3 Health Policies That Affect STD Prevention

Government choices impact your sex life in many unexpected ways

"Keep your laws off my body" has been the refrain of many a pro-choice protester. However, the impact of government regulation on reproduction is not limited to abortion rights. There are many ways that laws can affect sexual health.

Some of these effects are indirect. People who have access to insurance have an easier time affording STD testing and treatment. (Although they may be concerned about the confidentiality of seeking such care from their regular doctor.) Policies that make it easier to bill for preventative health care mean that more doctors will offer it.

There are also laws and policies that more directly affect access to STD treatment, prevention, and care. I'm not talking about the health guidelines from the CDC and other organizations that tell doctors how often people should be screened. I'm talking about state and local laws that can have direct effects on individual risk.  

Here are three types of laws that can directly impact sexual health in the form of STD prevention and treatment:

1
Laws That Criminalize STD Transmission

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There are a number of jurisdictions that criminalize STD transmission. Specifically, the laws generally state that knowingly exposing someone to an STD is a crime. That may sound reasonable, at least at first. However, these laws can provide a disincentive to get screened for STDs. After all, you can only be charged for spreading an STD that you know you have.Therefore, if you actually are malicious, an easy way to get around the law is to never be certain of your status.

However, I don't think most people who fail to talk about STDs are malicious. I think they're scared or uncomfortable. Talking about STDs and disclosing an infection can be incredibly difficult. It can be hard for people to know when and how to bring these things up. That's why I always encourage people to ask about the last time a new partner got tested and what they got tested for. It can make it much easier to have a discussion about STD risk when you're both openly putting your cards on the table. 

Finally, these laws have been shown to make it less likely that high-risk individuals will access treatment. Particularly for individuals with HIV, this can actually increase the risk of the spread of the virus.

2
Laws That Regulate Expedited Partner Therapy

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Expedited partner therapy can be an important tool in STD treatment. It allows someone to get medication for their partner at the same time they're diagnosed with an STD. This means that their partner can be treated without the need for a separate doctor's visit.

Expedited partner therapy isn't perfect. It means that partners aren't tested themselves, so diagnoses can be missed. There's also the possibility that they may not be effectively treated. Finally, insurance companies aren't always willing to pay for partner treatment. However, partner treatment can reach people who otherwise might not get seen by the doctor. That can make it cost effective, if used appropriately.

Unfortunately, expedited partner therapy isn't legal in all states. Laws about partner treatment vary from place to place. It's also not equally supported by all providers. 

3
Laws That Protect Access and Privacy (Particularly for Adolescents)

Boy and girl sitting on a bed talking
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There is a great deal of stigma associated with STD infection. As such, concerns about privacy are a big factor for those seeking testing and treatment. This can be particularly true for teenagers. Teens may worry that their doctors will disclose to their parents that they're having sex. That can lead to parental disapproval, or worse.

Unfortunately, that means that in states where teens aren't guaranteed access to confidential testing they're less likely to seek treatment. While teens are guaranteed access to STD testing in all 50 states, in many of those states their parents are allowed to access their test results. That doesn't motivate teens to seek care. 

It is important to note that concerns about privacy aren't only an issue for teens. Many adults also worry about what will happen if STD testing appears on their insurance bills. They might be concerned it could affect their job, if that's where they get health care. They might also be concerned it could affect their relationship, if a partner sees the bill. 

Because of this, many people seek STD care in STD clinics or family planning centers. These places can feel safer than visiting one's regular doctor. 

Sources:

Frost JJ, Gold RB, Bucek A. Specialized family planning clinics in the United States: Why women choose them and their role in meeting women's health care needs. Women's Health Issues 2012; 22: e519–e525./p>

Guttmacher Institute. State Policies in Brief: Minors' Access to STI Services. Updated March 1, 2016. Accessed June 22, 2016 at https://www.guttmacher.org/sites/default/files/pdfs/spibs/spib_MASS.pdf

Leichliter JS, Seiler N, Wohlfeiler DMJ. Sexually Transmitted DIsease Prevention Policies in the United States: Evidence and Opportunities. Sexually Transmitted Diseases 2016; 43(2S): S113-121. doi: 10.1097/OLQ.0000000000000289

Lichtenstein B, Whetten K, Rubenstein C. Notify your partners—it's the law: HIV providers and mandatory disclosure. J Int Assoc Provid AIDS Care. 2014 Jul-Aug;13(4):372-8.

Patterson SE, Milloy MJ, Ogilvie G, Greene S, Nicholson V, Vonn M, Hogg R, Kaida A. The impact of criminalization of HIV non-disclosure on the healthcare engagement of women living with HIV in Canada: a comprehensive review of the evidence. J Int AIDS Soc. 2015 Dec 22;18:20572. doi: 10.7448/IAS.18.1.20572.

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