Commentary Sexual Health

School-Based STD Screenings: One Way for Youth to Take Charge of their Sexual Health

Becky Griesse

How can we encourage youth to take control of their sexual health?  Here’s one example: school-based STD screening.

Editor’s Note: This article is part of a series developed by the American Social Health Association (ASHA) in celebration of Sexual Health Month 2012 during September. Rewire will be publishing articles by ASHA all month, see all the articles here and visit ASHA online throughout September for updates.

Cross-posted with permission from the American Social Health Association (ASHA).

Adolescents and sexual health are words not often uttered together unless they’re referring to negative news like teen pregnancy and sexually-transmitted-disease (STD) rates. But the negative news does not give us the full story of adolescent sexual health. Many youths lead sexually-responsible lives. They’ve been empowered to be abstinent, practice safer sex, communicate with their parents and their partner, and/or get tested for STDs. How can we combine the negative and positive messages to encourage youth to take control of their sexual health? Here’s one example: school-based STD screening.

My organization, the National Coalition of STD Directors (NCSD), has partnered with American Social Health Association (ASHA) to promote and recognize World Sexual Health Month this month. World Sexual Health Month provides an opportunity to increase awareness of sexual health and its impact on individuals and society. Sexual health is much more than STDs, pregnancy, and puberty. It is multidimensional—physical, spiritual, emotional, mental, and social. It is a part of each one of us.

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But we know teens are disproportionately affected by sexually-transmitted infections. Half of all new STD cases are in youth ages 15 to 24. One in four youth will contract an STD each year. Many STDs have no signs or symptoms. These statistics alone will not lead youth to get tested or use a condom every time they have sex. However, there are opportunities to provide youth with information and access to testing right at their fingertips and empower them to make healthy decisions. 

One way is through school-based STD screening programs. Schools, health departments, and community-based organizations are joining forces to provide youth with needed access to STD information, testing, and treatment—at school—where youth spend a larger portion of their day. 

Young people face numerous barriers in accessing medical care, especially for sexual health. Partnerships between schools, public health departments, and community-based organizations can help knock down barriers young people often face. Barriers such as inconvenient hours or locations, lack of financial means, fear of testing, lack of awareness about STDs, and stigma, can be mitigated by providing STD screening programs in school. In addition to eliminating barriers, schools provide an optimal location for STD testing because of the connection between academics and health. A student worried about whether or not he or she has an STD or a student in pain and discomfort, may be less motivated and engaged during the school day. This makes it harder to learn and may lead to absenteeism.

Conducting school-based STD screening programs takes coordination and cooperation among all interested parties including schools, medical providers, and community-based organizations. In general, an STD screening program targets high-school-aged youth. Each student is provided with a short educational session and a testing kit comprised of paperwork and a urine specimen cup. All youth are directed to a restroom and enter individual stalls. At this point, a young person is able to decide to take the test or not. If they decide to get tested then they provide a urine specimen. If they decide not to, then the directions ask them to fill out the paperwork and wait in the stall for a certain amount of time (for example, come out of the stall after singing a certain song in their head). After exiting the stall, students return the brown paper bag to dedicated staff. Because all students go through the same steps, students can choose to be tested without the concern of stigmatization by their peers or others. Following the screening event, the medical provider sends specimens to a lab for testing, and results are shared confidentially with students. Often the medical provider returns to the school to provide treatment for students who tested positive. 

Many states and cities are already offering school-based STD screening programs. NCSD, through a cooperative agreement with the Centers for Disease Control and Prevention’s Division of Adolescent and School Health (CDC DASH), is currently working with Michigan to develop an RFP to expand its school-based STD program throughout the state and to develop a memorandum of agreement to be used between the state health department, medical provider, and school. NCSD will also be working with other DASH-funded sites to increase awareness about school-based STD screening programs and move agencies toward action.

In previous years, with the support of CDC DASH, NCSD produced a series of webinars on the replication of school-based STD screening programs. The webinars include programs in a variety of locations in Louisiana, Michigan, District of Columbia, Miami-Dade County, and Durango, CO. The webinars offered participants strategies for successful implementation of  STD screening programs and other comprehensive reproductive health services in a school setting.

NCSD will also be highlighting the Philadelphia High School STD Screening Program in an upcoming publication focusing on how STD programs can bill for services. The Philadelphia program, through a partnership with the Family Planning Council, is able to bill Medicaid for the school-based STD test if students provide their consent. While it is not able to recoup all expenses, Philadelphia is able to off-set program costs. 

So, what’s the up side to this story? Young people are getting tested and treated, when they may not have otherwise. They are connecting with sexual health resources and medical providers. They are getting up-to-date, medically-accurate information to assist in decision making. NCSD and other non-governmental organizations are supporting and providing technical assistance to state health and education agencies to increase the number of localities conducting school-based STD screenings. National organizations are partnering to increase awareness of sexual health. With this combination of activities, we hope to see the number of sexually-healthy adolescents grow. Only time will tell.

News Law and Policy

Alaska Republicans Block Planned Parenthood From School Sex Ed

Nicole Knight Shine

The measure contains provisions that single out abortion providers, which is likely unconstitutional, as a recent legal analysis indicated.

The Alaska Senate last week approved a bill that bars school districts from contracting with abortion care providers like Planned Parenthood for sex education classes, as part of a broader Republican-led measure.

Backers of SB 89, which passed 12 to 7 in a near party-line vote, say the bill promotes parental control by requiring new school procedures, so parents can pull their children from any school activity, test, or program due to concerns over privacy or sexual content. The bill, sponsored by state Sen. Mike Dunleavy (R-Wasilla), prohibits abortion care providers from furnishing sex education course materials to schools or teaching sex ed to students.

The bill faces a near-certain legal challenge if enacted. The measure contains provisions that single out abortion providers, which is likely unconstitutional, as a recent legal analysis by the Alaska Legislative Affairs Agency indicated.

It’s unclear how schools would provide sex ed if SB 89 becomes law. Planned Parenthood officials have said in a statement that it is the state’s largest nonprofit provider of sex ed.

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Jessica Cler, Alaska public affairs manager with Planned Parenthood Votes Northwest and Hawaii, said the senate’s passage of SB 89 was “awful news for sexual health education in Alaska.”

“SB 89 and its even-more-extreme companion legislation SB 191 are unconstitutional restrictions on the education available to communities across the state, and today’s vote didn’t change that,” Cler said in a statement. “Senator Mike Dunleavy is an increasingly desperate demagogue who clearly doesn’t care whether his ideas are based in science, medicine, or even the law.”

The bill represents Dunleavy’s second legislative effort to prohibit abortion care providers from teaching sex ed or providing sexual health materials. A similar bill, SB 191, mandates penalties on teachers, including termination or the loss of their teaching certificates, for using sex ed materials from an abortion care provider. SB 191 is scheduled for a hearing Tuesday in the Education Committee.

Speaking in opposition to the legislation on the state senate floor on Friday, minority leader Berta Gardner (D-Anchorage) called the bill a prime example of legislative overreach in a state with a significant sexual health problem.

“Alaska leads the nation in chlamydia rates, we lead the nation in child sex abuse rates … we’re among the highest in teen pregnancy, and many of us as parents want our children to be informed, we want them to know the scientific facts,” Gardner said.

Alaska reported 808 cases of chlamydia per 100,000 people in 2011—the nation’s highest rate, according to the Centers for Disease Control and Prevention’s Surveillance Survey for that year.

Dunleavy, the bill’s sponsor, warned his senate colleagues against supporting the “abortion industry” and characterized Planned Parenthood’s sex ed programs as “indoctrination.”

“Parents want their kids to be educated in the public schools, they don’t want their children indoctrinated in the public schools,” he said.

2014 study in the Journal of School Health, which examined Massachusetts’ Planned Parenthood sex ed programs, showed that 16 percent fewer boys and 15 percent fewer girls had sex between the sixth and eighth grades in schools with the programs, compared to those in schools without them.

Sex ed is a growing target for anti-choice state lawmakers. Texas tried and failed in 2013 and 2014 to bar abortion care providers from providing materials for sex ed courses.

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.