On March 11, the U.S. Centers for Disease Control and Prevention released the news that one in four girls between the ages of 14 and 19 have at least one sexually transmitted infection (STI). If their study, which is based on a nationally representative sample of more than 800 teen girls, speaks for the entire country, it is estimated that 3.2 million teenage girls in the United States are infected.
These girls are not having sex alone. You can do the math yourself. If this many girls are infected, imagine how many boys have the same diseases -- many of them without even knowing it. And then imagine the total number of parents who are clueless about all this, let alone about the fact that their children are already having sex. Let's be clear: "Having sex" means any type of sexual contact. Ever since the Monica Lewinsky ordeal, some people seem to think that only vaginal intercourse counts as sex.
Here's a summary of the key findings of the CDC study:
• The CDC study was carried out between 2003 and 2004 and involved 838 teen girls who participated in the National Health and Nutrition Examination Survey (NHANES).
• Study participants were tested for the following STIs: human papilloma virus (HPV), chlamydia, genital herpes, and trichomoniasis.
• 48 percent of black, 20 percent of white, and 20 percent of Mexican-American teenage girls have at least one STI.
• Most common are HPV (18 percent) and chlamydia (4 percent), followed by trichomoniasis (3 percent) and genital herpes (2 percent).
• Overall, approximately half of the teens reported having had sex. Of these, 40 percent had at least one STI.
If you missed this news flash, you are not alone. At the time, the media, instead of launching a wake-up call to protect teen health, was occupied with covering the Eliot Spitzer prostitution scandal. After all, a juicy sex scandal is so much more captivating than dry public health statistics, as shocking as they are.
The study results were met with mixed reactions. My teenage daughter summed it up in two words: "That sucks." Countless parents, I am sure, found these statistics eye-opening. Others, including myself, were really not that surprised. How could it be any different? After all, for years most American teenagers have not been getting the necessary information and resources they need to make informed and healthy choices for themselves.
What is going on? How is it possible that this many teens are infected with STIs? How come they are not waiting to have sex? And how come those who do have sex don't protect themselves against STIs -- and pregnancy, for that matter?
I look at the situation from several different angles: one, as a sexual health professional who provides sexuality education to fourth, fifth and sixth graders (and their parents) in a private school; two, as a parent myself; and three, as someone who spent the first three decades of my life in Europe, where teen pregnancy and STI rates are drastically lower than in America.
In fact, let's start by taking a quick look at how European teenagers compare to American teens when it comes to STI and pregnancy rates:
In the U.S., the teen pregnancy rate is:
9 times higher than in the Netherlands
4 times higher than in France
5 times higher than in Germany
In the U.S., the teen birth rate is:
11 times higher than in the Netherlands
5 times higher than in France
4 times higher than in Germany
In the U.S., the teen abortion rate is:
8 times higher than in Germany
7 times higher than in the Netherlands
3 times higher than in France
In the U.S., the teen chlamydia rate is:
20 times higher than in France
(Data are not available for Germany and the Netherlands)
In the U.S., the teen gonorrhea rate is:
74 times higher than in the Netherlands and France
66 times higher than in the former West Germany
38 times higher than in the former East Germany
In the U.S., the teen syphilis rate is:
6 times higher than in the Netherlands
5 times higher than in the former West Germany
3 times higher than in the former East Germany
(Source: Advocates for Youth)
Why these differences, you might wonder? For one, European teens receive comprehensive sex education at school. "Comprehensive" means that their programs teach them about various methods to protect themselves against pregnancy and STIs. Abstinence from sex is one of the methods taught, but it is not the only one. European teens also learn about condoms and other types of birth control. Armed with this knowledge, they are able to make the right choice to use safer sex methods once they decide to become sexually active.
In comparison, for more than a decade, the U.S. government has focused its efforts on promoting abstinence-only-until-marriage programs, investing more than $1 billion so far. There is no federal government funding for comprehensive sex education in the United States. To date, 17 states have rejected federal government money for AOUM sex education programs. Instead, these states are now teaching or planning to teach comprehensive sex education in which abstinence is not the only option.
According to a recent New York Times article, various student-led abstinence groups have popped up on four college campuses in recent years. Princeton University and the Massachusetts Institute of Technology are home to the Anscombe Society, named for Catholic philosopher Elizabeth Anscombe. Harvard University undergraduates created True Love Revolution and at Arizona State University, there's a group that calls itself New Sexual Revolution. What mature students choose doesn't bother me. But we should press upon adolescents and teens more than the virtues of virginity.
We already know from various studies that AOUM programs are ineffective. Hence my lack of surprise when I learned about the recent CDC statistics. This news merely confirms that too many teens are already paying the price for not having essential information. And for many of these kids, that price is not just an infection that eventually goes away (in the case of viral infections like genital herpes, it never does). If left untreated, many of these STIs can have serious consequences, such as cervical cancer and infertility.
And the number of affected teens is unacceptable. As you can see from the summary of the CDC study, almost every other black teenage girl was infected. Have we not failed these teens completely? Isn't it about time that we wake up and do something about it?
The three Rs: right, respect, responsibility
Teens are smart. Let's not leave them in the dark any longer. American teens, just like their European peers, have the right to correct and complete information about how to protect themselves against STIs and pregnancy. We need to treat them with respect and provide them with tools to help them make responsible choices for themselves. According to Advocates for Youth, it is the "Three R Approach" that is so successful in Europe. Give me one good reason why we cannot use the same approach on this side of the Atlantic.
European teens have easy access to correct and complete sexual health information based on solid public health research, and not political or moral agendas. There are also mass media campaigns that send out the consistent message: Safer sex or no sex! I will never forget when nearly all the city buses in Copenhagen, Denmark -- and there are lots of them -- had a condom painted along their entire length. A public health condom campaign can't get more obvious than that.
By the way, just because they learn about condoms and other ways of protecting themselves against pregnancy and STIs, teens don't go out and start having sex. European youth on average start having sex a little later than American teens. The average age of first sexual intercourse in the States is 15.8 years, 17.7 in the Netherlands, 16.2 in Germany and 16.8 in France.
Mixed messages – and a word
to parents and caretakers
But what about the mixed messages today's U.S. (and European) youth get about sex? Popular music lyrics and videos often have "explicit" content, and so do magazines, films and advertising. Unless you live on a farm way out in the country without Internet access or TV, your teen will get bombarded with messages about how cool sex is. Look at it this way: What a great opportunity to find "teachable moments" to convey your own values and opinions to your kids! Talk to them about what they see and hear and let them know what you think.
What are "teachable moments"? Forget about "the one sex talk" to enlighten your adolescent child about how humans reproduce. It is much easier to start as early as possible to open up the door to brief conversations about sex. Kids prefer to get this type of information in small, age-appropriate doses.
Teachable moments, coined by author Debra Haffner, start in the bathtub when your boy toddler gets an erection. Tell him the correct term and that it is normal. No big deal. Tell your daughter the correct terms for her various body parts: "ear, nose, vulva." No big deal. Once you start paying attention to teachable moments, you will find that it is not that hard to inform your child about sexuality. And the best part is that you get to tell them the information you will want them to know -- and not let your child hear it from some obscure and questionable source, like a friend on the playground.
On the other hand, if you are a parent who has never spoken to your kid about sex, it is never too late to start. Believe it or not, your teen actually wants to hear from you. Tell him or her what your expectations are. When do you think that it is appropriate to start having sex? Don't be afraid of sending mixed messages: You can tell them that you want them to postpone sex at the same time you tell them about the various options to protect themselves against STIs and pregnancy.
I am as alarmed as everyone else by the declining average age at which kids have sexual intercourse these days. But we need to realize that the only impact we can have on this trend is by engaging our youth in an open and honest dialogue -- not by preaching a singular, moralistic message, which they are likely to ignore at some point. And besides that, AOUM is a message that gay and lesbian teens have no way of relating to, unless they live in Massachusetts, which is the only state that recognizes same-sex marriage.
In order to start reducing the numbers of infected teens, we need parents, as well as our public health and educational systems, to start providing adolescents and teens with the information they need to one day make healthy decisions for themselves. They will act responsibly if they are treated as responsible individuals. They do not want to be lied to. In 2004, a federally commissioned review of 13 AOUM curricula used by two-thirds of federally funded AOUM programs found that 80 percent of the curricula material contained "false, misleading, or distorted information about sexual health." Isn't it about time that we start telling kids the full truth?
What else can we do?
Check the sidebar for more information about the most common STIs. Too often, these infections have no major symptoms, and can be unwittingly passed on if the person does not use safer sex methods. The only way to catch these infections is through routine screening. If left untreated, the infections can lead to infertility, and some types of HPV are known to cause cervical cancer.
The CDC recommends annual chlamydia screening for sexually active women under the age of 25. They also recommend that girls and women between the ages of 11 and 26 who have not been vaccinated or who have not completed the full series of shots be fully vaccinated against HPV. The vaccine Gardasil was approved by the FDA in 2006. Washington, D.C., and Virginia, have recently passed laws mandating HPV vaccination for school admission, and more than 20 other states are currently considering mandating this vaccine.
In order to aggressively address the unacceptable rate of teen STIs before the situation gets any worse, here's what we have to do: We need to talk openly to adolescents and teens about sexuality, while sharing our values and expectations; launch a public health education campaign geared toward teens as well as parents and caregivers; and focus on providing comprehensive sexuality education, confidential STI screening, access to treatment, as well as vaccination. How hard can that be? It's not like putting a man on the moon -- and we accomplished that almost 40 years ago.
Annette Owens, MD, Ph.D., is certified by the American Association of Sexuality Educators, Counselors, and Therapists. She sees clients in her Charlottesville office and answers questions online at LoveandHealth.info and Sexual Health.com. This story originally appeared the C-VILLE, a news and arts weekly in Charlottesville, Va.
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