When the COVID-19 pandemic sparked the stay-at-home order in Philadelphia in March, sexual health centers across the city were allowed to remain open as long as they stopped elective procedures, and adhered to social distancing measures to protect patients and staff.
But those safety measures have led to an interruption in walk-in testing for sexually transmitted diseases (STDs) at some centers — many of which serve mainly patients without health insurance — because of the risk of COVID-19 exposure to staffers and other patients. So fewer people are getting tested, officials said. That’s particularly worrying in Philadelphia, where rates for syphilis, gonorrhea and chlamydia have far exceeded national averages.
Across the country, a survey by the National Coalition of STD Directors found that 83% of STD programs have paused services and community visits, and 66% of clinics reported a decrease in sexual health screening and testing due to COVID-19.
But the stay-at-home order has not stopped people from having sex, noted Eric Paulukonis, prevention services director at the Mazzoni Center, Philadelphia’s largest LGBT health-care provider. The Mazzoni Center stopped in-person HIV testing and sexually transmitted infection screenings on March 16.
“We know from hookup apps and conversations with patients that people are still sexually active with partners they are not quarantined with,” Paulukonis said. “That means there’s a demographic out there that doesn’t know their status in terms of STIs.”
Currently, the Mazzoni Center distributes free HIV test kits for people to take home at its South Philadelphia location and through a mobile testing unit. The kits, which were developed with the city’s Department of Public Health, include FDA-approved oral swabs that patients use on their upper and lower gums before inserting the swabs into a vial containing a developer solution, also included, that provides a result in 20 to 40 minutes.
Paulukonis said Mazzoni is working with the city health department to resume STD screenings as quickly as possible.
“Over a three-month period, we would usually identify anywhere between 150 and 250 cases of syphilis and gonorrhea, for example,” Paulukonis said. “When our testing stopped, those individuals potentially don’t know that they’re infected with something.”
Now that the city has moved into the “yellow” phase of reopening, he anticipates “a large spike, potentially.”
“People are feeling a lot freer,” Paulukonis said. “Social networks are going to widen, the numbers of people mingling are going to increase, and all that raises the possibility for infection.”
At the Y-HEP Adolescent and Young Adult Health Center in Center City, walk-in STD screenings stopped once the shutdown went into place. However, patients can make appointments to get tested, said Elaina Tully, medical director of the Y-HEP Health Center.
“Any time we limit access to walk-in patients, we are certainly limiting access to care,” Tully said. “And routine STI testing has been on hold because it doesn’t make sense right now. For patients who are higher risk or maybe have COVID symptoms, the benefits of coming in for testing do not outweigh the risk of exposure.”
Tully said that while it’s important to follow the city’s guidelines on COVID-19, young people still should pay attention to all aspects of their health.
“I understand why preventative health and sexual health have been put on the back burner in people’s minds,” she said. “But the reality is that just because COVID hit doesn’t mean that the astronomical rates of STIs in Philly have gone away.”
The Philadelphia Department of Public Health normally offers free STD screenings at health centers in South Philly and North Philly. But the North Philly location has been closed since the shutdown. Appointments to get tested are still available in South Philly, but patients should call ahead to keep the waiting room from getting crowded, said Cherie Walker-Baban, manager of the city’s STD Control Program.
» READ MORE: A guide to making sense of coronavirus studies
“Overall testing has been lower for us during this time,” Walker-Baban said. “But I wouldn’t say it’s concerning because of what’s going on. We expect what we’re seeing now, and as we go through the phases, there will be an increase in testing.”
At Bebashi, a full-service HIV/AIDS organization in North Philly that focuses on low-income people of color, fewer patients came in for sexual health screenings during March and April, said prevention supervisor Keira Ragsdale. Since then, there’s been a small uptick in people coming in with complaints about STD symptoms, she said.
“People were still meeting people and hooking up,” Ragsdale said. “They were entering into new relationships through dating and hookup apps. I don’t think the pandemic stopped that, honestly, and a lot of individuals had a lot of free time on their hands since they weren’t in school or employed.”
Like many other health clinics, Bebashi spent the first few weeks of the pandemic making adjustments so it could keep operating. The demand for the food pantry services they offer increased by 600%. By the second week of May, the organization began mailing out free at-home HIV test kits.
“Individuals are constantly requesting test kits,” Ragsdale said.
The Y-HEP Health Center is also working with the city health department on a protocol that will allow patients to complete STD screenings at home, which will likely ask patients to collect blood or urine samples to be analyzed at a lab, Tully said. She said at-home testing could be “a game changer for increasing access to care for many patients.”
“The pandemic took us all by surprise,” Tully said. “An incredible amount of our organization’s resources have been diverted to keeping patients safe. But at this point ... we’re able to start thinking more broadly about incorporating preventative health into our operations as the yellow phase begins.”