If you could look at a similar Geographic Information Systems (GIS) Map of New Jersey counties that charts Chlamydia infections, you would see intensive clusters centered in urban centers and around major hospitals and few infections in wealthy counties.

Chlamydia is a curable sexually transmitted infection (STI), which is caused by bacteria called Chlamydia trachomatis. You can get genital chlamydial infection during oral, vaginal, or anal sexual contact with an infected partner.

It can cause serious problems in men and women, such as penile discharge and infertility respectively, as well as in newborn babies of infected mothers. Chlamydia is one of the most widespread bacterial STIs in the United States. The Centers for Disease Control and Prevention (CDC) estimates that more than 3 million people are infected each year.

Why are Chlamydia infections clustered in poorer urban areas? Are poor people having more sex and using less protection? No. Why are Chlamydia infections less frequent in middle and upper income counties? Are rich people having less sex and using more protection? No. In New Jersey, Chlamydia infections are, by law, required to be reported.

When your doctor sends your genital swab to a lab and it is discovered you have Chlamydia, the lab must report your infection to the state so it can be logged and tracked in case of an Outbreak. Once your Chlamydia infection is reported to the state, you will get a home visit from state health officials in white van. That home visit will explain why Chlamydia is a notorious and dangerous infection that can have negative long-term effects if left lingering and untreated.

The difference between county Chlamydia infections in New Jersey isn’t about sex or having safe sex. The issue is one of reporting as well as the vast crevasse between those with money and power and influence and those without. People who live in urban areas are generally poorer than those who live in wealthier suburban counties.

The poor usually do not have a primary care physician or health insurance so they are forced seek routine healthcare in hospital emergency departments and when Chlamydia is confirmed, the entire neighborhood knows because the mandatory white van home visit is hard to hide.

If you have money and health insurance and a private doctor — and you shudder at the notion of having an embarrassing white van home visit for your Chlamydia infection — you and your doctor will know exactly what not to ask and what not to say and what not to test in order for that not to happen.

Most doctors, when they see a white discharge oozing from your genitalia, have a pretty good idea you probably have a Sexually Transmitted Infection and they know what medication to prescribe to make it, and any other similar infection you might have, and any subsequent home visit by a white van, go away.

If your doctor doesn’t swab your foaming genitals for lab analysis to confirm a suspicion, a white van cannot be dispatched for a visit. No law is broken because no test was done. The urban poor do not have that kind of inside access to manipulate the legal requirements of the reporting process. Remember when you see reported infections, especially those for Chlamydia and other STIs, you are seeing results skewed in favor of the wealthy and pressed against the poor.

Those manipulated reports are often used to advance public policy and to privately punish communities for being uneducated, immoral and undeserving. When we think about Race and Poverty and Power and Privilege in America we must look beyond skin and salary and wages and direct our attention instead to the prejudicial disparity between communities when it comes to Chlamydia and the white van.

Perhaps then we can begin to comprehend the hidden chasm between people and how even the law may not always do the right thing.

29 Comments

  1. You know, I think there was something similar to this on an episode of ER a couple of years ago, when I still watched. Bruce Wietz (I believe it was him) played some sort of local representative who came to the hospital with a problem, and Carrie was the doctor who attended to him. She was trying to get more funding for the hospital, and he was sympathetic to her cause.
    Then some bloodwork came back with results that Wietz’s character had an STD. In a smarmy, subtle way, he pressured Carrie to avoid reporting those results, holding the hospital funding over her head.
    I immediately thought of that episode when I saw your article. Not having money causes problems for the poor that we never realize.

  2. Ah, that’s a good example, Carla, and one many people will be able to relate to because of ER’s high popularity. Thanks for making that circle for me!
    It’s unfortunate the people who need the most services and the most help are those who find it most difficult to get unbiased assistance. If we work on ways to open up blind access points for vital services without unfairly logging and tracking what is provided, the better off we all will be in the far view.

  3. Golly, Dave, you have a lot of really good, hot-button issues going on here! Let me try to respond to them each.
    You are right about the rich having extended rights in every vein of our society. I went to graduate school with the son of the guy who invented a very famous band of blinds for house windows. The son was highly medicated (a good thing!) completely unstable and he lived in a posh apartment that cost $3,000 a month while the rest of us suffered in squalor. He was on a parental stipend of $10,000 a month and he would regularly call male Gay sex lines to the tune of $1,100 a month. His solution to every situation that meant interaction with people was to “flip them a few twenties” and it always worked! If he needed a favor or a parking spot or entry a place where he did not belong, he was always able to “cash” his way inside. He dropped out of the program due to emotional problems. I don’t know if he ever returned to finish his final years.
    Now on to healthcare…
    The problem is with our health insurance system. Private hospitals and the best doctors don’t want to take Medicare and Medicaid patients because they don’t get reimbursed enough fast enough, so the burden for healthcare for the disenfranchised elderly and the impoverished — and the disenfranchising was done by the very government sworn to protect them — falls on public hospitals.
    Yes, there are local clinics that cater to serving the poor, but they are usually run by public hospitals so, as government agencies using public funds, everything that needs to be reported will be reported because that is their reason for being — to continue the Möbius strip existence and pattern of co-dependency between policy and enforcement and acting upon the wishes of administrators who pretend to minister to the unrepresented and misbegotten.
    Also, public hospitals are required — again by law — to treat anyone and everyone no matter if they can pay or not — a very good thing — but then you have Emergency Departments overrun with the unidentifiable and unbillable ill (illegal immigrants, the psychotic, the criminal) and the public mandate of the hospital is made impossible and the noble idea of democratic access to healthcare is rendered null by those who refuse to be identified by the system that heals them.

  4. But this confidentiality can bite the privleged in the butt as well. Consider the issue of domestic violence. Suspected child abuse and neglect is reported at a much higher rate in an urban and lower socioeconomic population. It is not that physical and emotional abuse do not occur in the suburbs, it is just that when a well dressed child, with a well groomed mother, who speaks with a cultured manner comes to the doctors office with a black eye…the same kind of embarrassing questions are not necessarily asked of the mother. Doctors often will take the statement that the black eye came from “a fall from a swing set”, at face value. Domestic violence, then is underreported, and can go on to fester.
    I agree with the whole conversation here that wealth and social standing does create a two-tiered health system. It is an embarrassment to admit as a health professional. You do, however, see this in not just health care, but in many aspects of our society. The ever widening gap between the haves and have nots, those who can read and those who are illiterate, and so on can lead to crisis.

  5. But this confidentiality can bite the privleged in the butt as well. Consider the issue of domestic violence. Suspected child abuse and neglect is reported at a much higher rate in an urban and lower socioeconomic population. It is not that physical and emotional abuse do not occur in the suburbs, it is just that when a well dressed child, with a well groomed mother, who speaks with a cultured manner comes to the doctors office with a black eye…the same kind of embarrassing questions are not necessarily asked of the mother. Doctors often will take the statement that the black eye came from “a fall from a swing set”, at face value. Domestic violence, then is underreported, and can go on to fester.
    I agree with the whole conversation here that wealth and social standing does create a two-tiered health system. It is an embarrassment to admit as a health professional. You do, however, see this in not just health care, but in many aspects of our society. The ever widening gap between the haves and have nots, those who can read and those who are illiterate, and so on can lead to crisis.

  6. Jeff!
    I thank you for sharing your professional insight as an MD into this snaggy issue and you make an excellent counterpoint.
    Illiteracy and poverty and the subsequent denial of equal access to education and its new chits — the web, email, superfast internet access, and millisecond communication — will hurt the poor and the elderly and the homeless even more as we stretch into the quick sensation field of continued communication leading-edge healthcare commands.

  7. I’ve heard about a brown van that does the same thing in Gary, Indiana. I don’t live in the city, so I haven’t observed it personally, but I remember a friend telling me about how they would laugh about seeing it pull up to a neighbor’s house. I thought it was a bit of urban legend or an exaggerated story, but it sounds like NJ’s health system is similar.
    I remember seeing an HIV clinic sign at a county government office building a couple of years ago with an arrow pointing to the waiting room. I’m sure that encouraged people to go in for their confidential testing.

  8. Carla — We can report you for that kind of attitude ya know!
    :mrgreen:
    Chris! — Thank you for confirming the strange, wacky, colliding worlds of government and healthcare and the inappropriate branding of people’s behavior. It’s just terrible and it encourages people to stay home and not report these kinds of infections and that puts everyone at risk! I love your HIV story in the most awful way possible — you know what I mean — and I’m printing it out and adding it to my list of examples of health horrors.

  9. To me, they’re different. “Long-winded” is for when you have a lot to say, but you make sense. “Full of sh*t” is just talking to hear your voice… or in this case, typing to see your words.