Protecting Milwaukee’s teens in an STD hot spot
Research shows that the more young people know, the better off they are
Each time his organization unveils a new billboard promoting condom use, Anthony Harris, coordinator of Diverse & Resilient’s 414ALL program, hears from angry parents. ❚ How dare you push my kid to have sex, they tell him. ❚ Harris quickly counters: ❚ “We can’t pretend like our young people are not engaging in sexual activity,” he said. “The best thing we can do is teach them how to protect themselves.” ❚ Harris and his organization are working the front lines of an important battle in Milwaukee: reducing teen pregnancies and sexually transmitted infections.
One of those efforts has been successful: The birth rate for females aged 15-17 was 18 per 1,000 in 2016, a major change from a decade ago when the city had the second-highest teen birth rate in the nation.
But we’re losing the other battle: The city has the nation’s highest rate for gonorrhea and one of the highest rates for chlamydia and HIV infection for young men of color, the Journal Sentinel reported in March. That month, health officials and city leaders held a news conference announcing the discovery of an HIV and syphilis “cluster” in the city.
That young people in Milwaukee are at a high-risk for contracting STIs should be no surprise. Half of all new sexually transmitted diseases are acquired by people aged 15-24, according to data from the Centers for Disease Control and Prevention, and onefourth of sexually active adolescent females has an STD, according to CDC estimates.
But the research also shows that education has a profound effect on the numbers. The more young people know about sexually transmitted diseases — and how to protect themselves — the better.
A meta-analysis of research on this problem co-authored by Dafina Petrova is one of the most recent largescale analyses of STI curricula. Her work looked at nearly 300 evidencebased STI prevention programs in the U.S. and found that an effective STI prevention curriculum can reduce infection rates by 30%, she said. Petrova works in the Andalusian School of Public Health in Granada, Spain, and conducts collaborative research with the Decision Analytics Lab at the University of Oklahoma.
“I think the important message here is not that interventions are effective in general. But that a properly designed intervention can be very
Because many parents are reluctant to talk to their kids about sex ... teens rely on word of mouth or what they find online. Another traditional way for youth to learn about sexual health and STI prevention is through their schools, but sex education is limited in Wisconsin.
successful,” Petrova said.
Unfortunately, Milwaukee has a long way to go.
Getting information to youth
A preliminary analysis of an assessment administered by Diverse & Resilient placed the city at the third of nine stages of community readiness. That meant there was a “vague awareness” of the local STI crisis in the city and “limited efforts” to address it. It also means that there was a “limited identifiable leadership dealing with the issue and no immediate motivation to do anything,” according to the standard community readiness model created by the Tri-Ethnic Center for Prevention Research at Colorado State University. Diverse & Resilient runs programs for LGBTQ people in Wisconsin, including those on sexual health.
“There aren’t a lot of known leaders talking about this issue. We need more and visible leadership and to continue to reduce the misconceptions around condom use and sexual health,” Harris said.
Because many parents are reluctant to talk to their kids about sex, he said, teens rely on word of mouth or what they find online. Another traditional way for youth to learn about sexual health and STI prevention is through their schools, but sex education is limited in Wisconsin.
“Unfortunately in the world we’re living in, there are not a lot of schools that are offering sexual health education,” Harris said.
According to Molly Herrmann, education consultant for the Wisconsin Department of Public Instruction, the state receives federal funding from CDC for the administration of statewide surveys, sexual health education and to provide sexual health services that could include free STD or pregnancy tests in schools or through referrals to outside organizations.
But those funds are limited, she said, and the DPI cannot regulate what services a school can offer. For example, schools do not have to provide free testing or condoms nor do they have to educate students about sex and protection, Herrmann said.
According to Harris, MPS is not allowed to purchase condoms, so Diverse & Resilient is the sole supplier, providing condoms to 24 different MPS high schools and a few charter schools. MPS did not respond to an interview request for this story.
But kids still need information about sexual health. What type of education works best? Several recent studies provide clues.
What the research shows
Petrova, of the Andalusian School, said programs that provide youth with information about the diseases they are at risk of contracting and tips on how to protect themselves, including the use of condoms, are effective.
Programs that feature communication and negotiation skills also seem to work.
“Young women often report not knowing how to communicate with their partner and both males and females often discuss being influenced by the opinion of their peers. Learning how to communicate and negotiate either not wanting to have sex or the use of protection like condoms are some very practical skills that can help them avoid becoming infected,” Petrova said.
Another promising intervention is being evaluated at the University of Oklahoma; it is a risk-benefit approach using technology, she said.
“It’s a way to help them make informed decisions by presenting them with information on how they can benefit from using a condom, and doing so perhaps by using visual aids,” Petrova said.
A group of researchers from North Carolina and Pennsylvania conducted a meta-analysis of technology-based STI interventions, which was published in the Journal of Adolescent Health in June. The researchers synthesized 15 years of data on technology-based programs focused on youth and evaluated the effectiveness of programming delivered via computer, smartphone, text messaging and other web-based platforms.
Among the benefits: The programs had a broad reach and a low cost. Researchers also noted that technologybased programs gave kids a safe and familiar environment to get factual information about sexual health. They also showed promise in improving condom use, knowledge of sexual health, safer sex attitudes and even abstinence.
Generally, though, abstinence-based programs are not that effective, research has shown.
“Our ability to self-regulate when we are adolescents has not properly developed yet,” Petrova said. “It’s biology.”
It is harder to avoid risky behavior altogether, researchers argue, which means a more effective strategy will try to minimize the harm of those behaviors, she added.
Harris agrees.
“It’s important to talk about it, but you can’t leave out every other aspect of sexual health,” he said of abstinence education. “As human beings, we all have these urges to reproduce and that includes having sex.”
Another factor to consider: The corrosive impact of drugs and alcohol on judgment.
“It lowers your inhibitions so maybe then you will do something you’re not ready to do,” Harris said. “The reality is that drugged or inebriated sex is something that happens often with teens.”
Angela D. Bryan, professor of psychology at the University of ColoradoBoulder, examined what happens when information about alcohol and marijuana is included alongside HIV/STI interventions with high-risk youth. That type of approach could be effective in Milwaukee, which has a significant population of at-risk youth.
Published in the JAMA Pediatrics journal in April, the researchers found that interventions that combine HIV/ STI information with alcohol and marijuana content and motivational enhancement therapy (which helps people change behavior) were successful.
Another key to reducing STI infections: The involvement of an adult in the youth’s home, Harris said. He compared having “the talk” about sex with teaching a kid to drive. When you teach driving, you want students to learn how to stay safe and protect other people, Harris explained.
“With sex, it’s the same thing,” he said.
But if those conversations don’t happen at home or school, then it’s the responsibility of health workers to make sure the message gets delivered.
“We can’t wait for them to come to us because most times they won’t,” Harris said. “We find out where youth and young adults hang out and we connect with them there. It’s a difficult but necessary process that has to occur if we’re going to protect our young people.”
How I reported the story
Reviewed:
Effect of Including Alcohol and Cannabis Content in a Sexual Risk-Reduction Intervention on the Incidence of Sexually Transmitted Infections in Adolescents A Cluster Randomized Clinical Trial
Technology-Based Interventions to Reduce Sexually Transmitted Infections and Unintended Pregnancy Among Youth
Abstinence-Only-Until-Marriage: An Updated Review of U.S. Policies and Programs and Their Impact
Brief Messages to Promote Prevention and Detection of Sexually Transmitted Infections
Effective Evidence-Based Programs For Preventing Sexually Transmitted Infections: A Meta-Analysis Interviewed:
Anthony Harris, 414ALL program coordinator, Diverse & Resilient
Dafina Petrova, researcher at the the Andalusian School of Public Health in Granada, Spain, and the Decision Analytics Lab at the University of Oklahoma
Molly M. Herrmann, educational consultant, Wisconsin Department of Public Instruction
Angela Bryan, professor of social psychology and neuroscience at the University of Colorado-Boulder
Data used for the story was obtained from the Centers for Disease Control and Prevention (CDC) and Wisconsin Department of Health Services