Syphilis outbreaks highlight lack of funds for testing, prevention

LANSING — With Oakland county reporting a syphilis outbreak, and Ingham and Kent counties reporting significant new cases of the sexually transmitted infection, advocates and health officials say the state legislature’s budget-carving ways are in part to blame.

Oakland county health officials say there have been 16 reported cases of early/latent stage infections identified there since Jan. 1. Last year, there were 32 such cases identified for the entire year. Those officials say all 16 cases in 2010 are in men who have sex with men, and of those, seven are HIV-positive, six were HIV-negative and three were of unknown HIV-status.

Declaring an outbreak is based on two factors, says Vaishampayan. Are there a significant number of cases of a disease over and above what the usual number would be in a given time period, and is the disease impacting a specific and identifiable group? The Oakland county outbreak meets both of those definitions, she told the Michigan Messenger.

In Ingham county, officials say there have been 10 cases of early/latent infection since Jan. 1. Of those, four were HIV-positive. Ingham has also identified two third stage cases in HIV-positive individuals. As a result of the HIV status of those individuals, they are considered to be infectious as well. Officials there say 90 percent of the cases are in the men who have sex with men community.

Meanwhile, in Kent county, officials say there have been 11 reported cases since Jan. 1. Information on the number of co-infected HIV-positives in Kent were not readily available.

Ingham county officials declared they were in the midst of an outbreak last year, and ultimately ended up identifying 17 primary or secondary syphilis infections in the county.

Kent county, while not declaring it was an outbreak, did raise alarms after seeing an increase in reported cases as well. There, officials say, the county ended up reporting 33 early/latent cases, 11 were co-infected with HIV. Officials say they identified 200 partners of those infected with the bacteria and tested them and provided antibiotic treatment for syphilis.

Syphilis increases risk of HIV transmission

Syphilis is a sexually transmitted infection which can be spread even when partners are using a condom, health experts say. The bacterial disease is found in three stages. The primary infection stage is documented by a small sore, called a chanker. The painless sore lasts for up to two weeks, then goes away on its own. The second stage of the infection appears with a rash all over the body, most notably on the palms of the hands and soles of the feet. The third stage is classically attributed to a long period of latency, followed by the bacteria attacking internal organs like the brain or heart. The first and second stage of infection are considered contagious by health authorities, and can increase the likelihood of HIV transmission by as much as two and half times. The third stage of the disease is generally not considered infectious.

“[Syphilis infection] increases the risk of HIV infection, which I can’t cure. It alarms me to see this increase,” Vaishampayan says. “People need to be aware it’s out there.”

While syphilis infections tend to be cyclical in nature — spiking every seven to 10 years officials say — state budget cuts may have some effect on the increasing numbers in the state. State numbers show that in 2008 there were 301 reported cases of syphilis infections in the state. In 2009 there were 396 cases, nearly a 25 percent increase.

Budget cuts reduce ability to fight the problem

And this is all happening when state budget sharing on public health agencies has dwindled. Since the early part of this decade, the state has steadily decreased the amount of money it makes available to local health departments to carry out care such as sexually transmitted infection diagnosis, treatment and control. Last budget cycle, the state cut $2.7 million from the budget sharing with local health departments, and Gov. Jennifer Granholm’s executive budget called for another 7.7 percent cut in funding this year.

The state is supposed to share budget costs for public health at 50-50 split, says Vaishampayan, the medical director in Oakland county. But, she said, the state has not been funding public health at that level since the 1990s.

“Has it impacted us? Yes,” says Vaishampayan. “We did lose one state worker. That person retired and the (sexual transmitted disease investigator) position was not renewed. They (sexually transmitted disease investigators) are specifically syphilis workers.”

That cut, she says, was a 50 percent cut to her sexually transmitted disease investigation team, leaving the county with only one such investigator for the county’s nearly 2 million people. Add to that, Vaishampayan says, the difficulty of tracking sexually transmitted diseases resulting from having a “porous” border with Wayne county, home of the city of Detroit, and one can imagine the logistical issues involved in tracking a sexually transmitted disease outbreak.

And the budget pinches are getting worse. Local health departments are required under the state’s new smoking ban to enforce the law. However, those departments say the law creates an unfunded mandate.

The additional costs of enforcing the new smoking policy will likely reduce the ability of county health departments to handle these other public health problems, says Vaishampayan.

“They are meeting on that to try to see (how to fund it) right now,” she says. “It’s an unfunded mandate. It’s going to be hard — we don’t have the personnel.”

In the past, she says her department has swallowed budget cuts by shifting responsibilities in the clinical programs. That has allowed the county to maintain key services, such as sexually transmitted disease tracking, without impacting service to the public.

That echoes what Bridie Bereza from the Kent County Health Department had to say about budget cuts and unfunded mandates impacting the county’s health services.

“We are concerned about being handed responsibilities that there is no funding for, from smoking ban enforcement to pet store complaint investigations. We’ve also seen staff reductions across the board (by attrition and layoffs) over the past five years,” Bereza said in an email. “Our health response to STI has stayed strong both despite funding budget shortfalls and also because of the state grant we received for the Ambassador Program [a program designed to get more at-risk people tested for HIV by offering rewards for recruiting others to be tested]. I am not sure that is the case across Michigan, but we are somewhat fortunate in that area.”

Ingham County Health Department’s HIV and sexually transmitted infection programs remain frozen at 2009′s level, officials there say.

“You can’t prove that there is a correlation between flat or negative budget growth,” says Marcus Cheatham, spokesman for ICHD. But he notes there is a delay in responding because of the lack of funds. “Delay is the enemy in communicable diseases. If you can’t get to people right away, it is going to spread.”

“I can tell you that we know that prevention works and continued cuts to our public health programs we view as very poor public policy. We know we will pay a higher price down the road for that,” says Judy Putnam, communications director for the Michigan League for Human Services. “In light of the numbers [of syphilis cases and co-infections with HIV], it does not bode well that we are cutting the funds in public health that are there to prevent these things.”