Investigating sexual health and culture
By Mari Kanagy, Publishing Editor & Elizabeth Lande, Copy and Managing Editor
National, local STI rates rise
In early October, a report released by the Center for Disease Control announced that, for the fifth year in a row, U.S. Sexually Transmitted Infection (STI) rates had steadily risen. In particular, the number of reported cases for chlamydia, gonorrhea and syphilis spiked considerably. From 2014 to 2018, syphilis grew by 83 percent, chlamydia climbed by 22 percent, and gonorrhea increased by 67 percent.
The Center for Disease Control (CDC) report also reported that youth account for 50 percent of the country’s new STI cases. This means that of the 2.4 million new reported cases in 2018, 1.2 million came from adolescents aged 15 to 24. Men and women make up a roughly equal portion of these new cases, even though young women tend to be more biologically vulnerable to the effects of STIs.
For certain diseases, youth comprise a much higher percentage. Seventy percent of gonorrhea cases are reported in the 15 to 24 age group, and 63 percent of chlamydia cases come from the same demographic.
The increase of STIs has held true locally, too. Though King County STI rates have not risen as sharply as national trends, chlamydia, gonorrhea, and syphilis have still increased at 6.8, 11.77 and 19.67 percent, respectively, according to 2018 data.
The overall upward prevalence of STI rates at home and across the country would seem to imply increased rates of sexual activity. However, these rates are, perhaps counterintuitively, decreasing.
This rise in STI rates and decline in sexual activity has thus led to the conclusion that sexual activity is becoming riskier and that fewer people take measures to protect themselves from STIs.
This situation may come as a surprise, especially in an era of increased awareness around sexual health and the rising availability of medical treatment and testing. Nearly half the nation mandates that public schools teach sexual education, and 33 states require instruction on HIV and AIDs.
While Washington does not require public schools to teach sexual education, schools that elect to do so must provide an all-inclusive curriculum, as opposed to just abstinence-only. A bill is currently in the legislature that, if passed, would require all public schools to put sexual health education in their curriculum.
Some have named this lack of compulsory education as a leading factor in Washington’s own increased STI rates, while another explanation is also possible — and pertinent — to the high school demographic. In recent years, the increased emphasis on HIV prevention has drawn focus from other STIs.
Since the introduction of AIDs education into the majority of state health curriculums following the AIDs crisis, rates of HIV infections have dropped significantly. HIV/AIDs researchers have also successfully developed HIV prevention drugs.
Called Pre-exposure prophylaxis (PrEP), the medication is taken once daily by people who are HIV negative to reduce their risk of infection if they come into contact with the disease. It has been proven to reduce the risk of contracting HIV from sexual intercourse by 90 percent, a statistic that has acted in part to spread misinformation that protection is no longer as necessary because the “central threat” of STIs now poses less of a risk.
However, PrEP does nothing to prevent other STIs, so while sexually active teens may be protected from HIV — enough for them to not use barrier methods — their chances of contracting other diseases can actually increase due to lack of prevention. Consistent education and convenient testing, particularly from schools, have thus become increasingly vital to teen health.
Students and educators discuss sexual health
On Vashon, the high school has put in place systems with the aim of increasing sexual health among students — namely the confidential care system at the school-based clinic, Neighborcare. The confidentiality service covers mental health, as well as sexual health treatment, though it does not cover more general health needs, such as vaccinations.
The clinic is run by Washington State Healthcare Authority, and follows the state requirement mandating that teenagers have access to anonymous health resources. When a student signs up to get treated anonymously, they sign up for the Take Charge healthcare insurance, which means that parents are not billed, and therefore aren’t notified of the service. This process is intended to increase student usage to the clinic, as many students are more likely to access sexual health resources with the guarantee that their parent or guardian will not know.
Despite the anonymity of the confidential care system, there is still a cultural stigma around STIs and getting tested.
“There’s no shame in getting tested for an STI,” Neighborcare health educator Alison Delateur said. “It’s something that everyone should do, and we want to help make that process easier for people.”
Though the service does rely on the complete anonymity of student treatment, the clinic emphasized that the main purpose of the system is to provide students with access to valuable health resources, regardless of their parents’ approval of their sexual activity.
“Our goal is not to help students keep [sexual health treatment] a secret from their parents, but help them get a way to healthcare that they want access to,” Delateur said.
Students who utilize the anonymous care service echo this sentiment.
“I was glad I could get birth control without my parents knowing because it’s not really something I can talk to them about,” an anonymous student said. “The Neighborcare clinic was set up perfectly for students in my situation, and it was very easy and nice to have support in that area when I wasn’t getting it at home.”
When it comes to sexual health education, teachers see that culture and behavior of their students can make it more difficult to teach effectively. This dilemma is particularly prevalent within the freshman class, since, of all the grades, freshmen receive the most formal sexual health instruction in Family Health class.
“It’s sometimes hard for freshmen to accept the information and process it, just because it’s far off their radar,” high school health teacher Kara Sears said.
Students notice a similar difficulty in student receptiveness, blaming culture among students as a major barrier in focusing on issues related to sexual health.
“This school, in all grade levels, has an issue with maturity when it comes to sexual health, and being able to talk about it, so I think the biggest thing, first, is to get people to not think of it as a joke and understand that these are things that people do, and you need to be able to handle it well to talk about it,” senior Evan Stephanick said.
Each year, Teen Council gives lectures — one with sophomores, and another with juniors and seniors — about common and harmful STIs, and how to treat and prevent them. These lessons occur as part of a state mandate, which requires that students must receive compulsory HIV/AIDs education once a year.
A common belief among students is that the school should have more extensive lessons on sexual health topics.
“I think the school should offer more health classes,” Stephanick said. “I feel like having one little presentation every now and then during SMARTs or announcements, or flyers around the school aren’t effective, because people, especially at this school, just laugh about it.”