Analysis Sexual Health

It’s 2012. Shouldn’t College Students Know to Wrap It Up Already? (A Graduate Student’s Perspective)

Ivy Abiona

It is impractical to believe that college students will not be sexually active. Not using the appropriate preventive measures (i.e. a condom) can lead to both unintended and unwanted consequences, high-risk situations or not. It is obvious that changes need to be made. But where to begin?

This article is published in partnership with the National Coalition of STD Directors (NCSD) as part of our joint series on STD Awareness

They are more common than an all-nighter to finish a term paper or cramming for a final exam. Okay, maybe that’s a little extreme. But the fact that STDS have a high prevalence among college aged students in the United States is alarming. One in four college students today has some kind of STD, a shocking 25 percent. And according to the Centers for Disease Control and Prevention (CDC) 19 million new cases of STDs occur every year, half of them occuring in people between 15 to 24 years old. I can’t say that I am a math whiz but let’s just say I don’t like the odds.

After doing some investigating I found that a primary reason for these high rates was a lack of education. As a New Jersey (yes, New Jersey) high school graduate I found this to be somewhat puzzling. I remember learning about different STDS and preventive measures. Even the nurse’s office had signs and posters describing this information. Don’t all students learn about prevention and safe sex in their health education courses in middle and/or in high school? 

A 2006 study by the CDC demonstrates that my optimistic perspective is a utopian flaw. The CDC study indicated that among U.S. high schools, 28 percent taught 11 key pregnancy, HIV, or other STD prevention topics in a required health education course.  In addition, while 87 percent of high schools taught abstinence as the most effective method to avoid pregnancy, HIV, and other STDs in a required health education course, only 39 percent taught how to correctly use a condom in a required health education course.  Clearly, high school students are in dire need of preventive and safe sex education and just teaching abstinence isn’t going to cut it. Early last month, the Guttmacher Institute released new research reaffirming other data and information that a comprehensive sexual education (teaching both abstinence and preventive measures) not only helps teens delay sex but also has a positive impact on other decisions when they do, such as partner selection.

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Now, fast forward three months later and the high school senior is a college freshman. It is possible that this student attends college in another state or across the country; either way this student probably living in a campus dorm no longer under the direct influence of mom and dad. Also, this student is experiencing all of the liberating feelings that come along with college — making your own decisions, the freedom of living on your own, and meeting lots of new peers who will eventually become lifelong friends. And I would be remiss to mention the countless opportunities to party, let’s be real here we are talking about college. College creates an environment that can put many students in high-risk situations including having unprotected sex. Over 45 percent of college freshmen who have been binge drinking and under the influence of alcohol failed to use protection when engaging in sexual intercourse. Fifteen percent of these students contracted and/or spread STD’s amongst other college students. In addition, 7 percent of the students who contracted and/or spread STDs amongst other college students were unaware of their condition.

Check out this poster called “STDS on College Campuses.” It includes illustrations and depictions of the statistics and facts about sexual diseases as well as certain risk factors. What if these were sold on college campuses during Welcome Back week or hung in the hallways, preferably near the elevator? Just a thought.

It is impractical to believe that college students will not be sexually active. Not using the appropriate preventive measures (i.e. a condom) can lead to both unintended and unwanted consequences, high-risk situations or not. Eighty percent of people who have an STD experience no noticeable symptoms. Also, some STDs are treatable and curable while others are not. Preventing most STDs is a lot easier than treating most STDs. Prevention measures such as condom distribution, STD testing, and STD counseling are provided on most university and college campuses through the university’s student health service center. If you don’t feel comfortable talking to someone at your school’s student health service center, there are many options available online. Please visit the website of the National Coalition of STD Directors to find STD testing and referral information.

It is obvious that changes need to be made. But where to begin? Better promotion of sexual health-related courses can help make sure that college students are getting better information. In reality, however, this does not mean that these courses will reach the majority of the student body population.

Another area that could provide potential assistance is in the dorms. Typically, in every college dorm there are house proctors or an upperclassman monitor who is available to the students. The influence of these house proctors can be vital in disseminating sex health education (i.e. advice and information about services, etc).  This can be an effective option because most colleges require all freshmen to live in campus dorms. Educating house proctors on sexual health can assist in college students using preventive measures. For most, sexual health is a personal and sometimes difficult topic to openly talk about.

Therefore, I suggest a monthly distribution of a bag for all dorm rooms. This can be filled with information that includes risk factors, signs and symptoms, where to find nearby services, and condoms. This is also a great way for various student organizations and clubs on campus to get involved and have their input on critical sexual health issues.  This way for at least approximately 9 out of the 12 months of the year, college students are getting sexual health related information.

It’s your sex life. Get Yourself Talking. Get Yourself Tested. Be Responsible.

Roundups Sexual Health

This Year in Sex: It’s Time to Take Action

Martha Kempner

We have the tools to work against sexually transmitted infections, harmful "conversion therapy" for LGBTQ teens, and sexual assault on college campuses. Now, we just have to use them.

This Year in Sex takes a look back at the news and research related to sexual behavior, sexuality education, contraception, sexually transmitted infections, and other topics that captured our attention in 2015.

STIs Are on the Rise in Every Group

This year, it seemed like every week there was a new headline about a rise in sexually transmitted infections or diseases among a specific group, in a certain geographic area, or even among the general population. When states released their 2014 STI data, we learned that Minnesota’s rates hit a record high and that the rate of gonorrhea nearly doubled in Montana between 2013 and 2014. Counties across the country reported rising rates of chlamydia, gonorrhea, and syphilis. California’s Humboldt County, for example, noted a tenfold increase in gonorrhea since 2010, and Clark County, Nevada—home of Las Vegas—reported a 50 percent increase from 2014 in the number of cases of primary and secondary syphilis.

In fact, many of the headlines this year involved syphilis—a curable disease that the United States was once close to eliminating because rates were so low has continued its resurgence. A Department of Defense report, for example, points to a 41 percent increase in the rate of this disease among men in the military. Another disturbing report showed a dramatic rise in the number of babies born with syphilis; congenital syphilis can cause miscarriage, stillbirth, severe illness in the infant, and even early infant death. This reflects both an increase in cases of the disease among women and a lack of prenatal testing that could catch and treat syphilis during pregnancy. This year, there was also an outbreak of ocular syphilis on the West Coast that led to blindness in at least one patient.

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While syphilis is on the rise in both men and women, 90 percent of cases are in men, 83 percent of which are those who have sex with men in cases where the gender of the partner is known.

Young people are also disproportionately impacted by STIs, specifically chlamydia and gonorrhea—54 percent of the cases of gonorrhea and 66 percent of cases of chlamydia reported to the CDC occurred in those younger than 25. Though if detected early and treated, those STIs can be cured, they can also cause future health problems, including infertility.

Perhaps the ultimate headline about STIs this year, however, was the one in which we learned that almost everyone has herpes. A report by the World Health Organization estimated that 3.7 billion people worldwide—or about two out of every three adults across the globe—are infected with herpes simplex virus 1.

All of this news should remind us that sexually transmitted diseases and infections are a public health crisis and we have to up a fight. We need to prevent the spread by educating young people and adults and making condoms readily available. We need to invest in testing that can help people detect STIs before they face many potential health consequences and prevent them from spreading further. And, we need, of course, to provide access to treatment and combat stigma-based fear.

We Know How to Prevent HIV (Now We Just Have to Keep Doing It)

There was a lot of good news this year when it comes to preventing HIV, much of which focused on how well pre-exposure prophylaxis (PrEP) can work. PrEP is a combination of two antiretroviral drugs—tenofovir and emtricitabine—used to treat people who have HIV. When taken daily by people who are HIV-negative, these drugs have been shown to prevent transmission of the virus. In fact, a study by Kaiser Permanente found that since the approval of PrEP in 2012, none of the patients who were using it became infected with HIV. This was actually better than the researchers expected given the findings in clinical trials.

Incorporating PrEP into a multifaceted HIV-prevention program can work, and San Francisco—once a hotbed of the national HIV and AIDS epidemic—proved that, with just 302 new HIV diagnoses in 2014. Getting those HIV-negative residents who are at high risk of contracting the virus onto PrEP is one of the strategies the city uses. In addition, the city provides rapid treatment for the newly diagnosed and continued follow-up appointments to make sure that patients stay on their treatment plan. This can not only help them stay healthy but can prevent the further spread of the virus, as people who adhere to an antiretroviral drug protocol can suppress the virus to the point that they cannot transmit it to others. In San Francisco, 82 percent of residents with HIV are in care and 72 percent are suppressed. This is significantly higher than national statistics, which show that 39 percent of those with HIV are in treatment and only 30 are taking their drug regimen regularly enough to be considered suppressed.

While it will be difficult for many places to adopt a system as expensive as the one in San Francisco, its success shows us that we have the tools we need to prevent HIV. And, in fact, diagnoses of HIV are down in the United States by 19 percent, though the success was not evenly spread: some groups, such as Latino and Black men who have sex with men, are actually seeing increases. It’s time to renew our investment in ending this epidemic for everyone.

Vaccines (Including the HPV Vaccine) Are Not Dangerous, But Skipping Them Is

The year started with a massive outbreak of the measles on the West Coast, so it’s not surprising that there was a lot of conversation about the value of inoculations and what happens when too many people in a certain area are not vaccinated. In the midst of the epidemic and the debate, some schools asked unvaccinated children to stay home, and some states tried to close loopholes that make it easy for parents to opt of required vaccines because of “personal beliefs.”

Unfortunately, many of these personal beliefs are based on false reports and misinformation suggesting that certain vaccines cause autism. A study of anti-vaccine websites found that this misinformation is abundant on the Internet. Of 480 sites dedicated to the anti-vaccine movement, about 65 percent claimed that vaccines are dangerous, about 62 percent claimed vaccines cause autism, and roughly 40 percent claimed vaccines caused “brain injury.” Many of these facts lacked citations, but some were based on misinterpretation of legitimate research.

The scientific truth is that vaccines are safe and have no connection to autism. If there was any doubt, yet another study was released this year confirming it. In fact, the only study that has ever found a connection was proven to be falsified by an unethical researcher who stood to make a profit.

Of course, that didn’t stop the field of Republican presidential hopefuls—which includes two medical doctors—from trying to score political points by suggesting the government may “push” “unnecessary” vaccines.

Though not mentioned by name, they may have been referring to the HPV vaccine, which has always been controversial because of its connection to sex. There seems to be a sense that because HPV is sexually transmitted, vaccinating against it is less important or will give teens permission to have sex. Numerous studies have shown this to be false. One study published this year even found that girls who have gotten the HPV vaccine take fewer sexual risks.

But the fear and misinformation continues, and it turns out doctors might not be helping matters. One study showed doctors may be discouraging the HPV vaccine by not strongly recommending it, not doing so in a timely manner (the CDC advises that vaccinations should start at age 11), and only suggesting it to young people they perceive to be at risk. This could be part of why HPV vaccination rates still lag behind those of other recommended vaccines.

We need to remember that this vaccine prevents cancer. The newest protects against nine strains of the virus and has the potential to prevent 90 percent of cervical, vulvar, vaginal, and anal cancer. And there is reason to believe it will also prevent oral cancer. That’s five cancers prevented by one series of shots.

Of course, like the others, it can only work if our children obtain it. Hopefully, it will not take another outbreak of a preventable disease like measles for us to realize how lucky we are to live in an age in which we know how to stop so many of the diseases that disabled and killed generations before us.

Government Weighs in on ‘Conversion Therapy’

This year saw many positive developments in the struggle for LGBTQ rights, one of which was a willingness of both the White House and many senators to come out against “conversion therapy” for young people. Sometimes called reparative therapy, this is the practice of trying to change a person’s sexual orientation or “cure” their homosexuality. While no legitimate medical organizations sanction such a practice, some young people are subjected to it because their parents or their religion disapprove of same-sex relationships.

Conversion therapy can include anything from Bible study to forced heterosexual dating to aversion therapy, in which patients are shown homosexual erotica and shocked every time they display arousal. Research has found not only that it does not work to change an individual’s sexual orientation, but that it can be harmful and lead to depression, shame, and suicidal thoughts.

In April, the White House released a report condemning the practice for teenagers and asking states to ban it for minors. In an accompanying letter President Obama wrote: “Tonight, somewhere in America, a young person, let’s say a young man, will struggle to fall to sleep, wrestling alone with a secret he’s held as long as he can remember. Soon, perhaps, he will decide it’s time to let that secret out. What happens next depends on him, his family, as well as his friends and his teachers and his community. But it also depends on us—on the kind of society we engender, the kind of future we build.” Two Democratic legislators echoed this sentiment when they offered a resolution asking the Senate to condemn the practice as well, and a report from the Substance Abuse and Mental Health Services Administration attempted to offer parents alternatives that can support LGBTQ young people.

This year Oregon joined those states—including New Jersey, California, and the District of Columbia—that do ban the practice. Furthermore, a challenge to New Jersey’s ban failed when the U.S. Supreme Court turned the case away.

Doing away with harmful practices is a step in the right direction for LGBTQ adolescents, but there is still much more to do in order to protect and educate all of our young people.

We All Continued Talking About Consent

The problem of sexual assault on college campuses was pervasive in the news in 2015. At the end of last year, California became the first state to pass a law mandating affirmative consent on college campuses, also known as “yes means yes.” This year, New York joined it, and other states are considering doing the same.

Affirmative consent has its critics, who say that the standard is unclear and unrealistic in real-life settings. A poll by the Kaiser Family Foundation found that most college students (83 percent) had heard of affirmative consent and many (69 percent) felt it was very or at least somewhat realistic. But when asked whether different scenarios met the standard, students showed a variety of opinions, proving that putting the standard into practice might be tricky.

Still, I believe the conversations about affirmative consent have been useful. They have given us a platform to talk more about the role of alcohol in sexual behavior and sexual assault, and what happens when one is not passed out but clearly very drunk—and therefore incapable of giving consent. We’ve made college students more clearly establish their own boundaries. And educators have been able to both reiterate and go beyond the “no means no” message to talk about what good, consensual sex might look like.

Affirmative consent is not the end-all solution to sexual assault—it won’t, for example, prevent some perpetrators intent on raping. But if we talk about it enough and start before college—California, for example, mandated affirmative consent message in high school—we might have a generation who can think critically about their own behavior and the behavior of others, a generation that is prepared for healthy sexual relationships and knows that, at the bare minimum, a sexual encounter must include consent.

Commentary Sexual Health

It Shouldn’t Take a Chlamydia ‘Epidemic’ in Texas to Make Us Care About Teens’ Sexual Health

Martha Kempner

It was an outrageous—and ultimately false—story of 20 teens in a small high school in Texas having chlamydia that finally got media outlets to discuss whether kids need medically accurate information.

In recent weeks, numerous media reports have questioned whether abstinence-only-until-marriage programs are failing our high school students and leaving them vulnerable to sexually transmitted infections (STIs) and unintended pregnancies. Interestingly, it was not new statistics from the Centers for Disease Control and Prevention (CDC) showing the record high number of STIs among teens across the country, nor was it the mountains of research showing abstinence-only programs don’t work that made news. It wasn’t even the increased funding that Congress quietly passed for these failing programs last month that put this type of sex education in the spotlight. Instead, it was an outrageous—and ultimately false—story of 20 teens in a small high school in Texas having chlamydia that got media outlets, including the Washington Post, the U.S. News and World Report, People.com, and The View, to discuss whether kids need medically accurate information.

I appreciate the attention on this issue, and I hope the debate can go on even as we begin to learn the truth about what’s happening in Crane, Texas. But I am disappointed that yet again, the mainstream media and general public seem only to pay attention to teens’ sexual health needs when we can tie them to a situation so alarming or scandalous it can practically write its own headline.

This story began in early May, when the superintendent of the Crane Independent School District, Jim Rumage, sent a letter to parents alerting them that chlamydia was “on the rise” in the local high school. According to reports, the letter said that about 20 students out of the 300 in the school had tested positive for this bacterial STI. The article that ran on a local news website said that the CDC had declared this to be “epidemic proportions.” Rumage told reporters, “We do have an abstinence curriculum, and that’s evidently ain’t working. [sic] We need to do all we can, although it’s the parents’ responsibility to educate their kids on sexual education.”

From there the story took off, with articles and television pieces across the country and even internationally questioning how so many students could have an STI. (Rewire covered it in a podcast.) Most, like Rumage himself, ended up blaming the school’s poor sex education. Raw Story, for example, scoured the district’s website and pointed out that although the school does not offer a human sexuality course, it does run an optional three-day program that focuses on remaining abstinent until marriage. That story also noted that in 2012, an advisory panel recommended that the school adopt Worth the Wait, an abstinence curriculum produced by Scott and White Hospital in Texas that relies on fear and shame and suggests condoms provide very little protection from STIs.  

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This is not out of the ordinary for Texas, which has a long history of abstinence-only programs. When former President George W. Bush was governor, he started the Lone Star Leaders, one of the first state programs promoting abstinence until marriage. According to the Sexuality Information and Education Council of the United States (SIECUS), Texas has spent a total of $156 million in state and local funds on abstinence-only programs since 2003. And in March, the Texas House of Representatives voted to cut $3 million of funds currently allocated for HIV and STI prevention and devote them instead to abstinence-only programs, despite the fact that their state has the third-highest rate of HIV diagnoses in the country.

Though much of this abstinence funding is used outside of schools, Texas schools do often take a similar approach to sexuality education. State law does not mandate any sexuality education, but does say that it must focus on abstinence if it is taught. Though schools can discuss contraception and STIs, the law says that class must “devote more attention to abstinence from sexual activity than to any other behavior.” Moreover, the laws says that courses must “emphasize that abstinence from sexual activity, if used consistently and correctly, is the only method that is 100 percent effective in preventing pregnancy, sexually transmitted diseases (STDs), infection with human immunodeficiency virus (HIV) or acquired immune deficiency syndrome.”

It appears that superintendent Rumage agrees with this aspect of the law. He told a local paper: “If kids are not having any sexual activity, they can’t get this disease … That’s not a bad program.”

I suppose he’s not entirely wrong. If his students weren’t having sex, they could not get chlamydia. But clearly they are not being abstinent, nor are their peers across Texas. According to the CDC’s 2013 Youth Risk Behavior Survey, 43 percent of high school girls and 49 percent of high school boys in Texas have engaged in sexual intercourse. Texas also has the third-highest rate of teen pregnancy across the country. And, in 2012, there were nearly 40,000 cases of chlamydia among teenagers 15 and older reported in Texas.

These statistics should be enough to get everyone paying attention to the poor sexual health of teens in Texas, and similar statistics are available for states across the country. But the media tends to gloss over these health indicators or report them in a brief news story without ever investigating what we are doing wrong. Apparently, it takes a story like Crane to make the general public take notice.

Only what we have learned since the story broke is that the “outbreak” of chlamydia that was reported in Crane was greatly exaggerated. Some reporters began questioning the numbers because the local health department listed only eight cases of chlamydia in the whole county. Rumage has since agreed that his number was incorrect and explained that he got his information from a local doctor and that he misheard or possibly misunderstood. When the doctor said that more than 20 students had been tested for chlamydia he took that to mean they all had the infection. In fact, only three cases have been confirmed among students, though not all test results have come back.

But three high school students with chlamydia is bad news. Chlamydia is an easily treatable bacterial infection, if caught early, but it often has no symptoms and young people won’t know they have it unless they know to get tested for it. If they don’t get tested and treated, chlamydia can lead to pelvic inflammatory disease which, in turn, can lead to infertility. Moreover, the fact that three have chlamydia means that they are having unprotected sex and putting themselves in danger of contracting other STIs that can’t be cured, such as herpes and HIV. Given that we don’t know their gender, they are also at risk of getting pregnant or causing a pregnancy.

But is three students with chlamydia bad enough news to have made international headlines?

I doubt it. My guess is that if it had been clear from the start that this was not actually an epidemic, it wouldn’t have gotten past the local newspaper. Three chlamydia cases in one school is certainly alarming, but it’s not scandalous, and it doesn’t make for much of a headline.

I would argue, however, that it should. Every case of chlamydia or gonorrhea or herpes among teenagers should make headlines, or at least make us demand change, as should every teen who becomes unintentionally pregnant. These things can be prevented, and it is our responsibility as adults to give teens the information and tools necessary to prevent STIs and unplanned pregnancy. We also have to help them think critically about their sexual decisions, because if more than 20 kids in one high school needs to be tested for chlamydia, it means that at least some of them are having unprotected sex with multiple partners. Teens are capable of making responsible choices, but they can’t do it without the help of adults and education.

We may never have heard of Crane, Texas, or questioned its sexuality education if the truth had been known going in. Now that we have, though, we should not let the conversation drop. According to some reports, the school board in Crane was set to reexamine its sex education program early this week. I hope that the recent scrutiny on the town—whether deserved or not—spurs the board to improve its program and I hope that media stays on the story to keep the pressure on. I also hope that moving forward, it will not take an epidemic to get us to focus on the sexual health needs of teens—because the next epidemic will likely be real and it will be the teens who suffer.

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