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

(Bridge illustration/A.J. Jones)

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.

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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.”