Inequitable Experiences Between Black and White Women Discussing Sexual Health with Healthcare Providers: Findings from a U.S. Probability Sample. Issue 8 (2nd July 2020) - Townes, Ashley
Abstract: Background: In the United States, efforts to achieve health equity and reduce sexual health disparities remain a national priority; however, limited research has focused on understanding racial differences in patient/provider discussions about sexual health. Aim: To quantify racial differences between black and white women (aged 18–49 years) in the United States discussing sexual health with a healthcare provider in the past year. Methods: Data were analyzed from a subset of 1, 654 women aged 18–49 years who participated in the 2018 National Survey of Sexual Health and Behavior. Measures of interest included visiting a healthcare provider and discussing sexual health with the provider in the past year. Log binomial models were developed to estimate risk ratios for the likelihood of sexual health topics encountered by black women; models were adjusted for age, marital status, education level, and annual income. Main Outcome: Black women were significantly more likely to report having a healthcare visit in the past year compared to white women and were more likely to have discussed their sexual health activities. Results: The adjusted risk ratio (ARR) for black women who reported discussing sex or sexual health with a healthcare provider was 1.16 (95% CI: 1.06–1.26). The ARR for black women who were asked if they were sexually active was 1.16 (95% CI: 1.06–1.26) and about their condom use was 1.49 (95% CI: 1.27–1.74). Black women were nearly 2 times more likely to be offered sexually transmitted disease testing (ARR: 1.72, 95% CI: 1.46–2.02) and to report that they were provided condoms for future use (ARR: 1.94, 95% CI: 1.12–3.36). Clinical Translation: Healthcare providers are encouraged to have routine sexual health discussions with all patients; however, we found that there are differences among black and white women in discussing their sexual health activities. Strengths & Limitations: The present study utilized a nationally representative probability survey, including an oversample of black women. The study focused on sexual health discussions of black and white women with a healthcare provider, and therefore, women who did not have a healthcare visit in the past year were excluded from the analysis. Conclusion: Black women reported having conversations about their sexual activities (eg, condom use) and were offered sexually transmitted disease testing more often than white women. These data provide insights that will impact patient/provider communication and aid in improving the delivery of sexual healthcare for all women.