The new American administration led by Donald Trump and Michael Pence promises changes likely detrimental to the public health infrastructure addressing sexually transmitted diseases, and to the funding streams that support research on prevention, treatment, and education. Rollback of expanded health access, insecurity among immigrant populations, loss of legal protections for sexual and gender minorities, and aggressive restrictions on sexual/reproductive health services are just the most general areas that affect STD at the intersections of public health, science, and clinical services. Some states will mirror policies endorsed at the Federal level. However, some states may maintain or even expand programs related to STD and other sexual/reproductive health services. This will create havens of safety for residents of those states but exacerbate regional health inequities that are long-standing attributes of STD in the United States.
The challenges to the ASTDA mission brought by the broad political changes in the United States means that our organization can ill afford passivity and silence. In the short term, we will be working to increase the engagement of our membership in the state and federal issues that affect the ASTDA mission. We are already signing on to advocacy letters to Congress and other administration officials. We are enhancing partnerships with organizations such as the American Sexual Health Association and the National Coalition of STD Directors. These partnerships can multiply the reach and effectiveness of our efforts. We have expanded ASTDA’s regional perspective to include a member of IUSTI Canada on our Executive Committee, and have extended our global commitment through greater engagement in IUSTI. After all, the repeated lessons of global HIV, gonococcal resistance, and zika (among many others) teach us that walls or national boundaries are ineffective barriers to STD.
In the longer term, ASTDA will work toward more effective use of its extensive scientific and clinical expertise in defense of critical public health, research, and clinical infrastructure. We will also seek opportunities for advocacy that expands understanding of the complex social, behavioral, and biological elements of STD. This an ambitious vision. But, of course, that is what a crisis requires.
J.Dennis Fortenberry MD MS
President, American STD Association