STD rates in Philadelphia are at an alarming level amongst adolescents. Many educational and preventative methods have been put into place to help reduce the amount of teens that contract a sexually transmitted disease. Heterosexual teaching is no longer the only method of sex education, with LGBT Teen rates increasing alternatives to traditional instruction is needed to be a part of all school curriculum. Young people are at an increased risk due to inexperience and pressure from friends to conform to society.
This paper explores the current practices available through schools, clinics, and instruction from parents to assist adolescents in making better decisions about sex. Barriers to preventative care such as poverty, peer pressure, single parent households and lack of resources are discussed. City funding resources that are currently available for Philadelphia Youth such as CDP’s or Condom Distribution Programs are compared to Abstinence only education.
At age 12 M.W. as we will call her, experienced her first sexual encounter with her 16 year old boyfriend. A year later she was physically abused and sexually assaulted by both her boyfriend and his older brother. M.W. is now 16 years old and has been diagnosed with HIV. This story is just one of many among adolescents in Philadelphia. Sexually misguided youth are more prone to contracting an STD mainly as a result of multiple relationships, peer pressure and inexperience (phila.gov, 2011). Although many changes were made to improve the STD rates of teens in Philadelphia, more emphasis needs to be on education, prevention and healthcare access to reduce the numbers.
Many teens look to their parents as role models and sources of information. Adolescents that are educated by parents regarding sexual health have a lower risk of contracting an STD. “19.2 percent of students said they would prefer to get information about contraception from their parents rather than community health centers, classes, hospitals, private doctors, television or friends” (Lagina, 2002, p.2). Open communication between parent and child can delay a teen from having sex. Teens who have conversations with parents about sex are also more likely to use condoms. Parents struggle to talk to their children regarding sexual health, and are more comfortable with the subject of avoiding alcohol and drug use. It is beneficial to include STD prevention as a topic since alcohol and drug abuse increase the rate of STDs in adolescents (cdc.gov, 2014). Education from schools further elaborates on what is taught at home and helps youth who may not have sex education from parents.
“Today nearly 70 percent of all high school seniors engage in sexual intercourse before graduating, one in eight contracts a sexually transmitted disease each year”(Peeke, 2015 p.1). When sex education was first introduced into schools the primary teaching centered around abstinence until marriage. Schools face many challenges when educating teens about sexual health. According to the CDC 45% of Philadelphia schools teach at least 7 contraceptive choices to students in grades 9-12 (cdc.gov 2012). A traditional style heterosexual teaching now has to undergo continuous changes as a growing number of adolescents are part of the LGBT Community.
Youth also need to have choices which includes not only safe sex but also an abstinence program for adolescents who may not want to have sex or feel pressure from peers. Sex education in schools is funded largely by the federal government, the money is then passed down to states and school districts. The Allocation of funds and selection of instructional content directly affect student’s availability and amount of sexual education delivered (Bridges & Hauser, 2014). Lack of resources in schools and uncertain parental involvement make it very important for healthcare professionals to continuously educate adolescents about STDs.
Doctors, nurses, and other healthcare staff can educate youth at a preadolescent phase before a sexual encounter is initiated. A study that took place at Children’s Hospital of Philadelphia in 1996-98 had 393 participants. 97% of adolescents acknowledged being taught about STDs while only 2% could identify with the 8 main STD types. The majority of adolescents were taught sex education at school, while 52% had sex instruction from parents (Allen-Taylor et al., 2002). Growing numbers of adolescents miss key information from traditional sources. Healthcare professionals can use wellness checkup visits to encourage questions and educate youth about sexual health and development. Using a routine appointment to connect with adolescents can not only help in preventative measures, but will make a teen to feel more comfortable with talking to healthcare staff if an STD were discovered.
Prevention measures against STD’s in the city of Philadelphia have been very successful at community wide events. Condom Usage is increased when special events are held in neighborhoods and individuals receive STD teaching on site. CDP’s or Condom Distribution Programs encourage at risk groups such as adolescents 13-24, sex workers, and young males to ask questions and increase contraceptive use (cdc.gov, 2015). “15% of Philadelphia youth admit they have never been taught about HIV/AIDS in school” (Phila.gov, 2011, p. 3). CDP’s make receiving information easier and teens may not feel as embarrassed at a neighborhood event where others their age are involved. While condom usage is an effective contraception choice for a growing number of youth, abstinence can delay sexual relationships and further youth to make better choices when sexual activity begins.
Abstinence education has become a less popular method of sex instruction in most schools. Teaching adolescents to delay sex until a committed relationship is established not only decreases STD rates, it also encourages youth to understand their own body and develop a greater sense of self. Young people feel pressured to have sex since it is believed that most of their peers at school are in sexual relationships. According to the American College of Pediatrics adolescents have an underdeveloped frontal area of the brain. When teen’s behavior was compared to adults, a lack of consistency was shown in making decisions (Zeiler, 2010). This is very important as many teens receive continuous instruction about avoiding drugs and alcohol, but not sexual encounters. Younger female teens are also more at risk for contracting an STD since their cervix is still developing.
Abstinence teaching will help youths comprehend the risks involved and understand better contraceptive use if the first encounter is delayed until sexual maturity is reached. A high percentage of teens may consider to abstain from having actual sexual intercourse as a form of abstinence and still practice oral methods of sex without realizing that this can also lead to an STD. For teens who do not fully abstain from sex STD testing is vital in preventing the spread of disease.
The Philadelphia School District partnered with the Dept. of Health to produce a high school screening program. Many schools within the district noticed a decrease in STD rates as a result of early testing and treatment. “The relationship between prevalence in males, and effectiveness and cost-effectiveness of screening, is counterintuitive” (Fisman et al., 2008, p. S61- S64). Increases in female STD rates at schools led to the screening of more male students. When male testing and treatment was increased the female reinfection rate was less therefore decreasing the amount of STD rates in the total population. Screening for both males and females also saves the school district money that can be used for other preventative programs. For adolescents who attend charter school or are home schooled and may not be exposed to sex education healthcare access remains a high priority.
Philadelphia has established free and low cost health clinics that aid in STD prevention. Although most children in the city are covered through Medicaid and other insurance many barriers remain. Teens may also be afraid to seek sexual healthcare due to cultural stigmas, parental embarrassment and misunderstanding, and religious restrictions. For most adolescents permission from parents is not needed to receive STD testing and treatment. A small percentage of teens are underage and will need consent from parents or guardians and this may delay much needed care, as the adolescent may be hesitant to ask for help. “Adolescents make spur-of-the moment decisions and are limited in their ability to consider the consequences” (Matzo & Wisnieski, 2013 p. 69).
Teens often don’t seek care because they may be in denial of a possible STD. Multiple partners and emotional attachment to their significant other can add to delays in treatment. Doctors and nurses attend to many patients in overcrowded Philadelphia Health Clinics, and lack of quality care that includes prevention and treatment has become the norm.
Problems arise with affording to get to an appointment and having access to medical centers. 40% of children live in poverty in Philadelphia many parents are not able to afford private health insurance premiums and copays (Westervelt, 2013). Half of all Philadelphia households are made up of single parent families (city data.com, 2015). When parental support and income is limited to one parent tough decisions have to be made for the benefit of the whole family unit. If a parent has a teen needing consent it may be difficult for them to take off from work since most clinics are open during the day. Teens may be reluctant to seek care if there are gaps in clinical visits due to financial strain. Stigma attached to STD’s makes teens feel vulnerable, adolescents need to have continuity of care and the ability to develop a confidential relationship with their primary care doctor.
“Confidentiality protection is an essential component of health care for adolescents because it is consistent with their development of maturity and autonomy and without it, some adolescents will forgo care” (English et al., 2004 p.1). Hippa laws are made available to protect client’s personal health information, however some teens may be reluctant to ask the doctor about STD prevention or even to receive treatment. Most states will allow teens to talk to healthcare professionals independently in regards to sexual health, but for many services parent consent is still needed. With stigma already attached to STD’s many teens feel anxious and insecure about disclosing sexual information. If adolescents are a certain age parents may be able to let doctors have consent between the patient and teen so that sexual matters can be addressed without fear of parents finding out certain information.
Healthcare professionals should keep in mind that if trust in a minor is violated by divulging personal information to a parent it could break the trust in a minor and further treatment may either be stopped or postponed (English, 2004).
With three times the National Average of STD Rates the city of Philadelphia continues to move forward by battling a war against the growing number of teens with sexually transmitted infections (cdc.gov, 2012). Although school education, clinics and parental input has played a large role in reduction of STD’s a more thorough approach needs to be investigated. There is always a message coming from society about safe sex, but if numbers are climbing with all the contraceptives available maybe this is not a one solution answer. In the present moment a concentration in high levels of community support geared toward teens of low income families and single parents can help to further sexual education in youth. Setting up youth programs where teens can talk amongst themselves and also get a supportive adult to be a listening ear would be most favorable.
Community programs can encourage a teen to work on self-esteem, become independent, and feel good about their sexual development. Teens who have a higher self-esteem and feel comfortable with who they are can make better choices for themselves and healthy decisions about their body. Adolescents need to have love, care, and concern that starts in the family so when the time comes sexual relationships are handled responsibly and fast decisions due to inexperience do not cause a lifetime of regret.
