December 5, 2000
Milwaukee -- Following years of steady decline, gonorrhea infections among African Americans increased by more than five percent from 1997 to 1999, according to a new report from the Centers for Disease Control and Prevention (CDC). The CDC report, released at the National STD Prevention Conference, being held December 4-7 in Milwaukee, also shows that gonorrhea continues to disproportionately affect African Americans compared to other racial groups. Similarly, new data show that genital herpes continues to disproportionately affect African Americans, especially young African American women.
Other studies presented at the conference today suggest approaches that may be effective in helping to reduce this toll. These studies found that culturally appropriate television, print, billboard, and radio ads can successfully increase awareness of STDs among young African Americans at high risk for infection, an important first step toward behavior change.
"It is unacceptable that sexually transmitted diseases, which are preventable and can often be effectively treated when caught early, continue to be found at significantly higher rates among African Americans than the rest of the population," said Helene Gayle, M.D., M.P.H., director of CDC's National Center for HIV, STD, and TB Prevention (NCHSTP). "We must continue to develop effective prevention strategies and increase our efforts to reach communities at highest risk of infection."
CDC's new report, entitled "Tracking the Hidden Epidemics: Trends in STDs in the United States," found that gonorrhea rates increased from 802.4 per 100,000 African Americans in 1997 to 848.8 in 1999. Although gonorrhea infections increased more among white Americans and Latinos over this period, gonorrhea continues to have a much greater impact among African Americans. Gonorrhea rates among African Americans (848.8 per 100,000) are more than 30 times higher than whites (27.9 per 100,000), and more than 11 times higher than Latinos (75.3 per 100,000).
In the largest study of its kind, Sami Gottlieb, M.D., of the University of Colorado Health Sciences Center in Denver and colleagues found that African American women are at highest risk for infection with herpes simplex virus type-2 (HSV-2).
Dr. Gottlieb and colleagues analyzed questionnaires and HSV-2 blood tests from 4,128 high-risk individuals visiting STD clinics from July 1993 to September 1996 in five U.S. cities -- Baltimore, Denver, Long Beach, Newark, and San Francisco as part of project RESPECT, a trial evaluating HIV prevention counseling.
Overall, 40.8 percent (1,684) of the study participants were infected with HSV-2. Infection rates were higher among women (52 percent) visiting the clinics than men (32 percent), and higher among African Americans (48 percent) than whites (30 percent). Infection rates were high even among African American women who had few lifetime sexual partners. The infection rate for African Americans who had only one or two sexual partners during their lifetime was 29.7 percent, compared to 12.9 percent for all other racial groups with one or two lifetime partners.
The researchers also found that only 7.8 percent of African Americans infected with HSV-2 had been previously diagnosed, compared to 23.4 percent of whites. More than one in five Americans is estimated to be infected with genital herpes.
"It is alarming that such a small proportion of people with genital herpes know they are infected, especially African Americans who are at increased risk of infection. It is imperative that we increase awareness and testing for this serious disease," said Ronald O. Valdiserri, M.D., M.P.H., deputy director of CDC's HIV, STD and TB programs.
Study participants were more likely to be infected with genital herpes not only if they were African American or female, but also if they had more than 20 lifetime sexual partners, had been sexually active for more than ten years, had a prior diagnosis of syphilis or gonorrhea, had less than a high school education, or were 25 years of age or older. ["Seroprevalence and Correlates of Herpes Simplex Virus Type 2 (HSV-2) in Five Sexually Transmitted Disease Clinics," S. Gottlieb, et al.]
Two new studies released at the conference show that television, radio, billboard and other media ads can significantly increase awareness of STDs among young African Americans.
Ann Robbins, an epidemiologist with the Texas Department of Health, Bureau of HIV/STD Prevention, reported on the results of an STD media campaign to educate young people in East Texas about the risks associated with gonorrhea and chlamydia and the importance of testing. The researchers found that 19 percent of young people surveyed following the campaign said they were tested for an STD (other than HIV) as a result of the campaign.
The media campaign, which ran from October 1999 through December 1999, targeted African American females ages 15 to 19, a group with particularly high STD infection rates in the area. Ads were field tested with adolescents before the campaign was launched to ensure that they were effective and culturally appropriate.
Researchers conducted pre- and post-campaign phone interviews with African American females 15 to 19 years old in 125 households. The pre- and post-interview samples were selected independently to better gauge the effect of the campaign on the level of awareness within the community. Responses to the interviews suggest the campaign was successful at reaching its target audience. In the post-campaign survey, 72 percent of respondents reported seeing the campaign. Recognition of specific STDs mentioned in the campaign rose dramatically. Before the campaign, 28 percent of respondents spontaneously mentioned chlamydia when asked to name an STD, and 43 percent mentioned gonorrhea. After the campaign was completed, mention of these STDs rose to 62 percent for chlamydia and 76 percent for gonorrhea.
The media campaign appeared to have tangible effects on many young women in the target population. Of those respondents who said they had seen the campaign, 69 percent said it had made them think about STDs more, 28 percent said the campaign had caused them to talk to someone about STDs, and in addition to the 19 percent who got tested for an STD because of the ads, 76 percent said they were more likely to get tested in the future. ["Results of a Pilot STD Prevention Media Campaign in East Texas," A. Robbins, et al.]
In a second study on media campaigns, Lanya Shapiro, M.S.W., M.P.H., Project Manager of the American Social Health Association and her colleagues released findings from the "Know the Facts. Know for Sure" program in Jackson, Miss., and the Rio Grande Valley, Texas, to increase awareness of STDs among African Americans and Latinos ages 15 to 19. The campaign ran advertisements, developed with input from young people and community leaders, in a variety of forums, including 60-second paid radio spots, outdoor advertising, mini-magazines, in-theater advertisements and posters distributed through local community based organizations.
Following the campaign, Shapiro and colleagues used several approaches to assessing its success, such as school-based surveys, focus groups, interviews with people on the street and over the telephone, and tracking of calls to information hotlines. The researchers found that the campaign reached over half of the target audience at both sites. Sixty percent of teens in Rio Grande Valley said they were aware of the campaign, and of this group, 70 percent said it made them think about the risks of STDs. In Jackson, Miss., over 70 percent of teens surveyed correctly identified the main message of the radio spots, and over 65 percent identified the main message of the posters.
Researchers concluded that culturally appropriate electronic and print media can be used effectively to reach young people of color with information about STDs and other sexual health issues, and have plans to initiate media campaigns in California and North Carolina. ["Using Electronic and Print Media Advertisements to Reach Young Persons of Color with an STD Awareness Campaign," L. Shapiro, et al.]
A new study suggests that condom use among adolescent African American women is strongly associated with the power dynamics of their relationships and their condom negotiation practices. The study, authored by Catlainn Sionean, Ph.D., a behavioral scientist at CDC, and colleagues from Emory University, found that adolescent women who were less concerned that their partners would react poorly to suggestions of condom use were more than twice as likely to use condoms consistently than women who were more concerned about their partner's reaction.
The researchers interviewed 522 sexually active African American female adolescents -- ages 14 to 18 -- in an effort to understand the relationship factors associated with consistent condom use in this population. They found that, compared to those with older partners, adolescents with partners of similar age were twice as likely to use condoms regularly. Young women who consistently refused to have sexual intercourse without a condom were more than four times more likely to use condoms consistently in the previous six months.
The study authors concluded that sexual risk reduction programs should help young women develop their skills to negotiate condom use and refuse sex unless condoms are used. The researchers also recommended that prevention programs address young women's concerns about the possible negative consequences of condom negotiation with sexual partners. ["Power and Resistance: Partner Influences, Negotiation Practices, and Condom Use Among African American Female Adolescents," C. Sionean, et al.]