Social Determinants of Sexual Health in the USA Among Racial and Ethnic Minorities

  • Hazel D. DeanEmail author
  • Ranell L. Myles


Despite improvements in the prevention, diagnosis, and treatment of HIV/AIDS and other sexually transmitted infections (STI), racial and ethnic minority populations continue to experience disproportionately higher rates and increasing numbers of persons diagnosed with STIs. For example, in 37 states with mature HIV surveillance systems, there were 35,526 persons ≥13 years old who received diagnoses of HIV in 2009, 71 % of whom were racial and ethnic minorities [1]. Further disparities were also observed among persons reported with syphilis, gonorrhea, and Chlamydia. In 2009, more than 70 % of syphilis, 82 % of gonorrhea, and 71 % of Chlamydia cases were among racial and ethnic minorities [2].


Social Capital Ethnic Minority Sexual Health Sexually Transmitted Infection Pacific Islander 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Centers for Disease Control and Prevention. HIV Surveillance Report, 2009; vol. 21. Published February 2011. Accessed July, 2011.
  2. 2.
    Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2009. Atlanta: U.S. Department of Health and Human Services; 2010.Google Scholar
  3. 3.
    Dean HD, Fenton KA. Addressing social determinants of health in the prevention and control of HIV/AIDS, viral hepatitis, sexually transmitted infections and tuberculosis. Public Health Rep. 2010;125 Suppl 4:1–5.PubMedGoogle Scholar
  4. 4.
    Harrison KM, Dean HD. Use of data systems to address social determinants of health: a need to do more. Public Health Rep. 2011;126 Suppl 3:1–4.PubMedGoogle Scholar
  5. 5.
    Koh HK. The ultimate measures of health. Public Health Rep. 2011;126 Suppl 3:14–5.PubMedGoogle Scholar
  6. 6.
    Freiden T. A framework for public health action: the health impact pyramid. Am J Public Health. 2010;100(4):590–5.CrossRefGoogle Scholar
  7. 7.
    Office of Management and Budget. Revisions to the Standards for the Classification of Federal Data on Race and Ethnicity. Federal Register Notice October 30, 1997. Accessed July 2011.
  8. 8.
    U.S. Bureau of the Census. Population Estimates Program, DP-1 general demographic characteristics. 2008. Accessed July 2011.
  9. 9.
    Passel JS, Cohn D. U.S. Population Projections: 2005–2050. Washington DC: Pew Research Center; 2008.Google Scholar
  10. 10.
    Ennis SR, Rios-Vargas M, Albert NG. The Hispanic Population: 2010. 2010 Census Briefs, C2020BR-04. U.S. Census Bureau, Washington, DC. May 2011.Google Scholar
  11. 11.
    World Health Organization. Social determinants of health. Accessed 15 Mar 2010.
  12. 12.
    Tarlov AR. Public policy frameworks for improving population health. Ann N Y Acad Sci. 1999;896:281–93.PubMedCrossRefGoogle Scholar
  13. 13.
    Raphael D. Introduction to the social determinants of health. In: Raphael D, editor. Social determinants of health: Canadian perspectives. Toronto, Canada: Canadian Scholar’s Press; 2004. p. 1–18.Google Scholar
  14. 14.
    Earl CE, Penney PJ. The significance of trust in the research consent process with African Americans. West J Nur Res. 2001;23(7):753–62.CrossRefGoogle Scholar
  15. 15.
    Braun L. Race, ethnicity, and health: Can genetics explain disparities? Perspec Bio Med. 2002;45(2):159–74.CrossRefGoogle Scholar
  16. 16.
    Williams DR, Jackson JS. Race/ethnicity and the 2000 census: Recommendations for African American and other black populations in the United States. Am J Pub Health. 2000;90(11):1728–30.CrossRefGoogle Scholar
  17. 17.
    Ford CL, Harawa NT. A new conceptualization of ethnicity for social epidemiologic and health equity research. Soc Sci Med. 2010;71:251–8.PubMedCrossRefGoogle Scholar
  18. 18.
    Espinoza L, Hall HI, Selik RM, Hu X. Characteristics of HIV infection Among Hispanics, United States 2003–2006. JAIDS. 2008;49(1):94–101.PubMedCrossRefGoogle Scholar
  19. 19.
    Johnson AS, Xiaohong H, Dean HD. Epidemiologic differences between native-born and foreign-born blacks diagnosed with HIV infection in 33 U.S. states, 2001–2007. Public Health Rep. 2010;125(S4):61–9.PubMedGoogle Scholar
  20. 20.
    Grieco EM. Race and Hispanic Origin of the Foreign-Born Population in the United States: 2007, American Community Survey Reports, ACS-11. Washington, DC: U.S. Census Bureau; 2010.Google Scholar
  21. 21.
    James C, Thomas M, Lillie-Blanton M, Garfield R. Key Facts Race, Ethnicity & Medical Care. The Henry J. Kaiser Family Foundation. January 2007.Google Scholar
  22. 22.
    Williams DR, Collins C. Racial residential segregation: a fundamental cause of racial disparities in health. Pub Health Rep. 2001;116:404–16.Google Scholar
  23. 23.
    Acevedo-Garcia D, Osypuk TL, McArdle N, Williams DR. Toward a policy-relevant analysis of geographic and racial/ethnic disparities in child health. Health Aff. 2008;27(2):321–33.CrossRefGoogle Scholar
  24. 24.
    LaVeist TA, Gaskin D, Trujillo AJ. Segregated spaces, risky places: the effects of racial segregation on health inequalities. Washington, DC: Joint Center for Political and Economic Studies; 2011.Google Scholar
  25. 25.
    Pendall R, Davies E, Freiman L, Pitingolo R. A Lost Decade: Neighborhood Poverty and the Urban Crisis of the 2000s. Washington, DC: Joint Center for Political and Economic Studies; 2011.Google Scholar
  26. 26.
    Rossi PH, Weber E. The social benefits of homeownership: empirical evidence from national surveys. Housing Policy Debate. 1996;7(1):1–35.CrossRefGoogle Scholar
  27. 27.
    Dietz R, Haurin D. The social and private micro-level consequences of homeownership. J of Urban Econ. 2003;54(3):401–50.CrossRefGoogle Scholar
  28. 28.
    U.S. Bureau of the Census. Homeownership Rates by Race and Ethnicity of Householder: 1994 to 2010. Accessed 31 Aug 2011.
  29. 29.
    Taylor EM, Adimora AA, Schoenbach VJ. Marital status and sexually transmitted infections among African Americans. J Family Issues. 2010;31(9):1147–65.CrossRefGoogle Scholar
  30. 30.
    U.S. Bureau of Justice Statistics. Jail Inmates at Midyear 2010. Accessed 31 Aug 2011.
  31. 31.
    Bureau of Justice Statistics (US). Prison Inmates at Midyear 2009. Accessed 31 Aug 2011.
  32. 32.
    U.S. Bureau of Labor Statistics. 2011. Labor force characteristics by race and ethnicity, 2010. U.S. Department of Labor. Report 1032.Google Scholar
  33. 33.
    Williams DR. Race, socioeconomic status, and health—the added effects of racism and discrimination. Ann NY Acad Sci. 1999;896:281–93.CrossRefGoogle Scholar
  34. 34.
    DeNavas-Walt C, Proctor BD, Smith JC. U.S. Census Bureau, Current Population Reports, P60–239, Income, Poverty, and Health Insurance Coverage in the United States: 2010, U.S. Government Printing Office, Washington, DC, 2011.Google Scholar
  35. 35.
    Taylor P, Kochhar R, Fry R, Velasco G, Motel S. Twenty—to—One: Wealth Gaps Rise to Record Highs Between Whites, Blacks and Hispanics. Washington DC, Pew Research Center; 2011.Google Scholar
  36. 36.
    James C, Thomas M, Lillie-Blanton M, Garfield R. Key Facts Race, Ethnicity & Medical Care. Menlo Park, CA: The Henry J. Kaiser Family Foundation; 2007.Google Scholar
  37. 37.
    DeNavas-Walt C, Proctor BD, Smith JC. U.S. Census Bureau, Current Population Reports, P60-236, Income, Poverty, and Health Insurance Coverage in the United States: 2008. , Washington, DC: U.S. Government Printing Office; 2008.Google Scholar
  38. 38.
    Gottschalck AO. Net Worth and Asset Ownership of Households: 2002. Current Population Reports, P70-115. Washington, DC: U.S. Census Bureau; 2008.Google Scholar
  39. 39.
    Smedley BD. Moving beyond access: achieving equity in state health care reform. Health Aff. 2008;27(2):447–55.CrossRefGoogle Scholar
  40. 40.
    Agency for Healthcare Research and Quality (AHRQ). National Healthcare Disparities Report, 2005. Accessed 10 Jan 2011.
  41. 41.
    Keppel K, Pamuk E, Lynch J, et al. Methodological issues in measuring health disparities. Vital Health Stat. 2005;141(2):1–6.Google Scholar
  42. 42.
    Hall I, Byers RH, Ling Q, Espinoza LH. Ethnic and Age disparities in HIV prevalence and disease ­progression among Men Who have Sex with Men in the united states. Am J Public Health. 2007;97(6):1060–6.PubMedCrossRefGoogle Scholar
  43. 43.
    Rastogi S, Johnson TD, Hoeffel EM, Drewery MP. The Black Population 2010. Census Briefs, C2010BR-06. Washington, DC: U.S. Census Bureau; 2011.Google Scholar
  44. 44.
    Commission on the Social Determinants of Health. Closing the gap in a generation: health equity through action on the social determinants of health. Final Report of the Commission on Social Determinants of Health. Geneva, World Health Organization; 2008.Google Scholar
  45. 45.
    World Health Organization. Towards a conceptual framework for analysis and action on social determinants of health. Discussion paper for the Commission on Social Determinants of Health. 2007. Accessed: Jul 2011.
  46. 46.
    U.S. Congress. Senate. H.R. 3590, Patient Protection and Affordable Care Act. H.R. 3590. 111th cong., 1st sess. (March 23, 2010) Accessed July 2011.
  47. 47.
    National Prevention Council, National Prevention Strategy, Washington, DC: U.S. Department of Health and Human Services, Office of the Surgeon General, 2011.Google Scholar
  48. 48.
    White House Office of National AIDS Policy (ONAP). National HIV/AIDS Strategy for the United States. July 2010. Accessed: July 2011.
  49. 49.
    US Department of Health and Human Resources. Proposed Data Collection Standards for Race, Ethnicity, Primary Language, Sex, and Disability Status Required by Section 4302 of the Affordable Care Act. Accessed July, 2011)
  50. 50.
    Andrulis D, Siddiqui N, Purtle J and Duchon L. Patient Protection and Affordable Care Act of 2010: Advancing Health Equity for Racially and Ethnically Diverse Populations. Joint Center for Political and Economic Studies, July 2010: pg. 6. Available online: .
  51. 51.
    Holmes KK, Mardh P, Sparling PF, et al., editors. Sexually transmitted diseases. 3rd ed. New York, NY: McGraw-Hill; 1999.Google Scholar
  52. 52.
    Lichtenstein B, Hook III EW, Sharma AK. Public tolerance, private pain: stigma and sexually transmitted infections in the American deep south. Cult Health Sex. 2005;7(1):43–57.PubMedCrossRefGoogle Scholar
  53. 53.
    Bowleg L, Teti M, Massie JS, et al. ‘What does it take to be a man? What is a real man?’: ideologies of masculinity and HIV sexual risk among Black heterosexual men. Cult Health Sex. 2011;i:1–15.Google Scholar
  54. 54.
    Herd P, Goesling B, House JS. Socioeconomic position and health: the differential effects of education versus income on the onset versus progression of health problems. J Health Soc Behav. 2007;48(3):223–38.PubMedCrossRefGoogle Scholar
  55. 55.
    Springer YP, Samuel MC, Bolan G. Socioeconomic gradients in sexually transmitted diseases: A geographic information system-based analysis of poverty, race/ethnicity, and gonorrhea rates in California, 2004–2006. Am J Pub Health. 2010;100(6):1060–7.CrossRefGoogle Scholar
  56. 56.
    Cohen D, Spear S, Scribner R, et al. “Broken windows” and the risk of gonorrhea. Am J Pub Health. 2000;90(2):230–6.CrossRefGoogle Scholar
  57. 57.
    Bauermeister JA, Zimmerman MA, Caldwell CH. Neighborhood disadvantage and changes in condom use among African American adolescents. J Urban Studies. 2010;88(1):66–83.Google Scholar
  58. 58.
    Wingood GM, DiClemente RJ. Enhancing adoption of evidence-based HIV interventions: promotion of a suite of HIV prevention interventions for African American women. AIDS Educ Prev. 2006;18(4 Suppl A):161–70.PubMedCrossRefGoogle Scholar
  59. 59.
    Lang DL, Salazar LF, Wingood GM, DiClimente RJ, Mikhail I. Associations between recent gender-based violence and pregnancy, sexually transmitted infections, condom use practices, and negotiation of sexual practices among HIV-positive women. JAIDS. 2007;46(2):216–21.PubMedCrossRefGoogle Scholar
  60. 60.
    Adimora AA, Schoenbach VJ. Social context, sexual networks, and racial disparities in rates of sexually transmitted infections. J Infect Dis. 2005;191 Suppl 1:S115–22.PubMedCrossRefGoogle Scholar
  61. 61.
    Adimora AA, Shcoenbach VJ, Doherty IA. HIV and African Americans in the southern United States: sexual networks and social context. Sexually Trans Dis. 2006;33(7 Suppl):S39–45.CrossRefGoogle Scholar
  62. 62.
    Thomas JC. From slavery to incarceration: social forces affecting the epidemiology of sexually transmitted diseases in the rural south. Sexually Trans Dis. 2006;33(7 Suppl):S6–10.CrossRefGoogle Scholar
  63. 63.
    Laumann EO, Youm Y. Racial/ethnic group differences in the prevalence of sexually transmitted diseases in the United States: a network explanation. Sexually Trans Dis. 1999;26(5):250–61.CrossRefGoogle Scholar
  64. 64.
    Adimora AA, Schoenbach VJ, Martinson FE, et al. Social context of sexual relationships among rural African Americans. Sexually Trans Dis. 2001;28(2):69–75.CrossRefGoogle Scholar
  65. 65.
    Doherty IA, Padian NS, Marlow C, Aral SO. Determinants and consequences of sexual networks as they affect the spread of sexually transmitted infections. J Infect Dis. 2005;191 Suppl 1:S42–54.PubMedCrossRefGoogle Scholar
  66. 66.
    World Health Organization. Commission on Social Determinants of Health. A Conceptual Framework for Action on the Social Determinants of Health (Draft). Retrieved Accessed Sept 2011.
  67. 67.
    Muntaner C, Lynch J. Income inequality, social cohesion, and class relations: A critique of Wilkinson’s neo-Durkheimian research program. Int J Health Serv. 1999;29(1):59–81.PubMedCrossRefGoogle Scholar
  68. 68.
    Holtgrave DR, Crosby RA. Social capital, poverty, and income inequality as predictors of gonorrhea, syphilis, chlamydia and AIDS case rates in the United States. Sex Transm Infect. 2003;70(1):62–4.CrossRefGoogle Scholar
  69. 69.
    Kerrigan D, Witt S, Glass B, Chung S, Ellen J. Perceived neighborhood social cohesion and condom use among adolescents vulnerable to HIV/STI. AIDS Behav. 2006;10(6):723–9.PubMedCrossRefGoogle Scholar
  70. 70.
    Parker RM. Health literacy: a challenge for American patients and their health care providers. Health Prom Intl. 2000;15:277–91.CrossRefGoogle Scholar
  71. 71.
    DeWalt DA, Boone RS, Pignone MP. Literacy and its relationship with self-efficacy, trust, and participation in medical decision-making. Am J Health Behav. 2007;31:S27–35.PubMedCrossRefGoogle Scholar
  72. 72.
    Gfroerer JC, Greenblatt JC, Wright DA. Substance use in the US in the US college-age population: ­differences according to educational status and living arrangement. Am J of Pub Health. 1997;87(1):62–5.CrossRefGoogle Scholar
  73. 73.
    Feldman J, Makuc DM, Kleinman J, Cornoni-Huntley J. National trends in educational differentials in mortality. Am J of Epi. 1989;129:919–33.Google Scholar
  74. 74.
    Williams DR. Socioeconomic differentials in health: a review and redirection. Soc Psych Quart. 1990;53(2):81–99.CrossRefGoogle Scholar
  75. 75.
    Kirby D. Sex Education: Access and Impact on Sexual Behaviour of Young People. New York, NY: Population Division, Department of Economic and Social Affairs, United Nations Secretariat; 2011.Google Scholar
  76. 76.
    Santelli J, Ott MA, Lyon M, et al. Abstinence and abstinence-only education: A review of U.S. policies. J Adol. Health. 2006;38:72–81.Google Scholar
  77. 77.
    Kohler PK, Manhart LE, Lafferty WE. Abstinence-only and comprehensive sex education and the initiation of sexual activity and teen pregnancy. J Adol Health. 2008;42:344–51.CrossRefGoogle Scholar
  78. 78.
    Bureau of Justice Statistics. Prison Inmates at Midyear 2008—Statistical Tables and Jail Inmates at Midyear—Statistical Tables. NCJ 123456. March 31, 2009. Accessed Jul 2011.
  79. 79.
    National Commission on Correctional Health Care. Health status of soon-to-be-released inmates: a report to Congress. Vol. 1. Washington, DC: National Commission on Correctional Health Care, 2002.Google Scholar
  80. 80.
    Dean-Gaitor H, Fleming PL. Epidemiology of AIDS in incarcerated persons in the United States, 1994–1996. AIDS. 1999;13:2429–35.PubMedCrossRefGoogle Scholar
  81. 81.
    Hammett T, Harmon MP, Rhodes W. The burden of infectious disease among inmates of and releases from US correctional facilities, 1997. Am J Pub Health. 2002;92(11):1789–94.CrossRefGoogle Scholar
  82. 82.
    Wohl AR, Johnson D, Jordan W, Lu S, Beall G, Currier J, Kerndt PR. High-risk behaviors during incarceration in African-American men treated for HIV at three Los Angeles public medical centers. JAIDS. 2000;24(4):386–92.PubMedGoogle Scholar
  83. 83.
    Inciardi JA. Crack, crack house sex, and HIV risk. Arch of Sexual Behav. 1995;24(3):249–69.CrossRefGoogle Scholar
  84. 84.
    Kassira EN, Bauserman RL, Tomoyasu N, Caldeira E, Swetz A, Solomon L. HIV and AIDS surveillance among inmates in Maryland prisons. J Urban Health. 2001;78(2):256–63.PubMedCrossRefGoogle Scholar
  85. 85.
    Blankenship KM, Smoyer AB, Bray SJ, Mattocks K. Black-white disparities in HIV/AIDS: the role of drug policy and the corrections system. J Health Care Poor Underserved. 2005;16(4 Suppl B):140–56.PubMedGoogle Scholar
  86. 86.
    Centers for Disease Control and Prevention. Consultation to Address STD Disparities in African American Communities: Meeting Report. Published October 2007. Accessed Nov 2011.

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and PreventionAtlantaUSA

Personalised recommendations