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Wednesday, May 21, 2008

The Silent Epidemic

Teens & STDs

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MANY WERE SHOCKED WHEN THE CENTERS FOR DISEASE CONTROL and Prevention (CDC) reported last year that one in four teenage girls had contracted a sexually transmitted disease (STD). But Milwaukee experts weren’t. Milwaukee has a long-standing problem not only with teen pregnancy, but with teen STDs as well.

The city routinely rates in the top five or 10 cities for chlamydia, gonorrhea and teen pregnancy. Milwaukee County accounts for 50% of all STDs in the state of Wisconsin, and the city of Milwaukee has the 10th highest rate of STD infection among the 63 cities studied by the CDC.

The rate of infection is hitting the city’s minority and teen residents especially hard. African Americans account for 49% of all reported STDs in the city. In the neighborhoods with the highest rate of STDs, 22% of 15-19-year-olds had an STD.

“I would say that the Milwaukee community has done a poor job of ensuring that teenagers and sexually active young adults know about their risks and how to prevent those risks, as well as having the resources to prevent those risks,” said former Milwaukee Health Commissioner Seth Foldy, M.D., who now heads up the Milwaukee Alliance for Sexual Health (MASH).

Milwaukee’s alarmingly high rates of teens with STDs

MASH, a project funded by the Healthier Wisconsin Partnership Program of the Medical College of Wisconsin, is bringing together community organizations and medical professionals to look into why so many Milwaukee teens— especially African-American teens—become pregnant or infected with STDs, and what can be done about it.

It's not surprising that the two problems are intertwined, since unprotected sex leads to both unintended pregnancies and STDs. "I don’t think we can address teen pregnancy without addressing sexually transmitted diseases, and we can’t address sexually transmitted diseases without addressing pregnancy,” said Geoffrey Swain, M.D., associate medical director of the city of Milwaukee Public Health Department and an associate professor of family medicine UW-Madison School of Medicine and Public Health.

But unlike the highly visible epidemic of teen pregnancy, teens with STDs aren’t as easy to identify. In fact, many have no symptoms, so many infected teens aren’t tested or treated. Untreated STDs have serious health consequences, such infertility, pelvic inflammatory disease, tubal pregnancies cervical cancer.

“These are not minor issues,” Swain said. “These are very serious, life-changing issues. Everyone knows that teen pregnancy is a life-changing issue, but people don’t necessarily see that sexually transmitted diseases are, too.”

Why Is It So Bad?
Point to inconsistent messages about sexual responsibility,poverty and lack of hope in the future as reasons why Milwaukee has such high rates of teen STDs. Certainly, all experts are quick to endorse abstinence as the best safeguard against becoming pregnant or contracting an STD.

Foldy said teaching about abstinence, as promoted by conservatives, is important for teens who don’t want become sexually active. But abstinence-only education doesn’t necessarily lead to a reduction in the number of who have sex; in fact, students who receive comprehensive sex education are more likely to delay having sex and use contraceptives.

“Abstinence education is important, but not enough,” Foldy said.

The Milwaukee Public Schools (MPS) system has a well-thought-out comprehensive human development curriculum, Foldy said, that includes not only information about STDs and pregnancy, but has skill-building activities as well, so students can implement that knowledge in the real world.

“But that curriculum is not delivered uniformly,” Foldy said. “Many schools offer none of it. Some schools offer a tiny amount of it. It is up to the school to decide how it will be offered or whether it’s going to be offered.”

Lacking this universal implementation, MPS schools can invite outside educators (see “What Teens Want to Know” for Planned Parenthood’s outreach efforts in schools and community organizations) for their students. (MPS did not return a request to comment for this article.)

Adding to this lack of a consistent message about safe sexual practices is the high level of poverty in Milwaukee. Swain said that Milwaukee’s unusually high rates of poverty—especially child poverty—contribute to the STD epidemic, not only because low-income teens aren’t likely to spend money on condoms, but because they aren’t connecting safe sex practices to their future well-being.

“A group of people who are very poor, struggling to get by, don’t see a lot of hope for the future, and they’re less likely to act now in a way that will protect them in the future,” Swain said. Swain said that while people with STDs are more likely to be found in the poorer, predominantly African-American neighborhoods in Milwaukee, the behaviors that lead to unintended pregnancy and STDs can be found everywhere.

“At an individual level, what it boils down to is how many partners have you had, do you use condoms and do you engage in behaviors that impair your judgment, such as using drugs or alcohol while having sex, or trading drugs for sex,” Swain said. “Many affluent white teenagers have the same behaviors, and certainly older adults who are affluent and white have multiple partners. There are fewer of them, statistically speaking, but those individuals are at very high risk for sexually transmitted diseases.”

To help ensure that teens have access to condoms, a good way to prevent most STDs and pregnancy, the city of Milwaukee—with help from volunteers, outside donors and fund-raising efforts, such as the AIDS Walk—launched the “No Condom, No Way” campaign, which distributes free condoms and information about safe sex in friendly places. “It was important for us to combine the condom with message,” Foldy said.

What Can Be Done?
Blaming teens for being less-than-completely responsible isn’t going to solve the city’s STD and unintended pregnancy problems. So MASH is currently studying successful safe-sex programs in other cities and states with the hopes of replicating them in Milwaukee.

Foldy said that some good policies—such as New York’s distribution of condoms in public schools—wouldn’t fly in Milwaukee, even though they could help reduce the number of unintended pregnancies and STDs among city youths.

More resources for the city’s Health Department workers who track down partners of those who have been infected with an STD would also help, Foldy said. “We are reaching a small proportion of these contacts,” Foldy said.

He added that other states allow doctors to provide prescriptions not only for their patient who has tested positive for an STD, but for their partner as well. A recent effort to make this legal in Wisconsin died in the state Legislature. “It won’t be perfect, but you will eliminate a huge number of barriers,” Foldy said.

Foldy added that MASH is hoping to improve care at clinic level, by increasing patients’ enrollment in the Family Planning Waiver Program or BadgerCare, and urging mary care physicians to routinely screen patients for STDs. Alternate sites for testing—such as schools or community organizations—could also be explored.

Foldy said raising awareness of the impact of STDs on public’s health and the city’s future is important at every level, from an individual’s health to the cost of treatment of cancer and infertility in the decades to come.

“I think people tend to say this is a problem for [some] people, but not for everyone,” Foldy said. “But in fact sexually transmitted diseases are so common that they’re a problem for everyone.”

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