METHODS Survey data collected in October from 8, standard six and standard seven students aged 11—17 in schools in Nyanza Province, Kenya, were used in logit and log-normal hazard models to understand the factors that influence the timing of first sexual intercourse. RESULTS Both males and females who rejected myths about HIV transmission, those who experienced less sexual pressure and those who did not know anyone who had died of AIDS, as well as males who had a stronger belief in their ability to abstain, were more likely to postpone sexual intercourse than were young people who lacked those characteristics.
Poverty and Inadequate Access to Health Care Health insurance coverage enables individuals to obtain professional assistance in order to prevent potential exposures to sexually transmitted infections and to seek care for suspected STDs.
Uninsured persons delay seeking care for health problems longer than those who have private insurance or Medicaid coverage Freeman et al. Those with private health insurance who are living at or near poverty level have limited access to health care because of copayments and deductibles that are typically part of private insurance coverage Freeman and Corey, Medicaid coverage is often less effective than private health insurance coverage since many physicians refuse to treat Medicaid beneficiaries, thereby restricting access to comprehensive health services Schwartz et al.
Private health insurance generally provides the most comprehensive coverage with the greatest access to physicians and other health care professionals.
However, not all plans offer adequate coverage for STD-related services. Little information is available on coverage for STD-related services in the private health care sector. A recent study of how women pay for reproductive health care suggests that many health plans either do not cover some important STD-related preventive reproductive health services or require copayments and deductibles for these services WREI, STD-related diagnostic and treatment services are covered under general clinical care.
However, the study found that only about half of all health plans cover preventive care such as routine gynecological examinations that may be important in detection of asymptomatic sexually transmitted infections.
Managed care organizations may provide better coverage for certain STD-related services than do many indemnity health plans, but they pose different challenges to the prevention of STDs, particularly for many Medicaid beneficiaries enrolled in managed care.
Most managed care organizations require their enrollees to obtain all their health services from the plan's network of providers. This disrupts established patterns of STD care for many women on Medicaid by denying patients access to their preferred providers. A recent study found that neither the federal government nor the states had taken steps to ensure that Medicaid beneficiaries enrolled in managed care organizations could obtain services from family planning programs or public STD clinics Rosenbaum et al.
A number of family planning programs have taken the initiative to develop contracts with managed care organizations that serve Medicaid clients, thus both avoiding the problem of nonreimbursed out-of-plan use and retaining an important source of revenue for their program Orbovich, This is an especially important policy issue as states increasingly encourage or require Medicaid Page 75 Share Cite Suggested Citation: Confronting Sexually Transmitted Diseases.
The National Academies Press. The role of managed care organizations and other health plans in STD prevention is further discussed in Chapter 5.
Health insurance coverage influences where people obtain STD services. A recent study found that uninsured women and those covered by Medicaid were far more likely to obtain reproductive health services from a public or community-based clinic rather than a private physician's office, compared to women who were covered by either a managed care organization or other private health insurance Sonenstein et al.
Even those with adequate insurance coverage may be reluctant to obtain care for potential STDs from their regular health care providers because of the social stigma associated with these infections.
A significant number of persons with private insurance are reluctant to bring STD exposures to the attention of their family doctor or health plan and prefer the anonymity of a public STD clinic or other public clinic Celum et al.
Further analysis of these data revealed that of the 1. The age and ethnic groups with the highest rates of STDs are also the groups with the poorest access to health services.
Among persons years of age, 25 percent are completely uninsured Figureincluding one in every five persons years old and at least one in every four persons years old. One in every nine persons years old depends on Medicaid or other publicly sponsored insurance for health care access.
In addition, Hispanic and African Americans are most likely to lack insurance coverage. Poverty and other socioeconomic factors also contribute to STD risk in other ways. Even if a person in poverty perceives himself or herself to be at risk for an STD, he or she may not practice preventive behaviors if there are other risks that appear more imminent or more threatening or both Mays and Cochran, ; Ramos et al.The above factors have led to increased female intrasexual competition for desirable long-term mates which has resulted in the drive towards thinness.
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Get started now! Factors associated with being a victim of sexual violence. Jump to navigation Jump to search Women are at increased risk of sexual violence, as they are of physical violence by an intimate partner, when they become more educated and thus more empowered.
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