1. Fulton County and the Prevalence of Sexually Transmitted Diseases
Lakeria Watson
Dr. Cheryl Gaddis
Spring 2015

2. According to the Center for Disease Control (2010), 36 percent of the population belongs
to a racial or minority group. In the area of Fulton County, Georgia African Americans account
for the largest amount of minorities accounting for 44.4 percent of the population according to
the census. Although almost accounting for half of the population in Fulton County; minorities
are disproportionately affected by various health disparities in comparison to non minorities.
Health indicators such as life expectancy and infant mortality have improved for most
Americans, yet minorities experience an uneven burden of preventable disease, death, and
disability compared with non-minorities. Therefore it is not surprising and well documented that
minorities and white majority have different health experiences. These different experiences are
referred to as health disparities ( LaVeist and Issac, 2013) disparity—defined as differences by
the Webster dictionary. Although these “differences” and/or health disparities are well
documented; minorities continue to be marginalized and underserved due to social determinants
of health that continue to be perpetuated by governmental policies, politics and economics.The
purpose of this paper is to examine the health disparities that exist for African Americans in
Fulton County. As well as examine the context behind why that disparity exists.
Health factors in the County Health report represent what influences the health of the
county. Four types of health factors are measured: health behaviors, clinical care, social and
economic, and physical environment factors. In turn, each of these factors is based on several
measures. Out of the health behavior section in the report the most alarming was the level of
sexually transmitted disease . Fulton County appeared to have the highest levels of sexually
transmitted diseases was shown as getting worse (See Appendix A) Also the county health report
indicated that the amount of uninsured residents appeared to be worsening as well.

3. The World Health Organization defines sexually transmitted infections and/or diseases as
“ infections that are spread primarily through person-to-person sexual contact.” “There are more
than 30 different sexually transmissible bacteria, viruses and parasites “(WHO, 2015). Nationally
Georgia “ averages about 60,000 cases of chlamydia, gonorrhea and syphilis per year” ( Georgia
Department of Public Health, 2015). Like most diseases STD’S have clear disparities in disease
burden (GDPH, 2012).
Rates of chlamydia among black non-Hispanic females were 6.4 times higher than among
white non-Hispanic females. Gonorrhea rates were 16.2 times higher among black non-
Hispanics than whites’ non-Hispanics. P&S syphilis rates were 5.8 times higher among
black non-Hispanic males than white-non-Hispanic male (GDPH, 2012).
Even more disturbing is the fact that minorities are disproportionately affected by HIV/AIDS;
one of the most deadliest sexually transmitted diseases. (GDPH, 2012). According to the Georgia
Department of Health, in 2010 Georgia was ranked the sixth highest in the nation for adults and
adolescents living with HIV. Among the 18 county districts in Georgia, Fulton County was
among the highest. “During 2008 relative percentage difference in HIV diagnose rate among
blacks/African Americans in comparison to whites was 799 percent (LaVeist and Issac,
2012).”Research suggests that there are a number of reasons African Americans face the burden
of HIV and STDs. The CDC states that one reason is that studies suggest that a greater number
of African Americans have HIV and the fact that African Americans are having sex with the
same race means they face a greater risk of the infection with each new sexual encounter.
African Americans have higher rates of sexually transmitted infections compared with other
minorities. Contracting a sexually transmitted disease can significantly increase the chance of
HIV. Another factor that may contribute to reasons African Americans are affected by HIV is the

4. lack of awareness of their HIV status. It is believed that many are unaware and fail to seek early
medical care before spreading the disease. Lastly the CDC (2014), suggests that the poverty rate
is higher among African Americans than any other racial groups. Poverty as a social determinant
of health can create a number of challenges for the prevention of health or HIV such as limited
access to high quality health care, housing and HIV prevention education.
Social and Economic Factors
As stated earlier HIV and STD rates a higher among minorities. One of the reasons
provided is because of limited access to high quality healthcare. According to the county
rankings report ,the amount of uninsured Georgians in Fulton county seems to be getting worse
(Appendix B). According to an article by Rowland & Shartzer (2008) “ persons who are
members of racial and ethnic minority groups are much more likely to be uninsured co parted to
the 13 percent of whites in 2006.” The article suggests the disparity may reflect the fact that
minorities are more likely to be low income and less likely to have insurance offered through
their job or be able to actually afford premiums. The rate of unemployment has decreased but it
appears that African Americans still remain twice as unemployed in comparison to other races.
In the area of Fulton County it appears that only 8.6 percent of the population is unemployed but
is worsening as time progressing according to county health data. African American minorities
experience twice the rate of unemployment than the majority white see figure. In 2012 statistic
showed that about 12.4 blacks were unemployed compared to 5.9 percent of whites that were
unemployed and 5.4 percent of Asian (See Appendix C) . The fact that more minorities are
likely to be unemployed may be the reason minorities to receive lower quality health care than
compared with whites . Therefore issues such as HIV, will continue to rise in prevalence. An
article in the Huffpost offers that health care outcomes have little to do with health coverage or

5. lack of but minorities 25 -40 percent more likely to go to higher mortality, lower quality
hospitals than white populations ( Anderson, 2013). The reasons they offer is that it is an
ingrained referral pattern to send patients to suboptimal hospitals. A patient typically sees the
same doctors and has been going to the same hospitals which over time cater to that population
known as “minority-serving hospitals”. Even more interesting the author states that it is true in
regions with degrees of racial segregation both historical and geographical. Reasons for racial
disparities in healthcare date back historically. LaVeist and Issac(2013) “stated that there is
disturbing body of evidence of inferior medical care for blacks ( LaViest and Issac, 2013).”
Unfortunately a large number of persons with HIV/AIDS do not have private insurance
nor do they have any insurance at all. Luckily, President Obama signed the Affordable
HealthCare Act that insures affordable healthcare insurance. As of September 23, 2010, insurers
are no longer able to deny coverage to children living with HIV or AIDS (CDC, 2014). The
Affordable Health Care Act is an important linkage to access to health care. Without insurance
minorities will continue to face health disparities in terms of sexually transmitted diseases and
rates of prevalence will continue to rise.
Social Ecological Model
The Social Ecological Model can help to understand the range of factors that put people
at risk for HIV. Recommendations for addressing the issues of STD’s would be to examine
societal factors that promote or inhibit unsafe sex practices. Policies should be geared toward the
prevention of HIV. The proposed method of addressing STD’s and HIV is to first begin which
education in school level children from at least middle grades up to high school. Also in high
school it will be important to not only push the abstinence only message but also to inform high
school students about how important it is for them to practice safe sex. Also there should be a

6. required college level course that informs students about safe sex because college students are
likely to engage in risky behaviors because of parties, alcohol and peer pressure.
Based on the socioecological model, the community level risk increases based on a
person’s relationships and experiences with the community. As well as social environments such
as the workplace or school. It is recommended that sexually transmitted diseases be handled on a
community level because a person’s surroundings can often times be strong predictors of their
behavior. As one study suggests, the interaction of a child’s development with the social
environment during the years of developmental plasticity forms the basic endowment of
physical and mental health for later life. As well as forms the basis of an individuals biological
psychological and human capital. After all public health seeks to address health from a
population based standpoint so why not incorporation strategies for the community. With today’s
society; often fascinated with technology and media ; it is important to utilize that to create
interventions for the prevention of sexually transmitted diseases. Mass media campaigns, and
promotional activities such as health fairs should be fairly consistent.
Conclusion
In conclusion, sexually transmitted diseases as well as the amount of uninsured minorities
remain prevalent in the Fulton County area. According to the data conditions are worsening in
terms of sexually transmitted diseases. Not to mention the lack of insured minorities increases
health disparities because without proper insurance minorities are likely to receive medical care
that is uneven to majority whites. Lack of education, low socioeconomic status, lack of access to
quality healthcare; attitudes; beliefs and stigmas could all be attributed as to why sexually
transmitted diseases are rampant in marginalized communities. However, there are questions that
remain unanswered such as is the statistical information about sexually transmitted diseases

7. being more prevalent by minorities accurately reflected? Due to the fact that anything of sexual
nature is normally looked upon as taboo are people simply afraid to get tested. Also what are the
attitudes and beliefs of minorities vs. white majority concerning sexual activity. Lastly is a
universal healthcare system the answer to the gap that occurs in minorities receiving the quality
of healthcare as the majority?

8. References
Anderson, J. (2013, January 1). Minority Health Care Outcomes Have Little To Do With Health
Coverage Or Lack Of It, Study Finds. Retrieved April 7, 2015, from
http://www.huffingtonpost.com/2013/06/07/minority-health-care-outcomes-have-little-to-
do-with-health-coverage_n_3402166.html
Boggess, L., & Hipp, J. (2010). Violent Crime, Residential Instability and Mobility: Does the
Relationship Differ in Minority Neighborhoods?. Journal Of Quantitative Criminology,
26(3), 351-370. doi:10.1007/s10940-010-9093-7
http://www.cdc.gov/minorityhealth/
http://www.cdc.gov/hiv/risk/racialethnic/aa/facts/index.html
http://www.countyhealthrankings.org/policies/mass-media-campaigns-pregnancy-and-stis
Introduction: CDC Health Disparities and Inequalities Report — United States, 2013. (2013,
November 22). Retrieved April 24, 2015, from
http://www.cdc.gov/mmwr/preview/mmwrhtml/su6203a2.htm?s_cid=su6203a2_w
LaVeist, T.A., & Isaac, L.A. (2013). Race, Ethnicity and Health. (2nd ed.). San Francisco, CA:
Jossey-Bass. Saha, S. (2006).
Rowland, D., & Shartzer, A. (2008). America’s Uninsured: The Statistics and Back Story.
Journal of Law, Medicine & Ethics. Retrieved April 5, 2015.
Sexually transmitted infections. (2015, January 1). Retrieved April 15, 2015, from
http://www.who.int/topics/sexually_transmitted_infections/en/

9. Smith-Lindsey, C. (2015, April 20). STD Awareness in Georgia Addresses Syphilis and HIV
Infections. Retrieved April 22, 2015, from http://dph.georgia.gov/blog/2015-04-20/std-
awareness-georgia-addresses-syphilis-and-hiv-infections
Table A-2. Employment status of the civilian population by race, sex, and age. (2015, April 1).
Retrieved April 7, 2015, from http://www.bls.gov/news.release/empsit.t02.htm
The Affordable Care Act Helps People Living with HIV/AIDS. (2014, June 2). Retrieved April
13, 2015, from http://www.cdc.gov/hiv/policies/aca.html
http://www.countyhealthrankings.org/app/georgia/2015/measure/factors/45/data

10. Appendix A

11. Appendix B

12. Appendix C
HOUSEHOLD DATA
Table A-2. Employment status of the civilian population by race, sex, and age
[Numbers in thousands]
Employment status,
race, sex, and age
Not seasonally adjusted Seasonally adjusted(1)
Mar.
2014
Feb.
2015
Mar.
2015
Mar.
2014
Nov.
2014
Dec.
2014
Jan.
2015
Feb.
2015
Mar.
2015
WHITE
Civilian
noninstitutional
population
195,117 196,392 196,482 195,117 195,995 196,091 196,307 196,392 196,482
Civilian labor force 123,157 123,224 123,196 123,677 123,391 123,058 124,119 123,875 123,739
Participation rate 63.1 62.7 62.7 63.4 63.0 62.8 63.2 63.1 63.0
Employed 115,851 116,944 117,178 116,569 117,307 117,186 118,035 117,992 117,886
Employment-
population ratio
59.4 59.5 59.6 59.7 59.9 59.8 60.1 60.1 60.0
Unemployed 7,306 6,279 6,018 7,109 6,084 5,872 6,084 5,883 5,853
Unemployment rate 5.9 5.1 4.9 5.7 4.9 4.8 4.9 4.7 4.7
Not in labor force 71,959 73,169 73,286 71,439 72,604 73,033 72,189 72,517 72,743
Men, 20 years and
over
Civilian labor force 64,407 64,559 64,674 64,652 64,339 64,392 64,871 64,920 64,899
Participation rate 72.4 72.0 72.1 72.7 71.9 71.9 72.4 72.4 72.4
Employed 60,730 61,228 61,538 61,269 61,388 61,551 61,953 62,015 62,023
Employment-
population ratio
68.3 68.3 68.6 68.9 68.6 68.8 69.2 69.2 69.2
Unemployed 3,677 3,330 3,136 3,383 2,951 2,842 2,918 2,906 2,876
Unemployment rate 5.7 5.2 4.8 5.2 4.6 4.4 4.5 4.5 4.4
Women, 20 years
and over
Civilian labor force 54,537 54,499 54,239 54,504 54,587 54,223 54,683 54,401 54,256
Participation rate 58.2 57.7 57.4 58.1 58.0 57.5 57.9 57.6 57.4

13. Employed 51,674 52,186 52,027 51,603 52,142 51,824 52,267 52,105 51,998
Employment-
population ratio
55.1 55.3 55.1 55.0 55.4 55.0 55.4 55.2 55.0
Unemployed 2,864 2,312 2,212 2,901 2,445 2,399 2,416 2,296 2,258
Unemployment rate 5.3 4.2 4.1 5.3 4.5 4.4 4.4 4.2 4.2
Both sexes, 16 to 19
years
Civilian labor force 4,213 4,166 4,283 4,521 4,466 4,443 4,565 4,554 4,584
Participation rate 34.0 33.8 34.7 36.5 36.2 36.0 37.0 36.9 37.2
Employed 3,448 3,529 3,613 3,696 3,777 3,811 3,814 3,872 3,865
Employment-
population ratio
27.8 28.6 29.3 29.8 30.6 30.9 30.9 31.4 31.3
Unemployed 765 637 670 825 689 632 751 682 719
Unemployment rate 18.2 15.3 15.6 18.2 15.4 14.2 16.4 15.0 15.7
BLACK OR
AFRICAN
AMERICAN
Civilian
noninstitutional
population
30,719 31,222 31,257 30,719 31,005 31,040 31,188 31,222 31,257
Civilian labor force 18,763 18,941 19,020 18,790 19,056 19,037 19,040 19,101 19,055
Participation rate 61.1 60.7 60.8 61.2 61.5 61.3 61.0 61.2 61.0
Employed 16,501 16,975 17,117 16,492 16,957 17,050 17,071 17,122 17,129
Employment-
population ratio
53.7 54.4 54.8 53.7 54.7 54.9 54.7 54.8 54.8
Unemployed 2,262 1,966 1,902 2,298 2,099 1,986 1,969 1,979 1,926
Unemployment rate 12.1 10.4 10.0 12.2 11.0 10.4 10.3 10.4 10.1
Not in labor force 11,956 12,281 12,237 11,929 11,949 12,003 12,148 12,122 12,202
Men, 20 years and
over
Civilian labor force 8,531 8,628 8,714 8,511 8,594 8,717 8,676 8,710 8,711
Participation rate 67.3 66.6 67.2 67.1 66.9 67.8 67.1 67.3 67.2
Employed 7,471 7,685 7,810 7,500 7,630 7,756 7,757 7,805 7,841

14. Employment-
population ratio
58.9 59.4 60.2 59.1 59.4 60.3 60.0 60.3 60.5
Unemployed 1,059 943 904 1,011 964 962 919 905 870
Unemployment rate 12.4 10.9 10.4 11.9 11.2 11.0 10.6 10.4 10.0
Women, 20 years
and over
Civilian labor force 9,635 9,656 9,714 9,636 9,709 9,598 9,667 9,665 9,703
Participation rate 62.1 61.2 61.5 62.1 61.9 61.2 61.3 61.3 61.4
Employed 8,628 8,820 8,853 8,573 8,786 8,812 8,824 8,809 8,807
Employment-
population ratio
55.6 55.9 56.0 55.3 56.1 56.2 56.0 55.8 55.8
Unemployed 1,006 835 862 1,062 922 785 843 857 895
Unemployment rate 10.4 8.7 8.9 11.0 9.5 8.2 8.7 8.9 9.2
Both sexes, 16 to 19
years
Civilian labor force 598 658 591 644 754 722 697 726 642
Participation rate 23.7 26.4 23.7 25.5 30.2 29.0 27.9 29.1 25.7
Employed 401 471 455 419 541 482 490 508 481
Employment-
population ratio
15.9 18.8 18.2 16.6 21.7 19.4 19.6 20.4 19.3
Unemployed 197 188 137 225 213 240 207 218 161
Unemployment rate 32.9 28.5 23.1 34.9 28.2 33.2 29.7 30.0 25.0
ASIAN
Civilian
noninstitutional
population
13,769 14,291 14,296 13,769 13,927 13,886 14,253 14,291 14,296
Civilian labor force 8,889 9,042 8,967 8,857 8,768 8,771 8,899 9,038 8,934
Participation rate 64.6 63.3 62.7 64.3 63.0 63.2 62.4 63.2 62.5
Employed 8,409 8,672 8,685 8,375 8,353 8,398 8,540 8,680 8,646
Employment-
population ratio
61.1 60.7 60.7 60.8 60.0 60.5 59.9 60.7 60.5
Unemployed 480 369 282 482 415 373 359 358 288
Unemployment rate 5.4 4.1 3.1 5.4 4.7 4.2 4.0 4.0 3.2

15. Not in labor force 4,880 5,249 5,329 4,912 5,159 5,115 5,355 5,253 5,363
Footnotes
(1) The population figures are not adjusted for seasonal variation; therefore, identical numbers
appear in the unadjusted and seasonally adjusted columns.
NOTE: Estimates for the above race groups will not sum to totals shown in table A-1 because
data are not presented for all races. Updated population controls are introduced annually with the
release of January data.