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The Disparity Cascade: Attention to Sexual Health during an Epidemic
By Bobbie Emetu, PhD, MPH, MLS and Stacy Missari, PhD
Published December 10, 2020

During the time of coronavirus disease 2019 (COVID-19), people are mandated to social distance and wear masks. Whether it be loneliness, inability to have sexual intimacy or be screened for sexually transmitted infections (STIs), sexual health is equally as important as the current public health crisis. The phrase “acute on chronic” aptly describes the high COVID-19 death rates among people of color. Pre-existing chronic issues caused by an extensive history of oppression and resource limitation within communities of color make COVID-19 a significant contributor to racial health disparities among African Americans. Racism is a major stressor that cascades through people’s lives with detrimental consequences. Issues surrounding racism and social injustice exacerbate social, health, and cultural constraints that already exist for people of color. The impact of systemic racism and social injustice on the overall health of people of color has been well researched. As we are faced with a respiratory pandemic with inconsistent, oftentimes limited leadership from our federal government, and fragmented efforts at the state level, it is difficult to optimistically see an end to COVID-19 without an effective vaccine. African Americans have the highest risk of dying from COVID-19 partly due to poor access to healthcare, which leads to higher rates of chronic diseases such as diabetes, heart disease, or asthma; precisely, the illnesses that increases susceptibility to intubation, ventilator dependency, or death.

Similar to COVID-19, African Americans are disproportionately impacted by STIs. Heterosexual African American women and African American men of all sexual orientations are at the forefront of STI risk. Yet, STIs which consist of various bacterial, viral, and parasitic infections are oftentimes neglected and not held at high importance. Sexual minority women (SMW), those who identify as lesbian, bisexual, or queer, are equally at risk for STIs as their heterosexual counterparts and men. However, the misconception is that SMW are at reduced risk for STI acquisition. Same-sex behaviors among women include cunnilingus, anilingus, tribadism, and penetration with fingers or sexual adult devices, which are behaviors that could transmit STIs. Furthermore, STIs are augmented by disparities that hinder prevention efforts and coverage for specific populations. Among SMW, STI rates are not well tracked, primarily due to sexual identity disclosure limitations or discrimination and marginalization experienced within the healthcare system. Among African American SMW, STI rates are largely unknown since sexual minorities are often aggregated into one group. Lack of attention to fragmented surveillance for sexual minority populations limit the estimates of STI transmission burdens, which are often derived using inconsistent sexual identity measures.

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Our research team conducted two studies that are in peer-review for publication. The first study surveyed 90 SMW and found that 70% of respondents were not utilizing protective mechanisms for same-sex behaviors; 13% had never been tested for an STI; and of those tested, one in four were diagnosed with an STI in their lifetime. In the second study, we interviewed 19 SMW, with the aim of understanding why this group was not engaging in protective sexual behaviors. Findings indicated that lack of knowledge about sexual health; disdain for and inaccessibility of dental dams; perception of lower risk of sexual activity with women; and perceived emotional connection to female partners all superseded the importance of engaging in preventative practices. Both studies were a convenience sample, so African American women were not over-sampled. However, considering the STI disparity among African Americans, both studies highlight the need for future attention among queer women of color surrounding STI awareness and screening.

Complexities surrounding sexual health emphasize the importance of providing STI care within the realms of supporting vulnerable populations rather than only the individual. Identical to COVID-19, disparities exist among various aspects of health among African Americans compared to other racial groups. Surveillance of STIs inclusive of sexual orientation and race is critical for understanding transmission of sexual infections. Although risk behaviors vary by the individual, there are multiple health-related psychosocial factors that occur within the context of social marginalization and discrimination, and these factors could highlight missed opportunities for preventative care and reduction of sexual health disparities among African Americans. Building a culturally responsive public health system is a necessity for African American women and those of sexual minority status.

 

Dr. Bobbie Emetu, Associate Professor of Public Health at California State University, Northridge, is a member of the Los Angeles County Lesbian, Bisexual & Queer Women’s Health Collaborative.

Dr. Stacy Missari is an Assistant Professor of Sociology at California State University, Northridge.

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