Providing Accessible and Acceptable STD Health Care: Lessons Learned from the National Campaign to Eliminate Syphilis from the United State

The U.S. epidemic of infectious syphilis disproportionately affects disadvantaged racial and ethnic minority communities. In 2005, more than 41% of reported primary and secondary (P&S) syphilis cases occurred among African Americans, a rate more than 5 times higher than the rate for whites. Although a number of social determinants such as poverty and unemployment, often negatively impact access to health care for sexually transmitted diseases (STDs), provider bias, prejudice, and stereotyping can also negatively impact the acceptability of STD health care. The Institute of Medicine report, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, concludes that there is evidence that suggests that provider bias, prejudice, and stereotyping contribute to negative experiences that racial and ethnic minorities encounter in health care settings. As a result of experiences of provider discrimination based on race—and frequently social class—in health care settings, African Americans may be more distrustful of health care agencies and institutions and less inclined to seek care when needed. Improving community- and individual-level interventions should involve increased understanding of not only the more commonly studied social determinants of health but also the implications of provider bias, prejudice, and stereotyping associated with race and ethnicity. Lessons learned from the national campaign to eliminate syphilis from the United States affirm that to increase the accessibility and acceptability of STD prevention and control program for African American communities, health departments and other agencies should collaborate with affected communities, to provide more culturally-competent and community-centered STD services.