Sexual Health

Sex Education and STDs: Why the Message Matters

Sandra Serna-Smith

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.

April is STD Awareness month.  This article is one in a series published by Rewire 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… 

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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.  

Roundups Sexual Health

This Week in Sex: A Nursing Home With a Healthy Attitude Toward Sex

Martha Kempner

A nursing home understands that its elderly residents are still sexual beings; New York City is amping up its youth sexual health outreach with emojis of eggplants and monkeys; and if forced to choose between eating and sex, a good number of people pick food.

This Week in Sex is a weekly summary of news and research related to sexual behavior, sexuality education, contraception, STIs, and more.

Sex Is Not Just for the Young

The New York Times recently profiled a nursing home with a sex-positive attitude for its residents. The Hebrew Home at Riverdale adopted its “sexual expression policy” in 1995 after a nurse walked in on two residents having sex. She asked her boss, Daniel Reingold, what she should do. He said, “Tiptoe out and close the door.”

Reingold, the president of RiverSpring Health (which runs the nursing home), said that aging includes a lot of loss—from the loss of spouses and friends to the loss of independence and mobility. But he believes the loss of physical touch and intimacy does not have to be part of getting older.

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The policy acknowledges that residents have the right to seek out and engage in consensual acts of sexual expression with other residents or with visitors. The policy ensures that staff understand that their role is not to prevent sexual contact. In fact, some of the staff like to play cupid for residents. Audrey Davison, an 85-year-old resident, said that the staff let her sleep in her boyfriend’s room, and one aide even made them a “Do Not Disturb” sign for his door. She added: “I enjoyed it and he was a very good lover.”

Still, there are complicating factors to dating in nursing homes or assisted-living facilities. Some residents may be married to people who don’t live in the facility, and others may be suffering from memory loss, dementia, or Alzheimer’s, which can raise issues of consent. Hebrew Home’s policy states that Alzheimer’s patients can give consent under certain circumstances.

Though not all nursing homes have formal policies about sex, many acknowledge that their residents are or want to be sexually active and are working to help residents have a safe and consensual experience. Dr. Cheryl Phillips, a senior vice president at LeadingAge, an organization which represents nursing homes and others who provide elder care, also told the New York Times that this generation of older adults is different: “They’ve been having sex—that’s part of who they are—and just because they’re moving into a nursing home doesn’t mean they’re going to stop having sex.”

Of course, not all residents are lucky in love when they move in. Hebrew Home says that about 40 of its 870 residents are in relationships. Staff are trying to help the others. They set up happy hours, a prom, and have started a dating service called G-Date (for “Grandparent Date”). So far it hasn’t been too successful in making matches, but the staff is convinced that someday their efforts will pay off with a wedding.

Can Emojis Connect Youth to Sexual Health Services?

New York City’s public hospital system, known as Health & Hospitals, provides confidential sexual health services—including pregnancy tests, contraception, and tests for sexually transmitted diseases (STDs)—for young people 12 and older regardless of their ability to pay, immigration status, or sexual orientation. Health & Hospitals served 152,000 patients last year, but its leaders think it could do even more if more young people were aware of the services offered.

As a way to speak the language of young people, Health & Hospitals launched a campaign starring emojis in July.

The emojis are expected to reach 2.4 million young people in New York City through social media including Facebook and Instagram. The emojis include an eggplant, a monkey covering his eyes, and, of course, some birds and bees. The online ads read, “Need someone to talk to about ‘it’?”

When young people click on the emojis, they will be taken to the Health & Hospitals youth website, which explains available services and how to find accessible providers.

Dr. Ram Raju, president and CEO of NYC Health & Hospitals, said in a press release that the organization provides nonjudgmental services to youth: “Whether it’s birth control, pregnancy testing, emergency contraception or depression screening, the public health system has affordable services in local community health centers, where we speak your language, understand your culture and respect your privacy.”

But some worry that these emojis are confusing. Elizabeth Schroeder, a sex educator and trainer, told the New York Times that while she applauded the effort, she questioned if the images chosen were the best to convey the message.

We here at This Week in Sex have to agree and admit the images confuse us as well. The monkey is cute, but what does it have to do with STDs?

Choosing Between Appetites, Many Pick Food

Good food or good sex? These two sources of pleasure are rarely at odds with each other, but if they ever are, which would you choose?

A new survey, by advertising agency Havas Worldwide, posed this very question to almost 12,000 adults in 37 countries across the globe. The results show that about half of adults (46 percent of men and 51 percent of women) believe that food can be as pleasurable as sex. And one-third would choose a great dinner at a restaurant rather than sex; women were more likely to make this choice (42 percent compared with 26 percent of men).

Millennials were also more likely to make this choice than those slightly older Gen-Xers (35 percent to 30 percent). Of course, it’s hard to tell whether this says more about their sex lives or their eating habits.


News Sexual Health

State With Nation’s Highest Chlamydia Rate Enacts New Restrictions on Sex Ed

Nicole Knight

By requiring sexual education instructors to be certified teachers, the Alaska legislature is targeting Planned Parenthood, which is the largest nonprofit provider of such educational services in the state.

Alaska is imposing a new hurdle on comprehensive sexual health education with a law restricting schools to only hiring certificated school teachers to teach or supervise sex ed classes.

The broad and controversial education bill, HB 156, became law Thursday night without the signature of Gov. Bill Walker, a former Republican who switched his party affiliation to Independent in 2014. HB 156 requires school boards to vet and approve sex ed materials and instructors, making sex ed the “most scrutinized subject in the state,” according to reproductive health advocates.

Republicans hold large majorities in both chambers of Alaska’s legislature.

Championing the restrictions was state Sen. Mike Dunleavy (R-Wasilla), who called sexuality a “new concept” during a Senate Education Committee meeting in April. Dunleavy added the restrictions to HB 156 after the failure of an earlier measure that barred abortion providers—meaning Planned Parenthood—from teaching sex ed.

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Dunleavy has long targeted Planned Parenthood, the state’s largest nonprofit provider of sexual health education, calling its instruction “indoctrination.”

Meanwhile, advocates argue that evidence-based health education is sorely needed in a state that reported 787.5 cases of chlamydia per 100,000 people in 2014—the nation’s highest rate, according to the Centers for Disease Control and Prevention’s Surveillance Survey for that year.

Alaska’s teen pregnancy rate is higher than the national average.

The governor in a statement described his decision as a “very close call.”

“Given that this bill will have a broad and wide-ranging effect on education statewide, I have decided to allow HB 156 to become law without my signature,” Walker said.

Teachers, parents, and advocates had urged Walker to veto HB 156. Alaska’s 2016 Teacher of the Year, Amy Jo Meiners, took to Twitter following Walker’s announcement, writing, as reported by Juneau Empire, “This will cause such a burden on teachers [and] our partners in health education, including parents [and] health [professionals].”

An Anchorage parent and grandparent described her opposition to the bill in an op-ed, writing, “There is no doubt that HB 156 is designed to make it harder to access real sexual health education …. Although our state faces its largest budget crisis in history, certain members of the Legislature spent a lot of time worrying that teenagers are receiving information about their own bodies.”

Jessica Cler, Alaska public affairs manager with Planned Parenthood Votes Northwest and Hawaii, called Walker’s decision a “crushing blow for comprehensive and medically accurate sexual health education” in a statement.

She added that Walker’s “lack of action today has put the education of thousands of teens in Alaska at risk. This is designed to do one thing: Block students from accessing the sex education they need on safe sex and healthy relationships.”

The law follows the 2016 Legislative Round-up released this week by advocacy group Sexuality Information and Education Council of the United States. The report found that 63 percent of bills this year sought to improve sex ed, but more than a quarter undermined student rights or the quality of instruction by various means, including “promoting misinformation and an anti-abortion agenda.”


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