At the Primary Health Care Clinic in Des Moines, Prevention Specialist Noah Beacom points to a nondescript STI, or sexually transmitted infections, testing room filled with a basket of condoms and pamphlets.
"We just tell everybody, it's confidential, judgment free, we want to make sure everybody's as comfortable as possible," he said.
Last year, the clinic performed nearly 4,000 tests for STIs like chlamydia, gonorrhea and HIV. But John Shaw, the clinic’s prevention services manager, says this year looks much different.
"We're down to about a quarter of the amount of tests that we would normally be doing on like a month per month basis," he said. "But over this, like stretch of COVID, from the end of March to now, the end of September, we've actually had more new HIV diagnoses in just that short time period than we did in 2018 and 2019 combined."
Shaw says the clinic, which offers free state-funded testing, has limited the number of appointments due to new COVID-19 screening and cleaning procedures.
Plus his co-worker Beacom says they‘ve drastically cut back on community outreach events, which accounts for about a quarter of their tests.
"Like Pride, like Iowa Leather weekend or before we went to colleges a lot more and stuff like that," Beacom said.
As COVID-19 cases swept across Iowa last spring, many public health organizations had to temporarily suspend or cut back STI services.
"Really the effect it has had is we focus our STI efforts, or prioritize your STI efforts towards HIV, and toward infectious syphilis. We had to scale back what we're doing for gonorrhea for partner services or contact tracing," said George Walton, the sexually transmitted disease program manager at the state health department.
He said for several months, nearly his entire team of about a dozen people were assisting with COVID-19. That meant less contact tracing at a time when the state was already struggling to keep up.
"Well before even before COVID-19, we'd already had to scale back chlamydia quite a bit," he said.
Walton said the pandemic has caused shortages of STI testing supplies, medication and public health workers, and that’s already affecting numbers.
He said the rate of gonorrhea is up 12 percent compared to last year, but so far the rate of chlamydia appears to be down.
"I have a strong suspicion that it's not just a true decrease in transmission, I suspect that there's just more asymptomatic people who aren't getting tested and getting diagnosed," he said.
Walton said the department does contact tracing for every Iowa county except Polk, Linn, Scott and Black Hawk. Since the pandemic started, he said they've had to start covering the case loads for Linn and Scott counties.
In northwest Iowa, Siouxland District Health Department had to suspend testing from April to August. Stacy McNear, the laboratory coordinator for the department, says they’re now doing only half the number of tests they were pre-pandemic.
"We're the only ones in the county that are doing the follow ups for positive COVID cases, and so it's trying to juggle that, along with trying to do our other work too, right?" she said.
Polk County, the state's largest county, hasn't had to reassign any of its five staff members who work on testing and contact tracing for STIs during the pandemic, according to department spokesperson Nola Aigner-Davis.
Aigner-Davis said that's been fortunate because the county has rates at "epidemic proportions," but she said the department struggled with the shortage of testing supplies - the swabs used for the chlamydia and gonorrhea are the same ones used for COVID-19 and she suspects cases will increase because people are more hesitant to go to a doctor during the pandemic.
"We're gonna see more cases. I mean, people are scared to go the doctor, they're not getting tested. They're not seeing signs or symptoms, so they think they're fine," Aigner-Davis said.
But public health providers say the state desperately needs these STI services. Infection rates for syphilis, chlamydia and gonorrhea have been climbing rapidly for years.
"It is only going to exacerbate the public health crisis of STIs and you know, this is, this is a really serious health problem,' said Erin Davison-Rippey, the state executive director for Planned Parenthood in Iowa.
Davison-Rippey said the group temporarily reopened its Sioux City location in June. This was one of four clinics the organization initially closed in 2017 after the Iowa legislature stripped its funding. And Davison-Rippey said they’ve expanded STI testing and treatment services across the state through telehealth.
"So that allows patients from across the state to easily access care that might not otherwise be available, where they live," she said.
Stefan Baral, an epidemiologist at Johns Hopkins University, said pandemic-inspired innovations like this are long overdue in the STI world.
Baral says many clinics still focus on in-person testing and are located in urban areas. But it’s rural and suburban areas that are seeing the biggest increase in new infections. And Baral says many people nowadays are finding partners through online dating apps.
"We need to figure out how we can allow people to order STI kits, you know, via these apps, how they can get treatment via these apps, and really scale those services up, so that we sort of pandemic proof ourselves in the future," he said.
At the Primary Health Care Clinic in Des Moines, Noah Beacom says when the clinic temporarily shut down in the spring, it gave them time to come up with new initiatives.
"We're doing an at home HIV testing program. So we advertised on some of the gay, bi dating apps, and a lot of the folks that we're getting responses from live in like rural areas like New Virginia, or Albia," he said.
Beacom said they’re pleased they’ve been able to reach these new populations.
