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Taking on Colorado's Shocking Rise in Sexually Transmitted Diseases

An image from a recent report about sexually transmitted infections by the Colorado Department of Public Health and Environment.
An image from a recent report about sexually transmitted infections by the Colorado Department of Public Health and Environment.
Colorado Department of Public Health and Environment

Sexually transmitted infections are a major problem in Colorado. A state report released last year showed a steady and disturbing STI increase in a variety of communities; gonorrhea cases alone jumped just under 200 percent in five years.

Advocates for Senate Bill 20-156, also known as "Protecting Preventive Health Care Coverage," which debuts before the state Senate Health and Human Services committee today, see the measure as a way to lower these numbers by helping Coloradans avoid such infections in the first place — a goal currently made more difficult by rules that rarely allow preventative STI care without a co-pay.

"It makes no sense that patients can get STI testing if they don't think they have an STI, but someone who thinks they have an STI has to pay to get tested," says Jack Teter, political director for Planned Parenthood of the Rocky Mountains, an organization backing the proposal. "And it defies belief that STI testing with no co-pay is generally accessible for some women, but mostly not for men."

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The scope of the state's STI issue in Colorado is spelled out in the recent Colorado Department of Public Health and Environment study, as well as data from the federal Centers for Disease Control and Prevention. In 2017, there were 36,291 newly reported STI cases here: 26,995 involving chlamydia, 8,478 pertaining to gonorrhea and 818 dealing with all stages of syphilis. Those are the highest figures ever recorded in the state for each of the three conditions.

The rate of chlamydia in 2017 — 481.3 cases per 100,000 people — represented a 23 percent increase since 2013. The syphilis rate was more than two times higher: 14.6 cases per 100,000 people, a 61.5 percent leap over the same time span. And the 151.3 cases of gonorrhea per 100,000 people was up 182.3 percent in five years.

This graphic depicts reported gonorrhea cases and rates of reported cases in Colorado from 2008 to 2017.
This graphic depicts reported gonorrhea cases and rates of reported cases in Colorado from 2008 to 2017.
Colorado Department of Public Health & Environment

While more people in Denver were treated for these three STIs than anywhere else in Colorado in 2017, the rates of infection were particularly high in many of the state's less populous areas. That's no surprise to Teter: "There's a lack of health-care access in a lot of rural areas," he notes. "That's something the legislature has been debating about for years and years. And beyond that is the ability to access testing at a well visit without paying any additional money. That's critically important."

The bill, sponsored by four Democrats (senators Brittany Pettersen and Dominick Moreno, as well as reps Daneya Esgar and Kyle Mullica), doesn't focus entirely on these issues. Its introduction notes that it "codifies a number of preventive health care services currently required to be covered by health insurance carriers pursuant to the federal 'Patient Protection and Affordable Care Act' and adds them to the current list of services required to be covered by Colorado health insurance carriers, which services are not subject to policy deductibles, co-payments, or co-insurance," such as screening for osteoporosis, urinary incontinence, blood pressure, lung cancer and statin medication, as well as birth control.

This language is intended to "make sure that in the event of continued federal attacks on health care, people in Colorado will still have access to these preventative benefits," Teter explains.

With regard to sexually transmitted infections, he stresses that the bill is intended to address the fact that "women can access co-pay-free preventative screening under the Affordable Care Act for some STIs in some cases, and men generally can't." For example, "preventative visits only apply to asymptomatic people," meaning individuals who show no symptoms of an infection. "And men can never access preventative testing without a co-pay for chlamydia and gonorrhea, and can only do it for syphilis if they're considered high risk," Teter says. "And it makes no sense, when we're talking about illnesses and infections transmitted through sex, that only half the population can access testing without paying extra for it."

If the new law passes, women and men alike would be able to receive both preventative care and treatment for STIs without a co-pay.

This map displays rates of reported gonorrhea cases by county in 2017. Dark green represents the highest rates, as seen in counties such as Pueblo, Montezuma and Alamosa.
This map displays rates of reported gonorrhea cases by county in 2017. Dark green represents the highest rates, as seen in counties such as Pueblo, Montezuma and Alamosa.
Colorado Department of Public Health & Environment

The bill's fiscal note estimates the need for only a $90,547 withdrawal from the state's general fund to ensure that patients in Medicaid managed-care organizations like the one overseen by Denver Health can access relevant screenings before starting birth control, such as blood-pressure screenings. The lion's share of the proposal's cost, $814,920, would be covered by federal funds accessed by the Department of Health Care Policy and Financing — and Teter argues that the state would actually save money in the long run by preventing illnesses that it would otherwise have to pay to treat.

Of course, any bill dealing with certain horizontal acts can become controversial in Colorado, as seen in the reaction to last year's comprehensive sex education proposal. And SB 156 includes provisions that involve minors, such as this: "Current law requires a health care provider or facility to perform a diagnostic exam for an STI and subsequently prescribe treatment for an STI at the request of a minor patient. The bill allows a health care provider to administer, dispense, or prescribe preventive measures or medications where applicable. The consent of a parent is not a prerequisite for a minor to receive preventive care, but a health care provider shall counsel the minor on the importance of bringing the minor's parent or legal guardian into the minor's confidence regarding the services."

Still, Teter hopes the bill's long list of mainstream backers, including the American Cancer Society, the Colorado Children’s Campaign, Colorado Consumer Health Initiative, Healthier Colorado and the Interfaith Alliance, will prove reassuring to legislators. Besides, he adds, "it's hard for me to imagine anyone who would say access to STI testing is in some way a bad thing. If there are going to be a lot of people saying insurance shouldn't cover STI testing for men, I don't know who those people would be."

The February 26 meeting of the Senate Health and Human Services committee begins upon adjournment at the Old Supreme Court chambers in the Colorado State Capitol, 200 East Colfax Avenue. Click to read "Sexually Transmitted Infections in Colorado: 2017 Annual Report" and "Sexually Transmitted Disease Surveillance 2017," from the Centers for Disease Control and Prevention, as well as Senate Bill 20-156.

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