Risky activities in Alaska include summiting Denali, braving bear country and, well, having sex. While Alaskans are outfitted with the best gear for outdoor endeavors, some seem to forget what to pack for the indoor activities.
When it comes to sexually transmitted infections, Alaska is in the midst of outbreaks and upticks, according to recent bulletins from the Division of Public Health. Numbers are on the rise for chlamydia, gonorrhea, syphilis and HIV.
Susan Jones, HIV/STD manager for the epidemiology section of the division, said there’s not one cause across the board.
“There are several reasons and different populations involved,” Jones said. “It kind of depends on which disease we’re talking about.”
HIV and Syphilis
Jones said the biggest concern is the uptick in HIV cases, which generally affects the same population as the syphilis outbreak.
Twenty-four individuals were diagnosed with HIV in Alaska in 2013, though 59 cases total were reported to the section of epidemiology. To date in 2014, there have been 24 diagnoses, just as many as in all of 2013, Jones said.
The division tries to interview newly diagnosed individuals to learn about the behaviors associated with contraction of the disease. In 2013, they were able to interview 15.
“The majority of folks are men who have sex with men,” Jones said. “They’re seeking their sex partners through social media … and phone apps like Grindr.”
Ninety-one percent of those interviewed reported online sex-seeking behaviors, according to the April summary of HIV infection.
“There are several reasons that drive that, especially in small communities,” Jones said. “The new way to meet people is through social media and phone apps.”
For whatever reason, Jones said researchers have found people using apps to “meet and play” seem to be choosing not to protect themselves from disease effectively, leading to the uptick in cases of of HIV and syphilis.
An interview with a man in his mid-20s shed some light on the app’s use locally.
The young man said he has used Grindr for two years, but deactivates during the winter because the number of users in the city dwindles. He said it’s “a social network to connect with other gay men,” but admitted that “98 percent of it is focused on sex, even if it’s unspoken.”
When he first began using the app, he said, he was actively seeking sex, but has since changed his interactions to be more in line with use of other social media. Because the app is so new, he explained, there aren’t necessarily agreed upon rules of etiquette.
Even if it may be used for social media networking, Grindr is used by many as primarily a hookup app. The young man said his interactions that begin on the app “sometimes” lead to a sexual encounter.
He said he found it rare for someone to openly request unprotected sex — he experienced such a request once. He also said there was only one occasion in which someone he met using the app had initiated unprotected sex, which stopped at the request of the young man.
In users’ profiles, he said it’s not uncommon to read in the description “safe sex only.”
But even taking precautions doesn’t make sex 100 percent safe.
After a sexual encounter with a seasonal worker from a cruise ship, he said, he noticed symptoms he thought might indicate a sexually transmitted disease. He said he generally gets tested at least twice a year, or if he notices symptoms.
“We hooked up and I noticed symptoms of an STD,” he said. “I went in and immediately was tested and diagnosed with (syphilis).”
He was also treated immediately — “two shots, which are painful” — and went through the process of having other partners informed through the CDC.
With prevention of disease in mind, Jones said her division reached out to Grindr.
“Grindr has graciously agreed to have a message on all the accounts that are registered for Alaska,” Jones said.
When Alaskan users open the app, a message should pop up informing them of the rise in HIV and STD rates, reminding them to use preventive measures and to get screened. It should also offer a link to the Centers for Disease Control with information about prevention and screenings.
While a request for comments from Grindr was not fulfilled as of Friday evening, the web site has a page dedicated to health, with relevant links and suggestions for safe interactions.
“The first day, Tuesday of last week,” Jones said in a Thursday interview. “There were over 3,000 clickthroughs to the CDC website. We’re trying to get the message out to people at risk.”
The young man who uses the app said he hadn’t seen the message, but thinks it’s a good idea to “go straight to the source.”
As with this young man, when an individual is diagnosed with a sexually transmitted infection, public health agencies confidentially and discreetly conduct interviews to learn about behaviors, but also to offer guidance for services and to identify and test partners who might be at risk.
In addition to high risk sexual activity, HIV is also commonly spread through needle sharing among intravenous drug users. Many who contract HIV report alcohol or drug abuse, another contributing factor to the high risk behaviors associated with spread of the disease.
Though the majority of cases are in Anchorage and Fairbanks, caution is warranted across the state.
For chlamydia, Alaska has always been ranked first or second in the nation, Jones said.
“(Since it became reportable in 1996), the rates have just started to climb and have done so ever since,” she added.
Juneau Public Health Nurse Lindy Ferguson said chlamydia is common in Juneau.
“People have it and don’t know it,” she said. “It’s so sneaky, nobody knows they have it. It’s the most clever of STDs, I find.”
Between 70 to 90 percent of women with chlamydia don’t have symptoms, Ferguson said. For men, that number is still 50 percent.
She said a lot of people don’t take chlamydia very seriously because it is easily treated with one dose of antibiotic, but the stealthy infection can take a real toll.
“Having no symptoms doesn’t mean it’s benign,” Jones said.
Women have it worst with chlamydia, with potential for Pelvic Inflammatory Disease, and a high risk of pre-term labor during pregnancy, miscarriage, or infection of the child.
“Most of the consequences, the burden of consequences, are on the woman’s reproductive system. It can have a lifelong impact; females can become infertile.”
Young women, between the ages of 15 and 24, are most at risk because the cervical os is immature and more easily infected than in maturity. Men, who are most at risk between the ages of 20 and 24, may also experience a complicated infection that could cause health problems.
Jones speculates Alaska’s high rate is due in part to its young age demographic.
Those diagnosed with chlamydia can, like those diagnosed with HIV, utilize partner services, including notifications and expedited partner therapy, in which treatment can be prescribed and given to partners of an infected individual without the need for testing.
For gonorrhea, Alaska ranks third, said Ferguson, and it’s another sneaky one.
“With Gonorrhea, it may be asymptomatic or mild,” Jones said. “(This strain) is less symptomatic than in the 1970s.”
Jones said it is common for men to not get tested unless they experience symptoms that make them very uncomfortable.
Despite being a “mild strain,” gonorrhea is still dangerous and easily spread among partners.
The gonorrhea organism, Jones said, gets inside the cell and destroys it. Untreated, it can cause complications like Pelvic Inflammatory Disease, pre-term labor, ectopic pregnancy and infertility in women, and epididymitis and infertility in men, according to a June 18 bulletin on the Gonococcal infection.
Alaska is in the midst of a gonorrhea epidemic and Jones said it is hard to control.
“Alaska has a boom and bust economy — Gonorrhea has a boom and bust effect on the population,” Jones said.
The outbreak began in 2008, she said, peaked in 2010, was then under control, but resurged in 2012.
“It’s easily spread. People don’t know they have the infection,” Jones said.
When an infected individual is diagnosed, they are encouraged to utilize services to inform partners.
Jones said Public Health recommends a dual treatment for Gonorrhea, both an injection and an oral dose.
“It cuts down on the possibility of it becoming resistant. They work together,” Jones said. “The injection is not very comfortable, but it’s over very quickly. A lot of people don’t like injections, but it’s the most effective.”
While there may be more than one cause for the rise in rates in Alaska, there is one method of protection recommended across the board: condom use.
Ferguson laments the differences between sexual culture in Europe and the U.S.
“Someone who carries a condom in the U.S. is considered promiscuous,” she said with disappointment. “Someone not carrying a condom in Belgium is considered dangerous or dirty. The difference is so sad to me.”
Condoms are widely available in Juneau, thanks to efforts of agencies like the Juneau Public Health Center, Planned Parenthood of the Great Northwest and the Alaskan Aids Assistance Association. They can be found for free at bars, at both health centers, as well as at the teen health centers located in both Thunder Mountain and Juneau-Douglas high schools.
The teen health centers offer a number of services, all confidential, Ferguson said. Public Health nurses are there once a week to do family planning appointments, STD screenings and more.
“We also have cough drops,” she said. “You can get whatever you need that day.”
Wrap It Up Alaska, in partnership with iknowmine.org, offers a selection of free condoms in clever packaging, with witty lines like “Suit up.” with a silhouette of chest waders or “Before you summit…” with an illustration of Denali.
The hope is that the fun packaging will get the condoms in the hands of people who will use them, and maybe start some conversations about safe sex.
The young man who uses Grindr said safe sex and screenings are usually some of the first topics of conversation.
“I think it’s the norm, unless you’re in a monogamous long-term relationship,” he said. “I don’t know people in open relationships that have unprotected sex.”
For those who prefer to engage in sex without condoms, Ferguson said, she recommends getting screened regularly and having one’s partner screened regularly.
Jones brought up an HIV prevention method that is new to the scene: Truvada. The drug, already used to treat people diagnosed with HIV, was recently approved as a tool for prevention.
“We jumped right on that recommendation, too — another tool to help people out,” she said.
The drug is recommended for people who have high-risk sex, who have sex with people who have high risk sex, or for people in a relationship with someone who has HIV.
“If (a woman) took Truvada during the time of having unprotected sex, if taken as directed, it’s 92 percent effective in reducing transmission,” Jones said.
It is also recommended for intravenous drug users.
“If you’re HIV negative and want to stay that way while engaging in these behaviors, Truvada is an option,” she said. “This is another tool in addition to not doing the high risk behavior, barrier methods and reducing the number of people you have sex with and reducing the type of sex that would increase the likelihood of infection.”
Jones acknowledged it can be difficult to take a pill every day, but said, “if you have HIV, you have to take more than one pill every day.”
Know your status
There are options for every person and every budget available in Juneau when it comes to getting screened. Health centers like the Juneau Public Health Center and Planned Parenthood offer services on a sliding scale. If people can’t pay, they don’t have to.
She said people can also visit their primary care providers with health concerns, though the young man interviewed said he would choose to go somewhere more anonymous, like the Juneau Public Health Center, for his next screening, rather than seeing his primary care provider.
Because infected individuals may be asymptomatic, she recommends at least annual screenings, screenings when entering a new relationship, and an HIV test for every person, regardless of behavior, at least once. For baby boomers, born between 1945 and 1965, she recommends a one-time Hepatitis C screening as well.
“It’s a really quick appointment,” Ferguson said of the screenings. “Probably takes 45 or even 30 minutes.”
Juneau Public Health, Four A’s and Front Street Clinic also offer rapid HIV testing from saliva, which takes a total of 20 minutes — “you can get the results within the appointment. It’s really easy,” Ferguson said.
For anyone who is afraid to know their status, Ferguson said, “Knowledge is power. For all of the STDs we test for there are treatment options. It’s better to know than not know.”
Even HIV is considered a chronic disease now, she said. With medication, HIV-positive people can live long, full lives. There is also now a treatment for Hepatitis C that can cure it and has very few side effects, so Ferguson recommends anyone who initially tested positive but hasn’t followed up to take that next step.
For those shy about testing because of Juneau’s small-town status, Ferguson said there is an option to collect and send samples from the privacy of one’s own home. Website iwantthekit.org offers the service to residents of Maryland, Washington, D.C., and Alaska.
“The more people get tested, the more that culture around sex and sexually transmitted infections will improve, and hopefully reduce the rates,” Ferguson said.
Editor’s note: Reporter Melissa Griffiths is a member of the Southeast Advisory Board for the Alaskan AIDS Assistance Association, mentioned in this article. She would be an advocate for being informed, and having safe sex and regular screenings even if she weren’t.