Genital herpes (HSV-2) disproportionately affects African Americans, especially women. According to Jackson and Arcelay-Rojas (2021), African American women have the highest HSV-2 rates nationally. Data from Patel et al. (2014) in an urban emergency department (ED) shows 82.8% of African American women over 35 were HSV-2 seropositive. Despite high rates, African American women still face barriers to discussing sexual health with providers and partners (Jackson & Arcelay-Rojas, 2021). Prather et al. (2018) link this to historical events creating mistrust, highlighting the need for culturally competent care. There is a gap in understanding the context of risk and lived experience with HSV-2 for African American women that culturally conscious interventions could address.
Jackson and Arcelay-Rojas (2021) interviewed African American women with HSV-2, finding fear of judgment was a barrier to disclosure. All participants valued monogamy over disease prevention pre-diagnosis but pursued health education post-diagnosis to make informed decisions, demonstrating disease risk awareness and prompting preventative action. However, participants still expressed discomfort discussing outbreak triggers in committed relationships. Facilitating communication requires addressing cultural influences regarding trust and condom attitudes (Jackson & Arcelay-Rojas, 2021).
Statistics back patterns of higher risk. Prather et al. (2018) report that African-American women are disproportionately affected by STIs and HIV partly due to poverty, increasing the likelihood of encountering infected partners and biological susceptibility from trauma history. Data shows that 60% of Georgia’s 94,978 STI cases in 2019 were African Americans, with 29,807 cases being women (Prather et al., 2018). Patel et al. (2014) found that 66.3% of African Americans were HSV-2 positive in an urban ED, with 82.8% seropositivity for women over 35. Despite high rates, Prather et al. (2018) note African Americans perceive minimal STI treatments available and mistrust healthcare. Understanding perceptions and reasons behind behaviors is critical. Jackson and Arcelay-Rojas (2021) found women valued emotional safety over prevention before diagnosis. However, post-diagnosis, all participants expressed feeling empowered leading sexual health discussions and pursuing education and self-care. Facilitators included confidence, competence, and supportive personal relationships reinforcing self-worth (Jackson & Arcelay-Rojas, 2021). Jackson and Arcelay-Rojas (2021) argue interventions should encourage disclosure conversations and target condom negotiation behaviors and attitudes. However, influencing behaviors requires recognizing the reasons behind actions.
Here, historical events play a role in current attitudes. Prather et al. (2018) link high STI rates to segregation, limiting healthcare access and trauma history influencing behaviors. During slavery, rape was used to dominate enslaved women (Prather et al., 2018). Trauma and negative stereotypes tie to current behaviors and self-perception issues (Prather et al., 2018). Views persist today partly due to a lack of public knowledge of historical atrocities (Prather et al., 2018)—stereotypes also further racism when internalized (Prather et al., 2018). Addressing reasons behind actions and attitudes is vital for behavior change and requires cultural humility. Part of this involves dismantling stigma, as Jackson and Arcelay-Rojas (2021) found fear of judgment hindered disclosure until after diagnosis increased disease education and understanding. All participants were surprised by partner support post-disclosure, demonstrating that stigma barriers are addressable (Jackson & Arcelay-Rojas, 2021). Lewis et al. (1999) screened African American female college students, finding 38% HSV-2 positive and 84% asymptomatic. However, 78% knew little about HSV-2 risks (Lewis et al., 1999). Patel et al. (2014) note urban populations have the highest unpublished HSV-2 rates nationally but lack recent surveillance data. Continued seroprevalence research is essential for public health planning (Patel et al., 2014). Targeting stigma requires increasing general knowledge.
Mistrust in healthcare also stems from historical exploitation. Prather et al. (2018) outline events like experimentation on enslaved women without consent, eugenics programs, and the Tuskegee syphilis study. Ramifications include reluctance to engage in research or treatment (Prather et al., 2018). Acknowledging lived experiences is essential to address needs. This requires focusing on social determinants of health disproportionately affecting minorities like poverty, trauma history, and residential segregation influencing behaviors and limiting care access. Effectively serving African American women means recognizing barriers that mistrust can cause.
Prather et al. (2018) note healthcare provider diversity and communication style influence care quality for minorities. However, African American women report inadequate STI knowledge from providers (Jackson & Arcelay-Rojas, 2021). Despite the high-risk status, testing was not offered or addressed until symptom onset, causing delayed diagnosis (Jackson & Arcelay-Rojas, 2021). Poor information transfer relates to discomfort in initiating sexual health discussions (Jackson & Arcelay-Rojas, 2021). Prather et al. (2018) argue cultural competence training for public health professionals is vital to quality care and reversing mistreatment legacies. Improving provider communication and education requires humility and recognizing historical influences on current behaviors and attitudes.
In conclusion, while statistics demonstrate disproportionate HSV-2 and HIV rates for African American women (Prather et al., 2018), qualitative data provides cultural context revealing barriers to prevention and treatment engagement (Jackson & Arcelay-Rojas, 2021). Understanding lived experiences is critical to creating interventions targeting the root causes of risks behind statistics. This includes addressing poverty, trauma history, distrust, and stigma perpetuating the disproportionate disease burden faced by African American women (Prather et al., 2018; Jackson & Arcelay-Rojas, 2021). Efforts require focusing on social determinants influencing health and culturally tailoring approaches through perspectives of humility, not judgment (Prather et al., 2018). There is a need for continued HSV-2 surveillance, providing updated prevalence rates for public health planning (Patel et al., 2014; Lewis et al., 1999). However, qualitatively capturing lived experiences is equally important to provide cultural context guiding the development of responsive care strategies focused on awareness and empowerment for this disproportionately affected population. Reducing barriers unique to marginalized communities requires comprehending multi-level influences behind statistics and lived realities, not just data trends. This allows for the creation of supportive environments promoting engagement, education, and stigma reduction that make positive behavior change possible. Understanding lived experience facilitates providing the culturally conscious context-focused care needed to serve minority populations equitably and effectively, working towards health equity and social justice.
References
Jackson, C., & Arcelay-Rojas, Y. A. (2021). Experiences of African American women living with herpes simplex virus 2. Journal of Social, Behavioral, and Health Sciences, 15(1), 345-361.
Kelly, J. D., Cohen, J., Grimes, B., Philip, S. S., Weiser, S. D., & Riley, E. D. (2016). High rates of herpes simplex virus type 2 infection in homeless women: informing public health strategies. Journal of Women’s Health, 25(8), 840-845.
Lewis, L. M., Bernstein, D. I., Rosenthal, S. L., & Stanberry, L. R. (1999). Seroprevalence of herpes simplex virus type 2 in African-American college women. Journal of the National Medical Association, 91(4), 210.
Patel, E. U., Frank, M. A., Hsieh, Y. H., Rothman, R. E., Baker, A. E., Kraus, C. K., … & Laeyendecker, O. (2014). Prevalence and factors associated with herpes simplex virus type 2 infection in patients attending a Baltimore City emergency department. PloS one, 9(7), e102422.
Prather, C., Fuller, T. R., Jeffries IV, W. L., Marshall, K. J., Howell, A. V., Belyue-Umole, A., & King, W. (2018). Racism, African American women, and their sexual and reproductive health: a review of historical and contemporary evidence and implications for health equity. Health equity, 2(1), 249-259.
The New York Amstanderm News. (1999, May 20). Black Women at the Risk of Herpes Virus Infection.
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