Understanding High Levels of Sexually Transmitted Infections in the United States: A Comparative Analysis of Self-Reported STI Rates in Three Developed Countries

Kirsten P. Smith, Harvard University

Despite having the world’s largest expenditures on health care, and “average” sexual behaviors resembling those in many European countries, sexually transmitted infection (STI) rates in the United States are higher than in most developed countries. To increase understanding of why this is the case, this study uses nationally representative data from the early 1990s to analyze differences in diagnosed STI rates among the US, Britain, and Finland. I focus on the factors most commonly argued to explain high STI rates in the US: differences in sexual culture and reduced access to health care. I additionally analyze the contribution of demographic factors, and in particular, race/ethnicity, given dramatically higher STI rates among blacks than non-blacks in the US. I find support for the importance of cultural factors but not health-care access in explaining high STI rates in the US. Differences in demographic factors--and especially, race/ethnicity--also are found to contribute to differentials.