Improving Sexual Health in U.S. Rural Communities: Reducing the Impact of Stigma

Valentine, Jo A.; Delgado, Lyana F; Haderxhanaj, Laura T.; Hogben, Matthew

doi:10.1007/s10461-021-03416-4

Cited by 29 publications

(28 citation statements)

References 98 publications

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“…[ 8 ] Poverty, structural inequities (e.g., in housing, transportation, education), racism, mistrust in healthcare providers, barriers to preventive care and testing, lack of access to comprehensive sexual education, and concerns about confidentiality and quality of care are commonly cited factors that drive disparities in the incidence and prevalence of HIV and STIs among minoritized individuals and rural residents. [ 6 , 9 – 11 ] Health beliefs and cultural factors such as perceptions of limited susceptibility and variation in sexual networks are likely to also contribute to heterogeneity in the incidence and prevalence of HIV and STIs among racially and ethnically minoritized populations. [ 11 , 12 ]…”

Section: Introductionmentioning

confidence: 99%

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Racial, Ethnic, and Rural/Urban Disparities in HIV and Sexually Transmitted Infections in South Carolina

et al. 2022

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Examining the current incidence rates of HIV and STIs among racial and ethnic minority and rural residents is crucial to inform and expand initiatives and outreach efforts to address disparities and minimize the health impact of these diseases. A retrospective, cross-sectional study was conducted using Medicaid administrative claims data over a 2-year period (July 2019-June 2021) in South Carolina. Our main outcomes of interest were claims for chlamydia, gonorrhea, syphilis, and HIV. Any beneficiary with at least one claim for a relevant diagnosis throughout the study period was considered to have one of these diseases. Descriptive analyses and multivariable regression models were used to estimate the association between STIs, HIV, race and ethnicity, and rurality. Overall, 158,731 Medicaid beneficiaries had at least one medical claim during the study period. Most were female (86.6%), resided in urban areas (66.6%), and were of non-Hispanic Black race/ethnicity (42.6%). In total, 6.3% of beneficiaries had at least one encounter for chlamydia, 3.2% for gonorrhea, 0.5% for syphilis, and 0.8% for HIV. In multivariable models, chlamydia, gonorrhea, and HIV claims were significantly associated with non-Hispanic Black or other minority race/ethnicity compared to non-Hispanic white race/ethnicity. Rural residents were more likely to have a claim associated with chlamydia and gonorrhea compared to urban residents. The opposite was observed for syphilis and HIV. Providing updated evidence on disparities in STIs and HIV among racial/ethnic minority and rural populations in a southern state is essential for shaping state Medicaid policies to address health disparities.

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Section: Introductionmentioning

confidence: 99%

“…[ 6 , 9 – 11 ] Health beliefs and cultural factors such as perceptions of limited susceptibility and variation in sexual networks are likely to also contribute to heterogeneity in the incidence and prevalence of HIV and STIs among racially and ethnically minoritized populations. [ 11 , 12 ]…”

Section: Introductionmentioning

confidence: 99%

Racial, Ethnic, and Rural/Urban Disparities in HIV and Sexually Transmitted Infections in South Carolina

et al. 2022

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“…18,19 For people seeking STI services, stigma can be experienced at the individual level or at the community or interpersonal level. 20 Telehealth services can offer valuable solutions to these challenges by increasing access to care. 21 Telehealth offers greater flexibility to both the patient and the provider by eliminating the need for transportation regardless of geographic proximity.…”

Section: Telehealth As a Solutionmentioning

confidence: 99%

“…Interpersonal determinants such as racism and other forms of social stigmatization can also discourage health care seeking 18,19 . For people seeking STI services, stigma can be experienced at the individual level or at the community or interpersonal level 20 …”

Section: Telehealth As a Solutionmentioning

confidence: 99%

Telehealth Services: Implications for Enhancing Sexually Transmitted Infection Prevention

2022

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In the United States, sexually transmitted infections (STIs) are among the most persistent threats to health equity. Increasing access to STI prevention and control services through the provision of Remote Health and Telehealth can improve sexual health outcomes. Telehealth has been shown to increase access to care and even improve health outcomes. The increased flexibility offered by Telehealth services accommodates both patient and provider. Although both Telehealth and Remote Health strategies are important for STI prevention, share common attributes, and, in some circumstances, overlap, this article will focus more specifically on considerations for Telehealth and how it can contribute to increasing health equity by offering an important complement to and, in some cases, substitute for in-person STI services for some populations. Telehealth assists a variety of different populations, including those experiencing STI disparities; however, although the Internet offers a promising resource for many American households and increasing percentages of Americans are using its many resources, not all persons have equal access to the Internet. In addition to tailoring STI programs to accommodate unique patient populations, these programs will likely be faced with adapting services to fit reimbursement and licensing regulations.

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“…While the definition of what constitutes a rural community varies, rural communities are generally characterized as areas with low population density located outside of metropolitan areas or cities (Long et al, 2021; Zahnd et al, 2022). Irrespective of the exact definition used, rural communities are shown to face mental (Fontanella et al, 2015; Monnat & Rigg, 2016; Reiss, 2013) and physical health disparities (Ng & Kaye, 2015; Valentine et al, 2022; Ziller et al, 2019). However, adolescents from rural populations are an underserved and understudied population relative to disordered eating and eating disorder risk, and little is known about eating disorder risk among rural adolescents.…”

Section: Introductionmentioning

confidence: 99%

Eating disorder risk in rural US adolescents: What do we know and where do we go?

Hahn

Burnette

Borton

et al. 2022

Intl J Eating Disorders

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Adolescence is a vulnerable period for the development of eating disorders, but there are disparities in eating disorder risk among adolescents. One population that may be at increased risk but is vastly understudied, is adolescents residing in rural regions within the United States. Rural communities face many mental and physical health disparities; however, the literature on rural adolescent eating disorder risk is nearly nonexistent. In this paper we summarize the scant literature on disordered eating and eating disorder risk and prevalence among rural US adolescents. We also detail eating disorder risk factors that may have unique influence in this population, including socioeconomic status, food insecurity, healthcare access, body image, and weight stigma. Given the presence of numerous eating disorder risk factors, we speculate that rural adolescents may be a particularly vulnerable population for eating disorders and we propose critical next steps in research for understanding eating disorder risk among the understudied population of rural adolescents. Public Significance Rural adolescents may be at increased risk for eating disorders due to disproportionate burden of known risk factors, though this relationship remains understudied. We present a summary of the literature on prevalence and unique risk factors, proposing that this may be a high‐risk population. We detail next steps for research to understand eating disorder risk in this population to inform future prevention, identification, and treatment efforts needed in this community.

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Improving Sexual Health in U.S. Rural Communities: Reducing the Impact of Stigma

Cited by 29 publications

References 98 publications

Racial, Ethnic, and Rural/Urban Disparities in HIV and Sexually Transmitted Infections in South Carolina

Racial, Ethnic, and Rural/Urban Disparities in HIV and Sexually Transmitted Infections in South Carolina

Telehealth Services: Implications for Enhancing Sexually Transmitted Infection Prevention

Eating disorder risk in rural US adolescents: What do we know and where do we go?

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