Disparties in Sexually Transmitted Diseases (STD): The Need to Move Beyond the Traditional Behavioral Risk Reduction Strategies

Background: Traditionally, public health efforts to prevent and control STDs have been through surveillance, clinical services, partner management, and behavioral intervention. However, the persistence of disparities in STDs indicates that these strategies alone are not achieving sufficient impact in African American and Hispanic communities.

Objectives: To examine whether, individuals’ risk behaviors account for racial/ethnic disparities in STDs.

Methods: STD surveillance data was analyzed to describe racial/ethnic disparities through use of rate ratio. Both bivariate and multivariate statistical analyses were conducted to examine whether individuals’ risk behaviors account for the racial/ethnic disparities in STDs.

Results: African American:White rate ratio was 9.6:1 for gonorrhea, 8.5:1 for Chlamydia, and 1.8:1 for early syphilis, and that African Americans accounted for 41%, 24%, and 27% of all reported cases, respectively. Hispanic: White rate ratio was 0.9:1 for gonorrhea, 2.6:1 for Chlamydia, and 1.1:1 for early syphilis, and that Hispanics accounted for 22%, 40%, and 47% of all reported cases, respectively. Compared to Whites, African Americans were less likely to have multiple partners (PR=0.68, 95% CI 0.49-0.93); anonymous sex (PR=0.68, 95% CI 0.32-0.68); and there was no statically difference in condom use (p = 0.18). Hispanics were less likely to have anonymous sex (PR=0.50, 95% CI 0.38-0.67) than Whites; and there were no statically difference in condom use (p = 0.11) and having multiple partners (p = 0.70) between Hispanics and Whites.

Conclusions: Unlike Whites, African Americans and Hispanics need not engage in high-risk behaviors to be contracting an STD indicating that other factors seem to contribute to racial/ethnic STD disparities.

Implications for Programs, Policy, and/or Research: Traditional STD prevention and control interventions in the African American and Hispanic communities need to be tailored to enhance their outcomes. To accomplish this, the social and environmental determinants that make African American and Hispanics vulnerable to STD should be considered.