Racial/ethnic and sexual behavior disparities in rates of sexually transmitted infections, San Francisco, 1999-2008

Abstract

BackgroundRacial/ethnic minorities and men who have sex with men (MSM) represent populations with disparate sexually transmitted infection (STI) rates. While race-specific STI rates have been widely reported, STI rates among MSM is often challenging given the absence of MSM population estimates. We evaluated the race-specific rates of chlamydia and gonorrhea among MSM and non-MSM in San Francisco between 1999-2008.Methods2000 US Census data for San Francisco was used to estimate the number of African-American, Asian/Pacific Islander, Hispanic, and white males. Data from National HIV Behavioral Surveillance (NHBS) MSM 1, conducted in 2004, was used to estimate the total number of MSM in San Francisco and the size of race/ethnic sub-populations of MSM. Non-MSM estimates were calculated by subtracting the number of estimated MSM from the total number of males residing in San Francisco. Rates of MSM and non-MSM gonorrhea and chlamydia reported between 1999 and 2008 were stratified by race/ethnicity. Ratios of MSM and non-MSM rates of morbidity were calculated by race/ethnicity.ResultsBetween 1999-2008, MSM accounted for 72% of gonorrhea cases and 51% of chlamydia cases. Throughout the study period, African-American MSM had the highest chlamydia rate with 606 cases per 100,000 in 1999 increasing to 2067 cases per 100,000 in 2008. Asian/Pacific Islander MSM consistently had the lowest rate among MSM with1003 cases per 100,000 in 2008. The ratio of MSM/non-MSM for chlamydia was highest among whites 11.6 (95% CI: 8.8-14.4) and Asian/Pacific Islanders 8.6 (95% CI: 6.2-11), and lowest among African-Americans 1.53 (95% CI: 1.2-1.9) and Hispanics 4.43 (95% CI: 2.8-6.0). Gonorrhea rates were similar for African-American, white, and Hispanic MSM between 2137-2441 cases per 100,000 in 2008. Asian/Pacific Islander MSM had the lowest gonorrhea rate with 865 cases per 100,000 in 2008. The ratio of MSM/non-MSM for gonorrhea was highest among whites 11.6 (95% CI: 8.8-14.4) and Asian/Pacific Islanders 8.6 (95% CI: 6.2-11), and lowest among African-Americans 1.53 (95% CI: 1.2-1.9) and Hispanics 4.43 (95% CI: 2.8-6.0).ConclusionsFor all racial/ethnic groups in San Francisco, MSM carried a substantially higher burden of STIs compared to non-MSM except among African-American men. These racial and sexual behavior disparities warrant further public health attention and resources.

Patterns of Adolescent Sexual Behavior Predicting Young Adult Sexually Transmitted Infections: A Latent Class Analysis Approach

“…Nonetheless, these gender differences are strikingly different from those observed in the association with the outcome of young adult STIs. Consistent with prior research (CDC, 2008, 2011), women had higher rates of reporting STIs than men and this difference was consistent across all latent classes (although less pronounced for the Oral Sex Only class, a difference that could be driven by male same-sex behavior, which carries greater risk) (Scott, Bernstein, Raymond, Kohn, & Klausner, 2010). In addition, belonging to a class marked by more risky behaviors was associated with increasing STI risk for men whereas rates of STIs were similar for women in the Low-Risk, Multi-Partner Normative, and Multi-Partner Early classes.…”

Gay and bisexual men engage in fewer risky sexual behaviors while traveling internationally: a cross-sectional study in San Francisco

“…Population estimates of MSM stratified by race/ethnicity were unavailable for comparison with the demographic characteristics of study participants. However, MSM sub-population sizes can be projected using the total number of MSM from consensus estimates and census data 23. These projections suggest that with approximately one-fifth of study participants being of Asian/Pacific-Islander descent and one-sixth of participants being of Hispanic/Latino descent, we were successful in recruiting a racially and ethnically diverse sample of participants.…”

Unity in Diversity

“…These results contribute to the limited number of culturally appropriate interventions available for African American men who have sex with men (Centers for Disease Control and Prevention, 2010a; Centers for Disease Control and Prevention, 2010b; Scott, Bernstein, Raymond, Kohn, & Klausner, 2010). Content of both conditions promoted a range of risk reduction strategies including abstinence, reducing the number of sexual partners, condom use and HIV testing which may explain the reductions in risk behavior in the control condition.…”