Health system parameters and racial/ethnic disparities in gonorrhea

In 2005, the national reported gonorrhea rate for African Americans was 18 times greater than that for whites. Although this dramatic health disparity is thought to be due to a wide variety of factors, health system parameters such as access and acceptability of care are crucial contributors to disparities in gonorrhea.

Access to care has been defined as being able to obtain health care that is acceptable, timely, of high quality, and satisfactory to the patient. This presentation will review patterns of care-seeking behavior for patients with gonorrhea and barriers to access to STD care considering factors such as financial barriers, structural barriers, provider attitudes, and patient perceptions.

Care-seeking behavior of patients with gonorrhea varies widely by race and by sex. Financial barriers range from the more obvious such as frank poverty or being uninsured, to the more subtle such as reluctance in taking time off of an hourly job to seek care or fill a prescription. Structural barriers include distance to care, quality of available care, and lack of a regular provider. Several studies have documented differences in provider attitudes towards, and provision of services to, racial/ethnic minorities. Patient perceptions of providers and health care services are also important; satisfaction with care, perceptions of racism, and medical mistrust can have a significant impact on care-seeking behavior for both curative and preventive services.

It is crucial that all categories of barriers to high quality, available STD care be understood and addressed for racial/ethnic disparities in gonorrhea to be effectively eliminated.