The City of Milwaukee has dramatically scaled back testing for sexually transmitted infections despite having some of the worst STI rates in the nation.
Under a directive from interim Health Commissioner Patricia McManus, nurses can no longer perform a wide range of tests at city health clinics.
“These restrictive changes in services being recommended by interim Commissioner McManus are extremely puzzling to those of us who have been involved in actively educating and informing the public about the need for getting tested for STI,” said Melissa Ugland, a local public health consultant.
McManus’ directive forced the closure Wednesday of Keenan Sexual Health Clinic, the only city-run clinic that provides free testing for HIV and other sexually transmitted diseases.
The clinic reopened Thursday, but under the scaled-back orders.
The clinic sees as many as 5,000 individuals annually, with African-Americans representing the majority of clients. The city has been providing STI testing for nearly 30 years.
“Commissioner McManus has directed, effective immediately this morning, that STD (sexually transmitted diseases) clinic nurses cannot perform pelvic exams (speculum or bimanual) or any ‘invasive’ swab specimen collection,” Geof Swain, medical director at the Health Department, wrote in a Wednesday night memo.
“It is unclear to me at this time whether these procedural restrictions will be permanent, or whether they might be revisited and/or revised.”
McManus wrote a separate memo to Common Council members Wednesday telling them that she took action after learning registered nurses at the clinic “have been trained to provide pelvic exams and other services” she said were outside the nursing scope of practice.
“I met with the city attorney yesterday to discuss the city’s liability if this practice continued,” McManus wrote. She put out a news release Friday afternoon repeating many of the same points.
It’s unclear when the city attorney’s office will issue an opinion on the matter.
Ugland said it appears that McManus made these changes without consulting other local public health agencies. She said the city Health Department is working with a team of local officials to come up with a strategy for curbing STIs.
“Reducing services by type or according to gender identity was certainly not something indicated by this team, which was comprised of physicians, nurses, public health researchers, and countless public health workers,” Ugland said.
The move comes as Milwaukee is struggling with some of the worst STI rates in the nation.
The Milwaukee area is ranked first in the nation in gonorrhea rates; fourth in chlamydia; and is ranked as one of the worst places for HIV for men of color under the age of 25.
Earlier this year, a large sexually transmitted infection cluster, or network, was discovered among teens and adults in the city. Many in the group had contracted HIV, syphilis or both.
Three babies also were born locally with syphilis last year, health officials have said.
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Centers for Disease Control
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Troubles with the city’s STI testing efforts are just the latest problems for the beleaguered Milwaukee Health Department, which has been reeling for months since problems emerged with the city’s programs aimed at preventing lead poisoning among children.
Former Health Commissioner Bevan Baker resigned in January as a result of these issues. Members of the Common Council chose McManus in February to fill the post temporarily.
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Centers for Disease Control
Family planning programs — which aim to help people avoid unintended pregnancies with contraceptives and other services — were also disrupted in January.
In addition, earlier this year, more than 100 women were left waiting for breast and cervical cancer screenings after the city stopped providing those services. Some of those women had symptoms such as lumps in their breasts or reported pain or burning sensations.
McManus did not respond to requests for an interview.
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