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Decades of research and practice have shown that individuals can be predisposed to certain medical conditions based on their demographic segment, leading to health disparities among socioeconomic groups. Negative outcomes within these groups are impacted by inequities in healthcare, such as the lack of proper nutrition, wellness education, clean water and others that can affect disease severity, access to testing and treatment, and more. A top priority for the CDC, as well as PRL, is to achieve health equity, which is defined as every individual having an equal opportunity to attain full health potential regardless of social circumstances.1

In honor of Sexual Health Awareness Month in September, PRL is exploring the effects of health disparities and inequities when it comes to sexually transmitted infection (STI) rates in three historically underserved populations. According to the National Institutes of Health, STI prevention can help reduce long-term medical complications, costs and public health burdens in the U.S.2 Since a key element to prevention is access to health services, we will identify three factors posing significant barriers to sexual health equity: poverty, racial or ethnic identity, and sexual orientation.

Poverty

Low-income individuals struggling to attain food, water, shelter or other basic needs tend to lack consistent access to general and sexual health care. Despite the passage of the Affordable Care Act in 2010, which expanded the Medicaid program to make health insurance more affordable for low-income individuals, the gap in health equity still exists today.3 In addition to dealing with the struggles that come with poverty, some individuals also face substance abuse issues, which impair decisions and further heightens the risk of contracting STIs.

Women in poverty, in particular, often have limited access to reproductive health education and services, such as contraceptive care, pregnancy options and obstetrics services. A woman’s immigration status can also affect her willingness and ability to find and utilize some of these essential services.5

Racial or Ethnic Identity

Racial and ethnic minorities can experience economic inequity and health disparities. These groups also report high rates of STIs6 and face distinct barriers when it comes to accessing medical care. For example, bureaucratic roadblocks impede immigrants from receiving insurance coverage, systemic failures keep researchers and practitioners from monitoring and meeting the needs of native populations living on reservations, and bias or ignorance can prevent healthcare professionals from administering adequate care to patients outside their own race or ethnicity.7 Furthermore, some racial and ethnic communities have been historically subject to mistreatment by the medical profession, which can lead to a distrust of the industry and reluctance to seek care.8

Sexual Orientation

It is widely known that one of the primary groups disproportionately affected by the HIV/AIDS epidemic in the 80s and 90s were gay men.9 To this day, the lesbian, gay, bisexual, transgender, queer/questioning, intersex and asexual (LGBTQIA+) community—especially men who have sex with men—is at a higher risk of contracting HIV and other STIs. In 2019, 48% of new HIV diagnoses were among African American and Hispanic populations engaging in male-to-male sexual contact.10 Even more recently, the LGBTQIA+ community is facing the new looming threat of monkeypox, which is predominantly spreading among men who have sex with men, and is still suffering from limited access to healthcare treatment and resources. 

Another major driver of inequity for this group is widely reported discrimination and a resulting fear of mistreatment from medical professionals, which leads to delay in seeking care. Bias and misinformation can lead to substandard levels of care for LGBTQIA+ patients, especially with regard to sexual health and STI transmission. Lack of inclusion and representation of LGBTQIA+ people in sexual education materials is another important factor in the fight toward health equity. Less than 7% of LGBTQ students in the U.S. reported that sexual orientation and gender identity were topics of discussion during their sexual health education.11

Making Progress Toward Achieving Health Equity

Poverty, racial or ethnic identity, and sexual orientation each present challenges to sexual health equity, and these three socioeconomic groups frequently overlap. This intersectionality further complicates access to quality, accessible healthcare, effective preventive measures and treatment. 

Pandemic Response Lab strives to help make diagnostics and healthcare more equitable and accessible by utilizing laboratory innovation and next-generation syndromic PCR testing to improve patient outcomes. Born out of the COVID-19 pandemic, we’ve recently expanded beyond COVID/respiratory health diagnostics into sexual health testing. By leveraging automation and multi-target panels, we eliminate the need for serial testing and cut down wait times and costs for our customers, as well as the patients they serve. 

We are available to partner with federally qualified health centers, sexual health clinics and other community organizations providing medical or diagnostic support to historically underserved populations to provide equitable access to sexual health prevention, diagnostics and treatment.

 

1. Health equity. CDC. Published March 3, 2022. Accessed September 14, 2022. https://www.cdc.gov/chronicdisease/healthequity/index.htm

2. Chesson HW, Mayaud P, Aral SO. Sexually Transmitted Infections: Impact and Cost-Effectiveness of Prevention. In: Disease Control Priorities, Third Edition (Volume 6): Major Infectious Diseases. The World Bank; 2017:203-232. Accessed September 14, 2022. http://dx.doi.org/10.1596/978-1-4648-0524-0_ch10

3. Engineering National Academies of Sciences, Health, Division M, et al. The Need to Promote Health Equity. NCBI Bookshelf. Published January 11, 2017. https://www.ncbi.nlm.nih.gov/books/NBK425853/

4. Feaster DJ, Parish CL, Gooden L, et al. Substance Use and STI Acquisition: Secondary Analysis from the AWARE Study. Drug and alcohol dependence. 2016;169. doi:10.1016/j.drugalcdep.2016.10.027

5. Beyond the Numbers: Access to Reproductive Health Care for Low-Income Women in Five Communities - Executive Summary. KFF. Published November 14, 2019. Accessed September 27, 2022. https://www.kff.org/report-section/beyond-the-numbers-access-to-reproductive-health-care-for-low-income-women-in-five-communities-executive-summary/

6. Sexually Transmitted Diseases. Healthy People 2020. Accessed September 14, 2022. https://wayback.archive-it.org/5774/20220413182711/https://www.healthypeople.gov/2020/topics-objectives/topic/sexually-transmitted-diseases

7. Engineering National Academies of Sciences, Health, Division M, et al. The Need to Promote Health Equity. NCBI Bookshelf. Published January 11, 2017. https://www.ncbi.nlm.nih.gov/books/NBK425853/

8. Armstrong K, Ravenell KL, McMurphy S, Putt M. Racial/Ethnic Differences in Physician Distrust in the United States. American Journal of Public Health. 2007;97(7). doi:10.2105/AJPH.2005.080762

9. History.com Editors. AIDS Crisis Timeline. HISTORY. https://www.history.com/topics/1980s/hiv-aids-crisis-timeline. Published June 14, 2021. Accessed September 14, 2022.

10. CDC. HIV and African American Gay and Bisexual Men. Centers for Disease Control and Prevention. Published September 14, 2022. Accessed September 14, 2022. https://www.cdc.gov/hiv/group/msm/bmsm.html

11. Rabbitte M. Sex Education in School, are Gender and Sexual Minority Youth Included?: A Decade in Review. American journal of sexuality education. 2020;15(4). doi:10.1080/15546128.2020.1832009


 

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STIs in 3 Underserved Populations: How to Achieve Sexual Health Equity

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