Pick and Choose

This NY Times article regarding Chlamydia screening brings up several issues related to both our class discussions and the health disparities lecture given last week.  One of the first statistics given at the lecture was regarding the rate of this STD among St. Louisians– the population with the highest rate is African Americans.  This topic of screening goes beyond STDs and brings up several issues regarding approaches to disease prevention.

Issue 1: Lack of screenings. Despite the CDC’s call for all sexually active women under age 25 to be screened for Chlamydia, only a little over half of the women in the reported study were actually screened.  The majority of those who were screened fell in the “at risk” populations (i.e., young African American or Hispanic women).  Screenings are a source of early detection for various diseases and can save lives and prevent further damage if an individual is already affected.

How is it just to deny someone the opportunity to maximize their health?  In this specific case, women older than 25 and of non-Hispanic or African American background were least likely to receive the screening.  I understand that in some cases, the resources (material and monetary) are insubstantial or unavailable.  However, even people with adequate insurance are not receiving the recommended screenings… which brings us to Issue 2.

Issue 2: Stigma as a reason for screening. While the prevalence of Chlamydia is higher among Black and Hispanic women, women of different ethnic backgrounds are less likely to even be screened.  This STD is known for its “silent” symptoms.  If a woman (or man) is not even aware physically that (s)he  has the disease, how is this person supposed to seek treatment?  There can be many people walking around blind to the fact that they have the disease simply because their doctor did not deem them “at risk” enough to run the test.

If screenings are not being utilized as recommended, are the prevalence rates that we adhere to in order to define “at risk” populations legitimate?  Are the at risk individuals actually more likely to contract the disease or are they simply more likely to be tested due to stigma and, therefore, diagnosed? 

Issue 3: Spread of Disease.  If health professionals believe that only certain individuals should be tested, what about those that fall outside of that “at risk” category?  Do they just suffer the consequences of not being enough “at risk”?   The social justice issue is a bias in determining who is in most need of screening.  Not only can this lead to a person being oblivious to the fact that they have a disease, but it can then lead to the spread of this disease. 

As stated above, some diseases like Chlamydia are considered “silent” because the symptoms are not always physically present.  Without knowledge of one’s condition and proper action for preventing further cases, it is greatly possible that he or she can then spread the disease to others.  Screenings and other means of early detection are tools that have the capability of affecting a large number of individuals.  This specific article focuses on STDs, but the message can be applied to other areas of health care and social issues.  So far in class, we have emphasized the importance of prevention.  Providing recommended screenings to those in need is one way that we can contain the spread of disease and lower the incidence rate.

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