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

1. Accessibility & Acceptability
Effectively 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. “It is a peculiar sensation, this double-
consciousness, this sense of always
looking at one’s self through the eyes of
others, of measuring one’s soul by the tape
of a world that looks on in amused
contempt and pity.”
WEB Dubois, 1965

3. New York Times Book Review June, 1981

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 the
Science, 1999 Volume 285
Tuskegee Study.
Vanessa N. Gamble, 2002

5. Framing STD Disparities—Historical Context
Early 20th Century
“The Negro men love to frolic with the women; and the
women love to frolic with the men; so they frolic.”
“The gravest problem to be faced in dealing with the Negro is
not his or her industrial future or right to social equality with
the white man or woman. It is the danger to the public of his
or her contagiousness and infections from the standpoint of
physical and moral disease.”
Myers, NJ. Black Hearts: The Development of Black Sexuality in America. British
Columbia, Vancouver, Canada, Trafford Publishing, 2003.

6. What We Were Told…..
“We don’t criticize the existence of “There is a real dearth of
the government’s figures, but their scientifically arrived at
accuracy is not good because knowledge of the social
their statistics are derived from organization of blacks in
studies only of those who are America because there is no
treated in public clinics.” such thing as a monolithic
black community.”
“There is some over-reporting from
public clinics in the data we have and
there are a number of biases in the
“If we frame the programs to
data, but syphilis surveillance and focus on blacks in the south,
reporting is better than for gonorrhea then it will go nowhere
and Chlamydia.” among blacks in the south.”

7. “Healthy Cultural Paranoia”
In the book, Black Rage, the authors described the
tendency to be suspicious of or distrust institutions
or agencies regarded as being “white” as “healthy
cultural paranoia” that African Americans have
developed over generations in response to racism,
oppression, and discrimination
Grier and Cobbs, 1980

8. “The nine most terrifying words in
the English language are: I’m from
the government and I’m here to
help.”
Ronald Reagan, Chicago, August 12, 1986

10. Some Lessons Learned about Reducing STD Disparities
Multiple 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…”

11. 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

12. 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

13. The Value of
Community Involvement
The 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.

14. Defining Community Participation
• Advise and Consent
• Endorse and Cooperate
• Advise, Guide, Support, Execute
• Define, Decide, Design, Analyze, and Interpret
Hatch, et.al, 1993

15. “Upstream Solutions”

16. What Do We About “Race”?
“Despite general scientific agreement that the
biological definition of “race” is an anachronism,
modern-day medical journals remain replete with
racialized studies that compare the health of blacks
and whites without ever addressing the role of social
class in producing disease in either blacks or whites.”
N. Krieger, 2004

17. 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

18. Do black men get better
health care behind bars?
In the Grio
By Monique W. Morris
on 06/30/2011

19. 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…”

20. “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

21. For more information please contact Centers for
Disease Control and Prevention
1600 Clifton Road NE, Atlanta, GA 30333
Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348
E-mail: cdcinfo@cdc.gov Web: http://www.cdc.gov
The findings and conclusions in this report are those of the authors and do not necessarily
represent 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