Saturday, June 25, 2011

African American Health Disparities

Just as higher rates of some STIs among Black Americans are not "because they are black", neither are the higher rates of some STIs among gay men or MSM (men who have sex with men) simply "because they are gay".  Black people comprise approximately 13.5% of the American population.  Note that the information below is not intended to provide a balanced perspective of black people's health (sexual or otherwise) but is designed to demonstrate the absurdity of using STI or general health disparities to claim that a certain subpopulation is either pathological, immoral or deserving of mistreatment or fewer rights.  All points made are facts, quoted from reputable scientific sources.  Clicking on any of sections 1-5 will take you directly to that section.


          - Bacterial Vaginosis
          - Chlamydia
          - Gonorrhea
          - Syphilis
          - Tuberculosis
          - Human Immunodeficiency Virus
          - Hepatitis A,B,C
          - Herpes Simplex Virus
          - Human Papiloma Virus
          - Anal Cancer
          - Cervical Cancer
          - Breast Cancer
          - Prostate Cancer
          - Life Expectancy
          - Trichomoniasis
          - Obesity
          - Infant Mortality
          - Asthma


Bacterial vaginosis is a largely inconsequential STI, especially in comparison to various other ones.  However, it is the only one that heterosexists are able to even slightly demonstrate as being more prevalent among lesbians (or women who have sex with women).  It is far more prevalent among black women than lesbians and is believed to arise from stress.  It can arise in virgins and there is limited evidence for it's sexual transmission.  The stress described in the third study below in particular is exactly the kinds of stress that lesbians may suffer at the hands of heterosexists, therefore making any criticism of lesbians based upon BV prevalence high hypocritical.

Koumans et al. 2007, Sexually Transmitted Diseases, 34(11), 864-869:
"Prevalence was 51.4% among non-Hispanic blacks, 31.9% among Mexican Americans, and 23.2% among non-Hispanic whites."

Paul K et al. 2008, Social Science and Medicine, 67(5), 824-33:
"A higher number of stressful life events was significantly associated with higher BV prevalence among both African American and White American women."

Culhane JF et al. 2002, American Journal Obstetrics and Gynecology, 187(5), 1272-6:
"Black women had significantly higher rates of bacterial vaginosis (64%) compared with white women (35%). Exposure to chronic stressors at the individual level differed by race (eg, 32% of the black women reported threats to personal safety compared with 13% of white women). There were significant racial differences in exposure to stress at the community level (eg, 63% of the black women lived in neighborhoods with aggravated assault rates that were above the citywide mean compared with 25% of the white women)."


According to the CDC, in 2004:
"African-American women are also disproportionately impacted by chlamydia. In 2004, the rate of reported chlamydia among black females (1,722.3) was more than 7.5 times that of white females (226.6)."

According to the CDC, in 2007:
"The rate of chlamydia among blacks was over eight times higher than that of whites (1,398.7 and 162.3 cases per 100,000, respectively)."

According to the CDC, in 2009:
"African Americans had 8.7 times the reported chlamydia rates of whites".


According to the CDC, in 2004:
"In 2004, the gonorrhea rate among African-Americans was 19 times greater than the rate for whites, down from 28 times greater in 2000."

According to the CDC, in 2007:
"In 2007, approximately 70% of the total number of reported cases of gonorrhea occurred among blacks."

According to the CDC, in 2009:
African Americans had 20.5 times the reported gonorrhea rates of Whites".


The CDC:
"Racial gaps in syphilis rates are narrowing, with rates in 2004 5.6 times higher among blacks than among whites, a substantially lower differential than in 2000, when the rate among blacks was 24 times greater than among whites."

According to the CDC, in 2009:
"African Americans had 9.1 times the reported syphilis rates of whites".


According to the CDC, in 2008:
"83% of all reported TB cases occurred in racial and ethnic minorities (29% in Hispanics, 26% in Asians, 25% in non-Hispanic blacks or African-Americans, 1% in American Indians or Alaska Natives, and <1% in Native Hawaiians or Other Pacific Islanders), whereas 17% of cases occurred in non-Hispanic whites."


According to the CDC, in 2006:
"The rate of new HIV infection for black women was nearly 15 times as high as that of white women and nearly 4 times that of Hispanic/Latina women".

AVERT - International AIDS Charity:
"Despite comprising less than 1% of the total UK population, Black-Africans accounted for one third of all new HIV diagnoses in 2009."

AVERT's statistic is based upon The Health Protection Agency:
"In 2009, there were 23,288 diagnosed HIV-infected black-Africans and 1,932 diagnosed HIV- infected black-Caribbeans seen for  HIV care in the UK, which accounted for 36% (23,288/64,378) and 3% (1,932/64,378) of all HIV-infected persons accessing care."

The Centers for Disease Control:
"In 2009, blacks/African Americans made up approximately 13% of the population of the 40 states (surveyed) but accounted for 52% of diagnoses of HIV infection." (See slide 5).


The CDC regarding Hepatitis A:
"HAV infection produces a self-limited disease that does not result in chronic infection or chronic liver disease".
"Antibody produced in response to HAV infection persists for life and confers protection against reinfection".

Until very recently, Hepatitis A has been astronomically more prevalent among American Indians than any other race:

Acute hepatitis B infection is 2-3 times more prevalent among black Americans than white Americans:

In the year 2000, acute hepatitis C infection was approximately twice as prevalent among black Americans compared to white Americans:


The CDC (MMWR 2010, 59(15);456-459) found in a study on herpes simplex virus type 2 that:
"By race/ethnicity, HSV-2 seroprevalence was approximately three times greater among non-Hispanic blacks (39.2%) as among non-Hispanic whites (12.3%) (p<0.001)".

Kaposi's Sarcoma is a form of cancer that only occurs after infection with Human Herpes virus 8.  A 2004 publication of cancer statistics for 2001, by the CDC and National Cancer Institute claimed that:
"Among men aged 35–44, Kaposi’s sarcoma is 1.6 times higher for black men than for Hispanic men and 3 times higher for black men than for white men."


HPV (particularly types 16 and 18) are oncogenic and can lead to a variety of cancers:
"Black and Hispanic women had higher rates of HPV-associated cervical cancer than white women. Black women also appeared to have higher rates of HPV-associated vaginal cancer. Black men and women appeared to have higher rates of HPV-associated cancers of the oropharynx and oral cavity."


The CDC:
"More black men get anal cancer than men of other races."


American Cancer Society, 2011-2012:
"African Americans have the highest death rate and shortest survival of any racial and ethnic group in the US for most cancers."
"The incidence rate of cervical cancer remains 39% higher in African American women".


Smigal et al. 2006, A Cancer Journal for Clinicians, 56,168-183:
Breast cancer "death rates in African American women remain 37% higher than in Whites".
DOI: 10.3322/canjclin.56.3.168


According to the CDC:
"Men have a greater chance of getting prostate cancer if they are 50 years old or older, are African-American, or have a father, brother, or son who has had prostate cancer."

B. Walker et al. 1995, Environmental Health Perspectives, 103(8), 275-81:
"During the years 1987 to 1991, African Americans experienced higher incidence and mortality rates than whites for multiple myeloma and for cancers of the oropharynx, colorectum, lung and bronchus, cervix, and prostate."


The CDC, 2007 statistics, (MMWR 2009 / 58(42);1185):
"Life expectancy for white males in 2007 (75.8 years) was 5.6 years greater than for black males (70.2) and 3.7 years greater for white females (80.7) than black females (77.0)".

The CDC, 2006 statistics:
"In 2006, African Americans had the highest age-adjusted all-causes death rate of all races/ethnicities.  In addition, African Americans had the highest age-adjusted death rate for heart disease, cancer, diabetes, and HIV/AIDS."


Trichomoniasis is a protozoan parasite STI that can increase the chances of HIV transmission.

CDC 2001-2004 National Health and Nutritional Examination Survey data:
"NHANES data from 2001–2004 indicated an overall prevalence of 3.1% (95% CI: 2.3–4.3), with the highest prevalence observed among blacks (13.3%)"


The CDC, 2008 statistics:
"In 2008, African American Adults were almost 4 times as likely to be obese*  as Asian Adults, (African American: 36.1%, White: 26.5%, Asian American: 9.4%).  African American women were particularly impacted, with 42.1% of African American women 18 years of age and over obese in 2008."


According to the CDC (MMWR, 2011 / 60(01);49-51), 2006 statistics show that:
"The highest infant mortality rate was for non-Hispanic black women (13.35), with a rate 2.4 times that for non-Hispanic white women (5.58)."


According to the CDC (MMWR, 2011 / 60(01);84-86), 2006-2008 statistics show that:
"Current asthma prevalence was higher among the multiracial (14.8%), Puerto Rican Hispanics (14.2%), and non-Hispanic blacks (9.5%) than among non-Hispanic whites (7.8%)."

Epidemiology is highly complex, involving a range of different variables, with no one factor the sole cause of a higher disease prevalence.  Black people appear to be at high risk of almost every STI that MSM are at high risk for as well as suffering from various other health disparities.  There are a range of reasons for this in both cases, not all of which are accurately quantified or perhaps even known and none of which indicate that being black or MSM is immoral or pathological.  Attempts to suggest otherwise are typically malicious attempts to legitimize and provide excuses for prejudice and discrimination.

According to the American Academy of Family Physicians:
"The USPSTF recommends that physicians be aware that in some communities black and Hispanic men and women (including pregnant women) may be at increased risk of chlamydia, gonorrhea, and syphilis, irrespective of age or sexual behaviors, and may need to be screened."

"Research has documented that many social-contextual factors contribute to varying STI prevalence rates within communities. Through a variety of direct and indirect mechanisms, factors in a community (e.g., poverty, discrimination, illicit drug use, male-to-female ratio, incarceration rate, racial segregation) influence sexual behaviors and networks, subsequently affecting the spread of infection."

A review of racial/ethnic discrimination and health studies by Williams et al. (2008, American Journal of Public Health, 98(S1), S29–S37) found that:
"Perceptions of discrimination appear to induce physiological and psychological arousal, and, as is the case with other psychosocial stressors, systematic exposure to experiences of discrimination may have long-term consequences for health."

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