User:Syphillisedu

UNDERCONSTRUCTION
Introduction

Due to the increasing numbers of individuals having sexual intercourse and/or the use of intravenous drugs, there is an increased need for safety and awareness for sexually transmitted diseases. One disease that is becoming more prevalent in today’s society is syphilis. There has been increased literature on the rising rates of syphilis in urban areas, especially in the region of Baltimore City and those that make up the African American community. The articles discuss the varying ways in which syphilis is an ongoing problem and, if handled properly within the community, discussion can occur and preventable measures can begin to take place. In attempting to understand syphilis, there needs to be a understanding of the history of syphilis, the ways socioeconomic status affects ones access to health care, how health access coupled with distrust and stigma can create further disparities for those in the African American community and what policy implications can be put in place to improve the health access and lifestyle of those infected.

History

There are two competing theories regarding the emergence of syphilis in the United States. One such theory states syphilis was derived in what is now known as Haiti and was carried back with Christopher Columbus when he was traveling around the world (Singh 188). The competing theory is known as the “Pre-Columbus theory,” which indicates syphilis might have originated in Africa and was transmitted to Europe prior to Columbus arriving and traveling the world (Singh 188). Scholars believe that syphilis was present in Europe prior to Columbus it just was not in a recognizable form or was confused with that of another disease such as leprosy (Public Health Service 2). There is no doubt that by 1495 there was a widespread syphilis epidemic in Europe, which was transmitted to India in 1498 and then to China in 1505 (Singh 188). The primary mode of transmission for syphilis is through any form of sexual contact and across the placenta (Singh 189). “Syphilis may be transmitted from mother to child during pregnancy with potentially lethal implications to the infant” (Baltimore Health Dept 1). There can also be transmission through nonsexual contact such as through lesions of the finger and hand (Singh 189).

Recently there have been visible trends in the rising and falling rates of syphilis. The recent trends have shown that the outbreaks have affected those in urban areas, specifically African Americans and Hispanics, when compared to their counterparts (Singh 189). It would seem that African Americans have acquired syphilis a year or two earlier than their counterparts, while African American women have acquired the disease faster than men (Hazen 315). One of the problems that have been continually reported is that many people who are infected do not know they are infected. Although the lesions may appear, the individual is unaware of them, which causes the disease to go untreated (Turner 768). Another issue that has arose is the lag time present for finding and contacting the initial “contact” person or the carrier of the syphilis disease (Turner 775). An increased number of sexual partners an individual has is also increasing the cycle and spread of syphilis (Singh 190). If left untreated syphilis can cause blindness, dementia, paralysis and even death (Baltimore Health Dept 1). In the 90's in Baltimore City, syphilis rates reached a peak and has continually risen and fallen throughout the years (Baltimore City Health 2). In 1995, the rates climbed from 60.3 per 100,000 to 101.8 per 100,000 in 1997 (Baltimore City Health 2).

III. Socioeconomic Status

Socioeconomic status is defined as the classification of one’s economic and social position, based on others, to delineate their position in society. Based on ones socioeconomic status and other social strata such as race, sex, and religion, discrimination and unfair treatment, by those in the hierarchy, could occur. Socioeconomic status, because it is directly related to income, can directly affect the type of health care access one can have. Certain elements that can affect ones socioeconomic status consists of hazardous wastes, air and water pollution, loud noise, residential crowding, poorer qualities in housing, lack of educational facilities for children, lack of playground space for play, and even the types of violent crimes that may occur in the neighborhood (Evans 94). There is also discrimination towards those whom have lower literacy rates, whom have been incarcerated, mothers whom have not finished school, or whom did not receive prenatal care (CDC 2).

These constraints on socioeconomic status may further affect the types of jobs attained and the home conditions of individuals (Rosen 255). Because of the discriminatory practices already present, socioeconomic status, allows for discriminatory practices to continue and thus get further instilled in institutions, especially those in the health care sector. Intravenous drug use can also be a significant contributor for the continual spread of syphilis. There are instances when women are exchanging sexual favors for cocaine or heroin to provide for themselves, their families, or their habits. The socioeconomic environment also affects the types of health care one will receive in terms of third party health care, health care provided by oneself as well as health care provided by family and friends (Rosen 255). The types of health plans one can have can range from private sector HMO’s, Medicaid, or no health care at all. Individuals whom do not have adequate health care, could be less inclined to visit the doctors, unless there is an emergency because of the “pay out of pocket” health care system that the United States has set up.

Stigma and Distrust

In the health care sector, there are many implications of why individuals do not feel comfortable going to their health care provider in order to receive treatment when it is needed. Looking back in history, some believe that mistrust of others, from the African American community is a result of the era of slavery and the ways it affected the individuals psyche, and the ways in which they were not able to give consent to the actions that took place on their body (Whetten 716). Another action that reinforced this ideal was the Tuskegee Syphilis Study, when the researchers “failed to educate the participants and treat them adequately” and failed to provide the information needed for the participants to get better (Thomas 1499). The Tuskegee Syphilis study began in 1932, in which the Public Health Service worked with the Tuskegee Institute and implemented a study to record the natural history of syphilis, in hopes to justify the treatment programs already established for African Americans (CDC Timeline).The official name of the study was the “Tuskegee Study of Untreated Syphilis in the negro Male,” and initially involved 600 African American men, 399 of which had syphilis and the remaining 201 which did not (CDC Timeline). The study occurred without the patients being fully aware of what was happening, no telling them they could end the study whenever they chose, and as a result the men did not receive the proper cure for their illness. The study was designed to last for 6 months but went on for more than 40 years (CDC Timeline).

From hearing about what happened at Tuskegee, distrust is instilled in the medical and governmental industries and its officials by those in the African American community. The Tuskegee Syphilis Study even went as far to get the collaboration of other government agencies, local leaders and even politicians, which further influenced African Americans to participate in the survey, yet felt further betrayed when those individuals did not stand up against injustice (Thomas 1500). There are also reported racial discrimination ideals that occurred because of the Tuskegee study, in that it caused tensions amongst African Americans and was a sign of “racial medicine,” since the doctors were white and the patients black (Jones 15).

African Americans believe the government is essential in spreading more commonly incurable diseases as ways to keep individuals from reaching their fullest potential (Whetten 716). There was once an associated idea that African Americans, sex and disease were bound to happen and discounted any other reasons of lack of black health, saying that “better medical care could not alter the evolutionary scheme” (Brandt 18). The idea of stigma can be perceived by others or directly felt by an individual, which may lead to inequalities or discrimination (Whetten 535). African Americans want to have the freedom to ask questions of their physicians and not feel their physician will put them in any unnecessary risk (Whetten 716). There is a need for frank and open discussions about sex within the African American community as well as frank dialogue including leadership discussions amongst those in the physicians field (Fackelmann 203). There is also a stigma associated among African American men, because they are seen as hyper-masculinized and naturally dominant, they too have fears and anxieties about stigmas. They feel they have been disrespected, alienated, are powerlessness toward changing their situation, and have been unfairly treated, as well as the stigma associated with black men being incarcerated (Lichtenstein 385). These anxieties may cause African American men to not seek the help needed in order to be tested for a disease such as syphilis. When individuals do not get tested for syphilis it increases the chances and risk of getting a non curable disease such HIV/AIDS.

Stigma and distrust can also come from other varying factors that are commonplacce in one's community and/or one's mindset. One of which consists of lack of awareness, which may come in the form of signs and symptoms of diseases. This could result in individuals not knowing about the proper ways of prevention or prevention programs in the community. Fear, aside from discrimination and mistreatment can also come from hearing a morbid diagnosis or the actions that may result of hearing that diagnosis. Fatalism, according to Joseph Ravenell, is the mentality that because dying is inevitable, especially because of the stressors that may be associated with living in an urban area, why is there a need to discuss it in the first place. The last idea, of cost benefit analysis deals with the financial cost associated with going to the doctor on a regular basis and only going when absolutely necessary.

Policy Implications and Conclusions

Policy implications and conclusions are important in order to see what things need to be established and what can be inferred to move forward in order to adequately provide treatment to those who need it most. In urban areas there may be fewer resources for the clinic or hospitals in the area. They may be underfunded and/or understaffed which causes problems for the patients. The patients may not feel they can gain a relationship with neither their physician nor find someone who has their best interest at heart, which further discourages them from going to the clinic. Because of the educational requirements for becoming a physician and the discriminatory practices that once stopped African Americans from achieving those educational attainments, there is a sense of no visibility of relatable people. Increasing awareness programs, and including a process known as identity matching, will allow for there to be representatives of the race or culture inside hospitals so that it can be more representative of the people the physicians cater to (Epstein 816).

Listening to the patients, their fears, anxieties and even treating the patients with respect is a first step in regaining their trust (Corbie-Smith 2460). There also needs to be physicians that are trained to work in urban areas, so that they know what the fears of individuals in the community are and how those fears can be overcame in a positive way. There are a number of further policy implications that could be made. One of which is increasing the economic growth and allow the poor to become better off, while those whom are wealthy are not continuing to get wealthier. There should be implementation of policy so that others can see equal health care should be a given right not a privilege. Enforcement of anti discrimination laws against physicians should be enacted, so that patients are treated with dignity and respect, so that physicians in the urban areas do not treat patients differently because of their socioeconomic background. This also implies there has to be communication to let patients know the treatment they should be receiving and to feel comfortable to alert someone if they are receiving any other type of treatment that is not in correlation of the laws. There should also be equal access to job opportunities, job training skills, education and proper treatment for the elderly. More conducive discussions should occur of ways to get individuals out of poverty and not allowing them to be dependent on the system that does not always provide individuals with the right type of assistance when needed.

Conclusions

Because of the regular stressors of life associated with socioeconomic status and social strata there is a need for empowerment and hope for all people. The society at large must get out of the “trickle-down theory” mindset, that if taxes are cut for the wealthy they will help the poor, by decreasing the cost of products in the market. The problem with this theory is that if the wealthy get a break, they will only invest in things that have already made them money and things that will continue to make them money. They also spend their money on things that are out of the income bracket for lower socioeconomic individuals, which will cause the price to decrease on things the lower class cannot afford, which still does not help them nor the market as a whole. Representations of deviance are continually prevalent in the minds of African Americans, and allows them to think they are less or other, which further severs the mind body and soul. That severance allows for the oppression to continue and continues the silence surrounding the injustices that have been done to African American people (Collins 282). No one can dismiss the historically grounded fear that African Americans have of research experiments and credibility of physcians, yet there needs to be acknowledgment of the past in order to regain trust and seize the future (Washington 386). There needs to be a sense of urban revitalization in which the people get the appropriate tools to take action into their own hands and make a better future for themselves and each other.