STD
[Main List]
Articles and Presentations
Access to Care Issues for African American Communities: Implications For STD Disparities.
Sexually Transmitted Diseases, 35(12) Supplement:S19-S22, December 2008.
Deidra D. Parrish, MD, MPH&TM; Charlotte K. Kent, PhD, MPH
Abstract:
Reduced access to care is a major contributor to health disparities in black communities. This review discusses factors that serve to diminish access to care among blacks in the context of STD disparities and highlights strategies to improve access to STD care. At the individual level, structural factors such as poverty, lack of insurance, and lack of a regular source of care are known to decrease health service utilization and have been identified as barriers to STD care as well. Other individual level factors that influence access to care, particularly for STDs, include concerns about confidentiality and privacy, perceptions of discrimination, and perceptions of risk. At the health system level, availability of services, organizational inefficiencies, and staff perceptions affect access. Strategies to improve access to STD care include expanding services in high-risk nontraditional venues, developing multilevel partnerships, incorporating STD services into routine healthcare, integrating services with HIV, improving the quality of public STD clinic care, and ultimately addressing the broader underlying factors that contribute to health disparities.
Impact of Attitudes and Beliefs Regarding African American Sexual Behavior On STD Prevention And Control In African American Communities: Unintended Consequences.
Sexually Transmitted Diseases, 35(12) Supplement:S23-S29, December 2008.
Jo A. Valentine, MSW
Abstract:
Compared to whites, blacks experience significant health disparities for sexually transmitted diseases, particularly in the rates of chlamydia, gonorrhea, and syphilis. To develop more effective interventions to control and prevent STDs, public health practitioners should better understand and respond to factors that facilitate sexual risk-taking behaviors and impede access to STD health care and make use of factors that promote sexual health. Legacies of slavery, racism, and economic or class discrimination leave many blacks suspicious of interventions aimed at improving the welfare of their communities. Sexual behavior, in particular, has been used to justify social oppression of blacks in the United States. Although efforts to engage affected black communities in improving STD health care delivery have been undertaken, bias, prejudice, and stereotyping continue to contribute to negative experiences for many blacks across health care settings, including those involving STD care. Implementing more effective interventions to reduce the disparate burden of bacterial STDs in black communities requires accessible and acceptable STD health care. Understanding and addressing the potential impact of both provider and patient attitudes can improve these service delivery outcomes.
Traditional Sexually Transmitted Disease Prevention and Control Strategies: Tailoring For African American Communities.
Sexually Transmitted Diseases, 35(12) Supplement:S30-S39, December 2008.
Roxanne Y. Barrow, MD, MPH; Cady Berkel, PhD; Lesley C. Brooks, MD; Samuel L. Groseclose, DVM, MPH; David B. Johnson, BA; Jo A. Valentine, MSW
Abstract:
African Americans carry the largest disease burden for bacterial sexually transmitted diseases (STDs) in the United States. These infections can have a devastating impact on sexual and reproductive health if they are not diagnosed and treated. Traditionally, public health efforts to prevent and control bacterial STDs have been through surveillance, clinical services, partner management, and behavioral intervention strategies. However, the persistence of disparities in STDs indicates that these strategies are not achieving sufficient impact in African American communities. It may be that factors such as limited access, acceptability, appropriateness, and affordability of services reduce the efficacy of these strategies for African American communities. In this article we describe the STD prevention strategies and highlight the challenges and implications of these strategies in addressing disparities in African American communities.
Measuring Disparities in the Incidence Of Sexually Transmitted Diseases
Sexually Transmitted Diseases, 35(12) Supplement:S40-S44, December 2008.
Karen Hoover, MD, MPH; Michele Bohm, MPH; Kenneth Keppel, PhD
Abstract:
The Centers for Disease Control and Prevention (CDC) defines a health disparity as a "[health] difference that occurs by gender, race or ethnicity, education or income, disability, geographic location, or sexual orientation." Health equity is achieved by eliminating health disparities or inequalities. Measuring health disparities is a critical first step toward reducing differences in health outcomes. To determine the methods to be used in measuring a health disparity, several decisions must be made, which include: (1) selecting a reference group for the comparison of 2 or more groups; (2) determining whether a disparity should be measured in absolute or in relative terms; (3) opting to measure health outcomes or health indicators expressed as adverse or favorable events; (4) selecting a method to monitor a disparity over time; and (5) choosing to measure a disparity as a pair-wise comparison between 2 groups or in terms of a summary measure of disparity among all groups for a particular characteristic. Different choices may lead to different conclusions about the size and direction of health disparities at a point in time and changes in disparities over time. The objective of this article is to review the methods for measuring health disparities, provide examples of their use, and make specific recommendations for measuring disparities in the incidence of sexually transmitted diseases (STDs).
Taking Positive Steps to Address STD Disparities for African-American Communities
Barrow, Roxanne Y. MD, MPH; Newman, Lori M. MD; Douglas, John M. Jr MD
Centers for Disease Control and Prevention, Division of STD Prevention, Atlanta, Georgia RBarrow@cdc.gov
Sexually Transmitted Diseases:Volume 35(12) SupplementDecember 2008 pp S1-S3
AFRICAN AMERICAN COMMUNITIES continue to have higher rates of gonorrhea, chlamydia, and syphilis than any other population group in the United States. A review of racial/ethnic disparities in health outcomes measured by the Healthy People 2010 objectives found that sexually transmitted diseases (STD) and HIV accounted for the five greatest disparities for the African American population in 2003.1 National STD surveillance data in 2006 indicated that the African American:white rate ratio was 18:1 for gonorrhea, 8:1 for chlamydia, and 6:1 for primary and secondary syphilis, and that African Americans accounted for 69%, 47%, and 43% of all reported cases of these infections, respectively.2 Studies have shown that unlike whites, African Americans need not engage in high-risk behavior to be at high risk of contracting an STD owing to factors other than individual risk behaviors which seem to contribute to racial STD disparities.3 Therefore, it is critical to examine the social determinants that may affect the prevalence of STDs in African American communities to effectively reduce STDs in these communities.
Epidemiology of STD disparities in African American communities.
Newman LM, Berman SM.
Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. len4@cdc.gov
Sex Transm Dis. 2008 Dec;35(12 Suppl):S4-12
http://www.stdjournal.com/pt/re/std/abstract.00007435-200812001-00006.htm;jsessionid=JpgQbpG5L7qxbKMg7fZvb1FCPQ0fmmrmN KHQJ1hs2mSm1LVglGHH!1553038018!181195628!8091!-1
This article reviews the epidemiology of sexually transmitted disease (STD) disparities for African American communities in the United States. Data are reviewed from a variety of sources such as national case reporting and population-based studies. Data clearly show a disproportionately higher burden of STDs in African American communities compared with white communities. Although disparities exist for both viral and bacterial STDs, disparities are greatest for bacterial STDs such as gonorrhea, chlamydia, and syphilis. Gonorrhea rates among African Americans are highest for adolescents and young adults, and disparities are greatest for adolescent men. Although disparities for men who have sex with men (MSM) are not as great as for heterosexual populations, STD rates for both white and African American MSM populations are high, so efforts to address disparities must also include African American MSM. Individual risk behavior and sociodemographic characteristics of African Americans do not seem to account fully for increased STD rates for African Americans. Population-level determinants such as sexual networks seem to play an important role in STD disparities. An understanding of the epidemiology of STD disparities is critical for identifying appropriate strategies and tailoring strategies for African American communities. Active efforts are needed to reduce not only the physical consequences of STDs, such as infertility, ectopic pregnancy, chronic pelvic pain, newborn disease, and increased risk of HIV infection, but also the social consequences of STDs such as economic burden, shame, and stigma.
PMID: 18971796 [PubMed - indexed for MEDLINE]
High Rates of HIV Testing Despite Low Perceived HIV Risk Among African-American Sexually Transmitted Disease Patients
By Chandra L. Ford, PhD, MPH, MLIS; Mark Daniel, PhD; and William C. Miller, MD, PhD, MPH Chapel Hill, North Carolina and Montreal, Quebec, Canada. Journal Of The National Medical Association
http://www.nmanet.org/images/uploads/Publications/OC0841.pdf
In the current diagnosis-based, HIV prevention climate, previous testing among persons at elevated HIV risk has cost and efficacy implications, as it signals continued behavioral risk, limited HIV knowledge or overuse of services. This study sought to determine the proportion of African Americans newly seeking sexually transmitted disease (STD) diagnosis who previously had obtained HIV counseling and testing. Journal of the National Medical Association VOL. 98, NO. 6, JUNE 2006 pp. 841-844
Sexual Behavior and Selected Health Measures: Men and Women 15-44 Years of Age, United States, 2002 with updates
By William D. Mosher, Ph.D., Anjani Chandra, Ph.D., and Jo Jones, Ph.D., Division of Vital Statistics
"http://www.cdc.gov/nchs/data/ad/ad362.pdf
This report presents national estimates of several measures of sexual behavior among males and females 15–44 years of age in the United States in 2002, as collected in the 2002 National Survey of Family Growth (NSFG). These data are relevant to demographic and public health concerns, including fertility and sexually transmitted diseases among teenagers and adults. Data from the 2002 NSFG are compared with previous national surveys. Advanced Data from Vital and Health Statistics, Number 362 + September 15, 2005
Social Context, Sexual Networks, and Racial Disparities in Rates of Sexually Transmitted Infections
By Adaora A. Adimora and Victor J. Schoenbach
http://www.oneloveca.org/_files/_files/5251_SocialContextSexualNetwrks-Adimora.pdf
Social context (demographic, socioeconomic, macroeconomic, and sociopolitical features of the environment) influences the epidemiology and consequences of individual behaviors that affect health outcomes. This article examines the role of social context in heterosexual networks that facilitate the spread of human immunodeficiency virus (HIV) infection and other sexually transmitted infections (STIs), particularly in relation to persistent racial disparities in rates of STIs in the United States. Social Context and Sexual Networks • JID 2005:191 (Suppl 1) • S115
Prevalance of Chlamydial and Gonococcal Infections Among Young Adults in the United States
By William C. Miller, MD, PhD, MPH; Carol A. Ford, MD; Martina Morris, PhD; Mark S. Handcock, PhD; John L. Schmitz, PhD; Marcia M. Hobbs, PhD; Myron S. Cohen, MD; Kathleen Mullan Harris, PhD; and J. Richard Udry, PhD
http://jama.ama-assn.org/cgi/content/full/291/18/2229#ACK
Chlamydial and gonococcal infections are important causes of pelvic inflammatory disease, ectopic pregnancy, and infertility. Although screening for Chlamydia trachomatis is widely recommended among young adult women, little information is available regarding the prevalence of chlamydial and gonococcal infections in the general young adult population. Cross-sectional analyses of a prospective cohort study of a nationally representative sample of 14 322 young adults aged 18 to 26 years. JAMA. 2004; 291:2229-2236.