In the wake of recent CDC findings regarding the prevalence of HIV in the United States, the agency determined that it was necessary to reassess the country's approach to fighting HIV and improving sexual health in the US generally. While it is sometimes necessary to take a step back and objectively evaluate the situation, the problem with government organizations such as the CDC is that they are vulnerable to political pressure. And that pressure is strongest when discussing sexuality and children in conjunction with public policy.
If the CDC evaluates the situation objectively, they'll find that the problem is very simple. Large numbers of U.S. parents (though by no means all) labor under the delusion that there teens aren't having sex or current levels of sexual activity will only be increased by addressing the activity openly. And that is the largest road block to decreasing HIV/STD prevalence in the US.
The challenges to U.S. teens are well illustrated in this recent ABC news story which described the battle simply to make condoms and other contraceptives available to high school students. Despite the fact that the school eventually decided to allow contraceptives to be dispensed, a condition has been attached that requires the parents to be notified when teens seek some of these services. While this is a positive step insofar as contraceptives will be more easily available then they once were to those teens, the article cites that nearly 50% of teens were uncomfortable discussing sexual matters with their parents which means that notification rules could prevent students from seeking contraceptives. Several comments following the story articulate American attitudes towards teen sex:
"Ok, here's a bottle of Jack Daniels, I don't want you to drink it but if your going to drink I would rather have you drink Jack Daniels. Sound familar." - tiredstory2
"yea ok lets try to prevent pregnancy and stop kids from having sex by giving them condoms ok" - xilivis
"Apparently, some people think that kids who make bad decisions about sex will suddenly become mature adults with good judgment when you give them a condom. Kids who make bad decisions will continue to make them even with condoms in their pocket. Just because you give a kid a condom does not mean he will use it. It just clouds the judgment of kids who would otherwise know better. They are turning their schools into welfare offices. First, the kids who can choose will leave. Then the kids who want to stay will have to leave. Then the people will be complaining that they can't get vouchers to leave because they want to, but can't. Schools should be for education, not reproductive needs. "In fact, it seemed no one in Gloucester, a picturesque one-time fishing village, was opposed to condom distribution." Really? If you really believe this, I won't let the facts get in the way of your story. This is a bad decision." - Word2theWise
Recently, the organization, Advocates for Youth, which champions efforts to help young people make informed and responsible decisions about their reproductive and sexual health, released an intriguing fact sheet which paints a stark picture with regard to the sexual health of US youth as compared to their European counterparts.
According to Advocates for Youth among teens:
- Syphilis rates are more than 70 percent higher in the United States than in the Netherlands;
- Gonorrhea is the second most commonly reported infectious disease in the United States, and U.S. adolescent rate is 28 times greater than teen rates the Netherlands;
- Chlamydia infection is more than 15 times more common among U.S. teens than Dutch teens;
- The proportion of the United States’ adolescent and adult population that has been diagnosed with HIV or AIDS is six times greater than in Germany, three times greater than in the Netherlands, and one and a half times greater than in France.
These are some sobering and damning figures that illustrate a significant problem in the U.S. Anthropologically speaking, Europe and the United States aren't all that different from one another. Teens in the U.S. have similar levels of education, similar life styles,and similar sexual experiences as their European counter parts. So why the disparity? Advocates for Youth believe that one of the primary reasons is contraceptive availability.
Although U.S. teens report using contraception (usually either birth control pills or condoms or both) far more often than their peers of previous decades, U.S. teens still use contraception or condoms much less consistently than their peers in Europe. When measuring use of highly effective hormonal contraception, condoms, or both, researchers found that German, French, and Dutch youth were significantly more likely to be well protected at most recent sex than were their U.S. peers
The percentage of sexually active 15 year olds who reported using condoms in their most recent sexual encounter was 88%, 85%, 83%, and 73.2% for youths in France, the Netherlands, Germany, and the United States respectively. But is the secret simply condom use? Hardly. When it comes to teen sex and STDs, Europeans take a more realistic approach than the U.S. ever has. While Advocates For Youth cite several additional reasons for the disparity some of the more important appear to include:
- Politics and religion are kept out of public health policy which is evidence based. Europeans know condoms work and therefore they are provided to youth without question. Unlike our example in Massachusetts, government doesn't have to twist arms to gain public support to distribute contraceptives. This protects them against both STDs and unwanted pregnancy.
- There is much more significant cooperation from all parts of society. STDs, HIV, and teen pregnancy isn't just a family problem. It is a national problem being actively fought with easy access to contraceptives, strong relevant sex education programs, and widespread public education campaigns including Internet, television, films, radio, billboards, discos, pharmacies, and health care providers. When was the last time we saw a commercial discussing the important and perhaps even the use of condoms on day time TV or in prime time?
- Sex education at all grade levels and integrated into most school curriculum. Not just one class or special school programs with a specific focus.
- Liberal access to contraceptives.
- Parents who realize that teenagers have sex and recognize it as an inevitable result of a healthy life both physically and emotionally making sure they can interact on a frank and respectful level with their children.
What you don't see in that list is male circumcision. No, Europeans don't advocate neonatal circumcision to prevent STDs over sexual health education and open communication. In this sense, the United States appears embarrassingly closed-minded and even superstitious in that no reliable study has found consistent protection from circumcision against STDs.
Clearly, if circumcision were as protective as Americans want it to be, how could the difference between Dutch youth and American youth be explained? Circumcision is rare in the Netherlands and, in the corresponding age group, has a prevalence of perhaps 70% - 80% in the U.S. Even if condom usage is 15% lower among US youths surely the fact that they are circumcised should help close the gap. Yet there is a staggering difference among several classes of STDs.
If the CDC is serious about improving the sexual health of Americans, they need only look across the pond. They need to encourage Americans in all parts of society to shed their prudishness and be fully engaged in the problem. Condoms should be freely and anonymously available to all teens from middle school through high school. Other contraceptives need to be made similarly available. The CDC and the U.S. government needs to learn how Europeans integrate sexual education into the general education of their youth.
Similar types of advertising campaigns need to be started. Madison Avenue is very good at getting people of any demographic to buy things. The government should employ these skills. Specifically for HIV, we should work towards a national HIV/AIDS and sexual health policy. Whether this includes mandatory annual testing and disclosure of positive test results to recent sexual partners should be part of the discussion and policy-making process. Realistically, such national policies are greatly facilitated by universally available health care under a single payer plan.
It isn't simply condoms that make the Europeans successful. It is active participation at all levels of society, not the passive, shame-fueled approaches many Americans labor under. That is what the CDC needs to learn; that is what U.S. teens need. The question is, does the CDC have the political will to implement such beneficial changes? Can they fight the public dogma that, in the case of sexual health, leave American youths behind? Crucially, can Americans leave behind the magical thinking that male circumcision somehow protects them and makes them superior even as the evidence shows otherwise?
