• STDs. Clinicians and STD (including HIV) prevention programs, like family planning programs, should teach that use of a condom (male or female) along with an effective contraceptive for pregnancy is necessary to obtain maximum protection against both STDs and unintended pregnancy. This should be the standard approach for both men and women who are not in a mutually monogamous relationship with an uninfected partner.

Focusing On Adolescents

Many of the severe health consequences of STDs, such as cervical, liver, and other cancers, manifest themselves among older adults because they may not appear until decades after infection. This phenomenon contributes to the under-recognition of the impact of STDs among older adults. These complications, however, usually result from infections acquired or health behaviors initiated during adolescence or early adulthood. Therefore, STD prevention programs need to focus on adolescents. The committee's proposed focus and recommendations regarding appropriate policies to prevent STDs among adolescents are similar to those of numerous health professional and other organizations (AMA, 1996).

Ensuring Effective, Early Interventions and Confidentiality

As outlined in Chapters 2 and 3, three million teenagers acquire an STD each year and high-risk sexual activity among adolescents has become more common during the past two decades, increasing the number of adolescents and young adults at risk for STDs. Current data indicate that almost 40 percent of adolescents in the ninth grade have already had sexual intercourse (CDC, 1995). Adolescents are at greater risk of exposure to and infection with STDs than are adults. This is due to high-risk sexual behavior, increased biological susceptibility of the adolescent cervix to infectious diseases, and the greater likelihood of exposure to the social factors contributing to STD risk.

Many opponents of education for adolescents about sexuality and STDs believe that adolescents should only be told not to have sexual intercourse and that other forms of education are not appropriate. At the other end of the spectrum, some advocate that adolescents should be assumed to be sexually active and given appropriate education regarding STDs, without any messages regarding the appropriateness of sexual intercourse among adolescents. The committee believes that some aspects of both perspectives are valid and should be part of a national initiative to prevent the initiation of high-risk sexual activity among adolescents. Adolescents should be strongly encouraged to delay sexual intercourse until they are emotionally mature enough to take responsibility for this activity. In spite of messages to delay intercourse, most individuals will initiate sexual intercourse during adolescence. They should have access to information



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