New findings dramatically demonstrate how the spread of sexually transmitted diseases differs by age, gender, race and geography.
The U.S. Centers for Disease Control and Prevention (CDC) reports that some STDs - hepatitis B, chancroid and syphilis - are declining among teens, but gonorrhea is up, while other STDs continue to disproportionately affect youth, with young women and African Americans particularly hard hit.
After dropping each year from the late 1980s through early 1990s, gonorrhea rates are climbing again throughout the population, the CDC says in "Tracking the Hidden Epidemics: Trends in STDs in the United States 2000."
The disproportionate incidence of STDs among youth can be explained in part by some inherent factors: Teens are more likely to contract STDs because they are more likely to have multiple partners, while young women are biologically more susceptible to certain STDs and are more likely than young males to have older sexual partners (men who are more likely to have already contracted a disease).
These factors may explain the results of a recent study of 3,860 sexually active females in Baltimore, also conducted by the CDC, which showed that the chlamydia rate among females ages 12 to 24 was more than three times that of females 25 to 60.
Yet another CDC study, released last month ("Young People at Risk: HIV/AIDS Among America's Youth"), estimates that at least half of all new HIV cases in the United States are among people under 25. In one sample of more than 3,000 cases reported in 1999, females between ages 13 and 19 made up 64 percent of the cases, while African Americans in that age range made up 56 percent.
Race is a major factor in the spread of STDs according to "Tracking the Hidden Epidemic." Chlamydia, which is one of the most common curable STDs among teens, is more prevalent among women than men, but is especially prevalent among young black women. The chlamydia rates for 15-to-19-year-old females in 1999 were just under 4 percent for whites, 6 percent for Mexican Americans, and as much as 12 percent for African Americans.
As for gonorrhea, infections increased 13 percent among adolescents from 1997 to 1999. Meanwhile, while young African Americans remain at extremely high risk, male Hispanic teens continue to contract gonorrhea at a higher rate than their white counterparts, and female Hispanic teens, whose rate was lower than that of their white counterparts throughout the '80s, are now at higher risk.
Finally, the report calls syphilis, which is easily treatable and curable through basic health care, "one of the most glaring examples of existing gaps in minority health status." African Americans are 30 times more likely than whites to have the disease. "With increased awareness and access to acceptable health care," the report says, "this health disparity could be largely eliminated."
Why the disparities? "Race and ethnicity are markers for something else," says Dr. Susan Wang, medical epidemiologist at the CDC, referring to a lack of resources such as access to good medical care.
Douglas Kirby, senior research scientist at ETR Associates, a nonprofit health education organization, agrees, pointing out that adjusting for race does not eliminate the disparities, but dramatically reduces them. Factors associated with poverty that affect contracting diseases include: insufficient health care, insufficient education of children and parents and prevalent values that condone early sexual activity. What's more, African Americans are more likely to have sexual relations with other African Americans, who are more likely to be infected, triggering a recurring cycle.
One twist in the racial disparity, says Kirby, is that black teens are reportedly more likely to use condoms than are white teens. However, black teens are also more likely than white teens to become sexually active at an early age, and to have more sexual partners. Therefore, more condom use does not preclude more unprotected sex. As Monica Rodriguez, director of information and education at the Sexuality, Information and Education Council of the U.S. (SIECUS), says, youth workers need to "get people to use condoms consistently."
STDs are also highly concentrated in the southeastern quadrant of the United States. None of the nine states with extremely high rates of gonorrhea - over .2 percent - are north of the Mason-Dixon Line or west of Louisiana.
Why is gonorrhea, after declining for the past several years, beginning to creep back? "It's fascinating to me," says Rodriguez, who, like many others, has found no satisfying explanation.
All the more reason for more in-depth research. Rodriguez advocates focusing more on the differences between young African-American, Latina and white women, and determining how to reach those most susceptible to STDs.
She also urges listening to young people more, citing Sex etc., the magazine and website (www.sxetc.org), and Planned Parenthood's "teen wire" website (teenwire.com), as examples of teens educating adults and each other about sex-related issues. "We need to do that more," she says. After all, "Who knows better?"
Contact: Dr. Susan Wang at (404) 639-8373, or the CDC at www.cdc.gov.
- Amy Bracken