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Confronting disparities: race and sexual health in Minnesota

Amelia Harju

Minnesota is known for being one of the healthiest states in the U.S. This elevated ranking is certainly enjoyed by our white residents, but our racial and ethnic minority residents are often excluded from experiencing this preeminent state of health. Despite numerous efforts to reduce health disparities in Minnesota, we continue to have some of the worst disparities between whites and racial and ethnic minority groups in the U.S.

For example, there are striking racial and ethnic disparities in the incidence of sexually transmitted infections (STIs). The latest data show that in Minnesota, African-Americans are 9.7 times more likely to contract chlamydia and 20 times more likely to contract gonorrhea than whites. Similarly, Native Americans are 5 times more likely to contract chlamydia and 13 times more likely to contract gonorrhea than whites.

Many STIs are asymptomatic and, consequently, people are often unaware of being infected with them. This makes prompt diagnosis and treatment difficult and increases the risk of STIs rapidly spreading through a population. STIs can have detrimental and serious consequences if left untreated, such as pelvic inflammatory disease, infertility, and cancer.

Data from the Centers for Disease Control and Prevention suggest that the cost burden of treating preventable STIs and their complications in Minnesota is approximately $22.7 million per year. These tremendous costs are endured by all Minnesotans by way of tax increases, public programs such as Medicaid, and higher prices for everyone’s health care to compensate for the debt that medical centers have as a result of unpaid medical bills.

Issues contributing to STI disparities

It is becoming increasingly apparent that social determinants of health — such as socioeconomic status, education, social support, physical environment, and health care systems — contribute greatly to the health and well-being of all individuals and consequently play a vital role in the health disparities in Minnesota.

Racial and ethnic minority groups in Minnesota are much more likely to be in poverty, have lower levels of education, and have greater unemployment and uninsurance rates compared to whites as a result of many years of structural racism. These are all risk factors for contracting STIs because they increase the likelihood of individuals facing barriers to accessing affordable, high-quality health care.

Furthermore, racial and ethnic minority groups are more likely than whites to fear and lack trust in health care providers due to the long history of exploitation, unfair treatment, and neglect that these groups have encountered in medical settings in the U.S. Consequently, racial and ethnic minority groups are less likely to seek treatment and preventive health-care services than whites.

Lastly, sex education in Minnesota is not required to be comprehensive, in that it does not have to cover contraceptive use or be medically accurate or age-appropriate. There is considerable evidence that comprehensive sex education improves youths’ sexual behaviors and increases condom use, which is an effective method for preventing STIs. Sex education in Minnesota is also not required to be culturally appropriate, despite evidence that culturally appropriate sex education increases condom use in racial and ethnic minority groups.

Looking forward: solutions

Publicly funded health centers such as federally qualified health centers, Planned Parenthood affiliates, and local health departments provide STI preventive services for over 1 in 4 Americans and treatment for almost 1 in 4 Americans with STIs. They also provide education regarding sex and STIs. These health centers serve large proportions of underprivileged populations, including racial and ethnic minority groups, and are extremely cost effective, saving the government about $7.09 for every public dollar spent on sexual health programs.

We must urge our legislators to support initiatives that will control health care spending while simultaneously ensuring that all Minnesotans have the opportunity to benefit from the distinguished health status of our state. Increasing funding for sexual health programs at publicly funded health centers would be tremendously cost-effective and address many of the issues contributing to racial and ethnic disparities in STI incidence, including access to care, affordability of sexual health services, prevention, early treatment, and sex education.

Amelia Harju is a graduate student at the University of Minnesota, pursuing a master’s degree in public health administration and policy. 

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