State budget limbo putting STD treatment in jeopardy, providers say

  • This chart, by N.H. Department of Health and Human Services, shows the number of reported cases of the sexually transmitted disease gonhorrea in the state through July 31 of each year. NH DHHS

  • Dalia Vidunas, the executive director of Equality Health Center in Concord, left, speaks at a panel with U.S. Rep. Chris Pappas, center, and Sabrina Dunlop, vice president at Planned Parenthood of Northern New England, Aug. 14, 2019. Reproductive health centers are facing increasing budget squeezes after a Trump administration rule cut off funding. Ethan DeWitt—Ethan DeWitt

Monitor staff
Published: 8/14/2019 5:31:08 PM

The trend lines are clear: A 17% increase in chlamydia rates in New Hampshire over a recent five-year period; a 103% surge in the syphilis rate; a 352% explosion of gonorrhea.

New Hampshire has had a disconcerting swell of sexually transmitted diseases in recent years, according to numbers published by the Department of Health and Human Services in 2018.

The state experienced 521 cases of gonorrhea that year, up from 114 in 2013. Chlamydia stands at 3,686 cases a year and while HIV incidents have not notably increased, they still hover around 34 cases a year.

Now, as infections remain prevalent, providers say the absence of a budget this summer is hurting their ability to combat them.

A decision by the Trump administration to add new restrictions to federal funding for health care clinics that provide abortions – most notably Planned Parenthood – has taken a bite out of other health services, the organizations say.

And an attempt by New Hampshire lawmakers to alleviate that loss of funds via state money has also been put on ice, after a budget veto by Gov. Chris Sununu has sent both parties scrambling to find a compromise.

Without federal funding or state backup money, Planned Parenthood has seen a 25% hit to its operating budget, and other family planning centers are feeling crimped as well, officials at the organizations say.

One casualty of that funding crunch, providers say: STD testing. Efforts to help Granite Staters diagnose conditions and treat them are facing significant reductions – a cutback that they say especially affects those without insurance. 

At the Equality Health Center Wednesday – a Concord-based reproductive health clinic – top officials for that center, Planned Parenthood, and the Joan G. Lovering Health Center in Greenland gathered with U.S. Rep. Chris Pappas and state senator Tom Sherman – two Democrats – to express concerns over the Trump administration’s new funding rule.

Issued this year, the federal Department of Health and Human Services rule prohibits funds in the Title X program from going to any clinic whose practice includes abortions unless abortion care facilities are separated physically and other conditions are met. 

Federal money is already prohibited from being used for abortions, but anti-abortion activists argue the new rules strengthen that prohibition and close off indirect means for reproductive health centers to benefit from the money. 

But Planned Parenthood and other organizations have argued the funding withholding is illegal and unjust, and are presently suing in the U.S. Court of Appeals for the Ninth Circuit.

Since the rule was announced, Planned Parenthood, Equality Health Center and other New Hampshire facilities have voluntarily stopped accepting Title X funds – first made available in the 1970s. But on Tuesday, facing pressure from the Trump administration, the national Planned Parenthood announced it would withdraw from the Title X program entirely, unless the circuit court granted an injunction for the rule.

For Lisa Leach, executive director at the Lovering Health Center, the funding dilemma has created high stakes challenges just as breakthroughs are being made with sexual infection treatment. 

Preventing and treating HIV, for instance, has seen leaps and bounds with the increased availability of pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP), Leach said.

“The HIV prevention is huge,” said Leach. “I came through the 90’s when HIV was a death sentence. And now it’s not. Not at all. Not only can we prevent it but … we can make it undetectable.” 

But facing the loss of federal funds, the center’s whole program is at risk, Leach said. 

“It’s an amazing thing to have in the world,” she said. “But that’s one of the first things I’m going to have to think about letting go. That’s phenomenally wrong.”

Dalia Vidunas, executive director at Equality Health Center, is in a similar spot. The center has provided a testing package for those without insurance: $95 for a series of four tests that could set a patient back $400 in the hospital. It’s now evaluating whether it can continue at that price, Vidunas said. 

Preventative care for sexual diseases is available at hospitals and clinics. But Vidunas and Leach say their clinics provide services for those who can’t access them.

For starters, many uninsured patients simply don’t have primary care doctors, they said. And then, when they do, the procedures can be costly, they argued. 

Sometimes, the care may not be as strong; obstetrician/gynecologists might only carry out vaginal swabs for tests, whereas reproductive health centers might go further with throat and rectal tests too – increasing the chances of detecting a disease.

For now, the centers are hunkered down. Planned Parenthood is using reserve emergency funding; smaller centers like Lovering and Equality are facing down staffing reductions and service cuts. 

The budget passed by the Democratic Legislature included $3.2 million to boost those centers as the federal funding fallout continues. But with a budget deal still likely weeks on the horizon, providers say they can only wait. 

Sabrina Dunlap, vice president of public policy for Planned Parenthood of Northern England, said the organization’s doors would “stay open.” “But time is of the essence,” she added, “as this gag rule is an incredible hardship for providers throughout the state.”

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