Syphilis in the South: An Anthropological Analysis of a Sexually Transmitted Disease Epidemic

Kenneth J. Goodman

From the mid-1980s to the mid-1990s, early syphilis morbidity was reported disproportionately in the Southern United States, particularly among African Americans. Syphilis rates increased across the US from 1986 to 1991 and began to decline by 1992 in all regions, but epidemic syphilis rates persisted in the Southern states. In 1995, 84 percent of counties with early syphilis rates above the Healthy People year 200 objective (4 cases per 100,000 population) and all 8 states with early syphilis rates above 12 cases per 100,000 population were located in the South. During the period 1985 to 1990, early syphilis rates rose 165 percent among African Americans, while significantly decreasing for all other racial and ethnic groups. In 1995, the rate for non-Hispanic blacks was nearly 60 times higher than for non-Hispanic whites.

Based on ethnographic research in eight communities in four Southern states, the syphilis epidemic and public health response in the South is presented in three interlinked and overlapping systems of health action. First, the medical system consists of activities that occur after a person is sick, including issues of access to health care, treatment and the programmatic operations that accompany it, and contact tracing and partner notification. Second, the prevention system includes health actions that occur up to the point of illness, such as prevention education, prevention services, and health promotion. Both of these systems occur within the context of the third social/political/economic system, which includes things such as poverty, housing, racism, religion, employment, transportation, family structure, community organization, and others.

Findings are presented according to those characterized as being at greatest risk of syphilis infection, the institutions able to reach them, and the barriers to reaching them encountered in Southern communities.

The medical system alone is inadequate to understand and address the problem of syphilis in the South, as well as other health problems disproportionately seen among African Americans, without placing more emphasis on prevention, and especially without emphasizing the health consequences of political, economic, and class variables and the historical factors that led up to the present situation.