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Table 3.E Summary Case Study Sites - Institutions, Barriers


Institutions Able to Reach At-risk Populations
Barriers
Hinds Co

MS

Schools

Religious institutions

Health Department

White flight and inner-city deterioration create conditions of crime and drug use and hinder efforts to build city-wide coalitions to address public health problems. Local conservative views about public discussion of sexual health limit direct involvement of key community institutions like churches, schools, and the media. Some African-American clients avoid seeking care at public health clinics due to feelings of mistreatment, stigma, and embarrassment. Clinic staff attitudes, some clinic procedures, lack of awareness of services, and programmatic funding restrictions also contributed.
Humphreys Co

MS

Schools

Religious institutions

Health Department

Access to health care is limited in most of this rural county, and residents of small towns avoid seeking treatment for STDs in local clinics because of stigma, embarrassment, and concerns about confidentiality. Many African-American residents feel that public health staff treat them disrespectfully when they report to clinics with STDs such as syphilis.
Richland Co

SC

Health Department

Other health care providers

Drug treatment centers

Schools

Religious institutions

Correctional facilities

Housing authority

Community-based organizations

Like other sites, insensitivity by STD clinic staff toward clients hinders treatment seeking, especially among African Americans. Discussion of sexual health is left up to individual school districts to implement, and conservative local standards constrain realistic discussions of risk factors and often limit mention of sexual options other than abstinence.
Orangeburg Co

SC

Health department and other health care providers

Schools

Religious institutions

Community-based organizations

Mistrust of public health STD clinics, especially among African Americans, is a barrier to treatment seeking in Orangeburg County. Orangeburg's location between two urban areas makes contact tracing by DIS difficult because of the widespread network of sexual partners.
Shelby Co

TN

Health department

Schools

Religious institutions

Community-based organizations

Confusion over health care access due to the introduction of TennCare hinders treatment seeking in Memphis. Strict limits on the hours DIS are allowed to work hinders their ability to carry out contact tracing/partner notification efforts. Long lines in the STD clinic waiting room discourage some people from seeking treatment. Emphasis on treatment over prevention and lack of a unified STD message also contribute, as do some clinic fees and procedures.
Tunica Co

MS

Health care providers

Schools

Religious institutions

Community-based organizations

Preventive health care is a low priority among African-American residents in Tunica. Concerns about confidentiality and embarrassment in this small rural town keep people from seeking care for STDs.
Montgomery Co

AL

Schools

Religious institutions

Health care providers

Community health centers

Housing authority

Community-based organizations

The inordinate amount of time Public Health Reps spend doing paper work, the lack of available computers, and limited clerical staff all hinder their ability to follow up on contacts in the community or to deliver preventive health education. The strict "medical mode" followed by the county Health Department draws efforts away from prevention activities. Programmatic funding restrictions may mean patients must visit different providers for different services. Strong conservative influences severely limit the discussion of sexual health issues in the public and private school systems.
Lowndes Co

AL

Schools

Religious institutions

Health care providers

Community health centers

Housing authority

Community-based organizations

A lack of available transportation in this very rural county limits the ability of people to seek treatment for STDs. Stigma, embarrassment, and questions about confidentiality also hinder treatment seeking. A lack of recreation contributes to the high rates of unprotected sex with multiple partners among teenagers.

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