cases among Latinos have risen 132% since 2019, while dropping 63% among Black Rhode Islanders. Of newly diagnosed HIV cases in 2023, 31% were diagnosed in people born outside the United States, most frequently in the Caribbean and Central and South America.
Younger people ages 15-24 account for most new STI diagnoses, about half. The state’s urban core of Providence, East Providence, North Providence, Pawtucket, Woonsocket, Central Falls, and Cranston consistently reports the highest STI rates, with cases numbering in the dozens to hundreds, compared to fewer than five reported cases in many smaller towns.
“A lot of these STIs do disproportionately affect communities of color and other sorts of underserved populations,” Chan said. “It’s important, from a public health perspective, to think about how to continue and promote and increase access to care for those groups in order to address disparities like we see in STIs and frankly, many other things.”
Early diagnosis, prevention making a difference
While an assortment of drugs can stop bacterial infections, there’s no cure for HIV. But HIV-positive people are living longer than ever due to modern antiretroviral drugs that suppress the virus and prevent it from progressing to a more serious diagnosis of AIDS. An adequately suppressed viral load can also make the disease intransmissible, and greatly improves quality of life by halting the virus from replicating. Advances in HIV drug therapy largely account for the deep reduction in the rate of HIV-related deaths, which nationally fell by almost half from 2010 to 2017.
In Rhode Island in 2022, 93.2% of people living with HIV knew their status, 76% were receiving treatment and 71% had achieved viral suppression. And 93% of people who received their medical care within Rhode Island achieved viral suppression.
Still, there was an above-average number of HIV diagnoses, the preliminary 2024 data showed. From 2019-2023, RIDOH also observed that about 20% of people newly diagnosed with HIV had progressed to stage 3, or AIDS. On average, it takes eight years for HIV to develop into AIDS.
Rhode Island has tried to prevent those outcomes by early diagnosis and by fortifying its residents against HIV through preventative measures — namely, PrEP, or pre-exposure prophylaxis. Patients who adhere to the schedule for taking this group of antiretroviral drugs can have up to a 99% lower chance of contracting HIV from unprotected sex. PrEP provides an approximate 74% reduction in the likelihood of contracting HIV via injectable drug use.
Successful state laws from 2023 and 2024 made PrEP as widely available as possible by slashing away potential restrictions from insurers and eliminating out-of-pocket costs. Chan, only had “good things to say” about those laws — including the resulting interactions with insurers, who have largely been quick to correct mistakes in patient billing. The main challenge now, Chan said, is when interruptions occur, and a person loses their job, insurance, and access to PrEP.
“I actually had a patient of mine for several years who had insurance and was on PrEP,” Chan said. “They lost their insurance for a couple months and had to go off PrEP, and they actually, unfortunately, acquired HIV during that time. This was just a month ago.”
RIDOH continues to promote the Rhode Island PrEP Champions Network, which has participating clinics across the state that expedite access to PrEP as well as its sibling PEP, or post-exposure prophylaxis, which is taken for about a month, starting within 72 hours of possible HIV exposure. Properly taken, the drug prevents HIV infection.
The comparable treatment for preventing bacterial STIs is DoxyPEP, which usually consists of a single, two-pill, dose of doxycycline taken after sex. Doxycycline is an old drug, and thus an inexpensive means of lowering contraction rates, Chan suggested.
“DoxyPEP is the newest kid on the block,” he said, noting that the nationwide rollout is still in its early stages. But so far the data looks good, with evidence from places like San Francisco suggesting it can make a difference.
“We’re very optimistic about it, and I think the coming years will be able to tell whether or not it’s making a significant impact on overall population trends,” Chan said.
This story was originally published by the Rhode Island Current.
