STDs in Racial and Ethnic Minorities

Public Health Impact

Surveillance data show higher rates of reported STDs among some racial or ethnic minority groups when compared with rates among whites. Race and ethnicity in the United States are population characteristics that also correlate with other fundamental determinants of health status.^1,2

Social and economic conditions, such as high rates of poverty, income inequality, unemployment, low educational attainment and geographic isolation can make it more difficult for individuals to protect their sexual health.³ People who struggle financially are often experiencing life circumstances that increase their risk for STDs.⁴ Those who cannot afford basic necessities may have trouble accessing and affording quality sexual health services.⁵ As an example, in 2010, the poverty rates, unemployment rates, and high school drop-out rates for blacks, American Indians/Alaska Natives, and Hispanics were considerably higher than for whites, differences commensurate with observed disparities in STD burden.^6–9 Many people of Hispanic ethnicity face additional barriers arising from immigration or undocumented citizenship status.¹⁰ Even when health care is available, fear and distrust of health care institutions can negatively affect the health careseeking experience for many racial/ethnic minorities when there is social discrimination, provider bias, or the perception that these may exist.^11,12

In communities where STD prevalence is higher, individuals may have a more difficult time reducing their risk for infection. With each sexual encounter, they face a greater chance of encountering an infected partner than those in lower prevalence settings.¹³ Acknowledging the inequity in STD rates by race or ethnicity is one of the first steps in empowering affected communities to organize and focus on this problem.

STD Reporting Practices

Surveillance data are based on cases of STDs reported to state and local health departments (see Interpreting STD Surveillance Data in the Appendix). In many state and local health jurisdictions, reporting from public sources (e.g., STD clinics) is thought to be more complete than reporting from private sources. Because minority populations may use public clinics more than whites, differences in rates between minorities and whites may be increased by this reporting bias.¹⁴ However, prevalence data from population-based surveys, such as NHANES and the National Longitudinal Study of Adolescent Health, confirm the existence of marked STD disparities in some minority populations.^15,16

Method of Classifying Race & Hispanic Ethnicity

Interpretation of racial and ethnic disparities among persons with STDs is influenced by data collection methods, and by the categories by which these data are displayed. For the first time, data on race and Hispanic ethnicity are displayed in this report in compliance with the 1997 Office of Management and Budget (OMB) standards.¹⁷ While 48 jurisdictions (47 states and the District of Columbia) collect and report data in formats compliant with these standards as of 2012, some jurisdictions only recently adopted this standard and used previous standards to report their case data to CDC in past years. The completeness of data available in current OMB standards continues to improve. However, historical trend and rate data by race and Hispanic ethnicity displayed in figures and interpreted in this report for 2008–2012 include only those jurisdictions (38 states plus the District of Columbia) reporting in the current standard consistently for 2008 through 2012. Please refer to Interpreting STD Surveillance Data in the Appendix for a complete listing of these jurisdictions.

Completeness of Race/Ethnicity Data

Many cases are reported with race and/or ethnicity missing. Rate data presented in this report are not adjusted for missing race or ethnicity.

Chlamydia—In 2012, 25.8% of chlamydia case reports were missing race or ethnicity data, ranging by state from 0.0% to 57.0% (Table A1).

Gonorrhea—In 2012, 19.2% of gonorrhea case reports were missing information on race or ethnicity, ranging by state from 0.0% to 43.3% (Table A1).

Syphilis—In 2012, 2.6% of P&S syphilis case reports were missing information on race or ethnicity, ranging from 0.0% to 21.9% among states with 10 or more cases of P&S syphilis (Table A1).

Observations

Chlamydia

Among the 39 jurisdictions (38 states and the District of Columbia) that submitted data on race and Hispanic ethnicity from 2008–2012 according to the revised OMB standards, chlamydia case rates increased during 2008–2012 among all racial and ethnic groups (Figure 6). During 2008–2012, chlamydia rates increased by 3.7% among blacks, 26.7% among American Indians/Alaska Natives, 7.6% among Hispanics, 5.1% among Asians, 32.4% among Native Hawaiians/Other Pacific Islanders, and 38.5% among whites.

In 2012, 48 jurisdictions (47 states and the District of Columbia) submitted data on race and Hispanic ethnicity in 2012 according to the revised OMB standards. The following data pertain to those jurisdictions:

Blacks—In 2012, the overall rate among blacks in the United States was 1,229.4 cases per 100,000 population (Table 11B). The rate of chlamydia among black women was over six times the rate among white women (1,613.6 and 260.5 per 100,000 females, respectively) (Table 11B and Figure L). The chlamydia rate among black men was over eight times the rate among white men (809.2 and 95.9 cases per 100,000 males, respectively).

Chlamydia rates were highest for blacks aged 15–19 and 20–24 years in 2012 (Table 11B). The chlamydia rate among black females aged 15–19 years was 7,719.1 cases per 100,000 females, which was over five times the rate among white females in the same age group (1,458.3 per 100,000 females). The rate among black women aged 20–24 years was 4.4 times the rate among white women in the same age group (Table 11B).

Similar racial disparities in reported chlamydia rates exist among men. Among males aged 15–19 years, the rate among blacks was 9.9 times the rate among whites (Table 11B). The chlamydia rate among black men aged 20–24 years was six times the rate among white men of the same age group (3,556.0 and 590.6 cases per 100,000 males, respectively).

American Indians/Alaska Natives— In 2012, the chlamydia rate among American Indians/Alaska Natives was 728.2 cases per 100,000 population (Table 11B). Overall, the rate of chlamydia among American Indians/Alaska Natives in the United States was 4.1 times the rate among whites.

Native Hawaiians/Other Pacific Islanders— In 2012, the chlamydia rate among Native Hawaiians/ Other Pacific Islanders was 590.4 cases per 100,000 population (Table 11B). The overall rate among Native Hawaiians/Other Pacific Islanders was 3.3 times the rate among whites and 5.2 times the rate among Asians.

Asians— In 2012, the chlamydia rate among Asians was 112.9 cases per 100,000 population (Table 11B). The overall rate among whites is 1.6 times the rate among Asians.

Hispanics— In 2012, the chlamydia rate among Hispanics was 380.3 cases per 100,000 population (Table 11B) which is over two times the rate among whites.

Gonorrhea

During 2008–2012, among the 39 jurisdictions (38 states and the District of Columbia) that submitted data in the new race and ethnic categories for all five years during that period, gonorrhea rates increased 61.8% among American Indians/Alaska Natives (81.6 to 132.0), 33.5% among Native Hawaiians/Other Pacific Islanders (70.0 to 93.4), 22.9% among whites (27.1 to 33.3), 18.9% among Hispanics (52.3 to 62.2), and 14.5% among Asians (15.0 to 17.2) (Figure 19). The gonorrhea rate decreased 15.5% among blacks (542.7 to 458.7)

In 2012, 48 jurisdictions (47 states and the District of Columbia) submitted data in the new race and ethnic categories according to the revised OMB standards. The following data pertain to those jurisdictions:

Blacks—In 2012, 63% of reported gonorrhea cases with known race/ethnicity occurred among blacks (excluding cases with missing information on race or ethnicity, and cases whose reported race or ethnicity was other) (Table 22A). The rate of gonorrhea among blacks in 2012 was 462.0 cases per 100,000 population, which was 14.9 times the rate among whites (31.0 per 100,000) (Table 22B). This disparity has decreased slightly in recent years (Figure M). This disparity was larger for black men (16.2 times) than for black women (13.8 times) (Figure N, Table 22B).

As in previous years, the disparity in gonorrhea rates for blacks in 2012 was larger in the Midwest and Northeast than in the West or the South (Figure O). Considering all racial/ethnic and age categories, gonorrhea rates were highest for blacks aged 20–24 and 15–19 years in 2012 (Table 22B). Black women aged 20–24 had a gonorrhea rate of 2,172.6 cases per 100,000 women. This rate was was 11.1 times the rate among white women in the same age group (194.9 per 100,000). Black women aged 15–19 years had a gonorrhea rate of 2,032.2 cases per 100,000 women, which was 15.1 times the rate among white women in the same age group (134.5).

Black men aged 20–24 years had a gonorrhea rate of 1,903.7 cases per 100,000 men, which was 16.4 times the rate among white men in the same age group (115.9 per 100,000). Black men aged 15–19 years had a gonorrhea rate of 1,012.3 cases per 100,000 men, which was 26.2 times the rate among white men in the same age group (38.7 per 100,000).

American Indians/Alaska Natives—In 2012, the gonorrhea rate among American Indians/Alaska Natives was 124.9 cases per 100,000 population, which was 4.0 times the rate among whites (Table 22B). The disparity between gonorrhea rates for American Indians/Alaska Natives and whites was larger for American Indian/Alaska Native women (4.8 times) than for American Indian/Alaska Native men (3.1 times) (Figure N, Table 22B). The disparity in gonorrhea rates for American Indians/Alaska Natives in 2012 was larger in the Midwest than in the West, Northeast, and South (Figure O).

Native Hawaiians/Other Pacific Islanders—In 2012, the gonorrhea rate among Native Hawaiians/Other Pacific Islanders was 87.8 cases per 100,00 population, which was 2.8 times the rate among whites (Table 22B). The disparity between gonorrhea rates for Native Hawaiians/Other Pacific Islanders and whites was the same for Native Hawaiian/Other Pacific Islander women and Native Hawaiian/Other Pacific Islander men (2.8 times) (Figure N, Table 22B). The disparity in gonorrhea rates for Native Hawaiian/Other Pacific Islanders in 2012 was lower in the West than in the Midwest, Northeast, and South (Figure O).

Asians—In 2012, the gonorrhea rate among Asians was 16.9 cases per 100,000 population, which was lower than (0.5 times) the rate among whites (Table 22B). This difference is larger for Asian women than for Asian men (Figure N, Table 22B). In 2012, rates among Asians were lower than rates among whites in all four regions of the United States (Figure O).

Hispanics—In 2012, the gonorrhea rate among Hispanics was 60.4 cases per 100,000 population, which was 1.9 times the rate among whites (Table 22B). This disparity was larger for Hispanic men (2.2 times) than for Hispanic women (1.8 times) (Figure N, Table 22B). The disparity in gonorrhea rates for Hispanics was highest in the Northeast and lowest in the West and Midwest (Figure O).

Primary and Secondary Syphilis

The syphilis epidemic in the late 1980s occurred primarily among men who have sex with women only (MSW), women, and minority populations.^18,19 While the rate of P&S syphilis declined among all racial and ethnic groups during the 1990s, rates again began increasing in the early 2000s among men who have sex with men (MSM) in their 30s and 40s of varied racial and ethnic groups.¹⁹ Among the 39 jurisdictions (38 states and the District of Columbia) that submitted data on race and Hispanic ethnicity from 2008–2012 according to the revised OMB standards, rates increased among non-Hispanic whites, Hispanics, Asians, American Indians/Alaska Natives, Native Hawaiian or Other Pacific Islanders, and Multirace individuals, and decreased slightly among non-Hispanic blacks (Figure 38).

In 2012, 48 jurisdictions (47 states and the District of Columbia) submitted data on race and Hispanic ethnicity in 2012 according to the revised OMB standards. The following data pertain to those jurisdictions:

Blacks — In 2012, 39.7% of all cases reported to CDC were among blacks. The overall 2012 rate for blacks was 6.1 times the rate for whites. In 2012, the rate of P&S syphilis among black men was 5.7 times the rate among white men; the rate among black women was 16 times the rate among white women (Table 36B).

In 2012, rates among both men and women aged 20– 24 years remained highest among blacks (96.7 cases and 19.1 cases per 100,000 population, respectively). The 2012 rate among black men aged 15–19 years was 14 times the rate for white men and 4 times the rate for Hispanic men of the same age, and 2012 rates for black women aged 15–19 years were 23 times and 8 times the rate for white and Hispanic women of the same ages, respectively (Table 36B).

American Indians/Alaska Natives — In 2012, 0.4% of all cases reported to CDC were among American Indians/Alaska Natives. The 2012 rate of P&S syphilis for American Indians/Alaska Natives was 2.9 cases per 100,000 population, slightly higher than the rate for whites (Table 36B).

Native Hawaiians or Other Pacific Islanders — In 2012, 0.3% of all cases reported to CDC were among Native Hawaiians or Other Pacific Islanders. The 2012 rate of P&S syphilis for Native Hawaiians or Other Pacific Islanders was 8.4 cases per 100,000 population, which is 3.1 times the rate for whites (Table 36B).

Asians — In 2012, 1.9% of all cases reported to CDC were among Asians. The 2012 rate of P&S syphilis for Asians was 2.0 cases per 100,000 population, which was 0.7 times the rate for whites (Table 36B).

Hispanics— In 2012, 19.5% of all cases reported to CDC were among Hispanics (an increase from 16.7% of all cases in 2011). The 2012 rate of P&S syphilis for Hispanics was 5.7 cases per 100,000 population, which was 2.3 times the rate for whites (Table 36B).

Congenital Syphilis

Race/ethnicity for cases of congenital syphilis is based on the mother’s race/ethnicity. In 2012, the rate of congenital syphilis was 29.6 cases per 100,000 live births among blacks and 7.9 cases per 100,000 live births among Hispanics. These rates were 14.1 and 3.8 times, respectively, the rate among whites (2.1 cases per 100,000 live births) (Table 43, Figure S).

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