“These numbers are a wake-up call,” said Dr. Philip Huang, director of DCHHS, in a press release. “Prevention and early treatment aren’t just good medicine — they’re smart economics. Investing in STI prevention, early diagnosis, and treatment is both a public health and fiscal imperative.”
According to the report, published in the July 2025 Dallas Medical Journal, Dallas County has the second-highest rate of HIV in the state. The preventable disease accounted for $382.5 million, or 95.9%, of the county’s total economic detriment related to STIs in 2022. Non-HIV costs in the same year accounted for the other $16.1 million.
A team of researchers within DCCHS used national care cost averages for STIs in lieu of nonexistent county-specific data. The total direct medical cost estimates include diagnostics, treatment, follow-up , hospitalizations, medications, and long-term care. The report does not include non-monetized indirect costs, resulting in "an underestimation of the total societal burden."
Researchers were unable to aggregate costs by race, gender, socioeconomic status, or geographic location, but they note that these factors are known to impact the total cost of STI treatment and prevention. The DCCHS HIV/STI dashboard tracks cases divisible by a variety of demographics for adequate data collection and targeted prevention planning.
In 2022, there were 910 new HIV diagnoses, and 21,000 total positive cases were reported within Dallas County. There were 22,000 cases of Chlamydia at 848.7 positive tests per 100,000 people, which is higher than the state average. Syphilis increased by 45% since 2020, and congenital syphilis, transmitted between a mother and a fetus, increased 148% since 2018.
HIV, requiring a lifetime of treatment to remain undetectable and untransmittable, beginning with a new diagnosis in 2022, costs $420,000, according to Huang. But several million spent on other preventable diseases requiring much less comprehensive treatment plans is still unignorable.
“Gonorrhea is $1.4 million. Chlamydia is almost $3.7 million,” he told the Observer. “This is really costing us a lot. We need to invest in trying to prevent this. That's why it made no sense at all when there was discussion, and still it's out there, of ‘we don't need to do HIV prevention.’"
The Fate of Funding
The report trails a pending 2026 federal budget request from the White House that would completely slash HIV prevention and surveillance within the Centers for Disease Control, totaling $1.5 billion in cuts. Federal grant funding for wellness and public health, particularly focused on STIs, has taken significant hits, says Huang, partly because of the ongoing budgetary cuts affecting research, but also because of the national pushback against DEI programming. Statistically, women and gay men are more susceptible to contracting STIs because of the soft tissue lining within the vaginal and anal cavities. While STIs are not exclusive to any particular demographic, the unhoused, sex workers, gay men and Black women do have higher rates than other communities, and now, Huang says, the target is on their backs.
“There have been concerns because when we look at and address a public health issue, we try to look at who is disproportionately affected,” he said. “Sometimes now [people are] being labeled as DEI, but we're just looking at the data and trying to do what needs to be done. And we're not stopping that. We're doing what we need to do to try to address these… If those are the populations that are having some of these big problems, then we still need to address them.”
Funding isn’t just a problem at the federal level. This year, efforts to increase state funding for STIs, tuberculosis and immunizations within local public health departments failed, and Huang says his budget, and other counties’, have remained mostly level for the past decade.
“Just for Dallas County, [it cost] $398 million for one year's worth of new STIs, and we don't get nearly that funding,” he said. “We need to invest and do everything we can to prevent these costs and the impact on the lives of these people.”
Why Are Preventable Diseases Increasing?
The Lone Star State has the highest rate of HIV in the country, and it's particularly high in Dallas County, trailing only the more populous Harris County. But rates have been increasing across the country for several reasons.“Dallas-Fort Worth metroplex is a very large area in one of the largest states in America,” said Steven Tamayo, director of community health for Kind Clinic, an inclusive sexual health clinic, to the Observer in March. “And so there's naturally just more people. More people sometimes means more sex, more sex sometimes means more STIs, and that's just the natural progression of things.”
There was a notable uptick in STIs when widespread social isolation ended, for a couple of reasons, says Huang.
“We saw increases in STIs from COVID. We largely thought that it was decreased access to treatment during COVID… Now, some of the reasons, also more recently, over time, there are social factors that go into this,” he said. “We saw increases of apps, anonymous hookups are easier, that certainly has factored into it.”
Huang says the emergence of dating apps and a rampant hookup culture has made contact tracing much more difficult, hampering the usual notification process that is crucial to preventing the spread.
“The stigma and shame that are associated with [STIs] prevent people from seeking testing or talking about it or getting treated,” he said. “[There’s] reduced access to education. In the criminal justice sector, there are higher rates and addressing those factors, as well as the availability of housing, impacts some of this.”
Despite an unknown funding future and a changing social attitude towards proper sexual care, Huang says remaining vigilant about STI prevention, education and accessible care is a key concern.
“[This has] been a priority, and recognized as a priority since I came to the department six years ago,” Dr. Huang said. “We all want a solution. We've done a lot of things with HIV in particular.”
The city of Dallas is a designated fast-track city within the Paris Declaration, a commitment to accelerate citywide responses to HIV and the AIDs epidemic with the goal of having “90% of people living with HIV knowing their status, 90% of those positive on treatment, and 90% of those on treatment having suppressed viral loads.” The city is also a member city of the Ryan White HIV/AIDS program, a federal program that offers financial aid to those, including the underinsured, struggling with the costs of comprehensive HIV care.
“We have been increasing our services at our sexual health clinic,” said Dr. Huang. “We've been doing a lot to address this, and we consider it a very top priority.”
