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Rapid Rise in Syphilis Hits Native Americans Hardest
A woman in a blue shirt and mask stands in front of a car parked along a dirt road
Melissa Wyaco supervises about two dozen public health nurses who search for patients across the Navajo Nation who have tested positive for or have been exposed to syphilis. (Navajo Area Indian 国产精品视频 Service)

Rapid Rise in Syphilis Hits Native Americans Hardest

From her base in Gallup, New Mexico, Melissa Wyaco supervises about two dozen public health nurses who crisscross the sprawling Navajo Nation searching for patients who have tested positive for or been exposed to a disease once nearly eradicated in the U.S.: syphilis.

Infection rates in this region of the Southwest 鈥 the 27,000-square-mile reservation encompasses parts of Arizona, New Mexico, and Utah 鈥 are among the nation鈥檚 highest. And they鈥檙e far worse than anything Wyaco, who is from Zuni Pueblo (about 40 miles south of Gallup) and is the nurse consultant for the Navajo Area Indian 国产精品视频 Service, has seen in her 30-year nursing career.

Syphilis infections nationwide have climbed rapidly in recent years, reaching a 70-year high in 2022, according to the most recent data from the Centers for Disease Control and Prevention. That rise comes amid a shortage of penicillin, the most effective treatment. Simultaneously, congenital syphilis 鈥 syphilis passed from a pregnant person to a baby 鈥 has similarly spun out of control. Untreated, congenital syphilis can cause bone deformities, severe anemia, jaundice, meningitis, and even death. In 2022, the 231 stillbirths and 51 infant deaths caused by syphilis, out of 3,761 congenital syphilis cases reported that year.

And while infections have risen across the U.S., no demographic has been hit harder than Native Americans. The CDC data released in January shows that the among American Indians and Alaska Natives was triple the rate for African Americans and nearly 12 times the rate for white babies in 2022.

鈥淭his is a disease we thought we were going to eradicate not that long ago, because we have a treatment that works really well,鈥 said Meghan Curry O鈥機onnell, a member of the Cherokee Nation and chief public health officer at the Great Plains Tribal Leaders鈥 国产精品视频 Board, who is based in South Dakota.

Instead, the rate of congenital syphilis infections among Native Americans ( per 100,000 people in 2022) is now comparable to the rate for the entire U.S. population in 1941 () 鈥 before doctors began using penicillin to cure syphilis. (The rate fell to 6.6 nationally in 1983.)

O鈥機onnell said that鈥檚 why the Great Plains Tribal Leaders鈥 国产精品视频 Board and tribal leaders from North Dakota, South Dakota, Nebraska, and Iowa federal 国产精品视频 and Human Services Secretary Xavier Becerra to declare a public health emergency in their states. A declaration staffing, funding, and access to contact tracing data across their region.

鈥淪yphilis is deadly to babies. It鈥檚 highly infectious, and it causes very severe outcomes,鈥 O鈥機onnell said. 鈥淲e need to have people doing boots-on-the-ground work鈥 right now.

In 2022, New Mexico reported the among states. Primary and secondary syphilis infections, which are not passed to infants, were , which had the second-highest rate of congenital syphilis in 2022. In 2021, the most recent year for which demographic data is available, South Dakota had the nationwide (after the District of Columbia) 鈥 and numbers were the state鈥檚 .

In , the New Mexico Department of 国产精品视频 noted that the state had 鈥渞eported a 660% increase in cases of congenital syphilis over the past five years.鈥 A year earlier, in 2017, New Mexico reported only one case 鈥 but by 2020, that number had risen to 43, then to 76 in 2022.

Starting in 2020, the covid-19 pandemic made things worse. 鈥淧ublic health across the country got almost 95% diverted to doing covid care,鈥 said Jonathan Iralu, the Indian 国产精品视频 Service chief clinical consultant for infectious diseases, who is based at the Gallup Indian Medical Center. 鈥淭his was a really hard-hit area.鈥

A large building, a medical center, at the intersection of two roads.
Gallup Indian Medical Center is a hospital in Gallup, New Mexico, which is near the Navajo Nation.(Cecilia Nowell for KFF 国产精品视频 News)

At one point early in the pandemic, the Navajo Nation reported the in the U.S. Iralu suspects patients with syphilis symptoms may have avoided seeing a doctor for fear of catching covid. That said, he doesn鈥檛 think it鈥檚 fair to blame the pandemic for the high rates of syphilis, or the high rates of women passing infections to their babies during pregnancy, that continue four years later.

Native Americans are more likely to , far from , than any other racial or ethnic group. As a result, many do not receive prenatal care until later in pregnancy, if at all. That often means providers cannot test and treat patients for syphilis before delivery.

In New Mexico, did not receive prenatal care until the fifth month of pregnancy or later, or received fewer than half the appropriate number of visits for the infant鈥檚 gestational age in 2023 (the national average is less than 16%).

Inadequate prenatal care is especially risky for Native Americans, who have a greater chance than other ethnic groups of passing on a syphilis infection if they become pregnant. That鈥檚 because, among Native communities, syphilis infections are just as common in women as in men. , men are at least twice as likely to contract syphilis, largely because men who have sex with men are more susceptible to infection. O鈥機onnell said it’s not clear why women in Native communities are disproportionately affected by syphilis.

鈥淭he Navajo Nation is a maternal health desert,鈥 said Amanda Singer, a Din茅 (Navajo) doula and lactation counselor in Arizona who is also executive director of the Navajo Breastfeeding Coalition/Din茅 Doula Collective. On some parts of the reservation, patients have to drive more than 100 miles to reach obstetric services. 鈥淭here鈥檚 a really high number of pregnant women who don鈥檛 get prenatal care throughout the whole pregnancy.鈥

She said that鈥檚 due not only to a lack of services but also to a mistrust of health care providers who don鈥檛 understand Native culture. Some also worry that providers might report patients who use illicit substances during their pregnancies to the police or child welfare. But it鈥檚 also because of a shrinking network of facilities: Two of the Navajo area鈥檚 labor and delivery wards have closed in the past decade. According to , more than half of U.S. rural hospitals no longer offer labor and delivery services.

Singer and the other doulas in her network believe New Mexico and Arizona could combat the syphilis epidemic by expanding access to prenatal care in rural Indigenous communities. Singer imagines a system in which midwives, doulas, and lactation counselors are able to travel to families and offer prenatal care 鈥渋n their own home.鈥

O鈥機onnell added that data-sharing arrangements between tribes and state, federal, and IHS offices vary widely across the country, but have posed an additional challenge to tackling the epidemic in some Native communities, including her own. Her Tribal Epidemiology Center is South Dakota鈥檚 state data.

In the Navajo Nation and surrounding area, Iralu said, IHS infectious disease doctors meet with tribal officials every month, and he recommends that all IHS service areas have regular meetings of state, tribal, and IHS providers and public health nurses to ensure every pregnant person in those areas has been tested and treated.

IHS now recommends all patients be tested for syphilis yearly, and tests pregnant patients three times. It also expanded rapid and express testing and started offering DoxyPEP, an antibiotic that transgender women and men who have sex with men can take up to 72 hours after sex and that has been shown to reduce syphilis transmission . But perhaps the most significant change IHS has made is offering testing and treatment in the field.

A group of people stand in front of a pick-up truck. They are wearing scrubs and jackets. One is wearing a mask.
These public health nurses with the Navajo Area Indian 国产精品视频 Service can test and treat patients for syphilis at home. Syphilis infection rates in the Navajo Nation are among the nation鈥檚 highest.(Navajo Area Indian 国产精品视频 Service)

Today, the public health nurses Wyaco supervises can test and treat patients for syphilis at home 鈥 something she couldn鈥檛 do when she was one of them just three years ago.

鈥淲hy not bring the penicillin to the patient instead of trying to drag the patient in to the penicillin?鈥 said Iralu.

It鈥檚 not a tactic IHS uses for every patient, but it鈥檚 been effective in treating those who might pass an infection on to a partner or baby.

Iralu expects to see an expansion in street medicine in urban areas and van outreach in rural areas, in coming years, bringing more testing to communities 鈥 as well as an effort to put tests in patients鈥 hands through vending machines and the mail.

鈥淭his is a radical departure from our past,鈥 he said. 鈥淏ut I think that鈥檚 the wave of the future.鈥