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STDs in Racial and Ethnic Minorities

Public Health Impact

     Surveillance data show higher reported rates of 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 is a widely distributed STD among all racial and ethnic groups, trends in positivity in women screened in HHS Region X (Alaska, Idaho, Oregon, and Washington) show consistently higher chlamydia positivity among minorities (Figure U).
    
• In 2000, chlamydia positivity among sexually active 15- to 30-year old women screened at clinics of the Indian Health Service (IHS) in four IHS regions ranged from 3.9% to 9.9% (Figure V).
    
• In 2000, 76.4% of the total number of cases of gonorrhea reported to CDC occurred among African-Americans (Table 20A). The reported rate of gonorrhea among African-Americans in 2000 was 827.0 cases per 100,000 persons. Among Hispanics, the 2000 reported gonorrhea rate was 78.1 cases per 100,000 persons. These rates are 30 and 3 times higher than the rate reported among non-Hispanic whites in 2000 of 28.0 cases per 100,000 persons (Figure 13, Table 20B).
    
• Gonorrhea rates in 2000 were highest for African-Americans aged 15 to 24 among all racial, ethnic, and age categories. In 2000, African-American women aged 15 to 19 years had a gonorrhea rate of 3,594.3 cases per 100,000 females. This rate is 19 times greater than the 2000 rate among non-Hispanic white females of similar age (188.9). African-American men in the 15- to 19-year old age category had a 2000 gonorrhea rate of 1,911.6 cases per 100,000 males, which was 50 times higher than the rate among 15- to 19-year old white males of 38.1 (Table 20B). Among 20- to 24-year-olds in 2000, the gonorrhea rate among African-Americans was 26 times greater than that among non-Hispanic whites (3,418.2 and 130.9 cases per 100,000 persons respectively) (Table 20B).
    
• Despite declines in gonorrhea rates for most age and race/ethnic groups during the 1980s, African-American adolescent females aged 15 to 19 years did not show a decline in rates until 1991 (Figure W). Similarly, declines among African-American adolescent males did not begin until 1992 (Figure X). From 1999 to 2000 gonorrhea rates among African-Americans declined slightly by 2.5% (848.2 and 827.0 cases per 100,000 persons respectively). During the same period, gonorrhea rates increased by 11.7% among Hispanics, 43.5% among Asian/Pacific Islanders, and 4.1% among American Indians/Alaska Natives (Table 20B).
    
• The epidemic of syphilis in the late 1980s was largely an epidemic in heterosexual, minority populations.¹ From 1990 to 1996, rates of primary and secondary (P&S) syphilis declined among all racial and ethnic groups (Table 32B). Since 1996, rates of P&S syphilis have generally been stable among all racial and ethnic groups except African-Americans, among whom rates have steadily declined. Rates for African-Americans and Hispanics continue to be higher than for non-Hispanic whites. In 2000, 70.8% of all cases of P&S syphilis reported to CDC occurred among African-Americans (Table 32A). Although the rate for African-Americans declined from 15.0 to 12.8 cases per 100,000 persons between 1999 and 2000, the 2000 rate was 21 times greater than the rate of 0.6 per 100,000 persons among non-Hispanic whites. Between 1999 and 2000, P&S syphilis rates for African-American females aged 15 to 19 years declined by 16.1%, and for African-American males in this age group by 6.4% (Figures Y and Z, Table 32B). Similarly, the P&S syphilis rate declined by 8.6% between 1999 and 2000 among young African-American adults aged 20 to 24 years. The 2000 rate of P&S syphilis among Hispanics was 1.8 cases per 100,000 persons, which is 3 times greater than the rate among non-Hispanic whites (Table 32B).
    
• In 2000, the rate of congenital syphilis was 49.3 cases per 100,000 live births among African-Americans and 22.6 cases per 100,000 live births among Hispanics. These rates are 33 and 15 times greater than the 2000 rate of 1.5 cases per 100,000 live births among non-Hispanic whites respectively (Figure AA). Compared with 1999, the 2000 rate of congenital syphilis decreased by 15.9% among African-Americans but increased 12.4% among Hispanics.

¹Nakashima 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.

Figure U. Chlamydia — Positivity among women tested in family planning clinics by race and ethnicity: Region X, 1988–2000

Note: Women who met screening criteria were tested. Trends not adjusted for changes in laboratory test method and associated increases in test sensitivity in 1994, 1999, and 2000.

Figure V. Chlamydia — Positivity among 15-30 year old women tested in Indian Health Service Clinics by IHS regions, 2000

STDs in Racial and Ethnic Minorities figures continued on page 2