Soumya Karlamangla, Los Angeles Times, May 7, 2018

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Many health experts say that public health problems are best tackled outside the doctor’s office — that fixing the culture that perpetuates them is more effective than changing a single patient’s behavior. For sexual health, that means combating the stigma around sex.

The teenagers, the girl explained, would pass a plastic, life-size penis around the circle. Whoever was holding it when the music stopped would have to unroll a condom onto it, completing each of the eight steps they had been taught a few minutes earlier.

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The focus on stigma is just one of many ways Los Angeles County health officials are trying to think outside the box as they struggle to curb rising STD rates. It’s clear that the traditional ways of preventing disease — patients seeing a doctor regularly to get screened and treated — have not been working, said Dr. Jeffrey Gunzenhauser, L.A. County’s interim health officer.

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The county recently created a Center for Health Equity to evaluate the way certain public health issues are intertwined with social factors such as income and education, as well as racial discrimination.

High STD rates are at the top of the center’s list of priorities. In just the past five years, the number of gonorrhea cases in Los Angeles County doubled, with minorities suffering more than most.

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Spring Into Love, which began five years ago, is the brainchild of a coalition of L.A. County health advocates trying to bring down STD rates. This year’s event, held in late March, included workshops on healthy relationships and body image, as well as free STD testing.

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Researchers increasingly view public health problems as shaped by the environments in which people live. Neighborhoods where people of color reside, for example, are more likely to be pollution-ridden and have fewer parks and doctors — factors that directly affect people’s health.

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Los Angeles County launched a Center for Health Equity in October {snip}.

The center will target five health disparities, including high rates of STDs among certain minority groups.

Nationwide, STD rates have been climbing for the past five years. More people were diagnosed with syphilis, chlamydia or gonorrhea in 2016 than ever before.

Some blame underfunding of STD prevention programs, as well as falling condom usage. There’s also speculation that people are having sex with more partners because of hookup apps.

But the picture is more complicated when it comes to the high STD rates among minorities. Gay and bisexual men make up the vast majority of new syphilis cases. In L.A. County, syphilis rates among African American women are six times higher than white women and three times higher than Latina women.

Northover said that officials need to evaluate what’s called structural or systemic racism, the way housing or education policies may negatively impact people and their health. Studies have found, for example, that people with HIV who had low levels of literacy were less likely to follow their treatment, and that poorer Americans were more likely to engage in risky sexual behavior, increasing their risk of STDs.

The Centers for Disease Control and Prevention released a white paper in 2010 saying the country could not close disparities in STD rates without addressing “the interpersonal, network, community, and societal influences of disease transmission and health.”

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Poverty or a lack of opportunity may be forcing women to exchange sex for resources, leading to the spread of STDs, Northover said. There also tends to be a mistrust of the medical system among African Americans, making them reluctant to seek care. Certain neighborhoods may be excluded from access to healthcare because of geography or finances, she said.

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