Sexually transmitted diseases (also known as STDs – or STIs for sexually transmitted infections) are infectious diseases that spread from person to person through intimate contact. STDs can affect populations of all ages all ages and backgrounds. Unprotected sex can have negative consequences. Sexually transmitted diseases result in high social, economic, and health costs for affected persons, their children, and society. While sexually transmitted diseases (STDs) rates in the United States (US) have been in serial decline for the past several decades, rates of both Chlamydia and gonorrhea have increased in recent years. Reported cases of Chlamydia and gonorrhea in the United States exceeded 1.4 million in 2007, according to an annual report by the Centers for Disease Control and Prevention. These diseases continue to be the most commonly reported infectious diseases in the nation and pose persistent and preventable threats to fertility in the United States (CDC, 2009). Surveillance data show higher rates of reported STDs among some minority racial or ethnic groups when compared with rates among whites. Race and ethnicity in the United States are risk markers that correlate with other more fundamental determinants of health status such as poverty, access to quality health care, health care seeking behavior, illicit drug use, and living in communities with high prevalence of STDs.
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Tarrant County is an urban county located in the north central part of Texas. Fort Worth serves as the county seat to a county population of approximately 1.7 million citizens. Data indicates that the prevalence and morbidity of these two sexually transmitted infections continues to increase. The minority populations (African American or Blacks are about 13.8% while the Hispanics or Latinos make up about 23.9% about 56 %.).
In 2007, gonorrhea, accounted for 2565 cases, Chlamydia was 5583 cases. Gonorrhea total cases were 2565 (Blacks were 1831, while Hispanics were 260 and whites were only 394). Chlamydia total was 5583 with Blacks share of 2416 and Hispanics 1526) Tarrant County Public Health, 2009).
Prevalence seems to be ethnic and demographically concentrated. For example, incidence rates of sexually transmitted diseases in Tarrant County, Texas, from 2000 through 2007 were assessed and compared with the rates in Texas and the United States, with the focus on similarities and differences in gender, age, and race/ethnicity. Data were obtained from the Tarrant County Public Health Department, the Texas Department of Health, and the Centers for Disease Control and Prevention. The rates for gonorrhea and Chlamydia in Tarrant County were significantly higher than rates in Texas and the United States. The largest disparity was found among blacks, followed by Hispanics and then whites. To increase awareness and reduce the burden of sexually transmitted diseases, prevention programs need to be developed.
Understanding the epidemiology of these two treatable infections, especially among minority populations where disease burden is high, is important since together they account for over 95% of all STD morbidity in the US (CDC 2009). An estimated 18 million new cases of STDs occur each year at an estimated annual cost of $11.4 billion in year 2000 dollars (CDC, 2008).
Statement of the problem
Each year in the United States, about 15 million cases of sexually transmitted infections are identified (Adimora and, Schoenbach, (2003) making United States one the leading countries with the highest number of reported Sexually Transmitted Infections (STIs) in the world (Kilmarx PH, et al., 1997). For example, more than 1 million cases of Chlamydia were reported in the United States last year – the most ever reported for a sexually transmitted disease. CDC’s 2007 STD surveillance report also indicates ongoing racial disparities in common reportable STDs, with minorities, (African-Americans and Hispanics) bearing the greatest burden. For example, while representing 12 percent of the U.S. population, blacks had about 70 percent of reported gonorrhea cases and almost half of all Chlamydia (48 percent) in 2007 (CDC, 2008). Although STDs remain widespread, they are still considered to be “hidden” (unspoken and asymptomatic) epidemics with tremendous health and economic consequences (IOM, 1997). The Institute of Medicine (IOM) characterizes STDs in this manner because STDs remain an unspoken phenomenon in public even though they infect all segments of the US population (IOM, 1997). Another reason STDs can be described as hidden may be due to the asymptomatic nature for some of the diseases. Lack of awareness by the general public concerning the risks associated with STDs may cause serious health problems years after infection (IOM, 1997). Additionally, STDs not only lead to long-term health consequences, but they also add billions of dollars to the nation’s healthcare costs each year – an estimated $17 billion annually (CDC, 2001; Shafii & Burstein, 2004).
Nearly 1,031,000 cases were reported in 2008 up from 976,000 the year before U.S. Centers for Disease Control and Prevention (CDC, 2008). About three-quarters of women infected with Chlamydia in particular have no symptoms. Left untreated, the infection can spread and ultimately can lead to infertility. Untreated Chlamydia can lead to complications during pregnancy; fetal developmental disabilities (Kilmarx PH, Zaida AA, ThomasJC, Nagashima AK, St Luis ME, & Flock ML et al., 1997).Because of these complications, over 10 billion dollars is spent each year in the United States on STD’s prevention.
Shafer et al., 2002, noted that Chlamydia and gonorrhea infections are serious public health concern that disproportionately affects adolescents and adults especially, the minority population.
Significance of the Study
History is an important tool in understanding and interpreting the present and the future. Therefore, the significant of this paper deals with the understanding the history of race relations as it relates to factors and distribution of sexually transmitted diseases in United States. The history about health disparity and race relations in United States always a complex and controversial issue, because of the history of slavery and human dehumanization in America. Bernard J, (1966) laminated that race relations between the whites and the minorities still remain very controversial, because of the mistrust, miscommunications and ambiguity of human sexuality . Cornel W., (1993) wrote in his book Race Matters that the legacies of slavery still hunts our contemporary society, and that racism and social discrimination had created a complex mistrust in the United States that tend to render some good initiates on prevention with problems because sexual behavior is one of the factors that has been used to justify social repression. He concluded that as long as the society accepts that theory without challenge, we cannot investigate the reality of these significant events that have influenced our contemporary society. We as a society must examine our past in other to correct our present and future. Institute of Medicine (IOM) unequivocally declared in 2002 in a publication Unequal Treatment: Confronting Racial and ethnic Disparities in Healthcare, that bias, prejudice and stereotyping contribute seriously to the health disparities in United States. This study will examine the distribution and factors that have consistently led to the increase numbers of sexually transmitted diseases (Chlamydia and gonorrhea) in Tarrant County, understanding the distribution and factors that affect Chlamydia and gonorrhea epidemic among ethnic minorities in Tarrant county of Texas will add to the body of knowledge as to why these two sexual infections are more prevalent in certain areas of the county. In order to formulate policies, many governments and societies, depend on the scientific data available, so it is significantly imperative that we have contemporary data on the factors that are inflecting the increase in Chlamydia and gonorrhea. In the context of Tarrant County Texas, in spite of the available data on the number of infections yearly, no literature have attempted to understand to the distribution patterns that of these two preventable sexual infections especially in the minority population. Also, exposing the relationship between Chlamydia, gonorrhea, locality and ethnicity will assist the local government in decision making that will lead to narrowing the health disparity, improving the infrastructures and social institutions in addition the diverting the available resources appropriately to reduce infections.
In an effort to increase and improve access to quality services which prevent STDs and their complications, understanding what factors influence individuals to seek or not seek treatment is essential for effective control of STDs (Amaro & Gornemann, 1991).
Further, the findings from this research will shed more light on the role of social status, race and ethnicity in Chlamydia and gonorrhea increase in the county. Findings from this research will be usefully to the ongoing debate as to the role of economics and social factors play in the increase of these sexual infections.
This study can provide the platform for improving STD prevention interventions (i.e. developing STD knowledge and counseling sessions with home sampling techniques, improving services to treat partners for these diseases, etc.) that focus on preventing Chlamydia and gonorrhea prevalence and morbidity in minority populations.
The role of risk behaviors and health outcomes appears to be affected by individual characteristics and larger socioeconomic and environmental forces. The ecological theory in public health and sociology argues that humans and their environment should be understood as a single unit (Germain & Gitterman, 1995). Human and his environment are indispensably intertwined. The environment continually affects and shapes our behavior and health, creating a dynamic interaction of reciprocity. Thus, a range of both individualistic micro -level and environmentally macro- level forces directly influences our health (Holmes, 1994; Wasserheit, 1994). While they do exert a degree of influence of our health status, micro -level characteristics are shaped and ultimately controlled by the potent structural forces of the macro-environment, including socioeconomic, demographic, political, epidemiologic, and technological factors (Wasserheit, 1994, p.2432).
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Literatures reviewed indicate a certain geographic pattern associated with sexually transmitted infections such as Chlamydia, and gonorrhea (Tarrant County Public Health, 2009). It is important to acknowledge that many different theories have been promulgated about the factors and the distribution of Chlamydia and gonorrhea generically, but no coherent acceptable theory when it comes down to Tarrant County Texas. Tarrant County is made up of
Chapter 2: Literature Review
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Chapter 3: Research Method
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Chapter 4: Results
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Chapter 5: Discussion, Conclusions, and Recommendations
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