In the United States, sexually transmitted infections (STIs) are among the most persistent threats to health equity. Increasing access to STI prevention and control services through the provision of ...Remote Health and Telehealth can improve sexual health outcomes. Telehealth has been shown to increase access to care and even improve health outcomes. The increased flexibility offered by Telehealth services accommodates both patient and provider. Although both Telehealth and Remote Health strategies are important for STI prevention, share common attributes, and, in some circumstances, overlap, this article will focus more specifically on considerations for Telehealth and how it can contribute to increasing health equity by offering an important complement to and, in some cases, substitute for in-person STI services for some populations. Telehealth assists a variety of different populations, including those experiencing STI disparities; however, although the Internet offers a promising resource for many American households and increasing percentages of Americans are using its many resources, not all persons have equal access to the Internet. In addition to tailoring STI programs to accommodate unique patient populations, these programs will likely be faced with adapting services to fit reimbursement and licensing regulations.
Syphilis Elimination: Lessons Learned Again Valentine, Jo A; Bolan, Gail A
Sexually transmitted diseases,
2018-September, 2018-09-00, 2018-9-00, 20180901, Letnik:
45, Številka:
9S Suppl 1
Journal Article
Recenzirano
Odprti dostop
ABSTRACTIt is estimated that approximately 20 million new sexually transmitted infections (STIs) occur each year in the United States. The federally funded sexually transmitted disease prevention ...program implemented by Centers for Disease Control and Prevention is primarily focused on the prevention and control of the three most common bacterial STIssyphilis, gonorrhea, and chlamydia. A range of factors facilitate the transmission and acquisition of STIs, including syphilis. In 1999, Centers for Disease Control and Prevention launched the National Campaign to Eliminate Syphilis from the United States. The strategies were familiar to public health in general and to sexually transmitted disease control in particular(1) enhanced surveillance, (2) expanded clinical and laboratory services, ((3) enhanced health promotion, (4) strengthened community involvement and partnerships, and (5) rapid outbreak response. This national commitment to syphilis elimination was not the first effort, and like others before it too did not succeed. However, the lessons learned from this most recent campaign can inform the way forward to a more comprehensive approach to the prevention and control of STIs and improvement in the nationʼs health.
Sexually transmitted infections (STI), including HIV, are among the most reported diseases in the U.S. and represent some of America’s most significant health disparities. The growing scarcity of ...health care services in rural settings limits STI prevention and treatment for rural Americans. Local health departments are the primary source for STI care in rural communities; however, these providers experience two main challenges, also known as a
double disparity:
(1) inadequate capacity and (2) poor health in rural populations. Moreover, in rural communities the interaction of rural status and key determinants of health increase STI disparities. These key determinants can include structural, behavioral, and interpersonal factors, one of which is stigma. Engaging the expertise and involvement of affected community members in decisions regarding the needs, barriers, and opportunities for better sexual health is an asset and offers a gateway to sustainable, successful, and non-stigmatizing STI prevention programs.
BACKGROUNDCommunity Approaches to Reducing Sexually Transmitted Disease (CARS), a unique initiative of the US Centers for Disease Control and Prevention, promotes the use of community engagement to ...increase sexually transmitted disease (STD) prevention, screening, and treatment and to address locally prioritized STD-related social determinants of health within communities experiencing STD disparities, including youth, persons of color, and sexual and gender minorities. We sought to identify elements of community engagement as applied within CARS.
METHODS AND MATERIALSBetween 2011 and 2018, we collected and analyzed archival and in-depth interview data to identify and explore community engagement across 8 CARS sites. Five to 13 interview participants (mean, 7) at each site were interviewed annually. Participants included project staff and leadership, community members, and representatives from local community organizations (e.g., health departments; lesbian, gay, bisexual, transgender, and queer–serving organizations; faith organizations; businesses; and HIV-service organizations) and universities. Data were analyzed using constant comparison, an approach to grounded theory development.
RESULTSTwelve critical elements of community engagement emerged, including commitment to engagement, partner flexibility, talented and trusted leadership, participation of diverse sectors, establishment of vision and mission, open communication, reducing power differentials, working through conflict, identifying and leveraging resources, and building a shared history.
CONCLUSIONSThis study expands the community engagement literature within STD prevention, screening, and treatment by elucidating some of the critical elements of the approach and provides guidance for practitioners, researchers, and their partners as they develop, implement, and evaluate strategies to reduce STD disparities.
Racial disparities in female gonorrhea rates are not confined to the Southeast; both relative and absolute disparities are equivalent or larger in areas of the Northeast, Midwest, and West.
...Background
Spatial analyses of gonorrhea morbidity among women often highlight the Southeastern United States but may not provide information on geographic variation in the magnitude of racial disparities; such maps also focus on geographic space, obscuring underlying population characteristics. We created a series of visualizations depicting both county-level racial disparities in female gonorrhea diagnoses and variations in population size.
Methods
We calculated county- and region-level race-specific relative rates (RelR) and between-race rate differences (RDs) and rate ratios (RRs) comparing gonorrhea case rates in non-Hispanic Black (NHB) versus non-Hispanic White (NHW) women. We then created proportional symbol maps with color representing counties' RelR/RD/RR category and symbol size representing counties' female population.
Results
Gonorrhea rates among NHB women were highest in the Midwest (718.7/100,000) and West (504.8), rates among NHW women were highest in the West (74.1) and Southeast (72.1). The RDs were highest in the Midwest (654.6 excess cases/100,000) and West (430.7), whereas the RRs were highest in the Northeast (12.4) and Midwest (11.2). Nearly all US counties had NHB female rates ≥3× those in NHW women, with NHB women in most highly populated counties experiencing ≥9-fold difference in gonorrhea rates.
Conclusions
Racial disparities in gonorrhea were not confined to the Southeast; both relative and absolute disparities were equivalent or larger in magnitude in areas of the Northeast, Midwest, and West. Our findings help counter damaging regional stereotypes, provide evidence to refocus prevention efforts to areas of highest disparities, and suggest a useful template for monitoring racial disparities as an actionable public health metric.
Partnership is a much-venerated concept and is regularly applied to a broad range of human endeavors, as both a means to an end and the desired end itself. For example, to promote the public's health ...many programs often rely on partnerships between institutions and communities to implement interventions. Yet despite their generally positive value, partnerships are not without challenges. Unfortunately there are times when a given partnership does not advance a common good, as illustrated by the U.S Public Health Service Syphilis Study at Tuskegee, Alabama (the Syphilis Study), which lasted forty years. However, despite this tragic history, by employing the principles of authentic partnership, the relationships between the federal government, Tuskegee University, and the affected communities are experiencing transformation. By collaboratively working together these partners are able to effectively promote and support ethical public health research and practice.
BACKGROUNDThe Centers for Disease Control and Prevention recommends annual sexually transmitted infection (STI) and HIV testing and counseling for men who have sex with men (MSM) in the United ...States. We estimated the annual total direct medical cost of providing recommended STI and HIV testing and counseling services for MSM in the United States.
METHODSWe included costs for 9 STI (including anatomic site–specific) tests recommended by the Centers for Disease Control and Prevention (HIV, syphilis, gonorrhea, chlamydia, hepatitis B viral infection, and herpes simplex virus type 2), office visits, and counseling. We included nongenital tests for MSM with exposure at nongenital sites. All cost data were obtained from the 2012 MarketScan outpatient claims database. Men were defined as MSM if they had a male sex partner within the last 12 months, which was estimated at 2.9% (2.6%–3.2%) of the male population in a 2012 study. All costs were updated to 2014 US dollars.
RESULTSThe estimated average costs were as followsHIV ($18 $9–$27), hepatitis B viral infection ($23 $12–$35), syphilis ($8 $4–$11), gonorrhea and chlamydia ($45 $22–$67) per anatomic site), herpes simplex virus type 2 ($27 $14–$41), office visit ($100 $50–$149), and counseling ($29 $15–$44). We estimated that the total annual direct cost of a universal STI and HIV testing and counseling program was $1.1 billion ($473 million–$1.7 billion) for all MSM and $756 (range, $338–$1.2 billion) when excluding office visit cost.
CONCLUSIONSThese estimates provide the potential costs associated with universal STI and HIV testing and counseling for MSM in the United States. This information may be useful in future cost and/or cost-effectiveness analyses that can be used to evaluate STI and HIV prevention efforts.
Compared to whites, blacks experience significant health disparities for sexually transmitted diseases, particularly in the rates of chlamydia, gonorrhea, and syphilis. To develop more effective ...interventions to control and prevent STDs, public health practitioners should better understand and respond to factors that facilitate sexual risktaking behaviors and impede access to STD health care and make use of factors that promote sexual health. Legacies of slavery, racism, and economic or class discrimination leave many blacks suspicious of interventions aimed at improving the welfare of their communities. Sexual behavior, in particular, has been used to justify social oppression of blacks in the United States. Although efforts to engage affected black communities in improving STD health care delivery have been undertaken, bias, prejudice, and stereotyping continue to contribute to negative experiences for many blacks across health care settings, including those involving STD care. Implementing more effective interventions to reduce the disparate burden of bacterial STDs in black communities requires accessible and acceptable STD health care. Understanding and addressing the potential impact of both provider and patient attitudes can improve these service delivery outcomes.
Racial disparities in female gonorrhea rates are not confined to the Southeast; both relative and absolute disparities are equivalent or larger in areas of the Northeast, Midwest, and West.
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