Author: Christopher Haack, MPH candidate – [email protected]
At the risk of dating myself to some extent, I came of age during the dawn of HIV/AIDS. Suddenly faced with a sexually-transmitted disease (STD) that initially had no cure, vaccine or even viable treatment, young adults in the latter 1980’s and early 1990’s started to take “safe sex” much more seriously. As a result, the rates of infection for other STDs in the United States began to drop dramatically. Gonorrhea rates declined 74% from 1975 to 1997, syphilis declined from approximately 20 cases per 100,000 in 1990 to under 5 cases per 100,000 in 1997, and newly diagnosed cases of genital herpes dropped from over 225,000 in 1990 to 167,000 in 1997 (1).
These trends didn’t reflect a sudden shift in sexual morality or even a sign that Americans and younger adults in the US in particular had adopted a more responsible attitude towards sexually activity. The bottom line is that people were scared. Scared that a single bad decision could be potentially fatal. In addition, alarmed by the gravity of the situation, government agencies at the federal, state and local level began a concerted effort to invest in sex education as well as the free or discounted distribution of protective measures (condoms, etc.).
Although both a cure and a vaccine for HIV continue to elude medical science, the development of HIV protease inhibitors/anti-retroviral treatments for those infected with HIV has shown tremendous success in both minimizing the spread of HIV as well as drastically extending the lives of those currently infected. A significant decrease in AIDS mortality first became noticeable in 1996, the year after the first protease inhibitor was introduced. By 1997, the number of HIV/AIDS deaths had fallen by nearly 50%, followed by a further 20% reduction in 1998. According to the Centers for Disease Control and Prevention (CDC), HIV/AIDS deaths fell from more than 51,000 in 1995 to about 16,000 in 2002 (2). In other words, people infected with HIV in the US started to live somewhat normal lives once again, as long as they were following a prescribed anti-retroviral treatment regimen.
A happy ending, right? Well, not so much. Around the same time that HIV/AIDS was starting to recede from the national consciousness as a guaranteed death sentence, the US started to experience a rise in the rate of infection for a variety of STDs. By 2017, a record-breaking number of sexually transmitted infections were reported in the US according to the CDC. Altogether, there were nearly 2.3 million cases of chlamydia, gonorrhea, and syphilis, which is 200,000 more than in 2016, a record-breaking year on its own. To quote Jonathan Mermin, director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, “We are sliding backward. . . It is evident the systems that identify, treat, and ultimately prevent STDs are strained to near-breaking point.” (3)
Young adults have been disproportionately affected by this troubling trend. In 2016, there were 1,008,403 reported cases of chlamydial infection among persons aged 15–24 years, representing 63.1% of all reported chlamydia cases. During 2015–2016, the rate of reported gonorrhea cases increased 11.3% for persons aged 15–19 years and 10.9% for persons aged 20–24 years, and the rate of reported primary and secondary (P&S) syphilis cases increased 13.0% among persons aged 15–19 years and 8.1% among persons aged 20–24 years. (4)
Is all of this due to the fact that HIV/AIDS no longer exists as a sort of “boogeyman” to scare young adults into adopting sexually-responsible behaviors like using protective devices or regularly having themselves tested for STDs? Not exactly. The sad truth is that the US has drastically reduced its budget for traditional sexual education programs. While the 2016 US budget for "Abstinence Only Until Marriage" sex education in schools, which research has shown to be ineffective in combating both teen pregnancy and sexually transmitted infections, was increased to $85 million per year, the average high school health course in the US includes less than four hours spent talking about all Sexually Transmitted Infections (STIs) and pregnancy prevention combined. In addition, 87 percent of these programs allow guardians to exclude their children from even this small amount of coursework. According to J. Dennis Fortenberry, a professor of pediatrics at Indiana State University School of Medicine, "People working in this area have known for several years that decreases in resources committed to STD prevention would ultimately result in increases such as we’ve seen. . . We have passed a threshold of minimal investment and are seeing the predictable consequences." (3)
Recent studies have shown that there is still a tremendous social stigma associated with STDs among young adults in the US and that a large percentage of young adults do not realize that the risk of disease transmission during oral sex is nearly as high as during other sexual activities. Obviously, we have failed as a nation to adequately educate and inform young adults. Only a recommitment to sexual education and a reinvestment in prevention programs will enable us to start to move the needle in the right direction once again.
At the risk of dating myself to some extent, I came of age during the dawn of HIV/AIDS. Suddenly faced with a sexually-transmitted disease (STD) that initially had no cure, vaccine or even viable treatment, young adults in the latter 1980’s and early 1990’s started to take “safe sex” much more seriously. As a result, the rates of infection for other STDs in the United States began to drop dramatically. Gonorrhea rates declined 74% from 1975 to 1997, syphilis declined from approximately 20 cases per 100,000 in 1990 to under 5 cases per 100,000 in 1997, and newly diagnosed cases of genital herpes dropped from over 225,000 in 1990 to 167,000 in 1997 (1).
These trends didn’t reflect a sudden shift in sexual morality or even a sign that Americans and younger adults in the US in particular had adopted a more responsible attitude towards sexually activity. The bottom line is that people were scared. Scared that a single bad decision could be potentially fatal. In addition, alarmed by the gravity of the situation, government agencies at the federal, state and local level began a concerted effort to invest in sex education as well as the free or discounted distribution of protective measures (condoms, etc.).
Although both a cure and a vaccine for HIV continue to elude medical science, the development of HIV protease inhibitors/anti-retroviral treatments for those infected with HIV has shown tremendous success in both minimizing the spread of HIV as well as drastically extending the lives of those currently infected. A significant decrease in AIDS mortality first became noticeable in 1996, the year after the first protease inhibitor was introduced. By 1997, the number of HIV/AIDS deaths had fallen by nearly 50%, followed by a further 20% reduction in 1998. According to the Centers for Disease Control and Prevention (CDC), HIV/AIDS deaths fell from more than 51,000 in 1995 to about 16,000 in 2002 (2). In other words, people infected with HIV in the US started to live somewhat normal lives once again, as long as they were following a prescribed anti-retroviral treatment regimen.
A happy ending, right? Well, not so much. Around the same time that HIV/AIDS was starting to recede from the national consciousness as a guaranteed death sentence, the US started to experience a rise in the rate of infection for a variety of STDs. By 2017, a record-breaking number of sexually transmitted infections were reported in the US according to the CDC. Altogether, there were nearly 2.3 million cases of chlamydia, gonorrhea, and syphilis, which is 200,000 more than in 2016, a record-breaking year on its own. To quote Jonathan Mermin, director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, “We are sliding backward. . . It is evident the systems that identify, treat, and ultimately prevent STDs are strained to near-breaking point.” (3)
Young adults have been disproportionately affected by this troubling trend. In 2016, there were 1,008,403 reported cases of chlamydial infection among persons aged 15–24 years, representing 63.1% of all reported chlamydia cases. During 2015–2016, the rate of reported gonorrhea cases increased 11.3% for persons aged 15–19 years and 10.9% for persons aged 20–24 years, and the rate of reported primary and secondary (P&S) syphilis cases increased 13.0% among persons aged 15–19 years and 8.1% among persons aged 20–24 years. (4)
Is all of this due to the fact that HIV/AIDS no longer exists as a sort of “boogeyman” to scare young adults into adopting sexually-responsible behaviors like using protective devices or regularly having themselves tested for STDs? Not exactly. The sad truth is that the US has drastically reduced its budget for traditional sexual education programs. While the 2016 US budget for "Abstinence Only Until Marriage" sex education in schools, which research has shown to be ineffective in combating both teen pregnancy and sexually transmitted infections, was increased to $85 million per year, the average high school health course in the US includes less than four hours spent talking about all Sexually Transmitted Infections (STIs) and pregnancy prevention combined. In addition, 87 percent of these programs allow guardians to exclude their children from even this small amount of coursework. According to J. Dennis Fortenberry, a professor of pediatrics at Indiana State University School of Medicine, "People working in this area have known for several years that decreases in resources committed to STD prevention would ultimately result in increases such as we’ve seen. . . We have passed a threshold of minimal investment and are seeing the predictable consequences." (3)
Recent studies have shown that there is still a tremendous social stigma associated with STDs among young adults in the US and that a large percentage of young adults do not realize that the risk of disease transmission during oral sex is nearly as high as during other sexual activities. Obviously, we have failed as a nation to adequately educate and inform young adults. Only a recommitment to sexual education and a reinvestment in prevention programs will enable us to start to move the needle in the right direction once again.
- Aral et al (2007). Sexually transmitted diseases in the USA: temporal trends. Sexually Transmitted Infections, 83(4): 257–266
- Highleyman, Liz (2005). Mortality Trends: Toward a New Definition of AIDS? The Body Pro, Winter 2004/2005
- Feltman, Rachel (2018). Sexually transmitted diseases are at an all-time high (again). But why? Popular Science, 8/29/2018
- Centers for Disease Control and Prevention (CDC) (2017). STDs in Adolescents and Young Adults. CDC Website (https://www.cdc.gov/std/stats16/adolescents.htm), 9/26/2017