By Katherine McInerney
Special to the Reporter
A recent report from the Center for Disease
Control and Prevention revealed that one in four
teenage girls in the United States has a sexually
transmitted disease (STD) and nearly half of young
African-American women are infected.
"The report was no surprise," said Jane Tuitt, a
nurse practitioner at Dorchester High School.
Around 90 percent of the students she treats are
African-American, Tuitt said.
"We've known for years that this population is
at high risk. We see it," said Tuitt.
"The data confirms what we already knew," said
Dr. Lydia Shrier, a researcher at Children's
Hospital Boston. "Adolescent women are at an
extremely high risk of STDs," she said, "and the
racial differences are the most disturbing
According to the 2007 Health of Boston Report
from the Boston Public Health Commission, nearly a
third of reported cases of chlamydia in Boston in
2005 were found in 15 to 19-year-olds and the rate
of chlamydia among African-Americans in Boston was
more than eight times higher than that of
The report also shows disproportionate rates of
new cases of chlamydia reported in Dorchester and
Mattapan in 2005; the rates were more than 50
percent higher than that of Boston overall.
According to the 2000 census, 45 percent of
Dorchester residents and 83 percent of Mattapan
residents are African-American.
"It's a big issue in Dorchester health centers,"
said Bill Walczak, director of Codman Square Health
Center. "Doctors are very, very concerned."
"The numbers are alarming," said Dr. Ethan
Brackett, a family practitioner at Codman Square
Health Center. Brackett said he believes the
national numbers are representative of STD
prevalence rates in Dorchester, pointing to "a
difficult problem within the community."
"It's a very complex and charged issue," Shrier
said, attributing racial disparities in the STD
epidemic to issues including, but not limited to,
access to healthcare, poverty rates, and
"Race is a proxy for a number of other things
and it's not just [socio-economic status],"
Shrier said. There are also marked cultural
differences in partnering, she said, noting that
young African-American women are more likely to
have older partners, "introducing infection from a
sexually experienced group of men
frequency of partner change and the different pools
of partners in areas that are predominantly black"
also contribute to racial differences, she
"It's an issue of access, an issue of awareness
and an issue of shame," said Brackett, who notices
a reticence in his patients to seek medical care.
Differences in religious beliefs and family
dynamics among African-Americans - particularly
immigrants - he said, make it difficult to discuss
sex and intimate issues.
"Many patients come to me as almost a last
resort," Brackett said. "They have to reach a
tipping point of concern or symptom before engaging
with the medical community," at which point they
may have already spread the infection to
Shrier said researchers were excited about the
CDC report and the attention it could bring to the
STD epidemic. It was compiled from the 2003-2004
National Health and Nutrition Examination Survey,
which screened 838 randomly selected girls, ages
14-19, for four common STDs: human papillomavirus
(HPV), chlamydia, genital herpes, and
trichomoniasis, a parasite. The data says, "Look,
this is the burden of these common infections in
this age group," Shrier said.
The report, which was presented on March 11 at
the 2008 National STD Prevention Conference in
Chicago, included STDs that are not routinely
screened for, Shrier said.
"We've been studying gonorrhea and HIV, which
cluster more in poor urban areas where drug use is
a major issue," Shrier said, "but this report cuts
across a lot of those lines. We see that HPV is
Found in 18 percent of the young women screened,
HPV is the most common STD, causing cervical cancer
and genital warts. There is a vaccine available
which protects against four types of HPV that cause
70 percent of cervical cancer cases and 90 percent
of genital warts, though Shrier said a mandatory
vaccine for adolescent girls has been a hard case
"It's been a community-by-community debate
across the country," Shrier said, "This will
protect the individual and if enough people get
vaccinated it will become a herd immunity
it's different than going to school with the
measles." Nationwide, legislators and others are
reluctant to mandate comprehensive sex education,
let alone STD vaccinations, Shrier said.
Brackett said the report should be "a lesson to
all of us that we need to be even more serious
about prevention programs, talking to teenagers
about sex, being honest with them, and starting
conversations about sexual activity early." The
current plan of attack, he said&emdash;teaching
abstinence only, or starting sex education in the
fifth grade - is not enough.
Bracket also hopes that this will be "a wake up
call for us to reach out to young men in the
community," who are "vectors for many of these
STDs," though they are less likely to present
symptoms or seek care. Instead, they contribute to
the epidemic among females who bear the burden of
infections and suffer more serious consequences
such as infertility, cervical cancer, or ectopic
pregnancies, Shrier said.
At Dorchester High School, Tuitt said she
actively tries to reach as many students that are
sexually active as she can, reminding them that STD
screening is as simple as a urine test. She
suggests screening to anyone that comes to her
office for contraceptives or Plan-B, the morning
after pill, and said that many students don't
realize they are even at risk for STDs as
teenagers. "The adults that work with adolescents
weren't surprised" by the high rates of STDs
reported in adolescents, Tuitt said, but "the info
hasn't filtered down to the kids yet and we need to
push that more."
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