Performance Improvement 2010. Understand and Prevent Spread of Infectious Diseases


In 2009, a rapid ethnographic assessment identified and described community and structural level factors that contribute to persistent high rates of congenital syphilis among Latinas in Maricopa County, Arizona.  The county had the highest rate of the disease in the US from 2003-2005.  Most cases were born to Hispanic women.  In 2007, the county issued an order to promote prenatal syphilis screening during pregnancy.  The assessment identified the following contributing factors: low levels of knowledge and awareness about sexually transmitted diseases among Latinos; inconsistency among health care providers with regard to screening of pregnant women for syphilis; and insurance and cost barriers to receiving prenatal care services, especially for women not U.S. citizens or legal residents.  Contributing social factors to transmission risk included the frequency with which Latino men migrate for work in the absence of a girlfriend or spouse, cultural norms which make it acceptable for men to have multiple sex partners, the perception among men and women that condoms are primarily for contraception, and intimate partner violence and social isolation among recent immigrant women.  Barriers to prenatal care included the high cost of medical services, lack of insurance, lack of awareness of alternative forms of financial support, and challenges with understanding the system for qualifying for services and providing necessary documentation.  Most women who do interact with the health system remain in care unless other factors, such as availability, access, and cost become barriers.  Social networks appear to be instrumental in introducing women to services, as many women receive advice and guidance regarding prenatal care from relatives and friends already familiar with providers and the health care system. (9228

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