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Data must drive policy to halt LA STD epidemic

Grasping fully the implications and necessities of public policy in combatting sexually transmitted diseases (STDs) requires some amplifications and extensions of remarks I made in my recent Baton Rouge Advocate column.

Online publication not tied to a physical presentation liberates one from space constraints. Yesterday, I had published a barebones argument about government’s shaping and pursuing policy that would ameliorate Louisiana’s alarmingly-high rates in the three most commonly tracked STDs, syphilis, gonorrhea, and chlamydia. To quote:

Political, civic and religious institutions must do what they can to affirm the values of chastity and self-respect for all citizens. By promoting government policies that advance self-reliance and celebrate the sanctity of life, the state’s leaders can nurture a culture that values delayed gratification as a personal and civic good. More aggressive enforcement and prosecution of sex trafficking and prostitution would help, too.

In particular, two communities contribute overwhelmingly to the rates that put Louisiana in the unenviable category of one of the two highest among the states for the three indicators, plus almost double that of the runner-up in congenital syphilis. The piece noted that rates in the black community exceeded those for non-blacks by several times. As more than three in ten state residents are black, this inflates the overall rate. In fact, removing blacks from state calculations for Louisiana only, its ranking for chlamydia would fall all the way to 45th, for gonorrhea to 40th, for syphilis to 31st, and for congenital syphilis to fifth (of course, removing black populations from all states’ calculations would move the state up the rankings, as nationally we see the same much higher incidence in the black community).

But another, much smaller and somewhat overlapping group contributes even more disproportionately to the problem, at least as far as syphilis rates go (which has by far the lowest incidence: chlamydia’s is almost 50 times higher and gonorrhea’s over 15 times higher): what the Centers for Disease Control calls “MSM,” or men having sex exclusively with men. It tracks only syphilis according to sexual behavior, but the difference between MSM and all others (non-MSM males and women, obviously) is stunning.

Nationally, MSM produce 68.8 percent of all such cases and 80.6 percent of all male incidence. Blacks and Hispanics account for over half of MSM instances. Put another way, the syphilis rate among MSM is over 100 times higher than those who don’t behave sexually that way. If there’s any good news here, such similar statistics don’t exist for the other two maladies; the bad news, naturally, is that something approximating the enormous disparity probably would appear if CDC did track sexual behavior for these others (although likely less severely in the case of chlamydia, since overall it strikes women about three times as often as it does men).

The intersection of race and sexual behavior explains why Orleans Parish has such abysmal numbers on this account. With a population about 60 percent black and its metropolitan area (including Metairie) having an estimated 5 percent identifying as homosexual (including females), it ranked among the top ten counties in the country for all three diseases and, if removing it from Louisiana figures, would reduce the state’s rate for each kind by about ten percent and a couple of places in state rankings for each.

As I suggested in the column, policy that encourages a mindset of delaying gratification in general can stem sexual behavior, regardless of race; in other words, an attempt to change the culture that, in this realm of human interactions, in recent decades has shifted dramatically towards sexual license. But as the homosexual community defines its very self by its behavior, a certain segment of MSM feels it must pursue aggressively such liaisons as a lifestyle, as a result sending infection rates sky high.

Changing this attitude presents an enormous public policy challenge, as members of the tiny proportion affected defines their very being by promiscuous MSM behavior. It presents an extreme version of the general condition, one therefore likely much less amenable to the same kinds of solutions.

Finally, failure to understand the impact of these sub-populations can lead to mistaken policy assessments. By way of example, one researcher stated that Louisiana had such high rates because of “[t]he state’s high rates of poverty, homelessness, incarceration and abstinence-only curriculums, along with low literacy rates.” The policy recommendations I made address four of these points, as a smaller government footprint would discourage people settling for poverty and homelessness, and also spawning cultural attitudes valuing more education and avoiding crime. 

But the value of abstinence directly contradicts the promiscuous MSM subset’s worldview and is found more strongly in areas of Louisiana with lower rates outside its urban areas that, on the whole, have the highest rates. It certainly addresses the problem far better than the na├»ve view that more protective measures regardless of frequency will solve the problem; three decades of data have invalidated that argument. Attitudes precede behavior; only changing attitudes will alter behavior.

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