Public health is one of Taiwan’s greatest strengths. Its National Health Insurance was already one of the best single-payer systems in the world, ensuring that everyone has coverage while staying nimble in the face of financial challenges.
The COVID-19 pandemic was a chance for the world to see Taiwan’s full public health apparatus at work. Officials caught wind of a strange virus circulating in China and jumped to screen and then stem the flow of travelers before the word “coronavirus” even made headlines. It was one of the only countries in the world to escape widespread transmission before vaccines were distributed, becoming a case study for virologists everywhere. It did all this despite being barred from the WHO, lending weight to its appeals for inclusion.
Yet for all of its triumphs, there remain some frustrating blind spots in Taiwan’s public health system. One of the biggest is coverage of sexually transmitted infections (STIs).
According to Centers for Disease Control (CDC) data from last year, STI rates have been steadily rising. Gonorrhea diagnoses rose from 7,082 in 2020 to 8,015 in 2022, while syphilis cases increased from 8,800 in 2021 to 9,631 over the same period. Most were among people younger than 35, with the CDC warning at the time that more than 90 percent of young people are being exposed to STIs due to unsafe sexual practices.
Although cases are rising, most STI testing is paid out of pocket. At Po Jen General Hospital in Taipei, publicly available pricing shows it costs NT$3,000 for a “basic” suite of eight STI tests. A full suite of 11 tests costs NT$5,000. Due to the price, most doctors recommend only testing for common STIs and only paying for others if symptoms are present.
From a public health perspective, this is asking for trouble. The high prices discourage people from getting tested, meaning more people will spread diseases unknowingly. As health authorities know that most young people are engaging in unsafe sexual practices, it is irresponsible to rely on social stigma to stem the spread of disease. Concrete action must be taken.
HIV is an instructive case study. Tests are widely available for free through clinics and non-governmental organizations, while at-home test kits cost NT$200. By the end of last year, new diagnoses had dropped to a 20-year low.
At the same time, access to preventive treatment leaves much to be desired. People at risk of contracting HIV are encouraged to take pre-exposure prophylaxis (PrEP) regularly. In other countries the price can be negligible with generics, but in Taiwan, only the brand-name Truvada is available, costing an average of NT$12,000 per month. Although some hospitals offer patient assistance programs to help with the cost of PrEP, they are not available to non-citizens, who must order online from questionable sources.
One of the fundamentals of public health is to prevent the spread of disease. To do that, officials must do their utmost to make sure that everyone who might be at risk has easy access to testing and preventive measures, paired with comprehensive education.
Yet for all of its adherence to best practices in other fields, many parts of Taiwan’s health system remain antiquated when it comes to sexual health, preferring instead to slough off the burden of prevention to abstinence education and public shame. Sexual health is no less a part of a person’s well-being than other kinds. Breaking through the social stigma is the only way to truly protect ourselves and others.
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