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No one really wants to talk about sexually transmitted infections, especially if they’ve been affected by them, but it’s an important conversation to have to make topics like this less taboo. More significantly, we need to address the disparities in STI cases and care. Here’s a stat that everyone should know: In the year 2022, the CDC reports that Black Americans were diagnosed with 31.1% of cases of chlamydia, gonorrhea, and syphilis. Those who identify as Black women are specifically affected by long-term (sometimes referred to as “lifetime”) STIs such as herpes simplex much more frequently than white women, at rates of 34.6% to 8.1%.
To clarify, per the CDC, the disparities in STI cases are not about differences in sexual behavior, but disparities in access to comprehensive, culturally sensitive sexual health treatment and care.
Why are STIs more prevalent among Black women?
One of the contributing factors to STI disparities is inadequacies in thorough sexual education and limited access to high-quality healthcare, says Andrea Sleeth, Women’s Health Nurse Practitioner and Medical Advisor at Wisp. “Structural barriers including lack of health insurance and limited availability of healthcare providers in predominantly Black neighborhoods contribute to these systemic issues,” adds Sleeth.
On top of those disparities, there is medical racism, plus other biases that exist in the healthcare system and perpetuate untrue stereotypes about Black women’s sexuality. Those factors can lead to unequal treatment in clinical spaces, Sleeth says. And that creates an environment of distrust among Black women in medical settings, which can cause them to skip out on a check-up or leave a clinic in which they feel unsafe or unheard before getting a prescription they might need.
There is additionally so much stigma attached to STIs, and that is exacerbated for Black women who have higher rates of “lifetime” STIs, such as HIV, herpes (HSV), and hepatitis B. That terminology of “lifetime” STIs adds to further stigma, says Cordelia Nwankwo, MD, FACOG, an OB/GYN based in Washington, D.C. This does not mean that the infection is resistant to testing and treatment, even if it doesn’t have a “cure.” Some people never even experience symptoms or require treatment, Dr. Nwankwo adds. But for those that do, being able to access clinics with trusted clinicians to follow up with a case can be a challenge for Black women. “Part of this stems from inadequate access to continued care and emphasis on prevention,” says Dr. Nwankwo.
How can we advocate for better sexual health care?
There is no immediate “fix” to change the STI numbers among Black women overnight, emphasizes Dr. Nwankwo. “I think the first step is, yes, acknowledging that distrust and where it stems from, but then empowering Black women with the accurate information they need and tools they can use to advocate for themselves in these scenarios,” she says. It’s key to be armed with the knowledge of what questions to ask and symptoms to mention during a visit with a provider, according to Dr. Nwankwo. Part of that comes from more comprehensive and culturally competent sexual health education, beginning at a young age in schools. For the actual visits, having a trusted person with you at medical or sexual health clinic appointments can be another way to ensure that you have an additional advocate to ask questions and make sure your concerns are heard.
Since improving quality healthcare access is a long haul, in the meantime, it’s really important to democratize access to sexual healthcare. This looks like affordable and even free education and healthcare services via telehealth, Sleeth says. 2021 research supports the need for expanding access to digital and app-based sexual education and birth control resources that are specifically geared toward supporting Black women. There are plenty of organizations doing this work to address racial disparities in STIs, including Planned Parenthood. One great Atlanta, Georgia-based organization is SisterLove, which offers interactive Healthy Love workshops that aim to increase safe sex, and on-site STI testing or free self-test HIV kits that can be mailed to you.
Another piece of the puzzle is actively working to dismantle the stigma around STIs, especially around Black women who have STI diagnoses. Open dialogue about STIs and racial disparities can help raise awareness of both the issue and the need for more widespread, better-quality sexual health care for marginalized communities.
Mara Santilli is a journalist reporting on health and wellness and how social and political systems influence the well-being of certain groups, including but not limited to Black and brown communities, women, and the LGBTQ+ community. Her editorial work has appeared in publications such as Shape, Marie Claire, Cosmopolitan, Women’s Health, InStyle, Glamour, and more. Outside of reading and writing, she enjoys traveling (especially to Italy), singing, dancing, musical theatre, and playing guitar and piano.