The number of STDs is going up. That’s true for the population as a whole, and virtually all Americans are, at least theoretically, at risk of contracting one.
But a closer look at the numbers shows something more: Some groups are hit much harder than others. Much harder. In particular, women and racial and ethnic minorities carry most of the burden of sexually transmitted infections (STI) in the U.S., according to the Centers for Disease Control. Not only are complex, long-standing issues of health disparities among minorities to blame for this disproportionate impact, but simple female anatomy remains a risk factor as well.
Elena, an Hispanic-American woman, recent college graduate, and a licensed practical nurse (LPN), wanted to participate in an interview for this article about being a minority affected by an STD because, she told me, “I don’t think our community is aware of these things.” Elena lives and works in Florida near her family; her parents were second-generation immigrants from Chile. “Sure, we were poor growing up, and we couldn’t afford to go to the doctor very much, but that wasn’t really part of our culture anyhow,” recalls Elena. “Once I finally found out I had contracted an STI I was really scared; I didn’t know what to expect. I had never been tested—I don’t think anyone I know was.” Elena’s experience is no different than that of most minorities; the groups with the highest rates of STDs are often the same ones for whom access to health services is the most limited.
Now 22, Elena was diagnosed with pelvic inflammatory disease (PID) a year ago, and has since been treated for the cause—chlamydia—but she likely had chlamydia for some time before she saw a doctor. Her case of PID wasn’t at all uncommon, either: The disease is most often caused by an untreated bacterial STD (like chlamydia or gonorrhea) which goes unnoticed until it begins to wreak havoc on the reproductive system. Elena didn’t get tested for an STD until she had ruled out her diet, constipation, and her menstrual cycle as causes of her extreme pelvic pain. It was only then that she saw a doctor, who suggested testing. Simply put, an STD wasn’t on her radar at all.
That’s why targeted prevention efforts are so important if we want to reduce the extreme burden that women and minority ethnic and racial groups carry when it comes to these infections. The spread of STDs in Hispanic-Americans like Elena is directly affected by cultural factors. For example, people of Hispanic background may prefer to get healthcare from naturalists or holistic healers, and healthcare advice and decision-making is often done with help from family members.
Similarly, African-American communities tend to rely on their family, religious, and social communities for health support and advice as opposed to seeking care from mainstream healthcare professionals first. (American Indians and Alaska Natives tend to have cultural differences when it comes to STDs too.) All of these, as well as other factors, tend to cause serious obstacles to STD prevention which can result, in the worst cases, in irreversible damage.
Even though Elena’s STD is now gone, she doesn’t know how much damage the PID did to her reproductive system (while the bacteria that causes PID can be treated with antibiotics, any damage to a woman’s system can’t be undone). That’s a big concern; some 15 percent of all infertility cases are caused by an untreated STD. Keep in mind that figure doesn’t account for STD-related ectopic pregnancies (in which a pregnancy implants outside the uterus) or damage to the Fallopian tubes. “I want to get married and have children,” Elena told me. “Now I don’t know if I can, and right now I can’t afford any kind of [fertility] testing.”
She’s working at a local hospital and spends most of any extra income she has paying off student loans. “But I know there’s a chance I’ll have trouble [conceiving], because what PID does is irreversible,” she notes. “It’s like, how do I even explain that to guys? ‘Um, I don’t know if I can have kids, because a couple of years ago I had an STD I didn’t know about?’ It’s embarrassing and it makes me really sad; I know there are other people experiencing the same thing I am. I just wish there were more programs trying to help [minorities], because I don’t think our communities are getting reached.”
I believe she’s got a great point: Despite some funding to community programs scattered across the U.S., in general, prevention efforts are not usually specifically tailored to reach women or racial and ethnic minorities. Yet STDs disproportionately affect those groups because of anatomical differences (women’s anatomy makes them much more easily infected with all types of STDs), and because among close-knit communities where there’s a higher prevalence of STDs it’s more likely that people will have sequential or multiple, concurrent sexual partners, which raises STD risk. Other factors, like substance abuse (which makes riskier behavior more likely) and poverty (which makes it less likely someone will seek care for an infection), are big contributors to this ongoing cycle too.
If prevention efforts don’t take those factors into account, we’ll continue to miss the minority audience entirely. Access to high-quality healthcare and targeted STD prevention efforts are both essential for early detection and treatment of these infections—so others don’t have to experience the fear and anxiety Elena will have to endure until she conceives and gives birth to her first, healthy child.
What could be done to lessen the impact of STDs on minorities?
Jenelle Marie is the founder of The STD Project, an award-winning website and progressive movement aimed at eradicating the stigma associated with contracting an STD and living with an STD by facilitating and encouraging awareness, education, and acceptance through storytelling and resource recommendations. You can also find The STD Project on Facebook and Twitter. Look for her e-Book, “The Relationship Survival Guide to Living with an STD” available in 2013. TakePart.com