Gender, Race, Class and Self-Reported Sexually Transmitted Disease Incidence.(Statistical Data Included)

Multivariate analysis of data from two nationally representative surveys of adult men and women indicates that the likelihood of a self-reported sexually transmitted disease (STD) infection varies by gender, race and socioeconomic status, even after accounting for differences in sexual and health care behaviors. Women and black respondents are more than three times as likely to report an STD infection as men and white respondents; men and women with 12 or fewer years of education are about 30% less likely than those with more schooling to report having had an STD. Income, welfare status and access to health care have no significant association with self-reported STD incidence, but sexual behavior is strongly related. Men and women who have engaged in anal intercourse, have paid for sex or have had one-night stands are significantly more likely than those who avoid these behaviors to report an STD. Further, the likelihood of an STD dramatically increases with the lifetime number of sex partners reported: Compa red with men and women who have had only one partner, those who report 2-3 partners are five times as likely to have had an STD; the odds are as high as 31:1 for those who report 16 or more partners.

(Family Planning Perspectives, 27:196-202, 1995)

Sexually transmitted diseases (STDs) are a major public health problem in the United States, generating societal costs in excess of $3.5 billion annually. (1) During the last decade, both the number of STDs and their complexity have increased dramatically; more than 50 organisms and syndromes are now recognized. Although many of these diseases have long been known, others have recently achieved prominence because new diagnostic methods have helped investigators to describe their extent, method of transmission and clinical consequences.

STDs affect almost 12 million Americans each year, and nearly 50 million Americans may already have acquired viral STDs, which are not curable and infect the individual for life. (2) Gonorrhea is the most frequently reported STD; almost 700,000 cases were reported in 1990. Chlamydia is another common sexually transmitted bacterial pathogen; no formal surveillance system exists, but estimates derived from a variety of sources suggest that 3-4 million persons are infected with chlamydia annually. (3)

Women bear disproportionate consequences from gonorrhea and chlamydia because of the risk of pelvic inflammatory disease (PID), which often leads to such adverse sequelae as infertility and ectopic pregnancy. Some bacterial or viral STDs may affect infants either in utero or at birth. Additionally, other population subgroups are at increased risk of STDs. STD infection is more prevalent among blacks than among members of other racial groups, and is more common among those of low socioeconomic status than among those of higher status. (4)

Race and socioeconomic status may be different manifestations of the same phenomenon, but this supposition has not been unequivocally demonstrated. In any case, these two characteristics are clearly related to adverse health conditions, including cancer, diabetes and cardiovascular diseases, as well as STDs and AIDS. (5) Gender, race and social class not only influence risk behaviors, but also are presumed to affect the efficiency of transmission of some STDs, the ease with which infection is detected and care-seeking behaviors. (6)

In this article, we examine gender, race and class differences in the likelihood of ever having had an STD among a national sample of 20-37-year-old women and 20-39-year-old men.