Parrish Deidra D, Kent Charlotte K
Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Sex Transm Dis. 2008 Dec;35(12 Suppl):S19-22. doi: 10.1097/OLQ.0b013e31818f2ae1.
Reduced access to care is a major contributor to health disparities in black communities. This review discusses factors that serve to diminish access to care among blacks in the context of STD disparities and highlights strategies to improve access to STD care. At the individual level, structural factors such as poverty, lack of insurance, and lack of a regular source of care are known to decrease health service utilization and have been identified as barriers to STD care as well. Other individual level factors that influence access to care, particularly for STDs, include concerns about confidentiality and privacy, perceptions of discrimination, and perceptions of risk. At the health system level, availability of services, organizational inefficiencies, and staff perceptions affect access. Strategies to improve access to STD care include expanding services in high-risk nontraditional venues, developing multilevel partnerships, incorporating STD services into routine healthcare, integrating services with HIV, improving the quality of public STD clinic care, and ultimately addressing the broader underlying factors that contribute to health disparities.
获得医疗服务的机会减少是黑人社区健康差距的一个主要因素。本综述讨论了在性传播疾病差距背景下导致黑人获得医疗服务机会减少的因素，并强调了改善性传播疾病医疗服务可及性的策略。在个体层面，诸如贫困、缺乏保险以及缺乏固定的医疗服务来源等结构性因素，已知会降低医疗服务利用率，并且也被认定为性传播疾病医疗服务的障碍。其他影响获得医疗服务机会，尤其是性传播疾病医疗服务机会的个体层面因素，包括对保密性和隐私的担忧、对歧视的认知以及对风险的认知。在卫生系统层面，服务的可及性、组织效率低下以及工作人员的认知会影响获得医疗服务的机会。改善性传播疾病医疗服务可及性的策略包括在高风险的非传统场所扩大服务、发展多层次伙伴关系、将性传播疾病服务纳入常规医疗保健、将服务与艾滋病毒防治相结合、提高公共性传播疾病诊所的医疗质量，并最终解决导致健康差距的更广泛的潜在因素。
