An Evaluation of Sexually Transmitted Disease (STD) Among American Indians in Arizona

Background: The national rates among American Indians (AI) for chlamydia, gonorrhea and syphilis are two to six times higher than the comparable rates for non-Hispanic whites (NHW).

Objectives: An analysis of rates, geographic distribution, and time to treatment of chlamydia, gonorrhea and early syphilis (ES) among Arizona AI was conducted in order to define racial disparities that particularly affect these communities.

Methods: The Arizona Department of Health Services STD surveillance database was used to identify STD cases and calculate rates among AI in Arizona during 2003-2007. AI cases for early syphilis were mapped by reported resident zip code. Days elapsed from specimen collection to initial treatment were calculated. Rates and time-to-treatment among AI were compared to those of NHW.

Results: Annual rates among AI for chlamydia ranged from 952.1 to 1035.4 per 100,000 population, gonorrhea ranged from 148.2 to 184.5 per 100,000 population, and ES ranged from 10.2 to 37.8 per 100,000 population.  For these diseases and years, annual rates among Arizona AI ranged from 3.0 to 7.8 times higher than those of NHW. The majority of ES cases reported zip codes located in the northeastern and southern central portions of the state. In comparison with NHW, median time to treatment in AI populations was significantly longer for chlamydia (7 vs. 4 days, p < 0.001) and gonorrhea (3 vs. 0 days, p < 0.001).

Conclusions: High STD rates disproportionately occur among AI in certain regions of Arizona. Additionally, significant delays in treatment for gonorrhea and chlamydia exist.

Implications for Programs, Policy, and/or Research: Agencies delivering care to AI populations should consider the use of standard guidelines that include empiric treatment of partners, expedited partner therapy, expanded partner services, and the presumptive treatment of symptomatic patients in order to improve this significant health disparity.