"Let's talk about sex."

BY REBECCA PERLOW

We’re not. We haven’t for years. And we’re No. 1 nationwide in gonorrhea and chlamydia infections. Has our city and state’s apparent reluctance to talk honestly about sexually transmitted diseases exposed St. Louis teens to unnecessary risk?

According to the Center for Disease Control and Prevention’s 2007 report on communicable disease, St. Louis ranked #1 in gonorrhea, #1 in chlamydia, #5 in syphilis and #5 in HIV nationally. Our teen pregnancy rate is 150 percent of the national average.
Both St. Louis City and County have high incident rates for chlamydia, particularly among young women. Women, between the ages of 15 and 19 had the highest rates for chlamydia and gonorrhea in the St. Louis area between 2002 and 2006. Although the “scary” statistics are measured only in St. Louis city, the incidence of positive cases remains the same when the other six counties in the metropolitan area are included: Warren, Jefferson, Lincoln, St. Charles, Franklin and St. Louis County.

“When you look at the statistics in St. Louis, it has been comparing the number of cases we have to our population. We do have a large caseload of positive cases for gonorrhea and chlamydia, but it’s based on a population that’s much smaller than say New York or Miami or Phoenix or some of the other very large cities, so that’s going to make our prevalency rate look very high,” Mary Kogut, vice president of patient services at Planned Parenthood, said.

The steady number of positive sexually transmitted infection (STI) cases is also a reflection of current national trends, which have shown a sharp rise in reported cases of gonorrhea and chlamydia.

“It’s a national issue. Our rates have been coming down so we have some encouraging signs because we have not seen a decrease in testing, but in the last year our gonorrhea rates have gone down. Rates are still staggering everywhere,” Dale Wrigley, Program Manager, STD/HIV & Hepatitis Prevention Services for the City of St. Louis Health Department, said.

Chlamydia is the most commonly reported infectious disease according to the CDC’s national report. Last year, there were 4,321 reported positive cases of chlamydia in St. Louis City, 1,710 of those in the 15 to 19 age group. Among women, untreated chlamydia can lead to pelvic inflammatory disease and possible sterility. Among men, it can lead to urethral infection, epididymitis – an infection of the tubes where sperm mature in the testicles, and sterility. However, the national rates for positive cases may be caused by recent changes in STI testing.

“It wasn’t until 2005 that we even tested men for chlamydia. So nationally rates went up because men were finally being tested as well. In 2005, urine testing also became available for chlamydia and gonorrhea so our rates went up because it made testing easier.” Wrigley said.

For gonorrhea, St. Louis County had rates between three and eight percent, St. Louis City had between six and eight percent. Another possibly deceptive ranking is the inclusion of syphilis, of which there were only 116 total cases in the city last year.

“Because syphilis is so rare today, if you have more than one case, it creates a certain dynamic,” Erin Meyer, Public Relations and Media Coordinator for Planned Parenthood of the St. Louis Region, said.

“But that’s not to underestimate that we do have a lot of cases [of STIs] and we have some work to do,” Kogut said. “These are all preventable diseases. We shouldn’t be seeing these numbers at all.”

In years past, St. Louis’ reception of information and social marketing on the subject of STIs and testing has been relatively conservative.

In Sept. 2001, Mayor Francis Slay ordered the removal of two billboards in an AIDS awareness advertising campaign. One of the ads ordered removed featured two black men embracing with the slogan “Before the loving begins, get tested. Know your HIV status.” A second ad included an image of a condom. Slay told the St. Louis Post-Dispatch that his reasons were that the ads “would offend families, people with children, a whole host of people.”

It begs the question: why are we, as parents, guardians, citizens so averse to discussing the issue that affects our children?

“Society in general doesn’t want to talk about it. There’s a certain fear [in talking about sex]: ‘if I talk about it, you’ll want to do it,’” Wrigley said. “The reality is studies show kids delay when they have more information.”

The city health department’s “Body and Soul” campaign has also added a parent/guardian component to the program. They’ve hosted three break-out sessions, talking with 30 to 40 parents and guardians about how to approach the subject of STIs and testing with their children.

“It’s new still. It’s very small, but the reaction was positive. Parents have questions; parents don’t know how to approach the subject. And it’s because of our fear of talking about it probably,” Wrigley said. “I’ve been in this field for 15 years, it’s like second nature to me, but that’s not the case for the general population and it’s going to have to start small.”

While the percentage of teens positive for STIs in St. Louis has risen sharply in the last five years, the state of Missouri’s focus on sex education has mostly been centered on the issue of teen pregnancy and the body politic of abortion.

In July 2007, Governor Matt Blunt signed HB 1055, a house bill barring educators from Planned Parenthood or any other groups affiliated with abortion providers from disseminating materials related to sex education curriculum in Missouri schools. The law also removed the requirement that schools teach sexual education that is comprehensive and both medically and factually accurate, instead allowing schools to teach according to federal abstinence-only standards. The law also established an “Alternatives to Abortion” services program which does not provide any assistance with family planning services. The total funding for the program reached $1.9 million this year.

As a result of signing the measure, Governor Blunt received a great deal of praise from pro-life groups and supporters of abstinence-only education.

“It is an inherent conflict of interest to have abortion clinics teach school kids how to practice so-called ‘safe’ sex. Because when the school girls end up getting pregnant, the clinics can provide abortion as a back-up for a very hefty fee.” Samuel Lee, Director of Campaign Life Missouri, posted on the Concerned Women for America Web site last year.

“Let’s be real. We need more trained professionals teaching comprehensive sex education in our schools not fewer. Banning experts from schools takes us in the wrong direction,” Alison Gee, Planned Parenthood of the St. Louis Region’s Vice President of Public Policy, said. “And, it is not just about unintended pregnancy. One in four teenage girls has a sexually transmitted disease. One in five has human papilloma virus, and despite the $1.5 billion spent on abstinence-only-until-marriage education, about half of all teens are sexually active.”

Elimination of up-to-date, accurate materials on safe sex and contraception takes away from a comprehensive, factual, non-judgmental sex education in public and private schools. Why is it that so many people tend to focus narrowly on one issue of the broad issue of comprehensive sex education?

“The fact that the anti-abortion/anti-family planning lobby continues to always link any prevention issue to abortion [only] underscores how extreme and out of touch they are. They know there is significant public support for prevention programs like sex education and family planning. Instead of opposing prevention outright, they try to redefine them as abortion,” Gee said.

“The goal of comprehensive sex education—which includes information about abstinence as well as contraception—is to make sure our young people have complete information so they can make responsible decisions and protect their health and lives. ‘Protecting’ teens from information is immoral.”

To stem the tide of infection, both the city and county health departments and several special interest groups are currently working on a variety of outreach programs to educate teens about STIs and stress the importance of getting tested.

Last December, the City of St. Louis Health Department launched “Body and Soul,” a broad social marketing campaign aimed at combating the rise of STI infection among teens in collaboration with St. Louis Effort for AIDS, Project ARK, the Regional Health Council and others. The health department brought in “youth ambassadors,” student volunteers educated by the Communicable Disease Division to be able to go out and talk to teens about STIs and other health issues.

“I think that’s going to be the best way to address this problem,” Kacie Triplett, Alderman for the 6th Ward, said. “You can have educated people talk to kids about how to But it’s really going to take a peer-to-peer approach, to have people who can talk to kids on their level. I hope that will make a difference.”

As part of the campaign, St. Louis ConnectCare offered free STI testing through Valentine’s Day. The clinic offers a flat $25 for complete testing year round. The Juvenile Justice Center began offering chlamydia and gonorrhea testing last October. On June 14, the City of St. Louis’s STD/HIV & Hepatitis Services sponsored the “One Person, One Ward, One Test” walk with sites along the route for free lead, HIV and syphilis testing.

The St. Louis County Health Department’s Disease Intervention Activities and Health Promotions office also give presentations on risk reduction to both public and private schools.

“We talk about all types of prevention and risk reduction. We do tell them that abstinence is the only guaranteed method of not contracting an infection. However, we also emphasize getting tested, talking to your partner about STI testing and reducing the risks. We don’t limit it to a one-size fits all [presentation]: either don’t have sex or risk infection. We want to make sure we cover all the different areas of reduction.” Regina Whittington, STD Program Supervisor, said.

The content of each presentation is shown and approved by the teachers before it gets to the classroom. Slides that have been excised from the presentation upon request are usually “photos of genitals” rather than definitions of safe sex practices.

“We don’t emphasize a value system. It’s here are the diseases, this is how you can get them, here’s how you reduce your risk,” Whittington said.

You can e-mail Rebecca Perlow at ladyjane52983@hotmail.com.