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Racial Disparities in Sexually Transmitted Diseases (STDs) Erika Samoff, PhD, MPH Susan Watson, MPH CA DHS STD Control - PowerPoint PPT Presentation


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Racial Disparities in Sexually Transmitted Diseases (STDs) Erika Samoff, PhD, MPH Susan Watson, MPH CA DHS STD Control Branch. For which STDs do you think there are racial disparities?. Which racial/ethnic group(s)?.

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Racial Disparities in Sexually Transmitted Diseases (STDs)Erika Samoff, PhD, MPHSusan Watson, MPHCA DHS STD Control Branch



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Rates of Chlamydia, Gonorrhea, P&S Syphilis, and AIDS byRace/Ethnicity and Gender — California, 2005

Rate per 100,000 population

Race/Ethnicity

Note: NA/AN = Native American/Alaskan Native; A/PI = Asian/Pacific Islander

Source: California Department of Health Services, STD Control Branch and Office of AIDS



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Gonorrhea Rates, Females, by Race/Ethnicity and Age GroupCalifornia, 2005

13 times white rate

Note: Native American/Alaskan Native and Asian/Pacific Islander rates were excluded due to small case counts.

Source: California Department of Health Services, STD Control Branch


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Gonorrhea Rates by Health Jurisdiction & Race/EthnicityCalifornia, 2005

AFRICAN

AMERICAN

ASIAN/PI

LATINO

WHITE

Note: Cases with unspecified race have been redistributed based on the ratio of individual races to total known races.

Cases with missing gender have been excluded from the gender-specific redistribution analysis.

Source: California Department of Health Services, STD Control Branch


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Gonorrhea, Rates by Race/Ethnicity California, 1990–2005

Low Point

Note: Race/ethnicity “Not Specified” ranged from 24.7% to 39.4% of cases for males in any given year.

Source: California Department of Health Services, STD Control Branch


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Sexually Transmitted Disease and HIV

  • Genital ulcer disease (syphilis, HSV) is associated with increased risk of HIV seroconversion

  • Treatment of STDs decreases HIV concentration in genital fluids

  • One community trial showed decreases in HIV acquisition following improvements in STD care


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Highlights of HIV Surveillance, 2000-2003

  • Although blacks constituted 13% of the population, they accounted for 51% of the HIV/AIDS diagnoses

  • Rates of HIV/AIDS among African American females were 19 times higher than rates among non-Hispanic white females

  • Overall, 28% of cases were female; 69% of African American cases were female

  • In 2004, 73% of infants perinatally infected with HIV were African American

    Wald and Link (2002) estimate that 35% of HIV infection among African Americans can be attributed to herpes infection

MMWR Dec 3, 2004: 53 (47): 1106-1110

CDC HIV/AIDS Fact Sheet “HIV/AIDS among African Americans February 2006

Wald A and K Link. J. Inf. Dis. 185:45-52. 2002


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Contributing Factors

  • Individual Factors

  • Systemic Factors


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Individual Factors

  • What are some of the individual behaviors that can lead to these STD disparities?


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Individual Factors

  • Number of sex partners

  • Concurrency of sex partners

  • No/inconsistent condom use

  • Not getting tested/screened


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Systemic Factors

  • What are some of the systemic factors (things outside of the individual’s control) that can contribute to these disparities?


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Systemic Factors

  • Racism

  • Poverty

  • Policies and laws**

  • Educational opportunities

  • Access to quality health care

  • Differential treatment from health care providers**

  • Community prevalence of disease


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Historical Laws & Policies

  • 1930’s to present:

    • Neighborhood covenants

    • Discrimination for housing loans

  • 1940’s to 1960’s:

    • Subsidized housing creating “the projects”

    • Urban renewal highway projects

    • Collapse of urban industries

  • The war on drugs (1980’s-present)


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Prophylactic Measures Many Can’t Buy Condoms Now Before Paging a Store Clerk to Unlock Them

By Suz Redfearn

Special to The Washington PostTuesday, April 11, 2006

An informal survey found that almost half -- 22 of 50 -- of the District's CVS pharmacies lock up their condoms -- this in a city where one in 20 residents is HIV-positive. Most of those stores are in less affluent areas where the incidence of HIV/AIDS, other sexually transmitted diseases and unwanted pregnancy -- all preventable with condoms -- are highest.

http://www.washingtonpost.com/wp-dyn/content/article/2006/04/10/AR2006041001312.html


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It’s Illegal, but Mortgage Firms Aren’t Colorblind… Paging a Store Clerk to Unlock Them

Kenneth Harney Sunday, June 18, 2006

…Do mortgage brokers offer the same deals to African American and Latino applicants with identical -- or superior -- incomes, credit scores and employment histories compared with white applicants? …

…The complaint alleges that Allied brokers are "quoting different interest rates and fees on the basis of race" and steering African American borrowers to higher-cost subprime mortgages even when they are fully qualified for lower-cost, prime-rate products. …

URL: http://sfgate.com/cgi-bin/article.cgi?file=/c/a/2006/06/18/REGONJF4I51.DTL


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Summary of IOM Findings Paging a Store Clerk to Unlock Them

  • Disparities occur in the context of broader historic and contemporary social and economic inequality, and evidence of persistent racial and ethnic discrimination in many sectors of American life.

  • Many sources – including health systems, health care providers, patients, and utilization managers – contribute to racial and ethnic disparities in health care.

  • Bias, stereotyping, prejudice, and clinical uncertainty on the part of healthcare providers may contribute to racial and ethnic disparities in healthcare.


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What does culture have to do with it? Paging a Store Clerk to Unlock Them


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The Need for Cultural Competence in Health Care Paging a Store Clerk to Unlock Them

  • The perception of illness and disease and their causes varies by culture

  • Diverse belief systems exist related to health, healing, and wellness

  • Culture influences help-seeking behaviors and attitudes toward health care providers


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The Need for Cultural Competence in Health Care (con’t) Paging a Store Clerk to Unlock Them

  • Individual preferences affect traditional and non-traditional approaches to health care

  • Patients must overcome personal experiences of biases within health care systems

  • Health care providers from culturally and linguistically diverse groups are under-represented in the current service delivery system

    Source: Cohen & Goode, National Center for Cultural Competence, 1999


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Increasing Workforce Diversity Paging a Store Clerk to Unlock Them

Increasing Cultural and Linguistic Competence

Reducing Health Disparities

Improving Quality of Care


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Connecting the Dots Paging a Store Clerk to Unlock Them

  • Poor access to careincreased duration of infection, increased risk for HIV transmission

  • Poor access to preventionno/inconsistent condom use

  • Poor educational systemslack of knowledge about prevention, symptoms, available resources

  • Incarcerationavailable partners & concurrency, gender ratio imbalances

  • Historical laws/policiesgeographic isolation, mistrust


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Different Levels of Disparities Paging a Store Clerk to Unlock Them

  • Health status

  • Health care access

  • Quality of health care received

  • Healthcare outcomes


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Discussion Questions Paging a Store Clerk to Unlock Them

  • What is being done about these disparities?

  • What can we learn from successful health disparity efforts?

  • What else should be done?

  • How do we avoid stigmatizing racial/ethnic groups while trying to reduce the disparities?


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Advisory Groups/Initiatives Paging a Store Clerk to Unlock Them

  • CDC: African American Working Group & Minority AIDS Initiative

  • CA DHS Office of AIDS: Statewide African American Initiative

  • CA DHS Office of Multicultural Health: Cultural Competency training curriculum

  • Tavis Smiley’s Covenant with Black America


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Potential Interventions to Impact Disparities Paging a Store Clerk to Unlock Them

  • Education: development/implementation of comprehensive school sexual health curriculum

  • Screening: increased screening in high-yield settings (e.g., juvenile halls)

  • Surveillance: provision of timely, community-specific epidemiologic data to allow targeted screening

  • Treatment: recommendation for suppressive herpes treatment for HSV-2+/HIV+


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Culturally Appropriate Behavioral Interventions Paging a Store Clerk to Unlock Them

  • Popular Opinion Leader (adapted for African American MSM)

  • Sisters Informing Sisters About Topics on AIDS (SISTA)

  • Many Men, Many Voices

  • VOICES/VOCES

  • Be Proud! Be Responsible! (Jemmott & Jemmott)