1. Responding to Epidemic of Chlamydia in Minnesota Kandiyohi County Community Meeting October 1, 2012 Candy Hadsall, RN, STD Nurse Specialist Minnesota Department of Health

2. STDs in Minnesota: Focus on Chlamydia

3. Putting STD’s and HIV in Perspective in MN Much more likely to get an STD than HIV, especially in MN STD’s facilitate transmission of HIV Disease is only one part of sexual health

4. MDH Surveillance System Reportable STDs in MN: –Gonorrhea –Chlamydia –Syphilis –Chancroid –HIV Hepatitis –Information provided by case reports on positives required from all clinics, physicians and laboratories

5. All infected persons living in Minnesota Infected persons who were tested and reported to MDH Who are we talking about? Surveillance

6. STDs in Minnesota: Number of Cases Reported in 2011 Total of 19,547 STD cases reported to MDH: – 16,898 Chlamydia cases 11,888 ages 15-24 yrs – 2,283 Gonorrhea cases 1,392 ages 15-24 yrs – 366 Syphilis cases (all stages) – 0 Chancroid cases HIV = 292 new infections

7. Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review STDs in Minnesota Rate per 100,000 by Year of Diagnosis, 2001-2011 * P&S = Primary and Secondary

8. Chlamydia Also referred to as “CT”

9. Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review Chlamydia in Minnesota Rate per 100,000 by Year of Diagnosis, 2001-2011 168 per 100,000 319 per 100,000

10. Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review Suburban = Seven-county metro area including Anoka, Carver, Dakota, Hennepin (excluding Minneapolis), Ramsey (excluding St. Paul), Scott, and Washington counties. Greater MN = All other Minnesota counties outside the seven-county metro area. Chlamydia Infections by Residence at Diagnosis 2011 Total Number of Cases = 16,898

11. Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review Rate per 100,000 persons > 300 151 - 300 76 - 150 0 - 75 2011 Minnesota Chlamydia Rates by County City of Minneapolis 848 City of St. Paul 795 Suburban # 271 Greater Minnesota 198 (728 cases missing residence information) # 7-county metro area, excluding the cities of Minneapolis and St. Paul St. Louis Itasca Cass Lake Polk Beltrami Aitkin Pine Cook Koochiching Otter Tail Clay Roseau Marshall Becker Todd Stearns Kittson Swift Lyon Pope Morrison Wilkin Renville Carlton Martin Rice Wright Norman Fillmore Mower Nobles Murray Grant Sibley Brown Rock Redwood Douglas Jackson Meeker Goodhue Winona Isanti Faribault Dakota Freeborn Olmsted Scott Stevens Anoka Nicollet McLeod Chippewa Wabasha Carver Pennington Hubbard Crow Wing Lake of the Woods Clearwater Kandiyohi Lincoln Blue Earth Mille Lacs Houston Steele Traverse Dodge Wadena Hennepin Kanabec Lac Qui Parle Benton Big Stone Cottonwood Waseca Chisago Le Sueur Mahnomen Yellow Medicine Pipestone Red Lake Sherburne Watonwan Washington Ramsey

12. CHLAMYDIA ADOLESCENTS & YOUNG ADULTS (15-19 year olds) (20-24 year olds) STDs in Minnesota: Annual Review

13. Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review Chlamydia Cases in 2011 (n = 16,898) MN Population in 2010 (n = 5,303,925) Chlamydia Disproportionately Impacts Youth

14. AGES 15-19

15. Chlamydia Rates, 2011 Cases per 100,000 population Ages 15 – 25 years

16. Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review Chlamydia Rate Among Adolescents and Young Adults † by Race in 2011 † Adolescents defined as 15-19 year-olds; Young Adults defined as 20-24 year-olds. Rate=Cases per 100,000 persons based on 2000 U.S. Census counts.

17. What’s Behind the Increase? STDs in Minnesota: Annual Review Better tests, more sensitive Improved case reporting by providers Increased screening by clinicians Increase of disease in the population Effects of the first three factors above stabilize over time. Therefore, the sustained upward trend is most likely due to an actual increase of disease in the population. Increase since 1996 most likely due to combination of factors:

18. Why Concern About CT Epidemic? 75% of cases in females are asymptomatic, 50% of cases in males are asymptomatic –No symptoms = no problem –Don’t get screened = delayed treatment Develop serious complications

19. Chlamydia Complications Ectopic Pregnancy Infertility Chronic Pelvic Pain 9% 14-20% 18% Untreated Genital Chlamydial Infection 20-50% >50% Asymptomatic 70-80% Asymptomatic Male UrethritisFemale Urethritis PID (Acute & Silent) Orchitis Epididymitis Neonatal Infection Source: CDC Chlamydia in the United States. April 2001

20. Chlamydia: More than a Medical Issue Reasons why people have unprotected sex, even when aware of consequences = multiple, varied, complex

21. Socioeconomic, political, and cultural context e.g. Policy, gender norms, faith, culture, ethnicity, norms and values Socioeconomic, political, and cultural context e.g. Policy, gender norms, faith, culture, ethnicity, norms and values Distal social environment e.g. Neighborhood, community, school, work, faith group Distal social environment e.g. Neighborhood, community, school, work, faith group Proximal social and sexual networks e.g. Sexual partner(s), family, peers, teachers Proximal social and sexual networks e.g. Sexual partner(s), family, peers, teachers Determinants of Sexual Health Individual characteristics e.g. Biology, social skills, cognitive ability, knowledge, attitudes, confidence, competence Individual characteristics e.g. Biology, social skills, cognitive ability, knowledge, attitudes, confidence, competence Source: Amended from Zubrick et al (2008), Solar & Irwin (2007), Scottish Executive (2003) Characteristics Physical Cognitive Behavioral Emotional Social Characteristics Physical Cognitive Behavioral Emotional Social Conception Adulthood Health Care Outcomes Emotional Reproduction Disease (avoidance) Violence (avoidance) Outcomes Emotional Reproduction Disease (avoidance) Violence (avoidance) Sexual Health and Wellbeing

22. Minnesota Chlamydia Partnership and Strategy Purpose: Raise public and professional awareness Support communities in taking action

23. Reasons for Creating MN Chlamydia Partnership CT rates continue to rise = epidemic MDH has dwindling federal resources, no state funding MDH needs help from interested stakeholders and communities to impact epidemic Innovative new strategies are needed!

24. Activities Summit held in August 2010 Workgroups met through early 2011: –formulated actions in each of 5 strategic arenas –s ubmitted ideas, goals, objectives for strategy to MDH Chlamydia Strategy released April 12, 2011 – http://www.health.state.mn.us/mcp http://www.health.state.mn.us/mcp User-friendly version of Strategy printed in booklet form September 2012 Funded demonstration project in Kandiyohi Co.

25. What’s Unique? This is statewide partnership plan, not MDH plan Uses principles of community engagement and empowerment

26. What is Community Empowerment?  The only people who can deal with a problem are the people who are most affected by the problem.  People who have been excluded from full participation can be empowered to participate when they act collectively. (strength in numbers)  Basic tenets:  People identify their own problems  People determine their own solutions to the problems  People undertake the implementation of their solutions  Aim is to empower people = we can never do something for another person; that person must do it for themselves.  Leaders support them in this process.

28. Strategic Arenas for Actions Funding : needs related to screening, treatment, education, prevention Build awareness in communities: Informing all groups in communities (CT is more than a medical issue) Education in Communities: Training and education on sexual health across lifespan for teens and young adults, parents, schools (teachers, administrators, boards) Clinical Issues: Screening, treating and reporting CT Affordable and accessible STI/STD health services

30. Efforts Needed to Curb Chlamydia Epidemic Changes in policies – national & state; in orgs Increased public awareness Education of teens, young adults, parents, teachers, providers Advocacy for adolescent females Support for individual behavior change; includes changes in community norms Support from all levels of communities Increased screening and treatment by providers

31. 'If you want to go quickly, go alone. If you want to go farther, go together.” African proverb

32. If you want to join the Partnership, get involved in other ways, or have questions: Candy Hadsall 651-201-4015 Candy.Hadsall@state.mn.us