How sex and drugs took their toll on 21st-century America
A complacency about HIV and the opioid epidemic have combined to deleterious effect in the US. Credit: Spencer Platt / Getty   

The ‘New Optimist‘ narrative that the world is getting better draws mainly on global statistics – especially those demonstrating progress against poverty, disease, illiteracy and so on. However, there is a sub-genre that concerns social progress in the West. Wages may have stagnated and inequality increased, but at least we’ve enjoyed long-term declines in crime rates, not to mention the growing disinclination on the part of young people to smoke, drink and get pregnant.

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But it’s not all good news. In fact, as Ashley Fetters reports in the Atlantic, the latest news from the Centers for Disease Control and Prevention (CDC) in America is not good at all:

“…reported cases of three sexually transmitted diseases in the United States had reached an all-time high in 2017. Rates of gonorrhea rose by 67 percent, syphilis by 76 percent, and chlamydia by 21 percent, to a total of almost 2.3 million cases nationwide. According to the CDC, 2017 surpassed 2016 as the year with the most reported STD cases on record—and marked the fourth year in a row that STDs increased steeply in the U.S.”

Why are STDs spreading when Americans appear to be having less sex?

The answer is that one must disaggregate the figures. If the most vulnerable groups are becoming more likely to engage in high-risk behaviours, then we can expect more of the worst outcomes irrespective of any trend towards greater responsibility in the population as a whole.

A specific factor may be a rise in condomless sex linked to complacency about HIV-AIDS. We now live in an era where we have drugs to treat or prevent infection with HIV. They are saving lives, but unlike condoms, they don’t provide protection against other STDs.

And then there’s the impact of America’s opioid epidemic on sexual health:

“Gail Bolan, the director of the CDC’s Division of STD Prevention… [said] that other CDC research suggests a link between STD transmission and the risky sex acts often associated with opioid use and addiction. She cites a soon-to-be-published CDC study that found 15- to 24-year-olds who reported injected drug use in the last year were more likely to be diagnosed with chlamydia, syphilis, and gonorrhea than those who didn’t inject drugs. More importantly, she adds, ‘injecting drugs was also associated with higher rates of forced sex, sex with people who exchange money or drugs for sex, and sex with other people who inject drugs’—which are all ‘high risk factors’ for STD transmission…”

As reported by Margot Sanger-Katz in the New York Times, the latest news on the direct impact of the epidemic is also pretty grim:

“Drug overdoses killed about 72,000 Americans last year, a record number that reflects a rise of around 10 percent, according to new preliminary estimates from the Centers for Disease Control. The death toll is higher than the peak yearly death totals from H.I.V., car crashes or gun deaths.”

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The progress narrative is remarkably similar to its ostensible opposite – the decline narrative. Both peddle a myth of inevitability.

It’s not that progress isn’t real, but that it’s fragile – and that some unexpected external factor can result in rapid, unanticipated calamity.

Indeed, unexpected factors can be the inadvertent result of our advances. That we now have lifesaving drugs against HIV is undoubtedly-progress, but complacency about unsafe sex isn’t. We should also be thankful for the opioids that allow people to manage painful medical conditions – and yet, at the same time, the over-prescription and misuse of those substances has primed a life-destroying epidemic of monstrous proportions.

The dichotomy between the optimistic and pessimistic narratives is a false one. Progress is real – but so is the human capacity to use the advances we make as a pretext for, or the means of, destruction.

Or to put it another way, things get better all the time, but they can always get worse.