Magazine article The Nation's Health

Q&A with CDC's Hazel Dean: 'We Must Ensure That All Prevention Strategies Reach All Populations Equally': Exploring Strategies to Address Tuberculosis, STDs in America

Magazine article The Nation's Health

Q&A with CDC's Hazel Dean: 'We Must Ensure That All Prevention Strategies Reach All Populations Equally': Exploring Strategies to Address Tuberculosis, STDs in America

Article excerpt

Hazel Dean, ScD, MPH, is the deputy director of the Centers for Disease Control and Prevention's National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention. Dean is widely recognized for her work in addressing disparities in HIV and sexually transmitted disease rates and is the recipient of a number of honors, including the Presidential Rank Honor Award for Distinguished Service, the nation's highest civil service award. With continuing disease challenges on the horizon, Dean spoke to The Nation's Health about her top priorities, new prevention opportunities and why social media is a critical public health communication tool.

Your CDC center oversees a wide range of health issues, from multidrug-resistant TB to continuing disparities in HIV infection. What have been the most significant accomplishments?

Six particularly remarkable accomplishments, among many, come to mind. First, highly effective antiretroviral therapy has greatly extended life expectancy among people living with HIV and resulted in a dramatic drop in AIDS deaths. Additionally, consistent pre-exposure prophylaxis use now reduces HIV transmission, and considerable progress has been made in other highly effective interventions, such as male circumcision, STD treatments, antiretrovirals and vaccines. For hepatitis C, advances in antiviral treatments have helped cure infection, reduce transmission and prevent deaths. For STDs, better testing, treatments and partner management have reduced syphilis by 22 percent and gonorrhea by 34 percent among blacks. Finally, annual tuberculosis cases in the United States have reached an all-time low.

Despite these accomplishments, however, our center still has many urgent priorities, not the least of which are limiting antibiotic-resistant gonorrhea and reducing STDs among young people. We cannot claim victory yet over tuberculosis and must continue to take steps toward its elimination. While improved treatments for hepatitis C are a major step forward, there is still a great need for more widespread testing to make people aware of their infection so that they can benefit from new life-saving treatments. Progress in HIV prevention has been uneven, and gay and bisexual men and blacks continue to be most affected. We must ensure that all prevention strategies reach all populations equally.

In November, CDC reported that rates of gonorrhea, chlamydia and syphilis had risen for the first time since 2006. What are the drivers behind this?

To clarify, 2014 was the first time since 2006 that all three diseases increased in the same year. Nevertheless, this trend is particularly concerning because these complex diseases are being influenced by multiple factors. Increased implementation of STD screening recommendations--particularly screening and testing at least annually among all sexually active men who have sex with men--might be increasing chlamydia and gonorrhea detection.

For both primary and secondary syphilis, cases have been increasing among men who have sex with men since at least 2000. In 2014, men accounted for 91 percent of all syphilis cases, and among men for whom the sex of their partner was known, 83 percent were men who have sex with men. In 2014, syphilis cases also increased among women and heterosexual men. Some men have sex partners in both men-who-have-sex-with-men and heterosexual networks, which might account for syphilis rate increases among these additional populations. Compounding the challenge is a lack of resources in certain health jurisdictions for contact tracing and other services for new syphilis patients.

Because STDs are preventable, significant reductions in new infections are not only possible, they are urgently needed. CDC is working to provide resources to state and local health departments to support prevention efforts in communities. …

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