Sometimes it’s the small moments that change everything. For Honors College graduate Sierra Small ’17, it was a bus ride that transformed her worldview.
Sure, she knew that some people didn’t have as much as others. She knew that some were rich, some were middle class and some were poor. And in the back of her mind, she knew having less had consequences.
But Small hadn’t ever really thought about those consequences or the ripple effect they can have on a person’s life. Not until a bus ride across town.
Sierra Small ’17 plans to develop her passion for public health as she pursues a career in medicine. (Photos by Kip Bulwinkle ’04.)
Amid the rise and fall of the bus engine’s hum, Small shuttled from downtown Charleston to Mt. Pleasant, first taking in the affluent areas South of Broad, then in stark contrast, the public housing neighborhoods off of America Street, and finally watching a view of East Cooper’s prosperity unfold from the Ravenel Bridge. Suddenly, she had an epiphany.
“I just remember thinking, Wow, this is like night and day,” she recalls.
Small took that bus ride as part of an assignment for her Honors academic writing course aimed at getting students to think about health disparities and how income status impacts opportunities. The exercise hit close to home for Small, who was contemplating a career in medicine.
After that, the public health major and chemistry minor spent much of her college career researching how poverty, low educational attainment, race and community sex ratio (the ratio of men to women) affects the transmission of sexually transmitted diseases and HIV/AIDS.
“It’s basically the social side of sexual behavior,” she says of her research.
Small began her research during her sophomore year under the tutelage of former CofC public health professor Matt Page. With funding through the College’s Summer Undergraduate Research with Faculty (SURF) program, she continued her investigation into the effects of demographic variables such as income, education and racial distribution have on the transmission of STDs and HIV/AIDS.
Her findings, however, only led to more questions. Although Small’s research didn’t reveal a statistical association between the community sex ratio and the transmission of STDs, it did show that in predominantly African American communities in the Southeast, the community sex ratios were often more imbalanced, with a ratio of less than one indicating the presence of fewer men than women. That makes sense, Small says, when you account for African Americans making up a smaller portion of the overall population, but a majority of the prison population.
But, Small wondered, in South Carolina communities with a higher rate of incarceration among African American men, are the incidents of STDs and HIV/AIDS also higher?
Not one to let something linger, she decided to seek out that answer, too, making that question the subject of her bachelor’s essay. What she found confirmed her suspicions – namely, that there’s a strong correlation between the percentage of black inmates and the prevalence of HIV in the black population in the communities from which the inmates came.
“There’s so much research on how your socio-environmental factors impact your behavior in general,” she says, noting that if you grow up in a low-income,
high-crime area, you’re more likely to commit a crime yourself. “But I also believe your environment impacts your sexual behavior.”
As a future doctor headed to the Medical University of South Carolina this fall, Small insists that being intuitively aware of how social status and health disparities impact public health is essential to improving health outcomes. And recognizing how poverty, lower educational attainment and higher incidents of incarceration among African American men can increase incidents of sexually transmitted diseases is all part of the equation.
A complex equation that, for Small, started with a simple bus ride around Charleston.
