ROANOKE TIMES
Copyright (c) 1997, Roanoke Times
DATE: Friday, January 10, 1997 TAG: 9701100003
SECTION: EDITORIAL PAGE: A-9 EDITION: METRO
SOURCE: WILLIAM T. BUTLER
WHY DOES the United States have the highest rate of curable sexually transmitted diseases in the industrialized world? It's not because we have higher rates of sexual intercourse. It's because we do not have an effective national strategy to prevent these diseases and do not provide needed services to those most at risk.
Adolescents, in particular, have great difficulty obtaining information, contraceptives, and even treatment for sexually transmitted diseases. As a result, many suffer their whole lives from complications of diseases that could have been prevented.
Diseases such as syphilis, gonorrhea, and infection with hepatitis B or chlamydia are much more than temporary inconveniences. Nearly all cancers of the cervix are caused by sexually acquired human papillomavirus. Liver cancer can result from infection with hepatitis B virus. Several sexually transmitted infections can cause pelvic inflammatory disease, which in turn can lead to infertility or life-threatening problems in pregnancy. AIDS has killed more than 300,000 Americans, and many of these people became infected by HIV through unprotected sex. Sexually transmitted diseases, including HIV infection acquired through sex, cost the nation an estimated $17 billion each year.
Despite their severity, the health consequences of these diseases often are hidden. Many sexually transmitted diseases are asymptomatic and go undetected, although an infected person can continue to spread them to others. Cancer or infertility can occur years after infection, so that people are unaware of any link to the disease. And because of Americans' reluctance to discuss sexual health openly, a stigma surrounds sexually transmitted diseases.
Our reticence regarding sexual matters does a great disservice to adolescents. Many are not emotionally ready for intercourse, and they should be encouraged to delay sexual intercourse. But consider the facts. Seven of 10 high-school seniors have had intercourse. A quarter of high-school seniors have had four or more sex partners. Adolescents contract 3 million of the 12 million cases of sexually transmitted diseases that occur annually in the United States. Ignoring the implications of this widespread sexual activity adds to the long-standing denial that we as a nation bring to the epidemic of sexually transmitted diseases.
The tragedy of these diseases is that all of them are preventable - but only if we take the steps necessary to prevent them. Families need additional sources of information and assistance - and that means involving the schools.
An independent Institute of Medicine committee that I chaired has made some forceful recommendations: All schools should provide students with information about preventing sexually transmitted diseases and avoiding pregnancy - before sexual activity begins. Early education is essential, because high-risk sexual behaviors typically become established during adolescence. Information regarding the prevention of these diseases should be part of a broader health curriculum that is age-appropriate and delivered every year. Given the risks adolescents face of acquiring a sexually transmitted disease, schools should provide access to condoms and to clinical services.
Some parents appropriately worry that school-based sex education and condom-availability programs will increase sexual activity. However, the scientific evidence strongly points in the opposite direction. According to research reviewed by the committee, school programs that include instruction on contraception either delay the onset of sexual intercourse or do not affect onset.
Communities differ widely in their attitudes toward education about sexual matters, and school programs should reflect these attitudes. But if such attitudes block comprehensive school programs to prevent sexually transmitted diseases, the result will be higher levels of illness and personal anguish.
School programs cannot succeed in isolation. Health-care professionals, private health plans, businesses, religious and civic organizations, and others in the community also must take part in preventing these diseases. In particular, television, radio, print, music and other media organizations should disseminate messages that promote healthy sexual behaviors, including condom use and delaying sexual intercourse.
In addition, a national campaign should promote a new norm of healthy sexual behaviors that would provide the basis for long-term prevention of sexually transmitted diseases. It should be combined with increased public- and private-sector investments in prevention and research.
Sexually transmitted diseases are a national problem, and our response to them must be national in scope. But to stem this epidemic, we must act most forcefully where the risk is greatest and where high-risk behaviors start - among adolescents.
William T. Butler, chancellor of the Baylor College of Medicine in Houston, recently chaired an Institute of Medicine committee that studied sexually transmitted diseases among adolescents.
- National Academy
LENGTH: Medium: 89 linesby CNB