On Tuesday, a new report from the Centers for Disease Control and Prevention announced that nearly 2.3 million cases of syphilis, gonorrhea, and chlamydia were diagnosed in 2017—the highest number ever reported in the United States. Since 2013, diagnoses of gonorrhea, syphilis, and chlamydia are up 67 percent, 76 percent, and 21 percent, respectively. Chlamydia, the most common of the three diseases, saw 1.7 million cases last year.

There’s a breadth of factors at play in rising rates of sexually transmitted diseases. More babies are being born with STDs, since their mothers are more likely to be infected. And chlamydia detection could be getting better for women, who may be undergoing increased screening. But one of the main drivers is the massive budget cuts public-health centers and STD programs have seen over the past few years. When underfunded, these initiatives decrease their hours and staff, and sometimes close altogether, making STD detection and treatment more difficult.

The CDC acknowledges that budget cuts are posing an increasing challenge at battling the spread of STDs. Since 2003, the CDC’s STD-prevention budget has decreased by 40 percent. A 2012 article in Harvard Public Health noted that only 3 percent of government health spending went to public-health programs, and 52 percent of state and local STD programs experienced budget cuts; ultimately, the CDC estimates that 21 local health departments across the country closed as a result. These cuts have come from multiple administrations, and the Trump administration recently proposed a 17 percent cut to the 2019 STD-prevention budget, which could only make the STD problem worse.

“It’s not a coincidence STDs are skyrocketing—state and local STD programs are working with effectively half the budget they had in the early 2000s,” David Harvey, the executive director of the National Coalition of STD Directors, says in a press release. “Right now, our STD-prevention engine is running on fumes.” Read more via the Atlantic