Sexually Transmitted Diseases are currently on the rise in Swain County. Healthy People 2020 details that there are "more than 25 infectious organisms that are transmitted primarily through sexual activity. STD prevention is an essential primary care strategy for improving reproductive health.... Untreated STDs can lead to serious long-term health consequences, especially for adolescent girls and young women. The CDC estimates that undiagnosed and untreated STDs cause at least 24,000 women in the United States each year to become infertile." Other complications could include:

• Reproductive health problems
• Fetal and perinatal health problems
• Cancer
• Facilitation of the sexual transmission of HIV infection

The cost of ignorance surrounding STDs can be as bad as increased fatality rates or as infertility. Lack of education leads to increased spread of these disease when cases are not diagnosed.

Because of the delicate nature of these health issues and "despite their burdens, costs, and complications, and the fact that they are largely preventable, STDs remain a significant public health problem in the United States. This problem is largely unrecognized by the public, policymakers, and health care professionals."

Women and those age 15-24 tend to have higher rates of these diseases. According to Healthy People 2020, behavioral factors affecting the spread of Sexually Transmitted Diseases can include:

• Racial and ethnic disparities. Certain racial and ethnic groups (mainly African American, Hispanic, and American Indian/Alaska Native populations) have high rates of STDs, compared with rates for whites. Race and ethnicity in the United States are correlated with other determinants of health status, such as poverty, limited access to health care, fewer attempts to get medical treatment, and living in communities with high rates of STDs.
• Poverty and marginalization. STDs disproportionately affect disadvantaged people and people in social networks where high-risk sexual behavior is common, and either access to care or health-seeking behavior is compromised.
• Access to health care. Access to high-quality health care is essential for early detection, treatment, and behavior-change counseling for STDs. Groups with the highest rates of STDs are often the same groups for whom access to or use of health services is most limited.
• Substance abuse. Many studies document the association of substance abuse with STDs. The introduction of new illicit substances into communities often can alter sexual behavior drastically in high-risk sexual networks, leading to the epidemic spread of STDs.
• Sexuality and secrecy. Perhaps the most important social factors contributing to the spread of STDs in the United States are the stigma associated with STDs and the general discomfort of discussing intimate aspects of life, especially those related to sex. These social factors separate the United States from industrialized countries with low rates of STDs.
• Sexual networks. Sexual networks refer to groups of people who can be considered “linked” by sequential or concurrent sexual partners. A person may have only 1 sex partner, but if that partner is a member of a risky sexual network, then the person is at higher risk for STDs than a similar individual from a lower-risk network.

Healthy NC 2020 details evasion strategies in effort to reduce population risk:

Eradicating the spread of other infectious diseases such as food born illness and those largely avoidable through vaccination is a similar process because it is principally controllable through prevention.

Healthy People 2020 details the frustration that "people in the United States continue to get diseases that are vaccine preventable. Viral hepatitis, influenza, and tuberculosis (TB) remain among the leading causes of illness and death in the United States and account for substantial spending on the related consequences of infection.

The infectious disease public health infrastructure, which carries out disease surveillance at the Federal, State, and local levels, is an essential tool in the fight against newly emerging and re-emerging infectious diseases. Other important defenses against infectious diseases include:

• Proper use of vaccines
• Antibiotics
• Screening and testing guidelines
• Scientific improvements in the diagnosis of infectious disease-related health concerns"

Immunization is an evidence-based practice that is vital in avoiding the over use of antibiotics. Healthy NC 2020 states these strategies for stopping the spread of infectious diseases:

The following progress was made in 2017 on our action plan interventions for Reduce Substance Abuse in our community in Swain County.

• Action Plan Intervention 1
  • Coalition Vice Chair attended a training on RBA 
  • Coalition Vice Chair attended four performance measure workshop study halls
  • Coalition Vice Chair introduced RBA basic ideas to its meetings
  • 25% (Amber, Mark, Tobin, Myself out of 15 members) of Coalition for a Safe and Drug Free Swain County and Swain County Health Department members can talk about their program performance and how it contributes to population indicators 
  • A survey was developed using RBA language for Coalition members to show effectiveness of Coalition
  • Swain County Health Department was unable to complete a Whole Distance Exercise; however, Coalition leadership has introduced RBA basic ideas to its meetings
  • Swain County Health Department utilize Results Scorecard to develop a publicly available e-CHIP 

• Action Plan Intervention 2
  • Coalition for a Safe and Drug Free completed an environmental scan of Swain County - an Environmental scan is utilized to survey external factors (syringes & paraphernalia) that inform about a particular subject (IV drug use)
  • Coalition hosted a Discussion Platform and presentation by Full Circle Recovery Center on Harm Reduction/Needle Exchange January 23, 2018
  • Swain County Health Department provided education and material on drugs and drug use for the triennial Civil-Military Innovative Readiness Training Program August 2-10
  • Swain County Health Department provided education and material on drugs and drug use for the 1st annual NC Med-Assist on September 30th

• Additionally, the following progress was made in 2017 on Reducing  Substance Abuse in Swain County
  • Syringe Exchange – The coalition has been in support of this initiative since attending the stakeholder meeting 1/23/17Supplied over 15,000 Prescription Medication Disposal Stickers at Healthmart, Bryson City Pharmacy for use on Rx bag
    
  • Coalition supplied Prescription Medication Disposal Flyers for Crisp Funeral Home - for inclusion in family planning packets
  • Coalition completed an environmental scan of Swain County to determine where people are discarding needles and other paraphernalia
  • The Health Department has Prescription Medication Lock Boxes available free of charge from a Project Lazarus Grant and Mountain Projects, thus far we have supplied over 86 Lock Boxes or Bags to community members
  • Coalition and Swain County Health Department attended a Racial Equity Workshop May 2017
  • Coalition received a $2000. Grant from Project Lazarus this year to install a new Prescription Medication Drop Box at Healthmart, Bryson City Pharmacy; to provide a Prescription Medication Drop Event to support the new Drop Box, which we Conducted in October; to provide an educational campaign on the two locations of Drop Boxes in Swain County; and to purchase a new scale for the Sheriff's Department (they have been using a personal scale and/or the Health Department scale, but needs one that will go down to grams.
  • Coalition participated in Red Ribbon Week/Month which is a National Drug Prevention Awareness Campaign providing education throughout the community and schools as well as hosting a poster competition for the 5^th grade 
  • Coalition attempted to set up meetings between Bryson City Police Department, Sheriff's Department, Stephanie Almeida and Mountain Projects to help with funding for replacement of Naloxone Kits.
  • Swain County Health Department attended a series of Opioid poisoning strategies conference calls starting in April
  • Coalition held a fundraiser to help with Bryson City Police Department’s purchase of K—9 training kits, we are also working with connecting with Haywood Dog Fanciers Club to help support our K-9 units with other needs
  • Swain County Health Department attended an Opioid Round Table hosted by Cherokee Reservation on September 26th (Swain County completed their own Opioid Summit February 2018)
  • Medicine Abuse Project –planned for March 2018

The following progress was made in 2016 on infectious disease and STD prevention in Swain County.

• Coalition for a Safe and Drug Free Swain County created in December 2016 a planning committee for a county wide Environmental scan
• Increased education among health department nurses to be aware of and look for STD symptoms
• Updated educational information has been passed on to community partners, including: Appalachian Community Services, Swain Family Care, Swain Urgent Care, Swain County Detention Center
• Free hepatitis C tests are now available, as of 2016, in Swain County for at risk populations
• Needle Exchange dialoge was started with Commissioners and Advisory Board during the September 20, 2016 meeting.
• STD presentation/talks were implemented at Swain County Middle School and High School October 2016.
• Swain County Law Enforcement attended the December 2016 Coalition for a Safe and Drug Free Swain County meeting, participating in a discussion concerning the necessity of a Needle Exchange program and also optimal locations for sharps dispensers.
• Swain Health Department held a meeting with the Swain County Caring Corner, a local free clinic, on needle exchange and the need for STD screenings in Swain County.
• Project Lazarus STD prevention training held on November 8, 2016. Using this grant money, Swain Health Department in partnership with the Coalition for a Safe and Drug Free Swain County also distributed 46 lock boxes to the public. The purpose of the lock boxes is to contain prescription medications to ensure only those for whom the meds are intended partake.