Health Care, Health News, Love, Wellness

Communities like mine are being failed by the sexual health industry

I wish my parents had been brave enough to have "the talk" with me - instead of feeling ashamed about it.

At 23 years old, I’m still pretty sure that I have not had “the talk” with my parents.

I have had a “first-period briefing” and the mandatory “be-careful-of-what-you-wear briefing” that all young women have to endure. But none of that has culminated in the ultimate “talk,” where my poor mother has to explain S-E-X. 

Of course, through education, media, friendships, and relationships, it’s safe to say that I have figured it out. But my experience probably resonates with the vast majority of adolescents and young adults from ethnic minority backgrounds: open conversations about sex and sexuality is still taboo in families and communities of color. 

Culturally, I understand the challenge of talking to your children about something you might find shameful to address. However, from a public health perspective, parents need to begin to take ownership in educating their children about sex, especially when it comes to sexually-transmitted diseases (STDs). 

In healthcare communications across the world, STDs are often branded as maladies that come as a result of promiscuity and a more “carefree” sex life – people are generally advised to get checked after each new partner, as opposed to just regularly, even with one, steady partner. As most communities of color do not actively advocate for multiple sexual partners or even sex-before-marriage, it is automatically assumed that by extension, they are not impacted by this problem. 

The statistics, however, are shocking. The Centers for Disease Control and Prevention (CDC) have found that rates of gonorrhea, chlamydia, and syphilis have increased amongst all racial groups in the USA.

This is including African Americans, Native Americans, Hispanic communities, Asian Americans and White Americans. However, the rates of increase are disproportionately larger for the ethnic minorities: the rate of reported chlamydia cases was five times higher for Black women than for white women and reported cases of Native American men with gonorrhea were three times higher than that of white men.  

In the U.S., higher rates of STDs among communities of color are directly correlated to a severe lack of access to healthcare facilities in poorer neighborhoods. Insurance coverage, or lack thereof, has been cited by the CDC as a reason that STDs rates are shooting up in communities of color.

By extension, socio-economic status, employment, and family background also become key determinants. 

However, even when access to healthcare is equal, this statistic rings true. In the United Kingdom, where the National Health Service provides universal healthcare regardless of employment status, gonorrhea rates were much higher among black residents than white residents in five major British cities

It is, of course, far too easy to put the onus on parents and families to do the educating. Research also shows that immigrant families are actually less likely to contract STDs than native-born people of color. Although the study itself credits familial ties for this discrepancy, the reasons could actually be innumerable and interlinked.

Teenage rebellion, exploration of the self and sexuality and a disconnect from immigrant parents’ cultures could all lead to native-born minorities participating in risky sexual activity. 

Yes, my mother and many other mothers may have opted to not have that conversation with their children. But in light of a systematically racist healthcare system that also shuts communities of color out of the conversation, society also needs to take some responsibility. 

Immigrant communities often come seeking healthcare with linguistic barriers, which leads to ostracisation and bias on behalf of health workers. There is a minimum attempt made to make services accessible, and this overwhelming sense of exclusion leads to many communities of color mistrusting the healthcare system. 

This distrust is likely to permeate generations. So, those who are native-born, but have immigrant parents, could internalize their parents’ experiences of discrimination in the healthcare system. This is probably why even after diagnosis, poorer communities of color are less likely to follow their HIV treatment regime.

It would also be much too simplistic to say that the correct educational background would tackle this from the ground up. With sufficient amounts of systematic and structural discrimination in education, just as in healthcare, young people of color are set up to encounter this sort of social discrimination despite their academic attainment levels. 

The power of media and healthcare communications, however, can tackle this public health epidemic. The messaging around STDs needs to change in order to include people and communities of color, both immigrant and native. 

This includes services in multiple languages, presented by people of color, who live in and understand the circumstances of these audiences. Contextualized, tailored, culturally appropriate media is required so that healthcare providers can include communities of color in this vital conversation and create a more inclusive view of public health. 

Looking back, I do wish my parents had been brave enough to have “the talk” with me. I wish they had let go of perceptions of shame and lust, and instead thought about the value of teaching me about safe, healthy sex. Optimistically, I believe that millennial parents of color will do away with these historical taboos as they have their own children.

I will certainly be making sure that my children, regardless of gender, know what a condom is and how to use one.