Michigan’s STD belt: It’s not what you think

A line of Michigan counties, stretching along Interstate 94 from the Detroit River west to Lake Michigan, carries a dubious distinction: some of the highest rates of a sexually transmitted disease in the Great Lakes State.

This phenomenon – an (un)chastity belt, if you will – is not, however, the result of especially lascivious behavior by residents in those counties.

Rather, the figures reflect a quirk of infection reporting, driven by the policies of a private organization (Planned Parenthood), which experts tell Bridge actually hides a larger problem – the lack of consistent access and use of STD testing in dozens of counties across Michigan.

The data comes from a Robert Wood Johnson Foundation report ranking U.S. counties by various health measures, from smoking and alcohol use to access to doctors and health insurance rates. The rankings (and the data upon which the rankings were based) revealed wide disparities in health factors and health outcomes across the state.

MORE COVERAGE: Living on right side of county line means more life, better health

STD disparities between counties were startling.

In Wayne County, at the “belt’s” eastern end, the rate of newly diagnosed cases of chlamydia (the most common bacterial STD) was 1,162 per 100,000 residents, the highest in the state. Chlamydia can infect men and women, and, untreated, can cause serious damage to a woman’s reproductive organs.

Saginaw County had the second-highest rate, followed by Ingham, Muskegon and Kalamazoo counties.

By comparison, rural Luce County in the Upper Peninsula had a chlamydia rate of 15 per 100,000 residents – 77 times lower than Wayne County’s.

Reporting concerns health experts

It’s not that rural Michigan is generally healthier than urban Michigan. Thirteen of the top 20 counties in smoking rates, alcohol abuse and premature death in the northern half of the state. But only one of the top 20 counties in STD rates is in Northern Michigan.

Lori Lamerand, president and CEO of Planned Parenthood of Mid and South Michigan, doesn’t believe the data reveals differences in bedroom behavior.

“It doesn’t mean that people in some counties are having more sex,” Lamerand said. More likely, she explained, it’s an indication of travel patterns.

The Planned Parenthood director isn’t surprised that counties through which I-94, Michigan’s most-traveled road, have similar STD rates. For years, Lamerand has noticed that STDs appear to travel from one community to the next. “When the amount spikes in one county, it goes up in adjoining counties.” Lamerand said. In “companion communities that tend to socialize together … it can spread like wildfire.”

Marianne Udow-Phillips, director of the Center for Healthcare Research and Transformation at the University of Michigan, suggests the data may not even indicate higher actual STD rates, but just higher reported rates.

The report’s findings are based on reported cases of chlamydia, which, does not cause symptoms in most people -- so they don’t seek out treatment. Many times, people only find out they have chlamydia when they go to a clinic for tests for other things.

Of the 12 Michigan counties with the highest reported rates of chlamydia, 11 have a Planned Parenthood office or clinic offering services such as birth control and STD testing.  Out of the top 20 counties on chlamydia, 15 have Planned Parenthood offices.

“This is a reporting issue,” Udow-Phillips said. “This is where teens are going for care, not necessarily where they are having sex.”

Udow-Phillips looks at the STD map and worries more about the counties with low rates of reported STDs than the counties along I-94. Those counties, she fears, are populated with residents suffering from undiagnosed STDs because of lack of testing.

For example, Luce County has the lowest reported rate of STDs, but also has no obstetrics/gynecology physicians. A fourth of Michigan’s counties do not have a single practicing OB/GYN.

“It’s not that these communities have higher rates,” said Udow-Phillips. “It’s that young women are traveling to get medical care in areas they know will treat these problems.”

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Clemens Wittekind
Thu, 04/25/2013 - 1:25pm
I am very concerned when someone states: "... the figures reflect a quirk of infection reporting, driven by the policies of a private organization (Planned Parenthood)... In this article I see the clear need for more Planned Parenthood or other health care providers in more of our Michigan counties. How are the policies of Planned Parenthood to blame for the lack of a better set of data? This distracts from the overall problem of lack of proper health education in our state. We are not protecting our citizen enough from real and very preventable infections. That is where we need to focus on not Planned parenthood, that is actually in the business of educating and preventing this problem.
Ron French
Thu, 04/25/2013 - 1:41pm
Planned Parenthood isn't to blame for a presumed lack of accurate infection data in counties where it isn't located; Planned Parenthood is, in all likelihood, responsible for some of the better reporting in counties where it has offices. That's good, not bad.
Thu, 04/25/2013 - 8:21pm
Ron, I am not as confident in Planned Parenthood when it comes to any kind of reporting, and even less when it is data that might reflect on their agenda. Recent information, lack of reporting in Philadelphia, that has become public suggests Planned Parenthood is more concerned with others commitment reporting then they are about themselves.
Sun, 04/28/2013 - 10:41am
Planned Parenthood (PP) is one of the few places that offer free or reduced cost STI testing, treatment, and prevention in many communities. If you are talking about Planned Parenthood and abortion then you represent the ignorance people have about those important services PP provides to the community and probably have a general ignorance about STIs.
Ron French
Sun, 04/28/2013 - 1:15pm
As the story concludes, it's likely the difference in STD rates between counties is at least partially a factor of women coming to Planned Parenthood for services, and that there are likely more undiagnosed STD cases in counties without Planned Parenthood offices. The story does not refer in any way to abortion services.
Mon, 04/29/2013 - 6:26pm
Ron, If an orgainzation is not concerned about reporting on something such as abortion clinics then why should we believe that they would have concern for reporting or accuracy when it came to other issue such as STD.
Melissa Moorehead
Fri, 04/26/2013 - 4:04pm
Ron, I still don't see any connection between PP policies and STD reporting discussed at all - you just make the claim that the reporting quirk is driven by PP policies. What policies? If there are policies of a private organization having a measurable effect, good or bad, we should make an attempt to identify them for lessons learned. Real investigation into the phenomenon, along with possible explanations for the disparities, could lead to real positive public health work. What about similar issues in other travel corridors, like syphilis reports along I-85 in North Carolina? What was the point of this report? I'd love to see a little more depth.
Thu, 04/25/2013 - 8:43pm
" 77 times lower than Wayne County’s", " figures reflect a quirk of infection reporting" I am not clear how that can be explained as a quirk of reporting. That isn't an a few percentage points difference, that is even just and order of magnitude, it is 77 times different. Is that difference due to something like one not having a Planned Parenthood office in the county? "Marianne Udow-Phillips...suggests the data may not even indicate higher actual STD rates, but just higher reported rates." It is suprising that she simply suggests inaccurate reporting and yet offers not reason why that would happen or how to ensure that the reporting is consistent. Here is another exception without offering who is providing the most accurate reporting or how and why they are. It is seems to be of more interest to talk about a problem then to findout who is addressing it best and sharing how they do that. If it is travel patterns rather than practices, and the author focuses on the I-94 corridor then why is Saginaw higher on the list than Washtinaw? Isn't Ann Arbor closer to Detroit and in that '(un)chastity belt' and isn't Saginaw outside that '(un)chastity belt'? Either 1 & 2 have other things in common or as Udow-Phillips said. “This is a reporting issue,” “This is where teens are going for care, not necessarily where they are having sex.” Undow-Phillips is suggesting that Saginaw is really special in the care they give for those along the '(un)chastity belt' want to travel that far for treatment. Many might want to credit it as having to do with travel, but I wonder if personal practices are a contrinuting factor or how the issue/prevention is present.