Access to care issues for African American communities: implications for STD disparities.

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.