2021 is bringing queer culture back to the '90s with mini bags, wide-legged pants — and an increase in sexually transmitted diseases. While rates of all STDs are disproportionately high in King County, HIV in particular is making a staggering comeback.

In 2020, the Washington State Epidemiology Report found that 7,056 people were living with HIV in King County the previous year. Of these, 86% were cisgender men. White men make up the largest racial sector of HIV-positive people, but Black and Latinx people show rates disproportionate to their population in the county: for example, Black people make up just 7% of King County but 20% of those living with HIV.

Another staggering find is that people between 24 and 35 make up 13% of those with HIV. This segment of the population was not around for the height of the pandemic in the late '80s and early '90s.

So, what is causing this spike in HIV among young people, particularly young people of color? For one, it is a lack of testing. The CDC recommends that men who are sexually active and not in a long-term, monogamous, and HIV-free relationship get tested every year, but data reveal that this is not happening. Twenty-six percent of new HIV/AIDS diagnoses are "late," meaning that the person affected has been living with the disease for a year. Sexually active but unknown carriers are the leading cause of HIV spread.

A factor many fear may contribute to this spike in HIV is the winding down of the pandemic. Now that people have received their vaccinations and are beginning life again as it once was, they forget there are still other diseases to be feared. As a result, more cases of unprotected sex are happening.

While forms of birth control can protect against unwanted pregnancies, they do not necessarily protect against all forms of STDs. In King County, rates of chlamydia have skyrocketed past HIV, with 8,290 cases in 2020. Gonorrhea cases are also on the rise, with 4,277 people having reported an infection. (While the 2021 numbers have yet to be released, doctors are already warning they will be much higher than last year's.) These diseases are highly treatable, but the risk of contracting sexually transmitted infections (STIs) in the first place is reduced with protection (condoms).

Prevention
Not only are STDs like chlamydia and gonorrhea preventable, but there are additional measures available for those who are sexually active and at an increased risk of HIV. King County recommends all men who have sex with men to use PrEP (pre-exposure prophylaxis) as a preventive measure to protect against the possible contraction of HIV. While the county's goal was for 50% of these men to start using PrEP, only 47% have reported doing so.

King County has attempted to make PrEP accessible to anyone who wants it. Public Health — Seattle & King County now runs a program at the Sexual Health Clinic that offers PrEP to people receiving STD-infected partner services, partners with community-based PrEP programs, and provides online resources.

However, the numbers don't lie. People don't want to take PrEP.

One of the issues with promoting this preventive drug is the stigma that HIV/AIDS carries. For some, coming out is not a safe or plausible option. Taking PrEP, especially for teens and young adults who still live at home, risks possible outings, as the drug is not commonly used or advertised for straight people. The risk of HIV seems safer than the risk of a parent or guardian finding the medicine in the bathroom.

Other factors
Another issue facing members of the LGBTQ+ community is that those at high risk often don't see themselves as high risk. Human nature is to assume that we are like the rest of the crowd, and when stories circulate about the dangers and risks of COVID-19, which affects straight people just as much as LGBTQ+ people, we tend to ignore the other epidemic that has been ongoing for most of our lives now. We make justifications for ourselves and tend to believe we are smart enough, safe enough, and resourceful enough to avoid HIV. Often people associate the disease with drug use and will assume that if they are not partaking, their risk is low. This is not true.

Furthermore, there is a lack of education. For many, serious education on HIV doesn't come until after they have tested positive. Conversations around STD risk are difficult to have. Often parents and administrators shy away from such topics, fearing they may promote sexuality in their teens. These conversations can also take on a "slut-shaming" tone when not approached with tact.

Strategies
Professionals at the AIDS Health Foundation disagree on what must happen to combat the high STI numbers in Seattle. The CDC reports that one in five Americans are living with an STI, but doctors from the AHF estimate that the numbers here in Seattle are closer to 40%.

"Where we are as a society in terms of sexual health is dire," said AHF worker Howard Russell.

While some say tactful conversations are the answer, others think that the high rates, which are continuing to rise, should sound the alarms and speak for themselves.

Despite the different strategies, most can agree that the first step to decreasing high STI rates in King County is to create more safe spaces for sex-positive conversations. People often fear judgment, which prevents them from getting help. With marketing taking on an "us" vs. "them" mentality, people disassociate themselves from those at risk.

Another way to understand people's hesitation to take PrEP is to look at the breakdown of targeted advertisements.

With commercials and in print ads often showing men in same-sex relationships and Black men, those in both communities can feel as though they are unfairly made the face of HIV. After all, the disease does not discriminate. People of all races and sexualities are susceptible to HIV and should be taking precautions to protect themselves.

But even if the disease does not discriminate, the medical industry still does. BIPOC and LGBTQ+ people are less likely to receive preventive care when they ask for it and often receive lower-quality care.

There are important steps to be taken by the medical industry, King County's public education system, and individuals to combat the increasing spread of HIV. While people cannot change such large industries overnight, we can usher in social change that will aid in the fight against HIV. This means destigmatizing conversations around sex and sexual health, using protection and preventive medications, and getting tested every year. By taking these steps, we can save lives and stop the AIDS epidemic from rising again.

If you need STI testing, the AHF is open Monday-Friday at 1016 E. Pike St. #100. A wellness center for those with STIs is set to open in January.