SHAG and the Social Determinants of Sexual Health
Published: 09-20-2024 | 6 MIN READ | Author: Prism Health North Texas
At Prism Health North Texas, we are committed to improving the sexual health and overall well-being of the diverse populations we serve. As part of this mission, we have formed the Sexual Health Advisory Group (SHAG) to ensure that the voices of our patients and community members are at the forefront of our efforts. SHAG was created to engage the people most affected by sexual health disparities and involve them in the decision-making process for our services and programs.
The structure of SHAG is intentional. It reflects the diversity of our patient base and those we hope to reach as we expand into new services. This advisory group isn’t just symbolic; it’s a genuine reflection of the populations we serve. Our goal is to ensure that the people sitting at the table represent the lived experiences of the communities most impacted by sexual health challenges.
Who Makes Up SHAG?
SHAG is composed of a wide range of voices, with an emphasis on inclusion. Most of our group consists of people of color, particularly Black and brown individuals. These are the populations that are disproportionately affected by sexual health inequities, and it’s critical that their perspectives guide our work. Our group also includes intentional representation from the trans community, with most SHAG members identifying as trans.
We’ve also prioritized disability representation within SHAG, recognizing that people with disabilities often face additional barriers to accessing care. Moreover, SHAG members come from different parts of Dallas, with the aid of a zip code map to determine who would best represent communities with lower health outcomes. This ensures that we capture diverse perspectives based on geographical and socio-economic factors.
Avoiding Tokenism: A Focus on Meaningful Representation
A key concern when forming any advisory group is avoiding tokenism. Tokenism happens when only one person from a marginalized group is expected to represent an entire community, putting an undue burden on them to speak for all. At SHAG, we are mindful of this risk. By ensuring that there are at least two or more individuals from each represented group, we distribute the weight of responsibility and create a space where diverse voices can amplify each other’s concerns, ideas, and experiences.
Understanding Privilege and the Social Determinants of Sexual Health
One of the foundational concepts we discuss within SHAG is privilege and how it interacts with the social determinants of health. These determinants include factors like income, education, access to healthcare, and social support networks, all of which influence sexual health outcomes.
To help illustrate these dynamics, we conducted a privilege walk exercise. Participants were asked to step forward or back based on answers to various questions, like “Step back if you have an invisible disability” or “Step forward if your parents told you that you could be anything you wanted to be when you grew up.” As the group moved, it became clear how social advantages or disadvantages can accumulate over time, creating gaps between people with more and less privilege.
For example, some of the questions revealed who feels safe walking alone at night and who has experienced bias when seeking healthcare. By the end of the activity, participants who had taken the most steps forward received rainbow-colored pencils, serving as a metaphorical reminder that privilege comes with responsibility.
But this raised an important question: Who gets the pencils? In SHAG, we talk about how privilege affects the way resources—whether that’s information, support, or healthcare—are distributed. Part of the group’s responsibility is to ensure that everyone’s voice is heard, and that the resources within our control are shared equitably.
SHAG as a Privilege and a Responsibility
Being part of SHAG is a privilege in itself. Our members are trusted with the responsibility to represent their communities and ensure that our programs and services are equitable and inclusive. They serve as a crucial link between Prism Health North Texas and the patients who rely on us, bridging gaps and advocating for meaningful change.
Barriers to Sexual Healthcare Access
One of SHAG’s primary goals is to identify and address barriers to sexual healthcare in our community. These barriers are often rooted in both systemic discrimination and socio-economic disadvantages.
For example:
- Black women are frequently subjected to the harmful stereotype that they can endure more pain than others, which often leads to their pain being dismissed or minimized by healthcare providers.
- More broadly, women’s health concerns are sometimes downplayed, with many being told that their pain is “normal” or that it’s just a part of life, contributing to delayed diagnoses and inadequate care.
- Transportation can be a major barrier for people seeking care, especially for those who live in underserved parts of Dallas.
- Cultural and religious stigmas surrounding sexual health also play a significant role. Many people experience shame due to cultural or religious teachings, which can prevent them from seeking necessary healthcare services.
Sexual Health Education: The Role of SHAG
A major aspect of SHAG’s work is educating our community about sexual health and ensuring that our services are accessible to all. We’ve made it a priority to address the specific ways in which different populations are affected by sexually transmitted infections (STIs) and other sexual health concerns.
For example, Black and Latino communities often experience higher rates of HIV, Chlamydia, Syphilis, and Gonorrhea, while trans individuals may face additional barriers to receiving sexual health services, including stigma and discrimination from healthcare providers. SHAG helps us ensure that our educational efforts are both culturally competent and tailored to the specific needs of these populations.
How Sexual Health Impacts Different Groups
| STI/STD | I am… | Potential Symptoms | Transmission | Treatment | Most At-Risk Population |
|---|---|---|---|---|---|
| HIV | A virus with a spikey coat that swims in your bloodstream. For many years, you may not know I am here as my symptoms take years to manifest. | Within 2 weeks of infection, you may have symptoms similar to a terrible cold/flu, maybe with a body-wide red rash. In time, you’ll also experience, weight loss, fatigue, skin irritation, abdominal pain, shortness of breath, joint ache, and nerve pain. | HIV can be transmitted through anal sex, vaginal sex, oral sex, childbirth, breastfeeding, and sharing needles. | You can live a healthy life with HIV. It is not a death sentence. Treatment requires daily medication administration through pills or bimonthly through long-acting injectables. | Black MSM under 35, Latino MSM under 35, Trans women of color under 35 |
| Hepatitis C | A virus that can swim around in your bloodstream. | Symptoms may include brain damage, low thyroid disease, internal bleeding, liver cirrhosis and decay, jaundice (yellowing of the eyes and skin), and abdominal and lower extremity swelling. | Hep C can be transmitted through IV needle sharing and bloody transmission during sex. | Daily medication adherence over 8 – 12 weeks will virtually cure Hep C. | IV drug users and Baby Boomers |
| Chlamydia | A spherical bacteria that grows within normal body cells. I invade the cell and create a cluster of infection. | Symptoms may include painless, clear dripping discharge from the vagina or penis, burning while urinating, and if left untreated, blindness. | Chlamydia can be sexually transmitted through bodily fluids during oral sex, vaginal sex, and anal sex. | Chlamydia is curable with the adherence to medication regimen. | Black women 15-24 and Latina women 15-24 |
| Syphilis | A spirochete bacteria. My spiral shape helps me penetrate through bodily fluids, even heavy sweat. | Symptoms may include chancre on the penis, vagina, or tongue, a body-wide rash, and if left untreated, fetal infection. | Syphilis can be transmitted through bodily fluids, including blood, during oral sex, anal sex, vaginal sex, or close post-coital body contact. | If treated early, Syphilis is curable. If treated too late, it may not be curable. | Black men 15-34, white men 25-34, and Latino men 25-34 |
| Gonorrhea | A double-sphered bacteria with flagella. My flagella help me swim through the bodily fluids like blood, ejaculum (“cum”), and vaginal fluid. | Symptoms may include dripping white, yellow, or green discharge from the vagina or penis, a burning sensation while urinating, vaginal bleeding between periods, and ulcerations. | Gonorrhea can be sexually transmitted through bodily fluids during anal sex, vaginal sex, and oral sex. | Currently, Gonorrhea is curable with medication, including pills and injections. However, there is a growing number of drug-resistant Gonorrhea strands. | Black men 15-34 and Black women 15-24 |
Sexual Health Resources
- For more information about HIV, Hepatitis C, Chlamydia, Syphilis, and Gonorrhea, visit CDC.gov.
- Go to HIV.gov for the latest data on HIV and HIV prevention.
- Learn more about the Texas ADAP Program—Texas’ financial assistance program for HIV treatment and medication.
- Get HIV-focused content for many different audiences at thebody.com and thebodypro.com.
SHAG’s Intended Impact on Prism Health North Texas
SHAG is more than just an advisory group—it’s a way for us to stay accountable to our community. By centering the voices of those most affected by sexual health inequities, we can ensure that our services remain responsive, inclusive, and effective. As we expand into new areas of care and take on new responsibilities, SHAG will be there to guide us every step of the way, helping us break down barriers and create a more equitable healthcare system for all.
If you suspect you may have an STI or STD, schedule an appointment at one of our clinics by calling 214-521-5191 or requesting an appointment online. However,f you are a current PHNTX patient, please schedule your appointment on the patient portal. If you would like to test yourself for HIV in the privacy of your own home, using only your saliva, for FREE, visit FreeNicePackage.com.
