Accessibility & Acceptability Effectively Reaching Communities


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Presented by Jo Valentine, MSW, Associate Director, Office of Health Equity, Division of STD Prevention, CDC, at the 2012 National Chlamydia Coalition meeting

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Accessibility & Acceptability Effectively Reaching Communities

  1. 1. Accessibility & AcceptabilityEffectively Reaching Communities Jo A Valentine , MSW Associate Director, Office of Health Equity Division of STD Prevention, NCHHSTP January 2012 National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Place Division name here
  2. 2. “It is a peculiar sensation, this double-consciousness, this sense of alwayslooking at one’s self through the eyes ofothers, of measuring one’s soul by the tapeof a world that looks on in amusedcontempt and pity.” WEB Dubois, 1965
  3. 3. New York Times Book Review June, 1981
  4. 4. The Tuskegee Syphilis Study is frequently described as the singular reason behind African American distrust of the institutions of medicine and public health. Such an interpretation neglects a critical historical point: the mistrust predated public revelations about theScience, 1999 Volume 285 Tuskegee Study. Vanessa N. Gamble, 2002
  5. 5. Framing STD Disparities—Historical Context Early 20th Century“The Negro men love to frolic with the women; and thewomen love to frolic with the men; so they frolic.”“The gravest problem to be faced in dealing with the Negro isnot his or her industrial future or right to social equality withthe white man or woman. It is the danger to the public of hisor her contagiousness and infections from the standpoint ofphysical and moral disease.”Myers, NJ. Black Hearts: The Development of Black Sexuality in America. BritishColumbia, Vancouver, Canada, Trafford Publishing, 2003.
  6. 6. What We Were Told…..“We don’t criticize the existence of “There is a real dearth ofthe government’s figures, but their scientifically arrived ataccuracy is not good because knowledge of the socialtheir statistics are derived from organization of blacks instudies only of those who are America because there is notreated in public clinics.” such thing as a monolithic black community.”“There is some over-reporting frompublic clinics in the data we have andthere are a number of biases in the “If we frame the programs todata, but syphilis surveillance and focus on blacks in the south,reporting is better than for gonorrhea then it will go nowhereand Chlamydia.” among blacks in the south.”
  7. 7. “Healthy Cultural Paranoia”In the book, Black Rage, the authors described thetendency to be suspicious of or distrust institutionsor agencies regarded as being “white” as “healthycultural paranoia” that African Americans havedeveloped over generations in response to racism,oppression, and discriminationGrier and Cobbs, 1980
  8. 8. “The nine most terrifying words inthe English language are: I’m fromthe government and I’m here tohelp.”Ronald Reagan, Chicago, August 12, 1986
  9. 9. Some Lessons Learned about Reducing STD DisparitiesMultiple factors contribute to STD disparities including social determinants, e.g.: – Racial inequality – High levels of uninsured – Low educational attainment – High incarceration rates• To address STD disparities, involvement of affected communities at all steps in the process is required – Appropriate framing to minimize stigma• Integration of strategies with HIV essential to maximize impact – “people should look into what can be done to break down the silos of overlapping epidemics…”
  10. 10. Syphilis as a Social Disease“To take on the task of eliminating syphilis, the consultants said, it is necessary to acknowledge that syphilis is first and foremost a social disease. In otherwise healthy individuals and communities, syphilis is a disease that is easily interrupted.” National Plan to Eliminate Syphilis from the U.S., 1999
  11. 11. Community Involvement & Organizational Partnerships• Acknowledgement & response to the effects of racism, poverty, & other social issues on the persistence of syphilis• Development & maintenance of partnerships to increase access to prevention & care services• Assurance that affected communities are collaborative partners in developing, delivering, & evaluating interventions
  12. 12. The Value of Community InvolvementThe involvement of affected communities can:• facilitate more effective communication;• restore, build, and maintain trust;• improve access to utilization of services;• ensure the development of culturally competent interventions; and• mobilize participation to develop community capacity to eliminate syphilis.
  13. 13. Defining Community Participation• Advise and Consent• Endorse and Cooperate• Advise, Guide, Support, Execute• Define, Decide, Design, Analyze, and Interpret Hatch,, 1993
  14. 14. “Upstream Solutions”
  15. 15. What Do We About “Race”?“Despite general scientific agreement that thebiological definition of “race” is an anachronism,modern-day medical journals remain replete withracialized studies that compare the health of blacksand whites without ever addressing the role of socialclass in producing disease in either blacks or whites.” N. Krieger, 2004
  16. 16. Social Determinants Affecting Individual Health Social environment can determine the availability of healthy sexual partners  Endemic high STD prevalence creates risk even for persons with one partner  Limited availability of suitable partners can lead to imbalanced ratios of men to women in many communities, impacting sexual networks and fueling STD spread Challenging economic circumstances can increase risk for STDs if affordable quality health care is not accessible; and Community mistrust/miscommunication between providers and patients can negatively affect the health care-setting interactions & lead to barriers to care-seeking
  17. 17. Do black men get betterhealth care behind bars? In the Grio By Monique W. Morris on 06/30/2011
  18. 18. Washington Post Front-page January 22, 2012 “Rich or poor, educated or not, black women sometimes feel as though myths are stalking them like shadows, their lives a string of labels…”
  19. 19. “Take those like us who are willing to share and say we’ve had enough. We see what you’re doing. Let us be part of the reforms.” Male Inmate, Guilford County, NC March 1998
  20. 20. For more information please contact Centers forDisease Control and Prevention1600 Clifton Road NE, Atlanta, GA 30333Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348E-mail: Web: http://www.cdc.govThe findings and conclusions in this report are those of the authors and do not necessarilyrepresent the official position of the Centers for Disease Control and Prevention. National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Place Division name here