“Sex is a natural activity and part of our human experience.”
“As a society, we have tremendous difficulty talking about sex and recognizing that sex is a natural activity and part of our human experience,” he said in an interview.
Despite all this, the longtime public health official — who resigned from his federal post at the end of November — is fiercely optimistic. He insists there are glimmers of hope amid these dire statistics, including a new drug highly effective in stopping the transmission of STDs after unprotected sex and better at-home STD testing for people who are unable or unable to do so. Those wishing to go to the clinic.
However, the Dominican-born MENA has known for decades that even the most groundbreaking medical innovations are useless if they do not reach the hands of the people who need them most.
Mina’s focus on overlooked and underserved diseases and populations dates back to his internal medicine residency in Chicago in the mid-1990s—one of the deadliest years of the AIDS epidemic. As he saw tens of thousands of people continue to die even after life-saving medications were finally available, he decided to shift from a lucrative career as a private physician to dedicate his life to fighting sexually transmitted diseases and other public health threats, especially in LGBTQ+ communities. and communities of color.
“As a doctor, you can only care for one person at a time,” he added. “This is important – understanding one person’s issues. But I wanted the opportunity to translate what I learned from caring for one patient into actions that could improve the health of many individuals.”
While stepping down from his position at the CDC, Mina spoke to POLITICO about how Covid has made the battle against STDs better and worse, why so many doctors are still touchy-feely talking about sex, and what new inventions could change the course of health Nationality.
This interview has been edited for length and clarity.
I came to CDC at the height of the COVID pandemic, and was tasked with focusing on the various infections rampant in the United States, including syphilis and chlamydia. Did you get the resources you needed or did you have to fight for the attention of higher-ups?
It was an unprecedented challenge but a rewarding experience in many ways. The pandemic has significantly impacted public health priorities, resource allocation and access to health care in ways that have had direct implications for STD prevention.
A key challenge has been shifting public health resources towards COVID-19. This has disrupted routine STD testing and truly limited services. Clinics were closed or operating at reduced capacity, and many health care providers were reassigned to respond to COVID-19.
When the 2020 STD data was released, we saw that reported cases of chlamydia and syphilis had decreased significantly. But the subsequent increases were not only significant, they were higher than in 2019. So we saw an acceleration in STI case rates, exacerbated by the pandemic.
So we had to innovate quickly. Telehealth has become a vital tool, providing a way to continue providing essential services such as screenings and even some aspects of treatment. Home testing for STDs has also become a great resource.
Just a few weeks ago, we received FDA approval for our first out-of-clinic sample collection kit, which we’re really excited about. Our department has strived to ensure that STI prevention remains visible despite the overwhelming focus on COVID-19, and we have even been able to integrate messaging around sexual health into broader government communications about COVID-19 where possible.
Public health experts He had high hopes That their decades of work in the fight against STDs will help in the fight against Covid, and that lessons learned during Covid will help in the fight against STDs. But we seem to be doing very poorly as a country on both fronts. why is that?
I’m a little optimistic in my outlook.
The COVID-19 pandemic has left us with a deep understanding of how health disparities impact certain populations, but it has also taught us how much these populations want and care to be empowered and take control of their health if we give them the tools they need. .
So I’m very optimistic about many of these new tools emerging. For many years – for decades – we have not made any significant progress. But now, even though we have insanely high incidences, we also have tremendous innovations.
For example, doxycycline is an antibiotic that has been around since the 1940s, and we have long used it to treat chlamydia infections and syphilis. But we now know that using it within 72 hours after sex — at least for men who have sex with men and transgender women, two groups disproportionately affected by STDs — can significantly reduce the incidence of gonorrhea, chlamydia, and syphilis. .
We also have a new point-of-care test for syphilis that could dramatically shorten the time between the moment people have a blood test, receiving a diagnosis and receiving treatment – reducing the likelihood of people falling through the cracks and not receiving the right treatment.
I also think there is a lot of potential in the research currently underway on a vaccine that might reduce the incidence of gonorrhea. All of these tools will give us the opportunity to respond to this epidemic in new ways.
Are there lessons that public health agencies have learned from the launch of the HIV prevention drug PrEP, which has already succeeded in stopping HIV transmission but is still not reaching many people who need it? Are these lessons being applied to how doxycycline is distributed or are people making the same mistakes again?
As my director (National Center for HIV, Viral Hepatitis, and STD and TB Prevention Director) Jonathan Mermin always says: “In an unjust society, disparities will naturally occur.”
So we have to be very determined not to repeat the mistakes of the past. We must be very intentional in making sure that, from the beginning, we design interventions for people who are marginalized, who are most vulnerable, who are least likely to access our interventions but who need them most.
Part of the problem is that we tend to design interventions that suit the majority of the population.
When we provide services to the majority, we often ignore those on the margins – sexual and gender minorities and people with socioeconomic conditions that put them at a disadvantage.
The other lesson is that CDC and Public Health can’t do this alone. With millions of STDs diagnosed each year, we have to realize that it will take all of us working together to end this epidemic. We are reaching out to affected communities like never before, so they can inform and guide our approaches and interventions. We call on the (healthcare) industry to play its role and responsibility to develop much-needed new innovations.
Because 90% of STIs are diagnosed outside public health clinics, if more health care providers could become more comfortable taking patients’ sexual histories and performing age-appropriate screenings, we would see a significant reduction in the STIs we encounter.
Do you think getting more people in the medical field comfortable talking about these issues has been one of the biggest challenges for you?
The problem is actually our culture. We, as a society, have great difficulty talking about sex and recognizing that sex is a natural activity and part of our human experience.
With so much stigma around sex, it bleeds right through the general population and acts as a wall preventing them from accessing the services they need. We need to ensure that our routine medical education includes truly comprehensive training in how to approach individuals’ sexual health.
What do you consider unfinished business from your time running the Centers for Disease Control and Prevention’s Office of Sexually Transmitted Diseases?
Our world is constantly changing, and the landscape of STD prevention and control must evolve as well – especially with many recent technological and biomedical advances. The Department must continue to adapt its strategies as new information and tools become available and ensure they are implemented in a way that not only provides convenience to those who already have access, but is available and affordable to those who need it most. They are disproportionately affected by sexually transmitted diseases.
Understanding the needs and perspectives of the communities we serve is also critical. We have to really continue to engage with diverse populations, including racial and ethnic minority groups and the LGBTQ+ community, to make sure that what we’re doing is culturally competent, effective, and responsive to the needs of those populations.