April is STD Awareness month. This article is one in a series published by RH Reality Check in partnership with the National Coalition of STD Directors, focused on aspects of STD prevention, treatment and funding and the public health implications of neglecting STDs.
STD Awareness month gives us an excellent opportunity to focus in on the myriad ways to effectively tackle the promotion of sexual health, and in the process, to reduce the enormous number of STDs that occur annually in the U.S.
Last September, the National Center for Health Statistics issued a brief on sex education in the United States using data from the 2006–2008 National Survey of Family Growth (NSFG). The brief highlighted the fact that most teenagers reported receiving formal sex education before 18 years of age. In fact, 89 percent of males and 88 percent of females ages 15 to 19 have received information on how to prevent HIV/AIDS. Ninety-two percent of males and 93 percent of females ages 15 to 19 have also received formal sex education on the topic of STDs before they turned 18 years of age, with the majority of respondents indicating they first received this information in middle school (6th through 8th grades). In addition, at least half of all youth surveyed reported talking to their parents about STDs.
As a former health educator with experience teaching youth and their parents about how to communicate about sexual health and HIV/STD prevention, I am delighted to see that adolescents in this country are receiving some form of formal sex education and appear to be broaching these topics with a trusted adult. And yet…
According to the 2009 Sexually Transmitted Disease Surveillance report released by the Centers for Disease Control and Prevention (CDC) this past November, young women ages 15 to 19 continue to have the highest rate of gonorrhea (568.8 cases per 100,000) and Chlamydia (3,269.5 cases per 100,000) compared to any other age or sex group. Additionally, syphilis rates for both young men and women ages 15 to 19 continue to increase, with syphilis rates from 2005–2009 increasing as much as 167 percent among black males ages 15 to 19 years.
If the vast majority of youth in the country are receiving information about STDs, why do we see this disparity in infection rates? What exactly is being covered in discussions about STDs in classrooms and living rooms across the country? Are the enormously high rates of STDs among youth being discussed? Or the fact that many individuals with a sexually transmitted infection show no sign or symptoms? Or that refraining from vaginal sex does not completely eliminate one’s risk for contracting an STD?*
Clearly, the NSFG was not created to assess the depth, breath, and quality of the STD information presented by parents and educators. Too often, STD information provided to young people is based on fear appeals—a.k.a. scare tactics—featuring the most grotesque images of prolonged and clearly symptomatic infections. Research has shown that fear can only carry the message so far. If the recipients of fear-inducing messages do not think they are at risk for a STD or if they are not given clear and sufficient information about what they can do to mitigate their risk, they are very likely to reject the message in all its graphic glory.
We also know that increased knowledge does not automatically translate into practice. However, continuous opportunities for meaningful information-based, as well as skills- imparting dialog (in the classroom, in the home, at the doctor’s office) about important sexual health issues like STDs can facilitate a social and environmental context that encourages and empowers all people—not just youth—to engage in healthier behaviors. This is why a health communication campaign like Get Yourself Tested (GYT) is so important. GYT offers young people a place where they can get useful health information, acquire tips on how to talk to their friends, partners, and health care providers about getting tested for STDs, and become more involved bringing GYT to their communities.
In the classroom setting, high quality sex education curricula that have been shown to be effective in delaying sex, reducing the frequency of sex or the number of sexual partners, increasing condom and contraceptive use, and reducing the number of STDs in youth are those that not only discuss the dangers of high-risk sexual activity, but also address multiple factors affecting sexual behavior, such as perceived risk (i.e. the person’s belief that he or she is at risk for a STD), social norms (i.e. the attitudes and behaviors around condom use within the person’s social circle), and self-efficacy (i.e. the person’s confidence in their ability to insist on using condoms with their partner). Taken together, these factors can positively or negatively influence a person’s decision-making process just as much as his or her knowledge (or lack thereof) of which STDs are curable and which are not.
A society that is willing to move beyond scary pictures is one that is willing to address stigma and health inequities and promote sexual health—without which there is little chance of reducing the burden of STDs, including HIV, in our communities. Efforts such as GYT and the recent infusion of Office of Adolescent Health funding to replicate evidence-based programs that move beyond fear appeals are steps in the right direction. We owe our youth the opportunity to be self-advocates with an accurate and complete understanding of STD transmission, prevention, and treatment and what most impacts their risk.
* A study published January 2011 in Pediatrics found that 10.5 percent of youth who underwent screening for Chlamydia, gonorrhea, and Trichomoniasis and tested positive for at least one of these STDs had reported that they had abstained from vaginal sex in the past 12 months.