Native Americans hit hardest in syphilis surge | Healthiest Community Health News

from her base Gallup, New MexicoMelissa Waiako is one of about 20 people crisscrossing the vast Navajo Nation looking for people who have tested positive or been exposed to syphilis, a disease that was once nearly eradicated in the United States. Supervises public health nurses.

Infection rates in this region of the Southwest — the 27,000-square-mile reservation has arizona, new mexico and Utah —One of the highest levels in the country.And they are far worse than anything, Waiako is from Zuni Pueblo (approximately 40 miles south of Gallup) is a nursing consultant for the Navajo Area Indian Health Service and has seen a lot in her 30-year nursing career.

The number of syphilis infections nationwide has increased rapidly in recent years, and is expected to reach its highest level in 70 years in 2022, according to the latest data from the Centers for Disease Control and Prevention. The rise is lack of penicillin, is the most effective treatment. At the same time, congenital syphilis (syphilis transmitted from a pregnant person to their baby) is similarly out of control. If untreated, congenital syphilis can cause bone deformities, severe anemia, jaundice, meningitis, and even death. In 2022, CDC recorded Of the more than 3,700 cases of congenital syphilis reported that year, there were 231 stillbirths and 51 infant deaths due to syphilis.

And while cases are rising across the United States, no demographic has been hit harder than Native Americans. According to CDC data released in January, Congenital syphilis rate By 2022, the rate of American Indian and Alaska Native babies will be three times that of African Americans and nearly 12 times the rate of white babies.

“This is a disease that we thought we could eradicate not that long ago, because we have treatments that really work,” said Megan Currie O'Connell, a member of the Cherokee Nation and chief public health officer for the City of the Great Plains. . The Tribal Leadership Health Committee is located at: south dakota.

Instead, Native American congenital syphilis infection rates (644.7 items rate per 100,000 population in 2022) is now comparable to the rate for the total U.S. population in 1941 (651.1) — before doctors started using penicillin to treat syphilis. (In 1983 nationally this rate dropped to 6.6.)

O'Connell said that's the reason for the Great Plains Tribal Leadership Health Committee and Great Plains tribal leaders. north dakotaSouth Dakota, nebraska and iowa asked Federal Health and Human Services Secretary Xavier Becerra plans to declare a public health emergency in each state.declaration will expand Staffing, funding, and access to contact tracing data across the region.

“Syphilis is deadly to babies. It's highly contagious and has very serious consequences,” O'Connell said. “We need to hire people to work in the field right now.”

in October news release, the New Mexico Department of Health said the state “reported a 660% increase in cases of congenital syphilis over the past five years.” A year ago, in 2017, New Mexico reported only one case; by 2020, that number had increased to 43, and by 2022, to 76.

Since 2020, the situation has worsened due to the coronavirus disease (COVID-19) pandemic. “Nearly 95% of the nation's public health has been directed to COVID-19 care,” said Jonathan Iral, chief clinical consultant for infectious diseases at the Indian Health Service, based at the Gallup Indian Medical Center. Stated. “This was a really hard-hit area.”

At one point early in the pandemic, the Navajo Nation reported: Highest new coronavirus infection rate Iral suspects that patients with symptoms of syphilis in the United States are avoiding seeing doctors for fear of contracting the new coronavirus. But he doesn't think it's fair to blame the pandemic for the high rates of syphilis and the high rates of women passing the virus on to their babies during pregnancy, which persist four years later.

Native Americans are more likely live in the countrysidefar from hospital obstetrics unit, more than any other race or ethnicity. As a result, many people do not receive prenatal care until late in pregnancy, if at all. This often means that health care providers are unable to test or treat patients for syphilis before delivery.

In New Mexico, 23% of patients Not receiving prenatal care until after the fifth month of pregnancy or receiving less than half of the number of visits appropriate for the infant's gestational age in 2023 (national average is less than 16%).

Inadequate prenatal care is especially dangerous for Native Americans, who are more likely to transmit syphilis infections when pregnant than other ethnic groups. That's because in indigenous communities, syphilis infections are just as common among women as men. any other ethnic group, Men are at least twice as likely to contract syphilis, primarily because men who have sex with men are more likely to become infected. Ms O'Connell said it was unclear why women in Indigenous communities were disproportionately affected by syphilis.

“The Navajo Nation is a maternal and child health desert,” says Amanda Singer, a Diné (Navajo) doula and lactation counselor in Arizona and executive director of the Navajo Breastfeeding Coalition/Dine Doula Collective. In some areas on the reservation, a patient must drive more than 100 miles to get to obstetric services. “So many pregnant women do not receive prenatal care throughout their pregnancy.”

She said this was due not only to a lack of services but also to mistrust of health care providers who did not understand Indigenous culture. Others worry that health care providers will report patients who use illegal drugs during pregnancy to police or child welfare. But it's also because the network of facilities is shrinking. Two of the Navajo region's labor and delivery wards have closed in the past decade.according to recent reportsmore than half of rural hospitals in the United States do not offer delivery services.

Singer and other doulas in her network believe New Mexico and Arizona can combat the syphilis epidemic by expanding access to prenatal care in rural Native American communities. Singer envisions a system in which midwives, doulas, and lactation counselors could visit families and provide prenatal care “at home.”

O'Connell said data-sharing arrangements between tribes and state, federal and IHS offices vary widely across the country, but some Native communities, including hers, pose additional challenges in tackling outbreaks. He added that it was causing it. Her Tribal Epidemiology Center fighting for access South Dakota data.

Iral said that in the Navajo Nation and surrounding areas, IHS infectious disease physicians meet monthly with tribal stakeholders and that state, tribal, and He said he recommends that regular meetings be held between providers, public health nurses, and others. Those areas are being examined and treated.

IHS currently recommends that all patients be tested for syphilis annually, and pregnant patients are tested three times. It also expanded rapid and rapid testing and began offering DoxyPEP, an antibiotic that transgender women and men who have sex with men can take within 72 hours after sex to reduce the transmission of syphilis. It has been proven. 87% increase. But perhaps the most important change IHS has made is the provision of on-site testing and treatment.

The public health nurses Waiako oversees are now able to test and treat patients for syphilis at home, something they couldn't do just three years ago when she was one of the public health nurses.

“Rather than dragging patients into penicillin, what if we brought the penicillin to the patient?” Iral said.

Although this is not a tactic IHS uses for all patients, it has been effective in treating patients who may pass the infection on to their partners or babies.

Iral said the next few years will see the expansion of street medicine in urban areas, the increased penetration of vans in rural areas, and the availability of more tests in local communities, as well as testing in the hands of patients through vending machines and the mail. We anticipate that it will become available.

“This is a radical departure from our past,” he said. “But I think that’s the wave of the future.”

This article was created by KFF Health Newsa national newsroom that produces in-depth journalism on health issues, is one of our core operating programs. KFF. Posted with permission.