Adolescent Sexual Health: Preventing STDs, HIV and Pregnancy
One-third of teens become pregnant before age 20. One-fourth of young women acquire a sexually transmitted infection by age 19, making them more susceptible to HIV infection. This 4-page brief describes successful state health and education policies as well as successful targeted youth education activities that can prevent these conditions.
HOW MANY TEENS ARE AFFECTED BY STDs, HIV AND PREGNANCY?
- One-third of young women become pregnant at least once before age 20.1 The teen birth rate for mothers age 15 to 19 increased 5 percent from 2005 to 2007 after 14 years of declining rates.2
One-fourth of young women ages 14 to 19 have at least one of the four common sexually transmitted infections,3 and having an STD can double the chances of contracting HIV.4 Sexually active adolescents and young adults acquire STDs more frequently than older adults.5 The two most commonly reported STDs, chlamydia and gonorrhea, are curable but if left untreated can cause women to be infertile.6
- Chlamydia infection rates in youth are high. Youth ages 15 to 19 had the highest chlamydia rates of any age group in 2007,5 with reported rates of one in 33 young women and one in 170 young men.7
- Gonorrhea infection rates increased 10 percent over the past three years. Gonorrhea was reported in one in 150 women and one in 350 men, ages 15 to 19 in 2007. Racial disparities in gonorrhea rates are the most severe of all health disparities.6,8
- Most sexually active people will get Human Papillomavirus, commonly called HPV, at some time in their lives, though most will never even know it. A vaccine is available to protect girls and women from the four types of HPV that cause most cases of cervical cancer and genital warts. The vaccine is recommended for girls ages 11 and 12 years and is given in a series of three shots over a six-month period. The vaccine is also recommended for girls and women ages 13 to 26 who did not receive it when they were younger.9
- One-third of newly diagnosed HIV infections occurred in the 13-to-29 age group in 2006.10 More than 4,500 youth ages 13 to 19 are living with HIV infection (not AIDS) in 47 states, Washington, D.C., and five U.S. territories with confidential name-based reporting.11 The risk of acquiring HIV/AIDS is higher for racial and ethnic minority youth, particularly African-Americans.12
By the time teens graduate from high school, nearly two-thirds have had sex.
- 65 percent of high school seniors had sexual intercourse at least once, and 22 percent reported at least four sex partners in a 2007 survey.13
- Among all 2007 high school students who had sex in the three months prior to the survey, 39 percent did not use a condom during the last time they had sex. Among this same group, 23 percent drank alcohol or used drugs before the last time they had sex.13
HOW CAN THESE CONDITIONS BE PREVENTED?
- Education programs effectively reduce sexual risk behaviors in adolescents. Effective education is age-appropriate, is delivered by trained instructors and includes accurate information about preventing or reducing the risk of HIV and STD infections or getting pregnant, forming strong relationships and making good decisions.
- Health care providers can improve adolescents’ use of quality HIV and STD prevention services by partnering with other community resources to address their lack of insurance or other ability to pay, solve transportation issues, reduce adolescents’ discomfort with facilities and services designed for adults and respond to their concerns about confidentiality.14
- Continuing prevention and education efforts are required for each new generation entering puberty. Prevention education programs should address the needs of all youth—those who remain abstinent as well as those who engage in sexual activity.
STATE PREVENTION PROGRAMS FOR YOUTH FUNDED BY THE CDC
The Centers for Disease Control and Prevention funds school-based STD, HIV and teen pregnancy prevention programs in 49 states, Washington, D.C, 16 large urban school districts, one tribal government, and six territories to promote healthy, responsible choices by students and to:
- Implement evidence-based effective policies, programs, curricula and standards through support to schools and school districts;
- Integrate prevention efforts with other STD, HIV and unintended pregnancy programs;
- Implement strategies to reduce health disparities; and
- Support collaboration between health and education government agencies, community planning groups, parent groups, students and other groups or coalitions.
The CDC also funds collaborations between state departments of education and health.
- To encourage states to integrate efforts to prevent HIV, other STDs and teen pregnancy, CDC funds the National Stakeholders Collaborative to build partnerships between state STD directors, state maternal and child health programs, state AIDS directors, and state health, physical education and recreation directors. (See: http://www.cdc.gov/HealthyYouth/partners/funded/HIV.htm.)
- In 33 states, employees from these agencies worked together and drafted state action plans to integrate prevention efforts. (See: www.ncsddc.org/2230.xml.)
WHAT STATE HEALTH POLICIES ARE RECOMMENDED?
- Chlamydia testing and treatment as part of routine care. The CDC recommends annual screening for all sexually active women age 25 or younger, and for those older than 25 with new or multiple sex partners. Chlamydia infections are curable and often occur without symptoms. Screening and treatment programs can significantly reduce the incidence of complications that lead to infertility.15
- Expedited Partner Therapy. Remove state legal and regulatory barriers to EPT, which allows health providers to give patients infected with chlamydia or gonorrhea either medication or prescriptions and prevention information to deliver to their sexual partner(s).
- HIV testing as part of routine medical care. CDC recommends that all patients ages 13 to 64 receiving routine care in health care settings be tested for HIV. State requirements of separate written consent for HIV testing and prevention counseling may need modification so that general consent for medical care is sufficient to encompass consent for HIV testing a part of the general consent for medical care.
EXAMPLES OF SUCCESSFUL PREVENTION PROGRAMS FOR YOUTH
- Youth development for African-American middle school students (Project AIM - Adult Identity Mentoring). Through a youth development curriculum, students articulate personal goals and learn the skills required to achieve those goals.
- Educate parents of pre-teens ages9 to 12 in African-American and Hispanic/Latino communities (Parents Matter!).Parenting education is used to enhance protective parenting and encourage parent-child discussions about sexuality and sexual risk reduction.
- Educate African-American youth ages 12 to 15 and parents in community settings(Focus on Youth - FOY). Through eight group sessions, youth are taught skills and knowledge they need to protect themselves from STDs and HIV. This program also includes Informed Parents and Children Together – ImPACT, a short component for parents on parental monitoring and effective communication.
- Educate runaway and homeless youth ages 11 to 18(Street Smart). This multi-session, skills-building program helps youth practice safer sexual behaviors and reduce substance abuse.
- Protect high-risk youth and all youth in high-risk areas (Community PROMISE). Consistent HIV prevention is encouraged by mobilizing communities and distributing materials and risk reduction supplies in areas with high rates of STDs, injection drug users and their female sex partners, sex workers and men who don’t identify themselves as gay but have sex with men.
- Educate high-risk Hispanic/Latino youth ages 13 to 18 and residents in high risk areas (¡Cuídate!).This culturally based program is aimed at reducing HIV sexual risk, and incorporates cultural beliefs common among Hispanic and Latino subgroups that are associated with sexual risk behavior.
- Enhance prevention by educating youth ages 13 to 29 living with HIV (Together Learning Choices - TLC). These programs help young people identify ways to increase use of health care, decrease risky sexual behavior and drug and alcohol use, and improve quality of life.
- Inform heterosexual youth age 14 and older attending STD clinics (Project RESPECT). This educational program aims to reduce high-risk sexual behaviors and prevent new sexually transmitted infections.
RESOURCES FROM THE CENTERS FOR DISEASE CONTROL AND PREVENTION
1. The National Campaign to Prevent Teen and Unplanned Pregnancy. “Fact Sheet: How is the 3 in 10 Statistic Calculated?”
2. Hamilton BE, Martin JA, Ventura SJ. “Births: Preliminary data for 2007.” National vital statistics reports, Web release; Vol. 57, No. 12. Hyattsville, MD: National Center for Health Statistics. March 18, 2009.
3. Centers for Disease Control and Prevention. “2008 National STD Prevention Conference: Confronting Challenges, Applying Solutions, Press Release.” March 11, 2008.
8. CDC. “Annual CDC Report Finds High Burden of Sexually Transmitted Diseases, Especially among Women and Racial Minorities.” Press Release, January 13, 2009.
11. CDC. "Cases of HIV Infection and AIDS in the United States and Dependent Areas, HIV/AIDS Surveillance Report, 2007." Vol. 19. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2009.
12. CDC. “HIV/AIDS Fact Sheet: HIV/AIDS mong Youth.” August 2008.
13. CDC. “Youth Risk Behavior Surveillance—United States, 2007.” Surveillance Summaries, June 6, 2008. MMWR 2008;57 (No. SS-4).
14. Advocates for Youth. “Best Practices for Youth Friendly Clinical Services.”
15. U.S. Preventive Services Task Force. “Screening for Chlamydial Infection: U.S. Preventive Services Task Force Recommendation Statement.” June 2007. First published in Annals of Internal Medicine 2007;147:128-33. Agency for Healthcare Research and Quality, Rockville, MD.
This publication was supported by Cooperative Agreement 1H25PS00138-01 from the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention.