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New Dear Tribal Leader Letter Addresses Syphilis Epidemic, Misses Essential Data Access Needs
On July 19, 2023, IHS Director Roselyn Tso published a Dear Tribal Leader Letter providing new guidance for IHS, Tribal, and Urban Indian Organizations to address the syphilis epidemic in American Indian and Alaska Native (AI/AN) communities. Syphilis is a sexually transmitted infection (STI) that can cause serious or life-threatening health problems, especially during pregnancy or among newborns. Notably, syphilis is also an illness that is curable in its early stages with drugs like penicillin. From 2017 to 2021, the AI/AN population saw an increase of over 700% in the rate of newborns contracting syphilis through their birthparent (per 100,000 live births). In South Dakota, the rate of congenital syphilis is even higher, with one out of every hundred AI/AN newborns having the disease, according to a calculation made by the Great Plains Tribal Epidemiology Center. In February 2023, the Great Plains Tribal Leaders’ Health Board passed a resolution declaring syphilis a public health emergency in the Great Plains Area. Other areas have also seen concerning and rapid rises in syphilis cases.
Director Tso’s Letter summarizes the ten guidelines made by IHS Chief Medical Officer, Dr. Loretta Christensen, to address the epidemic. These recommendations include the following: annual syphilis testing, three-point syphilis testing for all pregnant people, STI testing bundle for screening at all sites, express STI testing, field treatment for syphilis, presumptive treatment of syphilis, and awareness-building for syphilis through the Stop Syphilis Campaign. The letter concludes with Director Tso calling on its readers to “collectively work together to address this very serious issue.”
Missing from these recommendations are plans to facilitate and improve access to IHS case data that Tribes and Tribal Epidemiology Centers need to respond to this public health emergency. Identifiable data of syphilis cases from IHS medical records are necessary to perform contact tracing to test or treat people exposed to infection. Access to this data is necessary to perform effective, targeted interventions.
NIHB Board Member and Great Plains Area Representative, Janet Alkire (Standing Rock Sioux Tribe), raised this issue with Director Tso at the NIHB Second Quarter Board Meeting in June, emphasizing that the Great Plains Tribal Epidemiology Center and Tribes need to access IHS data to address the issue adequately. Director Tso acknowledged that IHS was aware this has been an issue for years but did not provide any clear next steps on how it would be resolved.
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