Washington University School of Medicine
St. Louis is known as the sexually transmitted disease (STD) capital of the nation. The statistics are irrefutable: St. Louis city currently ranks 1st nationally for gonorrhea, 2nd for Chlamydia and 5th for syphillis.
There are proven ways of lowering rates and raising the overall health of our community. One effective approach is making contraception affordable, accessible and socially acceptable.
Age-appropriate sexual education in conjunction with appropriate condom use has been shown to lower the rates of HIV and other STD transmissions as well as help prevent unwanted pregnancies.
Reasons for the low use of condoms in inner-city communities were well documented in a report from Johns Hopkins University, which noted the most frequent explanation given for not using condoms included partner trust (19.6 percent), the feel of condoms (11.9 percent), and lack of condom availability (11.5 percent).
Currently in our city, linked contraception and sexual education is limited to organizations such as Project Arc, St. Louis Effort for AIDS, Planned Parenthood and Connect Care Clinics. For most citizens, these restrictions on access mean purchasing condoms from the local pharmacy.
City health officials, under the leadership of health director Dr. William Kincaid, have been engaged in a coordinated approach to reduce STDs through improved surveillance, access to clinical services and strengthening community involvement. Condom availability should be an integral component of that effort.
However, disparities in price and access to condoms hamper effective preventive health practices. In a recent analysis of condom prices and access in St. Louis city, information was obtained from 17 “brand pharmacies” in 18 different ZIP codes across the greater area. Prices were evaluated at these locations to see if pricing patterns matched any of the region’s demographic data.
Indexing neighborhoods by their racial makeup, there was a striking correlation between prices, condom accessibility and the race. On average, prices for 12 or 36 packs of condoms in mixed black or mostly black neighborhoods were $2 to $6 dollars more, respectively, than the same pack in mixed or mostly white neighborhoods.
Even accessibility within pharmacies varied greatly between white and black neighborhoods. In four of the seven pharmacies in or near African-American neighborhoods, condoms had to be obtained from a locked cabinet or behind the pharmacist counter, resulting in a potentially embarrassing wait for the customer. There is a very different trend in predominantly white neighborhoods, where condoms were universally available in the open isles of the store.
African Americans make an average $13,590 dollars less annually than their fellow white residents, and 34 percent of blacks living within the city of St. Louis live in poverty. Why would we be charging more, instead of less, in neighborhoods where incomes are lower and the need for affordable and accessible condoms is higher?
Our local businesses must fairly decide their prices based on the social and moral realities of the world in which we live. As citizens we should redouble our efforts to improve sexual education, in conjunction with improved contraception access, education and distribution programs.
We should additionally support organizations dedicated to the goal of equal access to family planning. This means supporting politicians and government organizations that recognize the reality of this health crisis and are dedicated to correcting the problems we face.
Disease and pregnancy do not respect the racial boundaries that still divide our city. If we continue to neglect or, worse yet, profit from these threats to our citizen’s health and safety, we are putting ourselves, and our future, in peril.