Studies Seek Reasons for Disparity in STD Rates

Understanding and addressing the factors that contribute to the heavy disparities in sexually transmitted disease (STD) rates — especially among African-Americans and women — is critical to reducing the national burden of STDs.

The Centers for Disease Control and Prevention (CDC) estimates that there are 19 million new STD infections every year, making STDs the most commonly reported infectious diseases in the United States. STDs are estimated to cost the U.S. health care system about $16 billion annually, and can cause serious long-term health consequences. Left untreated, STDs such as chlamydia and gonorrhea can lead to infertility, and many STDs increase the risk of HIV infection.

African-Americans represent 12 percent of the U.S. population, yet account for almost half of all reported chlamydia and syphilis cases, more than 70 percent of all reported gonorrhea cases, and almost half of new HIV infections. In addition, new CDC data show that one in five women is infected with herpes (HSV-2), as are more than one-third of African-Americans overall and almost half of African-American women (48 percent), compared to the herpes infection rate of 12 percent for Caucasian Americans.

To better understand the reasons for this disheartening disparity, four studies were conducted to provide new insight into the socio-economic and other barriers to STD prevention and treatment.
"We have a better understanding than ever of the reasons for STD disparities," said John M. Douglas, Jr., M.D., director of CDC's Division of STD Prevention. "It's critical that we address the root causes of this problem because it is affecting our most vulnerable populations. We must use insights gained through research and conferences like this to guide the development of STD prevention programs."

The first study, conducted by surveying college-age women in Wisconsin, found that a vast majority (88 percent) would be uncomfortable seeking STD testing from a male health care provider. Most said they would rather have STD testing from a specialist rather than a family doctor. In addition, one-third reported concern about STD results appearing in their medical records.

Data collected from the National Medical Association (NMA), the leading professional organization of doctors of color, showed that many black men, especially black gay and bisexual men, are not tested for HIV and STDs during routine medical visits. Over half of the physicians surveyed were reluctant to initiate sexual health discussions, particularly with their black male patients, as a transition to offering an HIV test. The main reasons cited were that sexual health was not the main reason for the patient’s clinical visit and that the physician was not comfortable engaging in a sexual health conversation. 

African-American women who have experienced higher rates of racial discrimination run higher risks of STDs, according to CDC research. A study of African-American women living in Atlanta found those who reported having more than four incidents of racial discrimination also were more likely to report they had engaged in risky sexual behaviors, including having multiple sexual partners, an abusive or risky sexual partner, less frequent communication about sex with their partners, and barriers to condom use.
Poverty and access to health care play a major role in the disparity. Many urban STD clinics serve low-income and African-American populations and face greater demand for same-day services than they have the capacity to provide. A survey of four Chicago STD clinics showed that almost half of patients who were turned away had no income, 70 percent had no insurance, and 82 percent had no regular doctor.

"It is clear that public programs alone won't be able to dramatically reduce STD rates. Everyone must be involved in the solution," said Douglas. "We need to collaborate with the private sector to expand public awareness, increase the role of private health care providers in STD screening and treatment, and encourage open discussions about sexual health within our families and communities to reduce the stigma of STDs."

Source: Centers for Disease Control and Prevention