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. Acknowledging the disparity in STD rates
by race or ethnicity is one of the first steps in empowering affected
communities to organize and focus on this problem.
Surveillance data are based on cases of STDs reported to state
and local health departments (see Appendix). In many areas, reporting
from public sources, (for example, STD clinics) is more complete
than reporting from private sources. Since minority populations
may utilize public clinics more than whites, differences in rates
between minorities and whites may be increased by this reporting
bias.
Observations
Although chlamydia in women is a widely distributed STD
among all racial and ethnic groups, trends in positivity
in women screened in HHS Region X show consistently higher
chlamydia positivity among minorities (Figure
W).
In 2003, the rate of chlamydia among African-American
females in the United States was more than 7 times higher
than the rate among white females (1,633.1 and 217.9 per
100,000, respectively) (Table
11B). The chlamydia rate among
African-American males was 11 times higher than that among
white males (584.2 and 52.9 per 100,000 respectively).
In 2003, chlamydia positivity among sexually active 15-
to 30-year-old women screened at clinics of the Indian Health
Service (IHS) in two IHS areas was 11.0% (Figure
X).
In 2003, 70.7% of the total number of cases of gonorrhea
reported to CDC occurred among African-Americans (Table
21A). In 2003, the rate of gonorrhea among African-Americans
was 655.8 cases per 100,000 population, among American Indian/Alaska
Natives the rate was 103.5, and among Hispanics the rate
was 71.7. These rates are 20, 3, and 2 times higher, respectively,
than the rate among whites in 2003 of 32.7 cases per 100,000
population. The rate of gonorrhea among Asian/Pacific Islanders
in 2003 was 22.8 cases per 100,000 population (Figure
16,
Table 21B).
Gonorrhea rates in 2003 were highest for African-Americans
aged 15-24 years among all racial, ethnic, and age categories.
In 2003, African-American women aged 15-19 years had a gonorrhea
rate of 2,947.8 cases per 100,000 females. This rate is
14 times greater than the 2003 rate among white females
of similar age (204.8). African-American men in the 15-
to 19-year-old age category had a 2003 gonorrhea rate of
1,464.1 cases per 100,000 males, which was 39 times higher
than the rate among 15- to 19-year-old white males of 37.7
per 100,000. Among 20- to 24-year-olds in 2003, the gonorrhea
rate among African-Americans was 18 times greater than that
among whites (2,683.1 and 152.0 cases per 100,000 population,
respectively) (Table 21B).
Although gonorrhea rates declined for most age and race/ethnic
groups during the 1980s, they did not decline for African-American
adolescents. African-American females 15 to 19 years of
age did not show a decline in rates until 1991 (Figure
Y).
Declines among African-American males aged 15-19 years did
not begin until 1992 (Figure
Z). From 1999 through 2003,
gonorrhea rates among African-Americans declined by 18.9%
(808.4 and 655.8 cases per 100,000 population, respectively).
During the same period, gonorrhea rates increased by 22.5%
among whites, 17.5% among Asian/Pacific Islanders, 11% among
Hispanics, and 5.5% among American Indian/Alaska Natives
(Table 21B).
The syphilis epidemic in the late 1980s occurred primarily
among heterosexual, minority populations.1During
the 1990s, the rate of primary and secondary (P&S) syphilis
declined among all racial and ethnic groups (Figure
30).
During 2000-2003, the rate continued to decline among African-Americans,
but the overall rate of P&S syphilis and rates among
non-Hispanic whites, Hispanics, Asian/Pacific Islanders,
and American Indian/Alaska Natives increased; increases
in P&S syphilis occurred only among men and the most
rapid rate of increase occurred among non-Hispanic white
men during this time (Table
34B). Despite recent changes
in the demographics of syphilis infection, the rates of
P&S syphilis continue to be higher among African-Americans
and Hispanics than among non-Hispanic whites.
In 2003, 39.2% of all cases of P&S syphilis reported
to CDC occurred among African-Americans and 41.9% of all
cases occurred among non-Hispanic whites (Table
34A). Although
the rate of P&S syphilis among African-Americans declined
from 9.5 to 7.8 cases per 100,000 population between 2002
and 2003, the 2003 rate was 5.2 times greater than the rate
among non-Hispanic whites (1.5 cases per 100,000 population).
The incidence of P&S syphilis among African-Americans
was highest among women aged 20-24 years (11.1 cases per
100,000 population) and among men aged 35 to 39 (25.7 cases
per 100,000 population) in 2003 (Table
34B).
Between 2002 and 2003, P&S syphilis rates for African-Americans
aged 15-19 years declined 18.1%; rates declined 31.8% among
African-American females but increased 3.4% among African-American
males in this age group (Figures
AA and BB, Table
34B).
The P&S syphilis rate among young African-American adults
aged 20-24 years declined 13.7% between 2002 and 2003; rates
declined 30.6% among African-American females and 1.4% among
African-American males in this age group (Table
34B).
In 2003, 16.2% of all cases of P&S syphilis reported
to CDC occurred among Hispanics (Table
34A). The rate of
P&S syphilis among Hispanics increased 20.0% (from 2.5
to 3.0 cases per 100,000 population) between 2002 and 2003.
The rate among Hispanics in 2003 was 2.0 times greater than
the rate among non-Hispanic whites.
The incidence of P&S syphilis among Hispanics was
highest among women aged 15- to 24-years (2.3 cases per
100,000 population) and among men aged 35 to
39 (12.7 cases per 100,000 population) in 2003 (Table
34B).
In 2003, the rate of congenital syphilis (based on the
mother's race/ethnicity) was 33.9 cases per 100,000
live births among African-Americans and 18.1 cases per 100,000
live births among Hispanics. These rates are 26 and 14 times
greater, respectively than the 2003 rate among non-Hispanic
whites (1.3 cases per 100,000 live births), respectively
(Figure CC, Table
44).
1 Nakashima AK, Rolfs RT, Flock ML, Kilmarx P,
Greenspan JR. Epidemiology of syphilis in the United States, 1941
through 1993. Sex Transm Dis 1996;23:16-23.