Gonorrhea and Chlamydia Reduction in Hispanic Women

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Table of Contents

Introduction
Vulnerable Population Assessment
Qualitative Data
Analysis and Summary of Data
Review of Literature for Intervention Studies
Program Plan and Evaluation
Annotated Bibliography
References

Introduction

Sexually transmitted infections (STI’s) are contracted through sexual contact. There are more than 25 such diseases that are spread through vaginal, anal, and oral sex (Womenshealth.gov, 2018). The main causes of the diseases are bacteria and viruses, which spread through unprotected sex with an infected person (Womenshealth.gov, 2018). According to Womenshealth.gov (2018), there are 20 million reported cases of STI’s every year and most of them are in the age group of 15-24. It is reported that women tend to have more serious problems form STI’s than men (Womenshealth.gov, 2018). Gonorrhea and chlamydia, if left untreated, can increase the risk for chronic pelvic pain, ectopic pregnancy, and infertility. This project is an attempt to reduce the incidence of STIs Gonorrhea/Chlamydia among Hispanic women. Its purpose is to reduce STI’s Gonorrhea/Chlamydia among Hispanic women in Michigan and to plan a culturally appropriate intervention to address this area of health.

Vulnerable Population Assessment

Quantitative Data

This section of the paper shows the steps and data that were gathered from a quantitative review of health information relating to the topic under investigation. The final data is also inclusive of the ethnic and cultural factors relating to the sexual health of Hispanic women.

Demographic Data

The population of Michigan (9,889,024), Berrien Co. (155,912), Cass Co. (52,001), Van Buren Co. (75,569) (Lakeland Community Needs Assessment, 2016).
Hispanics Women population of Michigan (214, 415) (Suburbanstats.org, 2017).
Caucasian Women population of Michigan (3,957,000) (Suburbanstats.org, 2017).
About 59% of Hispanic women are gainfully employed (CDC, 2016).
The median earnings of Hispanic women are $460 per week, thereby placing Michigan in position 45/50 states with the lowest earnings for women (CDC, 2017).
Hispanics have among the lowest rates of health insurance at 83% (CDC, 2017).
About 77% of Hispanic women are Christians (Paz & Massey, 2016).
Up to 50% of the population of Hispanic women do not speak English (Paz & Massey, 2016).
Only 15% of women have completed college or a higher education level, while the national average of women who have attained this education level is 18% (Paz & Massey, 2016).
Women only earn 64% of what men get in Michigan state, thereby putting them at risk of defaulting on their loans or on their health payment plans (Paz & Massey, 2016).
More than 50% of Hispanic women attend college on a part-time basis (Rhodes et al., 2015).
The life expectancy of Latinas is considerably shorter (77.1 years) compared to their Asian (86.8) and white counterparts (79.6 years) (Paz & Massey, 2016).
Immigrant Latino women have a 15%-20% lower mortality compared to US-born Latinos (Paz & Massey, 2016).
Hispanic women have twice the level of unemployment (7.7%) compared to their white counterparts (3.3%) (Paz & Massey, 2016).

Statistical Data about Health Issue

The total cases of Chlamydia reported in the US is 1.59 million cases (4.7% rate increase since 2015) (CDC, 2017).
The total cases of Gonorrhea reported in the US is 468,514 cases (18.5% rate increase since 2015) (CDC, 2017).
Michigan has Ranked 21st among the 50 states in Chlamydial infections 469.1 cases per 100,000 and ranked 26th in gonorrheal infections (104.2 per 100,000) (CDC, 2015).
The incidence of Gonorrhea reported in Michigan is 12,450, 125.5 per 100,000 population (CDC, 2015).
The incidence of Chlamydia reported in Michigan is 45,936, 462.9 per 100,000 (CDC, 2015).
Total cases of Chlamydia reported in the US among Hispanic women is (149,009) 532.4 per 100,000 population compared to Caucasian women at (272,126) 271.1 per 100,000 population (CDC, 2017).
The incidence of gonorrhea is 73.3 cases per 100,000 population in the US (1.9 times higher than the rate among Caucasian females) (CDC, 2017).
The incidence of Chlamydia is 380.6 cases per 100,000 population which is 1.9 times the rate among whites (CDC, 2017).
There are 365 cases (or a rate of 3.7 per 100,000 people) of gonorrhea reported in Michigan annually of primary and secondary syphilis (CDC, 2015).
There are 13 cases (or a rate of 11.4 per 100,000 people) of congenital syphilis in Michigan annually (Pflieger, Cook, Niccolai, & Connell, 2013).
The asymptomatic nature of chlamydial infections in about 85% of the cases affecting Hispanic women prevents them from going for screening (CDC, 2017).
Limited resources, lack of information, and concerns about other people’s view outline the barriers to STI screening in about 60% of Hispanic women (Paz & Massey, 2016).

Cultural Factors Contributing to STIs

Up to 60% of Hispanic women have not received any form of sex education from their parents (Samari & Seltzer, 2016; NHCSL, 2017; Vincent et al., 2016).
More than 65% of Hispanic men subscribe to the concept of machismo which accentuates attributes of male sexual dominance and superiority, which encourages some of them to have relationships outside their primary unions (Samari & Seltzer, 2016).
More than 50% of Hispanic households teach their children to uphold values of virginity, and no sex before marriage (Samari & Seltzer, 2016).
Fear of deportation impedes immigrant women from reporting risky sexual behaviors such as the exchange of sex for money or substance abuse (McCabe, Solle, Montano, & Mitrani, 2017).
Myths and misconceptions about sexually transmitted diseases in about 24% of the female population affect the ability of Hispanic women to gain the correct health knowledge (Rhodes et al., 2017).
Immigrant and less acculturated Hispanic women who comprise about 50% of the Hispanic population are less likely to engage in condom use and more likely to engage in risky sexual behaviors such as commercial sex work and the use of alcohol/drugs during intercourse (Paz & Massey, 2016).
Machismo and Marianismo cultures, which affect about 63% of the Hispanic population, pose a challenge to condom use because they undermine the power of women in negotiating for the same (Paz & Massey, 2016).

Qualitative Data

Windshield Survey

In this qualitative data segment, information relating to the community’s environment, people, attitudes, social functioning, and environment are explored.

Sight: Restaurants and retail shops were the most commonly visible businesses in the community. Detached houses, mobile homes, and townhouses were also commonly found in the area, with the most common types of health services being maternal and reproductive health treatments.
Sound: The noise made by moving cars was the most commonly heard.
Taste: Many people shop for food in grocery stores and in supermarkets. A loaf of bread costs about $1.44, a dozen eggs would be sold for $2.09, and one-quarter of mild sells for $3. Most of the products bought from the stores are fresh. Restaurants and pubs were the most common types of eateries in the community.
Smell: The smell in the community is generally pleasant. However, there were industrial emissions in some sections of the city, which also had some debris. Lastly, some garbage cans were visible.
Touch: Fences were used to define boundaries. In some instances, natural boundaries such as roads, trees, and even hedges demarcated certain sections of the community.

Interview with a Hispanic Person

The existence of alternative forms of medicine significantly impeded people’s resolve to seek mainstream medical services. Some botanical and herbal medicine shops existed in the community and some local healers operated in the underground scene by offering health services to a largely immigrant population. Planned health fairs and advertisements for health-related events in the community were visible in some sections of the community, but the efficacy in the use of health resources was subjective to the types of health services offered.

The family unit was at the center of the community’s societal structure. Although parents were the main guardians for children, it was common to find households with two generations living under the same roof. Drug abuse was a key social problem in the community. Environmental conditions were “generally good.” There were no serious cases of pollutants noted or nuisances such as insect infestations and the likes. In this regard, there were no serious environmental risks related to the health of the region.

An assessment of the community’s vitality showed that most members were vibrant. Women were often seen strolling on the streets with their children and people from multiple races dotted the landscape. Tourists also visited the locality and the community members had a good general appearance. However, some people appeared to be under the influence of alcohol and other substances. The use of health resources is below par. In addition, most community members are aware of the existence of several health care centers.

Analysis and Summary of Data

Risk for STIs

In this section of the report, an analysis of the qualitative and quantitative data highlighted above is done. For example, some key pieces of data that indicate the risk for sexually transmitted infections among the target population center on the cultural makeup of the community. This information has been discussed in the quantitative section of the report. Particularly, the lack of sex education among Hispanic women, which has been reported to affect up to 60% of the population, is worrisome because it means that most young women start having sex without having the accurate knowledge that would help them make informed decisions about their health (McCabe et al., 2017).

The retrogressive cultural practices that stem from dominant patriarchal systems in the Hispanic community further put women at risk of infections because it undermines their ability to negotiate for condom use (Haderxhanaj, Rhodes, Romaguera, Bloom, & Leichliter, 2015). In this regard, they are living in a community that has little regard for their opinions (especially regarding sexual health matters), thereby making them secondary decision-makers (subject to their opinions or wishes of the male sexual partners) (Haderxhanaj et al., 2015). This issue makes it difficult for women to take control of their sexual health. Furthermore, it creates a cyclic dependence trap for the female population because women have to constantly look up to their male partners for “direction” regarding sexual health matters.

The findings highlighted in this study have also shown that many Hispanic women are likely to be living in low-income communities relative to their white counterparts (Haderxhanaj et al., 2015). This situation makes them vulnerable to misinformation and the lack of proper access to sexual health care services because their communities often lack adequate health and education resources that would empower women to make sound health decisions or seek health services when there is a need to do so. To demonstrate their vulnerability, women who live in high-income neighborhoods often have good health outcomes because their socioeconomic determinants of health (such as education and adequate access to health care) provide them with the resources to make sound health decisions and seek appropriate health care services (McCabe et al., 2017). Thus, they are likely to experience low incidences of STI screening and reporting. They are similarly likely to gain access to contraceptive services, which would help them to prevent STI transmission, relative to their Caucasian counterparts.

Hispanic women are at risk of contracting sexually transmitted diseases because their low socioeconomic status exposes them to multiple risk factors that lead to the spread of such infections (McCabe et al., 2017). For example, the quantitative findings highlighted earlier showed that they are among the most underinsured populations in America (McCabe et al., 2017). This situation acts as a barrier to health care access. It is further worsened by the existence of a significant population of Hispanic females (about 50%) who are immigrants and cannot speak proper English (Samari & Seltzer, 2016). Their inability to communicate effectively also acts as a barrier to health care access because they cannot communicate well with health workers (NHCSL, 2017). Additionally, they would not want to reveal their immigration status to health officials because they could transfer the same information to authorities (Samari & Seltzer, 2016; NHCSL, 2017; Vincent et al., 2016). Their low economic status and volatile living conditions add to their vulnerable status because some of them are involved in commercial sex work to provide money for the families they leave at home, thereby increasing their exposure to sexually transmitted diseases (McCabe et al., 2017).

The qualitative data gathered from this review also show that reproductive health services are not commonly visible to the population because health centers offering these types of health services are not openly accessible to a majority of the population. Since some Hispanic women are vulnerable to violence from their male counterparts, the lack of open protective services in the community could abate the problem because many community members identified child protective services as being the most visible protective care in the community (McCabe et al., 2017; NHCSL, 2017; Vincent et al., 2016). This finding means that it may be difficult for some of the women to know where to seek help when they experience violence from their spouses or partners (Stockman, Hayashi, & Campbell, 2015). Collectively, these factors explain why a Hispanic woman is a vulnerable group.

Community Population Diagnosis

This community population diagnosis is developed according to the guidelines provided by Curley and Vitale (2012). A large immigrant population, high levels of underinsurance, low socioeconomic status, low ability to negotiate for condom use, prominence of myths and misconceptions about sexually transmitted diseases, low levels of sex education, and high numbers of non-English speaking women characterize the vulnerability of the target population to STIs (Villar-Loubet et al., 2016; Cipres et al., 2017).

This fact is evidenced by the high incidence of gonorrhea, which is 73.3 cases per 100,000 population (1.9 times higher than the rate among Caucasian females), a high incidence of Chlamydia, which is 380.6 cases per 100,000 population, and the high incidence of syphilis, which is 7.6 cases per 100,000 population (2.2 times the rate of whites) (CDC, 2017). Comprehensively, the above data provides a holistic picture of the population health incidence of STIs. The group factors highlighted in the assessment also explain why the target population is at risk of sexually transmitted diseases.

Goals and Objectives of the Intervention

By the year 2020, the program should reduce the incidence of newly diagnosed STIs in Michigan, by 45% to no more than 77 diagnoses for every population of 100,000 people.
To increase early access to STI prevention services by 20% in the year 2020 by increasing people’s awareness of available sexual reproductive health care services in the community.
Decrease STI disparities among Hispanic and Caucasian women by 25% to 26.6 cases per a population sample of 100,000 in the year 2020.

Review of Literature for Intervention Studies

Literature Search

Previous research studies that have promoted positive sexual health behaviors among immigrants highlight the need to formulate culturally appropriate interventions. For example, a study by Garbers et al. (2016) which targeted black and Latino minorities showed that a culturally appropriate intervention needed to be formulated to encourage them to be tested for STIs and HIV. A study by Teitelman, Calhoun, Duncan, Washio, and McDougle (2015) also emphasizes the importance of understanding individual and group dynamics when formulating interventions to encourage people to test for STIs.

According to McLellan-Lemal et al. (2013), public health workers should also know that many Hispanics are likely to be living in low-income communities (relative to their white counterparts). Therefore, they are likely to suffer from poor access to health care services. Studies by Lanier and Sutton (2013) also highlight the importance of understanding the diversity that exists among the Hispanic population, especially when targeting the population through elaborate sexual health interventions.

Comprehensively, the above studies show different recommendations made by researchers who have studied how to create effective public health interventions to improve sexual health outcomes among Hispanics. Their links are available in the annotated bibliography section. Nonetheless, the two articles below provide significant lessons in formulating the same interventions among minority groups. The information obtained from them will be useful in developing a program, which is highlighted in the last section of this report.

Intervention Articles

Rotblatt, Montoya, Plant, Guerry, and Kerndt (2013) and Sanchez et al. (2016) have developed two intervention articles that have investigated health programs aimed at decreasing the incidence of STIs among minority populations. They are discussed below.

First Article

The purpose of the article by Rotblatt et al. (2013) was to increase the rate of chlamydia and gonorrhea testing among Hispanic and African-American women in Los Angeles through a culturally sensitive program – No Place like Home. The research design was premised on a social marketing campaign intended to encourage women to order for testing kits online (Rotblatt et al., 2013). The cultural considerations acknowledged by the researchers were centered on providing bilingual services in Spanish and English. At the same time, the program’s design allowed the women to order for the tests anonymously, thereby safeguarding their privacy and protecting them from the social stigma of undertaking such tests with other people present. Lastly, the study outcomes suggested that the program’s scalability, morbidity, and high response rates made it an acceptable tool for controlling sexually transmitted infections (Rotblatt et al., 2013).

Second Article

Sanchez et al. (2016) prepared the second article selected for review. Its purpose was to evaluate the effectiveness of a culturally sensitive program – Health, Education, Prevention, Self-care (SEPA), which was aimed at preventing HIV and sexually transmitted diseases among Latina immigrants in the farmworker community of Miami, Florida. The intervention was premised on a community-based participatory research (CBPR) framework and its cultural considerations were based on the principles of acculturation and the role of the female gender in the Hispanic community (Marianismo) (Sanchez et al., 2016). The study outcomes indicated that the program was effective in increasing the knowledge of HIV and sexually transmitted diseases among the target population. It was also found to be useful in reducing sexually risky behaviors among the same population (Sanchez et al., 2016).

Key Cultural Interventions to Include in the Intervention Design

Promote collaborative relationships.
Skills building activities (identification of personal risk behaviors, and role-playing).
The inclusion of closed-ended questions to enable participant understanding.
Promote personal relevance to the health issue by tailoring questions to the specific context of the research participants.
Tailor questions to participants’ risk reduction and informational needs (Grau et al., 2013).

Program Plan and Evaluation

Goal

To reduce the incidence of STI among Hispanic women in Nile Michigan in two years by starting a school-based intervention known as CONCEPT that would teach adolescent girls about the importance of condom use as a strategy of promoting better sexual health behaviors.

Cultural Relevance

To align with the cultural practices of Hispanic women, people who are proficient in both Spanish and English would implement the program. The program coordinator must also be an indigenous member of the community and demonstrate adequate knowledge of the target population.

The Relevance of the Program

The CONCEPT program will be appropriate in boosting the STI fight in the Hispanic community because it will empower young girls to take firmer control of their sexual health by being more proactive and decisive in making sexual health decisions. The program will equip them with knowledge about how to negotiate with their partners about condom use and encourage them to be vigilant about sexual health matters. These measures will help them to protect themselves from sexually transmitted infections. Lastly, the program will also teach them about the importance of getting reproductive health services. Collectively, CONCEPT will support the STI fight by improving access to health care services and equipping young girls with knowledge about sexual health matters that will help them make informed health decisions in the future.

Program Evaluation Plan

The program will be evaluated every six months by the product coordination team. To do so, they will evaluate the incidence of STIs in Nile Michigan. A comparison will be made between the incidence of STIs among Caucasian and Hispanic women as an indicator of the existence of health discrepancies (or lack thereof). An application will be made for the program to be included in the Healthy People 2020 framework because it strives to improve community health outcomes by promoting the sexual health and well-being of minority populations.

Annotated Bibliography

Links to the Articles

Garbers, S., Friedman, A., Martinez, O., Scheinmann, R., Bermudez, D., Silva, M., Chiasson, M. A. (2016). Adapting the get yourself tested campaign to reach black and Latino sexual-minority youth.Health Promotion Practice, 17(5), 739-750. Web.

Teitelman, A. M., Calhoun, J., Duncan, R., Washio, Y., & McDougle, R. (2015). Young women’s views on testing for sexually transmitted infections and HIV as a risk reduction strategy in mutual and choice-restricted relationships.Applied Nursing Research, 28(3), 215-221. Web.

McLellan-Lemal, E., Toledo, L., O’Daniels, C., Villar-Loubet, O., Simpson, C., Adimora, A. A., & Marks, G. (2013). A man’s gonna do what a man wants to do: African American and Hispanic women’s perceptions about heterosexual relationships: A qualitative study.BMC Women’s Health, 13(1), 27. Web.

Lanier, Y., & Sutton, M. Y. (2013). Reframing the context of preventive health care services and prevention of HIV and other sexually transmitted infections for young men: New opportunities to reduce racial/ethnic sexual health disparities.American Journal of Public Health, 103(2), 262-269. Web.

References

CDC. (2015). Michigan 2015 state health profile. Web.

CDC. (2016). STDs in racial and ethnic minorities. Web.

CDC. (2017). Hispanics/Latinos. Web.

Cipres, D., Rodriguez, A., Alvarez, J., Stern, L., Steinauer, J., & Seidman, D. (2017). Racial/ethnic differences in young women’s health-promoting strategies to reduce vulnerability to sexually transmitted infections. The Journal of Adolescent Health: Official Publication of the Society for Adolescent Medicine, 60(5), 556-562.

Curley, A., & Vitale, P. (2012). Population-based nursing: Concepts and competencies for advanced practice (2nd ed.). New York, NY: Springer Publishing Company.

Grau, L.E., Krasnoselskikh, T.V., Shaboltas, A.V., Skochilov, R.V., Kozlov, A.P., & Abdala, N. (2013). Cultural adaptation of an intervention to reduce sexual risk behaviors among patients attending an STI clinic in St. Petersburg, Russia. Prevention Science: The Official Journal of the Society for Prevention Research, 14(4), 400-410.

Haderxhanaj, L.T., Rhodes, S.D., Romaguera, R.A., Bloom, F.R., & Leichliter, J.S. (2015). Hispanic men in the United States: Acculturation and recent sexual behaviors with female partners, 2006–2010. American Journal of Public Health, 105(8), 126-133.

Lakeland Community Needs Assessment (2016). Community health needs assessment. Web.

McCabe, B.E., Solle, N.S., Montano, N.P., & Mitrani, V.B. (2017). Alcohol misuse, depressive symptoms, and HIV/STI risks of US Hispanic women. Ethnicity & Health, 22(5), 528-540.

NHCSL. (2017). A growing concern: Latinas, HIV/AIDS, and other STDS. Web.

Paz, K., & Massey, K. P. (2016). Health disparity among Latina women: Comparison with non-Latina women. Clinical Medicine Insights. Women’s Health, 9(1), 71-74.

Pflieger, J.C., Cook, E.C., Niccolai, L.M., & Connell, C.M. (2013). Racial/ ethnic differences in patterns of sexual risk behavior and rates of sexually transmitted infections among female young adults. American Journal of Public Health, 103(5), 903-909.

Rhodes, S.D., Alonzo, J., Mann, L., Freeman, A., Sun, C.J., Garcia, M., & Painter, T.M. (2015). Enhancement of a locally developed HIV prevention intervention for Hispanic/Latino MSM: A partnership of community-based organizations, a university, and the Centers for Disease Control and Prevention. AIDS Education and Prevention: Official Publication of the International Society for AIDS Education, 27(4), 312-332.

Rhodes, S.D., Alonzo, J., Mann, L., Song, E.Y., Tanner, A.E., Arellano, J.E., Painter, T.M. (2017). Small-group randomized controlled trial to increase condom use and HIV testing among Hispanic/Latino gay, bisexual, and other men who have sex with men. American Journal of Public Health, 107(6), 969-976.

Rotblatt, H., Montoya, J.A., Plant, A., Guerry, S., & Kerndt, P.R. (2013). There’s no place like home: First-year use of the “I know” home testing program for chlamydia and gonorrhea. American Journal of Public Health, 103(8), 1376-1380.

Samari, G., & Seltzer, J.A. (2016). Risky sexual behavior of foreign and native-born women in emerging adulthood: The long reach of mother-daughter relationships in adolescence. Social Science Research, 60(1), 222-235.

Sanchez, M., Rojas, P., Li, T., Ravelo, G., Cyrus, E., Wang, W., … Kanamori, M. (2016). Evaluating a culturally tailored HIV risk reduction intervention among Latina immigrants in the farmworker community. World Med Health Policy, 8(3), 245-262.

Stockman, J.K., Hayashi, H., & Campbell, J.C. (2015). Intimate partner violence and its health impact on disproportionately affected populations, including minorities and impoverished groups. Journal of Women’s Health, 24(1), 62-79.

Suburbanstats.org. (2017). Population demographics of Michigan 2017-2018. Web.

Villar-Loubet, O., Weiss, S.M., Marks, G., O’Daniels, C., Jones, D., Metsch, L.R., & McLellan-Lemal, E. (2016). Social and psychological correlates of unprotected anal intercourse among Hispanic-American women: Implications for STI/HIV prevention. Culture, Health & Sexuality, 18(11), 1221-1237.

Vincent, W., Gordon, D.M., Campbell, C., Ward, N.L., Albritton, T., & Kershaw, T. (2016). Adherence to traditionally masculine norms and condom-related beliefs: emphasis on African American and Hispanic men. Psychology of Men & Masculinity, 17(1), 42-53.

Womenshealth.gov. (2018). Reproductive health. Web.

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