Confronting STD Disparities In African American Communities: Awareness of and Suggestions for Addressing the Problem

Theoretical Background and research questions/hypothesis: African Americans (AAs) make up 12% of the United States (U.S.) population, yet they account for about half of all reported chlamydia and syphilis cases, and 70% of gonorrhea cases. Raising AA community awareness of these STD disparities may be an important first step in addressing the problem, but how and whether this information can be effectively conveyed is unknown. This research sought to uncover community member’s reactions to STD-disparity information and suggestions for effective dissemination, if appropriate.

Methods: Triads (n=31) and individual interviews (n=64) were conducted with sexually active, heterosexual AA adults, ages 18-45, in four high STD incidence communities. Triads were segmented by age, gender, and urban/rural residence. Participants were given plain-language STD-disparities information to review. Interviewers used a loosely-structured guide to explore participant reactions to the information, including believability/credibility, and how/whether it should be disseminated. Discussions were audio-taped and transcribed. Three analysts coded transcripts using QSR NVivo8, based on a codebook developed from identified themes.

Results: A total of 158 adults participated. Many reacted with surprise, fear, and sadness/despair, questioning why AA always bear the heaviest disease burden. Most participants believed the information, referring to statistics they had heard before. Even among those who were aware, many did not perceive it to be personally relevant to them. Some wondered if socioeconomic status, rather than race/ethnicity, was behind the disparity. Sixteen participants did not believe the information, citing suspicions about the data sources, collection methods and artificially inflated rates; disbelief that other races have such low rates; and  government conspiracies. Suggestions for making the information more believable included: providing clear sources and details about the research, data collection, analysis and results; segmenting the data by age group/gender; and adding rates for other races. All participants thought it was important to get the information out to AA communities to raise awareness and promote testing. Many were neutral about or against disseminating the information in non-AA communities, explaining that it would be offensive or embarrassing, perpetuating racism and discrimination. Alternative dissemination modes were discussed.

Conclusions: AAs feel it is important to inform their communities about STD disparities, but this information must be carefully crafted, explained, and disseminated, given the historical context of racism, discrimination and STD stigma in the U.S.

Implications for research and/or practice: Although only a minority of participants did not believe the STD disparity information, their comments hinted at a dislike of, and defensiveness toward, direct black-white comparisons. Health communicators should consider providing contextualizing information and clear explanations of data sources and methods when communicating about health disparities, particularly with regard to sensitive and stigmatizing conditions. Presenting data in absolute terms (rather than comparing by race/ethnicity) may help avoid comparisons that can further contribute to stigmatization. Finally, communication from within the community and at a personal level (e.g., personal stories or testimonials) may increase message acceptability and help to personalize, normalize and destigmatize the issue of STDs. Research is needed to explore whether the presentation of STD rates in absolute or relative terms furthers understanding and promotes message acceptability, perceived relevance of STDs, and motivation to act on the information.