S.F clinics limiting STD tests to cut costs

With the exception of professional athletes, it's hard to imagine a more sexually irresponsible mainstream population than adolescent males. So you have to wonder whether it's wise that city public health clinics are no longer testing many San Franciscans, including horny young men, for chlamydia, gonorrhea, or syphilis.

The city's new screening guidelines, designed to save money, explicitly shut out heterosexual men unless they already have symptoms, know for a fact they've been exposed, have had a previously documented STD, or live in a detention center (sorry, school doesn't count).

High school health educators returning from summer break were shocked to learn they could no longer automatically send sexually active male students to clinics to get tested. "Everything I know about sex education says you teach youth to get tested early and often," says Robin Levick, a community health outreach worker at Phillip and Sala Burton Academic High School. He and others worry that students now might lie about their sexual histories or orientations to qualify for screening: "It's crazy, because if you want good health care, you have to be honest with your doctor."

Dr. Susan Philip, medical director of San Francisco City Clinic, created the new guidelines, and says they're partly resource-based. In the last two years, the San Francisco Department of Public Health's STD section budget has been chopped by $1.2 million, and she predicts the department will save $58,240 this year by doing fewer tests. Philip says clinics still offer condoms and information packets to asymptomatic men, but that test kits and lab work (together $40) don't offer enough bang for the buck.

"In the current climate, we want to focus our resources on the populations that most need care," she says.

While guys get the shaft, the new guidelines allow females under 26 one annual screening. Philip says there's a good reason for the disparate treatment: Centers for Disease Control (CDC) data show that, unlike women, men who go untreated for STDs don't face problems down the road such as pelvic inflammatory disease and infertility. Also, Philip says that in San Francisco, more women test positive for certain STDs than men. For instance, only 4.3 percent of males under 19 tested positive for chlamydia last year, while 11.6 percent of females in the same age group tested positive for the disease.

But the DPH's Web site (whose mission statement promises "equal access to all") says that asymptomatic transmission of STDs is common, and not just for women. Last year, more than 2,000 men under 19 were tested for chlamydia, gonorrhea, or syphilis in DPH clinics and San Francisco detention centers, but records don't distinguish between symptomatic and asymptomatic screening.

The schools' preventive health advocates don't make that distinction, either. They worry that young men who've had unprotected sex won't be able to get tested before hooking up with new partners. Call it a hunch, but teenage boys, hormones raging, just might decide to keep having unprotected sex, whether they get tested or not.

 
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