The state of Alaska ranks among the highest in the nation for sexually transmitted infection (STI) rates. In 2023, two of Alaska’s most common STIs were treatable bacterial infections. And the Yukon-Kuskokwim (Y-K) Delta isn’t exempt.
Yukon-Kuskokwim Health Corporation (YKHC) Chief of Staff Dr. Ellen Hodges has been a family medicine physician on the Y-K Delta for more than 20 years. She said that sexually transmitted infections have been a consistent issue in the region through the decades.
“During that entire time, our region has unfortunately had high rates of sexually transmitted infections, and this would be compared to the state of Alaska, and the state of Alaska has high rates compared to the rest of the United States,” Hodges said.
In 2023, Alaska had the third highest number of recorded cases of chlamydia in the country and ranked number one for gonorrhea, according to a Centers for Disease Control and Prevention (CDC) report. Southwest Alaska follows that trend, with the second highest rates of chlamydia in the state.
Hodges said that research indicates that it’s likely that there are a combination of factors that make STI rates so high on the Y-K Delta.
“We know that in populations that have difficult access to health care, and in populations that have higher than background rates of substance misuse, they may have increase in that,” Hodges said. “We know that socioeconomic status plays into that; we know race plays into that.”
Like the rest of the state, chlamydia and gonorrhea are the two most commonly reported STIs in the Y-K Delta. Both are treatable bacterial infections, and according to Hodges, stopping the spread begins with testing. Recently, there’s been a change in how the region’s been going about it.
Contact tracing is a practice best known for its implementation during the COVID-19 pandemic. It involves asking those who test positive to voluntarily report who they were in contact with, and then those people will be reached out to and recommended a test. It’s a method proving effective in stopping the spread of many different infectious diseases, especially those that can go undetected, like some cases of chlamydia and gonorrhea.
YKHC recently took over the role of contact tracing from the state’s Public Health Department in Bethel.
“And because we then have access to information that maybe the Public Health Department might not have, we have had increased success in contacting people and getting their disease treated, and then identifying people who also might be at risk and offering them testing and treatment,” Hodges said.
Hodges said that with access to more complete health records, YKHC can contact trace more effectively, likely accounting for an increase in overall testing. She said that increase could also be responsible for the higher reported rates of STIs in the Y-K Delta, with more testing overall equating to more positive tests.
People can get tested for chlamydia and gonorrhea for free at any YKHC clinic using a urine sample. Those in villages without clinics or preferring to test from home can opt for a free mail-in test, which can be ordered online through iknowmine.org and iwantthekit.org.
“So that has really increased our ability as well to offer testing that is more acceptable to patients, and makes it a little less intimidating to go ahead and get tested, especially since we don't have to do an invasive exam of any kind,” Hodges said.
In the state of Alaska, confidentiality applies to minors under 18 in regards to sexual health. Hodges said that minors can be tested, treated, and contact traced without a parent or guardian being informed.
“We do our very best to reduce the stigma to this and protect everyone's confidentiality with regards to testing and treatment, and we want to encourage everyone to come get tested and treated so that we can, you know, put an end to these diseases,” Hodges said.
Other STIs, such as syphilis and HIV, are tested using a blood sample that can be collected at clinics or using a free at-home sample collecting kit found at iknowmine.org.
What follows is treatment.
Both chlamydia and gonorrhea are treated with oral medications. Those who test positive are asked to abstain from intercourse until the medication takes effect, which can be as little as one week. Hodges said that patients who test positive have the option to bring a take-home kit with medication for their partner to take, totally anonymously.
The Alaska Native Tribal Health Consortium has an HIV program where they help patients manage the life long infection with antiviral medications.
Syphilis can be treated with a one-time injection of penicillin.
Overall, when looking at the Y-K Delta and the state of Alaska’s high STI rates, the health consortium's response is multi-pronged, according to Hodges.
“Probably the first and most important is prevention and education,” Hodges said. “So if we can prevent people from getting infected with these diseases, these infections, that would be the best, so making sure that people are aware of how to prevent them.”
Hodges noted that the key way to prevent STIs is the use of barrier contraception, which people can access for free at any YKHC clinic or order for free online from iknowmine.org. The site also has a display of resources and general information about STI testing and protection.
