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Despite greater access to health insurance, many people of color are still not taking advantage of preventive sexual health services.

In response, the National Coalition for Sexual Health (NCSH) has issued a “call-to-action” to encourage African-Americans especially to take advantage of free preventive sexual health care services, including the human papillomavirus (HPV) vaccine, female contraceptives, pap smears and screening for sexually transmitted diseases (STDs).

“Knowledge is power. It’s important to take charge of your own sexual health, and get informed about the services that are recommended for you,” coalition Co-Director Susan Gilbert said in a news release announcing the effort. “Don’t assume that you are automatically getting these services when you go to your health care provider.”
The NCSH website provides an action plan to make sexual health choices, as well as a guide, with tips and tools, that can be downloaded.

The Centers for Disease Control and Prevention (CDC), and the U.S. Preventive Service Task Force are encouraging all Americans to take advantage of services, as well as treatments for common STDs before they cause serious problems.

While the advice is universal, organizers are targeting African-American women particularly because they have been disproportionately affected by a lack of access to medical services and preventive care.

For example, the coalition reported that in 2013, about 34 percent of Black girls and 16 percent of black boys received all three doses of the HPV anti-cancer vaccine, about 44 percent of sexually active African-American girls and women ages 15-21 were not screened annually for Chlamydia, which is a leading cause of preventable infertility, and more than a third of African-Americans have never been tested for HIV.

It is recommended that all sexually active people, regardless of race, be tested at least once for HIV, and be tested annually if they are at increased risk because of a variety of factors, including multiple partners or intravenous drug use.

The HPV vaccine is considered especially important for Black women because they are 34 percent more likely to develop cervical cancer and twice as likely as White women to die from it.

According to CDC 2013 data, nearly 34.8 percent of non-Hispanic White females ages 13-17 had received all three doses of the vaccine, while 44.8 percent of Hispanic teen girls and 40.4 percent of non-Hispanic Asian girls had received three doses.

The rates among adolescent males were markedly lower. Twenty percent of Hispanic males, 15.7 percent of non-Hispanic Black, 11.1 percent of non-Hispanic White male and 9.1 percent of non-Hispanic Asian males had received all three doses.

According to the CDC’s National Immunization Survey 2013, 43.2 percent of American Indian/Alaska Native (AI/AN) females completed three doses of the HPV vaccine. There were no data available on AI/AN males completing three doses, but 24 percent of AI/AN males completed two doses of the HPV vaccine.

“Everyone has a stake in protecting their own and others’ sexual health,” said Christian J. Thrasher, M.A., Director, The Center of Excellence for Sexual Health, Morehouse School of Medicine.

“We need to all work together to ensure that all of know how to take advantage of the available services, and information and education are key to making this happen,” he said.

Contraception more affordable

Thrasher added, “The Affordable Care Act will go a long way at reducing and, hopefully, ultimately eliminating disparities in health given that most services are now available at no or low-cost through the ACA or through community health centers or clinics.”

Preventing unintended pregnancy also has become easier because of the act. Researchers at the Perelman School of Medicine at the University of Pennsylvania found that average cost of contraceptive pills and the intrauterine device (IUD) has decreased significantly since the Affordable Care Act (ACA) took effect.

The average out-of-pocket expense for a prescription for the pill fell from $32.74 in the first six months of 2012 to $20.37 in the first six months of 2013 (a decline of 38 percent), and out-of-pocket expenses for an IUD insertion fell from $262.38 to $84.30 (a decline of 68 percent), the researchers found. The costs of other, less popular forms of contraception declined as well.

The Affordable Care Act requires private health insurers to cover the cost of prescription contraceptives, with no consumer co-pay. However, the study found, many consumers still paid for birth control because not all contraceptive devices were under the no-cost provision, some were enrolled in plans that were not subject to the requirement or their employers opted out of the plan for religious reasons.

“I’m glad the Affordable Care Act allows contraception free of charge. That’s the way to go to ensure people are safe,” said Dr. Yolanda Wimberly. a pediatrician and adolescent medicine specialist at Morehouse School of Medicine, who added that while co-pays seemed low to many people, for others struggling with money issues, even a relatively low co-pay may have been considered too much.

Thrasher at Morehouse said he believes “that ultimately we will see the rates of STDs and unintended pregnancies go down throughout our nation,” Thrasher said. “As we work toward that end goal, it would be my hope that we as a nation learn how to communicate better regarding sexuality and sexual health.”

Creating rapport with patients

Dr. Wimberly said part of that process is better training for physicians in communicating with patients.
When patients feel they are being judged, they are less likely to ask questions or share information with their doctors. Rather than a barrage of questions that suggest there is a right or a wrong answer, the doctor said, a more open-ended approach generally yields better results.

“We need to look at things that underlie sexual behavior,” Wimberly said.

In terms of sexual education, he said “this cohort of adult teens are more educated” about the mechanics of sex and contraception, but make sometimes questionable choices based on a whole host of reasons from low self-esteem, a desire to please others and low expectations.

Wimberly said it was important to be careful when questioning patients. For example, instead of asking someone if he always uses condoms, the doctor may ask someone to identify the instances in which he would not use a condom or how long it takes to build enough trust with a partner to decide to stop using a condom.
The relationship between doctor and patient needs to be more conversational, demonstrate more interest in the individual as a person, and be less directive, Wimberly said.

“We have to do a better job of asking the questions,” she said of health care providers. “We have to deal with our own comfort level [about the topic of sex]. Sex is not necessarily looked at as something medical” by health professionals, even though there are a wide range of issues that are directly tied to sex, including pregnancy, STDs, infertility and impotence.

Thrasher noted that the Morehouse School of Medicine has created the first-ever endowed chair in sexuality and religion, which will be tasked with creating critical communication.

“One of the realities that we as a nation face regarding sexual health is that we lack a language,” he said. “All too often, when individuals have an issue regarding their sexuality and/or sexual health, they seek out information from their doctor or their religious leader, like a pastor, Imam, minister, etc.,” he said. “Unfortunately, it is these very individuals that do not receive the appropriate training, leaving them ill-prepared to address these difficult issues. Whether it be in the exam room or from behind the pulpit, we lack a language.”