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Episode #1709
Sexually Transmitted Diseases
Holloway: Jay Holloway,
host
Holt: Deborah Holt
Smith: Barbara Pullen Smith
Rozier: Ashley Rozier, II
Foust: Evelyn Foust
Troy: Eveylyn Troy
Ashby: Rhonda Ashby
Matthews: J.R. Matthews
Parker: Joan Parker
Campbell: Sherman Campbell
M: Unidentified Male Voice
F: Unidentified Female Voice
Holloway: It's
another silent killer you need to know about. We'll talk about
STDs and the choices you can make, next on Black Issues
Forum. You stay tuned.
Voiceover: This program
was made possible in part by contributions to UNC-TV from
viewers like you. Thank you.
[THEME MUSIC]
Holloway: Good evening
and welcome to Black Issues Forum. I'm Jay Holloway,
and tonight we'll talk about another health issue that is
significantly impacting the African American community here
in North Carolina. But the good news is that we have the choice
and the power to turn those statistics around. We're talking
about sexually transmitted diseases, and particularly syphilis.
In 1999 Columbus County, North Carolina reported four cases
of syphilis. But when 41 cases were reported in April of 2001
the state's division of public health decided it was time
to take action. Our producer, Deborah Holt, has this story
about how the state is working to attack the problem with
the help of the Columbus County Dream Center.
F: You ain't never
too good to get a shot to save your life.
Holt: That is a sentiment
that Dream Center volunteers hoped all residents of Columbus
County would share as teams journeyed out for two days of
targeted outreach.
M: Hello.
F: Hey, how are you.
Troy: We are one of
the non-traditional testing sites for the state under the
HIV/STD Prevention and Care Branch. That means we go out into
the community and do testing on non-traditional hours for
HIV and syphilis. Columbus County has had a great increase
in the number of syphilis cases. And usually when we have
an increase there is also, following it, an increase in HIV.
Holt: Columbus County
is the third largest county in the state. To battle the syphilis
epidemic, health officials commissioned a RIOT.
Ashby: RIOT stands
for Rapid Intervention Outreach Team. It is a unique response
where the state health services join and collaborate with
community members and the local health department and other
medical providers to go out into the community and to take
education on sexually transmitted diseases out to community
members at their home and to offer them the opportunity to
be tested at their home or at their hangout.
Holt: That location
could be on a street corner, inside a resident's vehicle or
even a secluded park. Wherever it is, volunteers are trained
and ready. In teams they knock on doors, talk to residents,
hand out information and offer free blood testing on the spot.
Matthews: First we
tell them about abstinence, or if you're married we tell them
about being true to your partner. But we also teach them about
condoms and we teach them about other ways of protecting themselves
if they are going to encounter high-risk behaviors, that they
need to protect themselves. Traditionally, African Americans
have been less receptive to this type of education. And because
of that we find ourselves in the predicament that we're in
so far as with the percentage being much higher.
Holt: According to
the Center for Disease Control and Prevention, the syphilis
rate for African American women is 34 times higher than it
is for white women, and there is a higher concentration of
the disease among African Americans in general.
Parker: A lot of people's
doing a lot of things, you know. Everybody doing their thing,
especially me. I'm not that perfect. So that's why I felt
politely to take this test.
Campbell: It's good,
it's good to have somebody out here that cares.
Ashby: Kim, Kristen,
how did it go out in the field today?
Holt: Volunteers collect
the blood samples and shuttle them back to the Dream Center.
Here more volunteers label, sort and ship the samples off
to the state health department for testing. Residents receive
an identification number so they can return to the health
department for their results.
Ashby: For the individuals
that do not return to the health department, then members
from the HIV/STD Prevention and Care Branch will actually
come back down and we will go out into the field, whether
they are positive or negative, and ensure that they get their
test results.
Holt: So you guys are
really concerned about making sure that they not only take
the test, but that they find out what the results are.
Ashby: Yes. It's important
that they know because we talk to them not only about what
the diseases are, but what puts you at risk for those types
of infections.
Holt: The RIOT lasts
for two days, with teams working in neighborhoods until dusk.
And if successful, a RIOT can actually rid a community of
syphilis entirely.
Holloway: To help educate
us more on this issue we have from the North Carolina Department
of Health and Human Services, Office of Minority Health and
Health Disparities, Executive Director Barbara Pullen Smith.
Thank you Barbara for being with us.
Smith: Thank you.
Holloway: Also, Mr.
Ashley Rozier, II, CEO and founder of the Cape Fear Regional
Bureau for Community Action, Incorporated. And Evelyn Foust,
the branch head of the HIV/STD Prevention and Care Branch
for the North Carolina Department of Health and Human Services.
Thank you all for being with us on a such an important topic.
Smith: Thank you.
Faust: Thank you.
Rozier: Thank you.
Holloway: Mr. Rozier,
while we were watching this feature you were just really animated,
"I know them, I know them, I'm from this community, they're
my age!" What would you say not only to those people
and people around the state about this tough issue? Because
as the guy said in the piece, traditionally African Americans
have not been open to this kind of education.
Rozier: Well, coming
from Columbus County, and awhile ago we saw pictures of the
Chadbourn community where I went to school. And I was amazed,
I saw some of my very dear friends, personal friends, when
I go back often and try to do work in the community. 20 years
ago, I can go back to 1976 when I graduated from West Columbus
High School in Cerro Gordo, right outside of Chadbourn. We
never thought we would have crack cocaine and substance abuse
in our community, you know. You could leave your doors open
all night. The worst you could do back then was smoke marijuana
and drink some liquor and some grapefruit juice and thunderbird
and get drunk, you know, as a teenager. And being very practical
too, the worst you could do was go out in the woods and maybe
have a sexual affair with the mosquitoes biting you. And I
just want to be honest with you. Rural people, you know, there's
no need. Many of us we get in positions, we forget about just
being plain and simple.
Holloway: Where you're
from.
Rozier: Right. And
that community, you had the juke joints, you had the wolf
clubs. Many people are laughing listening to me now, and they're
saying, "Come on, talk to me."
Holloway: They know
what you're talking about.
Rozier: They know what
I'm talking about. Just people who just work hard for a living,
farmers trying to make a decent living. You know, you didn't
think about syphilis, you didn't think about AIDS because
we didn't start hearing about the AIDS epidemic until the
late '70s.
Holloway: So now this
community is open for that kind of education?
Rozier: It's open for
that. We need more HIV/AIDS and sexually transmitted disease
prevention information in the rural communities. It is very
important that we go out and empower the community, but not
make the decisions for them. The policies need to be made
with them. We need to have them at the table before we make
these decisions also.
Holloway: Barbara,
why is this going on and why does North Carolina have such
a disparity, and particularly women, black women?
Smith: Before I get
to that point I want to just follow up on something Ashley
was saying, because I think the RIOT represents the best of
partnerships between the federal agencies, state and local
communities. And it is effective for one given point in time,
and what needs to happen is some continuity. Local communities
and agencies need to put something in place so that the prevention
message is always there in the community at a level that is
effective and appropriate.
And in response
to your question about the disparities, I mean, there are
just multiple reasons why disparities exist.
Holloway: Just start
with one. We've got another 20 mintues.
Smith: I'll start with
one. Clearly the poor, regardless to their race or location
in this state, suffer disproportionately from many of the
chronic diseases and conditions, and sexually transmitted
diseases are certainly no different from heart disease and
HIV/AIDS and cancer and so forth. So part of it is rooted
in poverty and all the things that go along with being poor.
Sometimes it's lack of information. A lot of times it's lack
of access because you don't have the insurance coverage. It's
lack of access because you don't have the information. It's
lack of access because of the history and experience that
poor people have had in many of these healthcare systems.
So the list goes on and on.
Holloway: Disproportionate
in the eastern area.
Smith: Yes.
Rozier: Definitely.
Holloway: How successful,
Evelyn, was that program and is it now?
Foust: Well, that particular
weekend I was there and we did over 500 bloods on Friday night
and then Saturday. The local health department led by Maryanne
Duncan as well as Evelyn Troy in the Dream Center and then
our staff, I'm tremendously proud of them. I just want to
point out to you, Jay, and Ashley will appreciate this, one
of our great community leaders here, that was staff that was
out there after 5:00. They were knocking on doors well until
8:30, 8:45. And nobody complained, Barbara. Barbara's staff
were out there too because we felt a tremendous mission to
get the word out to people that sexually transmitted diseases
were a problem in their community, particularly syphilis.
But that the good news, as you said, Jay, is that they could
do something about it by getting tested, finding out their
status and then if they were infected get free and confidential
treatment. So it was just a tremendously moving experience
for me because one of the things, Ashley, that I got in touch
with about that community again is that no one there wants
to have these diseases, and most people are not aware that
they have it. If you come to them with a problem, they're
the first ones to say, "Heck yeah, I want to get tested
and find out what's going on with me." Jay, we also pay
particular attention to young women that are even thinking
about getting pregnant or are perhaps already pregnant, because
if you have syphilis a mother can pass this disease unknowingly
to their baby. And I am not proud of this, last year North
Carolina reported over 17 cases of congenital syphilis, and
that's baby's born with syphilis. Most of those babies died,
and that is unacceptable. So we've got work to do, Barbara.
Holloway: Let's talk
about the whole controversy. The faith community is very strong
in the black community, strong in this bible belt region for
everyone in North Carolina, but the whole idea of abstinence
versus safe sex or condoms, the guy mentioned in the piece
here. How do you all deal with that at the governmental level,
at the street level when talking to folks in our state about
this?
Rozier: Can I comment
on that?
Holloway: Please do.
Rozier: Well, I think
that it's important before we even go into that. Can I just
make mention of this part concerning the African American
community and the rural community. We can go back to the Tuskegee
experiment through the '30s and '70s. You've got to remember,
the African American community, every time you turn on the
television many times you see anything negative, you see a
black man handcuffed or shooting in the neighborhood.
Holloway: So trust
is an issue.
Rozier: So the trust
is an issue. Thank God we have grass-root government agencies
now. I've deemed them as grass-root. The North Carolina HIV/STD
Prevention and Care Branch and the North Carolina Office of
Minority Health and Health Disparities are grass-root programs
now that understand the need to empower grass-root community-based
organization through a public/private partnership we're working
on. So when you do that, then you can get the faith community
involved.
What we're doing now with the
faith community, we say even the Bureau, Cape Fear Regional
Bureau headquartered in Fayetteville, when I go out and speak
in the churches or we go into the church community.
Holloway: That's your
organization?
Rozier: Right. What
we say to them is until we can change the behavior of individuals,
if you go to the housing projects and a young lady is smoking
a Philly blunt-and to the audience that's putting marijuana
inside a cigar-and she is smoking a Philly blunt and she's
already had two children and she's at risk for a sexually
transmitted disease or at risk of having another child, at
that moment we have to treat that individual just the way
they are. Then once we can gain that trust with them we gradually
can change their behavior once they trust us, but at the moment
we have to give them a condom until we can change that behavior.
Now secondly, what we say to
the church community is that an individual who is an injectable
drug user, when you're an injectable drug user you are not
only at risk for HIV but syphilis and many other, like hepatitis,
you're also at risk. So what we say to them, we teach them
to cleanse their syringes until we can change their behavior
or get them in NA or AA or get them at a treatment facility.
What is important, those people who are Christians, if Jesus
was here on the face of the earth now he would change their
behavior. We challenge the Christian community, instead of
being judgmental, to be more culturally sensitive to people.
Go out in the byways, hedges and trenches and change their
behavior, then we would never have to pass out a condom. So
until we can change people's behavior we have to meet them
right the way they are, just the way they are.
Holloway: So Barbara,
do you agree? I mean, has the black church failed by not really
going out there and meeting them where they are in the highways
and byways and compelling them to change?
Smith: Well, I wouldn't
say the black churches failed at all. I would say that the
systems have failed our communities and our people of color,
absolutely.
M: All of them.
Smith: And that's where
we have to first understand and define where the systems failures
are. For example, in terms of just the disparities issues,
CDC-Center for Disease Control, excuse me-reports that about
50% of all of the mortality is the result of some kind of
lifestyle behavior, what we eat, what we drink, whether we
smoke, sexual behaviors and practices. And that's all well
and good, but environmental factors also play a part in that
as well as systems barriers play a part in that. So part of
it is the systems have failed to keep our communities informed
about these issues before they become a crisis. I think the
system has failed to provide the ongoing kinds of support
and information that faith leaders need in order to address
this issue. And we have to remember, the role of the church
historically in the black community has been all-in-all to
the black community. It was not just about spiritual growth,
but it was about protecting and promoting the health of communities.
It was about dealing with social injustice issues. It has
always been there to support the total needs of the community
and churches are still, I think, ready and willing to do that;
not all of them. Some faith leaders are open to this. We have
to be smart as state agencies to find them and to build on
what we have and the ones that we know are ready. And we have
to get faith leaders to educate other faith leaders. And I
think there is a very nice program and a strong program that
came out of Evelyn's shop that kind of builds on that kind
of thinking. Sometimes the messenger is as important as the
message.
Holloway: Well let's
talk about that. We're talking about sexually transmitted
disease, if people are just tuning in now, but we heard initially
about one of the programs which you all said was one of the
best examples in the state, the RIOT program. Explain what
that acronym is for and what other programs is she talking
about.
Foust: Well, the RIOT
stands for Rapid Intervention Outreach Team, and I think the
key, to relate to what Ashley and Barbara are saying, is that
it means outreach. I believe very strongly, Jay, that if you're
going to have a successful people program-and that's what
public health is all about, they are people programs-that
you can't sit in your office and just contemplate the issues.
Barbara, you laugh, but I know you're right there with me.
You have to get out and confront the issues, but do it with
your community. We don't have all the answers in Raleigh.
We don't have all the answers wherever we are if we are confined
in a building, and I think the same is true for a church or
a public health agency, social services, we need to get out
to where people are. Again, the lesson that I took away from
the work we did in Columbus County is that everybody we interacted
with, and I know I talked to several hundred people myself,
they were all concerned about their health. So if you ever
hear anybody say, "What is wrong with those people?"
there is something wrong with the person asking that question.
The system's failure is because we maybe get too comfortable
in our eight-to-five comfort zone, right Ashley? And as Ashley
said, you've got to get out and go where people are.
Rozier: And it's attitude
too. Can I say just.
Foust: Well and I just
want to make this point, with technology now-because I really
want to challenge all public health programs whether it be
local, state or federal government-with technology we have
better testing. We can take those tests right out to somebody's
home. It's not that far away, Barbara, that we actually could
offer treatment in, and in fact we're doing it, and that's
the successful church program. There are churches.
Holloway: So local
health departments can contact you to do these same things.
Foust: Absolutely.
Absolutely. But Jay, you asked me about churches and I'm sorry
I got a little off the subject there, but churches can offer
HIV/STD testing and they are offering that. There is no reason
to believe that you couldn't offer treatment in a church.
In fact, Evelyn Troy used the word "non-traditional test
site." And she does it, her agency the Dream Center,
which is a wonderful agency, is not that far from a church.
But they opened up a place where you can go and get tested
right there. You can get tested at the local health department.
See, we need to get folks to have as many places as possible
to just say yes to public health.
Holloway: Ashley, we
hear a lot about HIV and AIDS and we talk about, not a lot
about this sexually transmitted disease maybe as much, and
then she referenced those people. What are some of these myths
that we're having to deal with, gender as well as sexual orientation.
Rozier: I'm glad you
asked that. I had a burning desire when she stated that, and
that was very good. Well, one problem that we've got-I'm being
very candid with you Mr. Holloway-is that HIV/AIDS and STDs
are still unpopular social ills. It's very popular to have,
believe it or not, diabetes or cancer or prostate cancer,
but when you talk about sexually transmitted diseases then
we begin to label people. And we need to be very candid with
ourselves. One reason why America has not gotten totally involved
in HIV/AIDS and STDs the way they should is because they still
deem it as a "gay disease" or "injected by
drug users disease" or "those poor people's disease."
And the problem that we've got until we address these issues
and stop being judgmental.
Holloway: And you're
saying that's not true.
Rozier: Right, it's
not true. And the problem we've got, sir, is that we need
to now look at this as a human disease, and all these sexually
transmitted diseases. The problem we've got is like D&L,
down low men, men who don't identify themselves as gay at
all, at all. These men actually will go out and fight other
gay men publicly because they're so insecure they don't want
anyone to discover that they are gay. Secondly, we have a
lot of closeted MSM, men who have sex with men, particularly
men, most men who are gay are married or they have a female
partner. They're not the traditionally gay individual that
people may think "flamboyant" or "sissified"
They are men who look like Mike Tyson and Michael Jordan-I'm
not saying Mike Tyson and Michael Jordan are gay, okay, I
want to clarify-but they look like that and we stereotype
so much. A problem that we've got is that most of the time
no one wants to go out and find these men because there are
very few people across this country can go out and identify
those type of individuals.
Holloway: Now are you
saying from your observation, or are there statistics showing
that a lot of gay men happen to be married, or most of them?
Rozier: Well, sir,
I can definitely tell you that most gay men in my line of
work I know many, many gay men who have sexual affairs with
women of childbearing age. We should not discriminate. A problem
that we've got in addressing the STDs is that there is no
one basically in the state of North Carolina or the country
that really can address the issues of MSMs. Traditionally
when we talked about HIV/AIDS in the late '70s and early '80s,
we talked about gay men in bathhouses in San Francisco, gay
men in Miami and Atlanta. We didn't talk about the rural community,
the south. And if we did give monies out we gave monies out
to traditional gay organizations that were white ran. Grant
you now, the African American community should be very proud
of white gay traditional CBOs because they are the ones responsible
for African American women even today taking AZT medicine
when they are pregnant, reducing greatly the chance of a child
becoming HIV infected. So the white gay community mobilized.
The African American community has been very passive. It is
time now that African American men can say, "We have
issues here and we need to go out like we did in the '60s
during Dr. King and Malcolm X and mobilize our communities."
You see, the branch in the Office of Minority Health can provide
the technical assistance. They have done a great job. Without
them we would not have the minority community-based organizations
like we have.
Holloway: So Evelyn,
has that history benefited your organization and outreach
now?
Foust: Absolutely.
You know, Ashley, not just for African Americans but I think
his point is absolutely true, that in the South, Jay, I believe
we have a really hard time talking about sex. Let me just
share with you some brief statistics. We have over 21,000
cases of chlamydia reported in North Carolina. There are over
17,000 cases of gonorrhea. We just talked about syphilis and
we are number two in the nation for early syphilis cases.
The only way you get a sexually transmitted disease is by
having sex with someone that gives it to you, and usually
unknowingly. So the reality is, North Carolina is a place
where people have sex. And we can kind of laugh and joke about
that, and of course when it comes to STDs it's not funny,
but the point is we don't talk enough not just about sex but
about how people can protect themselves. We've got to get
that out of the closet and we've got to reduce the stigma
so that people feel comfortable enough to talk about their
risks of STDs and then ask for help.
Holloway: What about
at public school? I'm sorry, you wanted to say something first.
Smith: Yeah, I just
wanted to add to what Evelyn is saying, because we have to
remember that this focus on eliminating health disparities
is an initiative and an idea and a concept that grew out of
federal and state government. So we really have to be careful
about how we go into communities and define people's problems,
and also try to set people's priorities for them. And I think
that's part of why, I think, our offices have recognized that
we can't do anything well unless we have total partnerships
with the communities, and that they lead us. We go to them,
we try to provide the resources and the technical support
that they need, but we follow their lead to help identify
what the problems are and how best to reach the churches and
how best to reach community-based organizations around sexually
transmitted diseases or any other health issue we're trying
to deal with.
Holloway: We didn't
talk at all about the public schools' involvement in this,
and there was the whole controversy for the last 30 years
about teaching sex education, but what involvement do the
public schools have, or what is their role in terms of teaching
this sexual education?
Foust: Well Jay, I
want to point out to you that when you look at the 21,000
cases of chlamydia, over 1/3rd of those are in
young kids 13 to 19, so I appreciate your question. In North
Carolina we have a healthy living curriculum, and although
abstinence needs to be taught. And as a parent-and I've shared
this with you on this show before, Jay, about HIV infection-as
a parent we need to talk to our young people about abstaining
from sex. They are seldom morally, spiritually or physically
ready. At the same time, the reality is, based on our statistics,
many of our young people are having sex and they're having
at-risk sex, unprotected sex, so we need to get that skeleton
out of the closet. And in schools I believe North Carolina
has great improvement that needs to be done. The healthy living
curriculum does say that you can teach it, but we really need
to look at each individual school and make sure it's being
done properly.
Holloway: Thank you.
10 seconds.
Rozier: Okay, but also
society needs to stop promoting promiscuity themselves. It's
easy to pick on adolescents and children when we have many
athletes and even spiritual leaders.
Holloway: And you see
that modeled.
Rozier: The model,
right. It's very important.
Holloway: I've got
you. Well look, thank you all so much. Time has run completely
out and we had a tough issue here, but you all handled it
and informed us well. Thank you so much.
Rozier: Thank you.
Smith: Thank you.
Holloway: Healthy living
is definitely a choice, and as you've heard tonight you can
choose to engage in high-risk sexual behaviors or not. You
can also choose to protect yourself and others. It's all up
to you. For more information on STDs and the information you
heard on tonight's program visit us online at www.unctv.org
or you can call us with your questions or comments at (919)
549-7167. For Black Issues Forum I'm Jay Holloway.
Join us again every Friday night at 9:30 now, only on UNC-TV.
You have a blessed evening. Good night.
[THEME MUSIC]
Voiceover: This program
was made possible by contributions to UNC-TV from viewers
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