Income and Wealth Inequality: Crash Course Economics #17



Large Racial Disparity in World's Most Common STI

Infection with Trichomonas vaginalis affects the black community more than others in the United States.

By Cathy Cassata

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The STD trichomoniasis is caused by a protozoan parasite called Trichomonas vaginalis.
The STD trichomoniasis is caused by a protozoan parasite called Trichomonas vaginalis.
Kateryna Kon/Alamy

March 15, 2019

The cause of the most common curable sexually transmitted infection (STI), Trichomonas vaginalis(TV), disproportionately affects black Americans, according to a study released today by Johns Hopkins Medicine in Baltimore.

Infection withTrichomonas vaginalis, a protozoan parasite, causes trichomoniasis — called “trich,” for short.

"Increased public-health action is needed to eliminate the stark racial disparities in TV infection and achieve racial equity in sexual health," says the study’s senior author, Aaron Tobian, MD, PhD, an associate professor of pathology at the Johns Hopkins University School of Medicine.

Dr. Tobian and his colleagues evaluatedTrichomonas vaginalisresults from urine samples of more than 4,000 men and women ages 18 to 59. The results were collected for the Centers for Disease Control and Prevention 2013–2014 National Health and Nutrition Examination Survey.

Women and men who were not black showed a 0.03 and 0.8 percent prevalence of TV, respectively, while black men had a 4.2 percent prevalence, and black women an 8.9 percent prevalence.

Women who are black, older, have less than a high school education, and live below poverty level also had a higher prevalence of infection with TV.

Behavior? Biology? Or Both?

While it's not known exactly why there’s such a disparity, Tobian points to a combination of potential factors, such as sexual network characteristics, including favoring sexual partners of the same race, and biological differences in susceptibility to infection.

He also brings forth the notion of sexual risk behaviors, such as how many sexual partners a person has. However, he notes that in this study, the racial disparity in TV infection persisted despite the number of sexual partners participants had in the past year. TV infection also appeared to exceed the relative racial disparity observed for other STIs.

"Which supports the hypothesis that high individual sexual-risk behavior likely does not fully explain the racial disparity in TV infection," says Tobian.

Inadequate Healthcare May Play a Role

Social and structural disparities, such as inadequate healthcare, may also play a part.

"From a social justice lens, it cannot be underscored enough that structural racism could be a contributing factor; neighborhood social disorganization has been shown to be significantly associated with TV infection," Tobian says.

Most people don't know they have trichomoniasis, and if it's left untreated, it can cause pelvic inflammatory disease and infertility in women. Women with trichomoniasis may experience foul-smelling discharge, and both women and men may have stomach pain or pain when urinating.

Right now, screening for TV is only recommended for people who are HIV positive.

Adding educational information about TV to existing public health campaigns for HIV and STI prevention is one way to spread awareness, says Tobian.

A Public Unaware and Often Unconcerned

Jill Placek, MD, an obstetrician-gynecologist in Arlington Heights, Illinois, agrees that more education could help.

"Unfortunately,Trichomonasis a common STI that, for whatever reason, does not have as much mainstream infamy as other STIs, including chlamydia or gonorrhea," says Dr. Placek. "I think this has erroneously given people the misconception that it is not a significant health concern or something requiring appropriate and timely treatment."

She adds that the healthcare community could be more vigilant about screening people for TV who are candidates for STI screening. For instance, clinicians could routinely screen and treat people in high-prevalence communities, whether or not they have HIV. Additionally, treating all sex partners of someone who tests positive for TV, as well retesting those infected after they finish treatment, may make an impact.

"We have a duty to help educate patients on TV as a sexually transmitted infection so that patients are better able to advocate for their own sexual health and that of their partners," says Placek.

A Clear Need to Eliminate Health Disparities

On a broader level, Tobian says making TV infection a nationally notifiable condition is worth considering. This would allow all levels of public health — local, state, territorial, federal, and international — to share TV-related health information and monitor, control, and prevent its occurrence.

"While there may indeed be insufficient empirical evidence that these strategies will lead to epidemic control or a reduction in the racial disparity of TV infection in the United States, it would be an injustice to the black population to continue to ignore this STI until such evidence is available," says Tobian.

TV is preventable through correct use of condoms and male circumcision, and treatable with an oral antibiotic.

"A combination prevention strategy can yield a significant reduction in TV infection prevalence," Tobian adds, noting that despite accurate diagnostic tools and effective treatment options in the United States, the sex- and race-stratified estimates of TV infection prevalence in this study exceed estimates of TV in other developed countries.

"There is a clear need to eliminate the health disparities and improve the overall sexual health of the U.S. population," he says.






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Date: 15.12.2018, 02:38 / Views: 53135