There were certain things that the 1990s just did better — including getting the word out about the dangers of unprotected sex.
According to the Centers for Disease Control and Prevention (CDC), the percentage of American students using condoms hit its peak at around 60% a decade ago, and has stalled since then, even declining among some demographics. A recent study released by the Sex Information and Education Council of Canada found that nearly 50% of sexually active college students aren’t using condoms. Other reports have found that while teenagers are likely to use a condom the first time they have sex, their behavior becomes inconsistent after that.
Health officials from Oregon to Georgia are ringing alarm bells about rising rates of sexually transmitted diseases, worried that kids aren’t getting the message. Sex education is more robust than it was for previous generations, but a 2012 Guttmacher Institute report revealed that while nearly 90% of high schools are teaching students about abstinence and STDs, fewer than 60% are providing lessons about contraception methods.
The CDC estimates that half of new STD infections occur among young people. Americans ages 15 to 24 contract chlamydia and gonorrhea at four times the rate of the general population, and those in their early 20s have the highest reported cases of syphilis and HIV. Young men and women are more likely than older people to report having no sex in the past year, yet those who are having sex are more likely to have multiple partners, which increases the risk of STDs.
“We need to do better as a nation,” says Laura Kann, an expert in youth risk behaviors at the CDC. “Far too many kids in this country continue to be infected with HIV and continue to be at risk.”
When condom-usage rates were on the upswing in the ’90s, America was in the midst of an AIDS epidemic that was claiming young lives daily. The fear of the disease gave heft to safe-sex campaigns. Today, public-health officials are partly a victim of their own success; contemporary teenagers grew up after the terror had subsided, thanks to antiviral drugs and those messages that helped bring infection rates down. “The young people today know HIV as a manageable, chronic disease,” Kann says. “It’s not something that can kill you in their eyes. So that leads, most likely, to an attitude that it’s not something that they have to protect themselves from.”
In Oregon’s Lane County, senior health official Patrick Luedtke is in the midst of confronting an ongoing gonorrhea outbreak, with rates jumping as much as 40% in recent years. Like Kann, he believes complacency is a large part of the problem. “People don’t have the fear of death from sex like they had 15 years ago,” he says. “For the teenagers, that fear is gone, and people are not practicing safe sex as much as they used to.”
Other research collected by the CDC shows that some schools aren’t hammering away at the safe-sex lessons like they once did. In Alabama, Alaska and Florida, for instance, fewer public schools are teaching teenagers how to obtain condoms and why it’s important to use condoms. “Schools have competing health issues that they’re asked to deal with, things like tobacco use, bullying, the obesity epidemic. It’s been hard to keep attention focused on HIV and STD prevention,” Kann says. “This complacency issue [is not] unique to just youth themselves.” Last week, the American Academy of Pediatrics issued a policy statement supporting better access to condoms for teenagers, saying schools are still hesitant to provide them because of an enduring fear that access to condoms will make kids have more sex.
Public institutions beyond schools have had setbacks too. Budget cuts in Oregon meant that Luedtke’s county closed its STD clinic. “People don’t stop having sex because of the bad economy,” he says. “Where are the resources?”
Even in places where there’s money and free condoms to go around, health departments haven’t necessarily seen safe sex go viral. New York City health officials are reporting that only 1 in 3 adult residents uses protection, despite years of PSAs and prophylactic handouts under Mayor Michael Bloomberg. While condom use among young people in New York City is slightly up since 2009, that puts it on par with the stagnant nationwide average.
Kann says there are broader societal factors at work too, ones that disproportionately affect African-American youth. Compared with the population as a whole, their parents are less educated and have lower incomes, both factors that have been linked to sexually risky behaviors, including having unprotected sex. Adolescents who postpone sex have parents who are more educated. Lower incomes, meanwhile, are associated with factors like parents working multiple jobs, which can mean kids are left home alone without a watchful eye to factor into their decisionmaking.
Some research has suggested that sexually active Americans simply assume their partner is free of STDs, and an infected partner may be unaware, given that diseases like “silent” chlamydia often don’t have obvious symptoms. And there is a perception — if not a diehard belief — that using condoms makes sex less pleasurable. That’s why Bill Gates challenged designers earlier this year to create a better-feeling condom that sexually active people might be more likely to use.
While it’s hardly a sexy, revolutionary proposition like remaking the condom, Kann says the key to driving condom use higher is more education. Canada’s survey, for instance, was revealing about how relatively unimportant the students considered STDs. Those who used condoms were much more likely to cite pregnancy than STDs as their main concern; 54% said their single motivation for using protection was birth control, while just 6% cited STDs as their sole reason.
“It’s really critical for kids to know about their risk,” Kann says. “They need to know how to get tested. They need to know how to prevent infection. And we can’t do that alone here at CDC. We’re going to need action not only by this agency but also by parents, by schools and communities.”