Figure 3-2

Distribution of U.S. teenagers by primary source of information regarding STDs, 1995. SOURCE: ASHA (American Social Health Association). Teenagers know more than adults about STDs, but knowledge among both groups is low. STD News. A quarterly newsletter of the American Social Health Association. Winter 1996;3:1,5.

Ironically, it may require greater intimacy to discuss sex than to engage in it. The kind of communication that is necessary to explore a partner's sexual history, establish STD risk status, and to plan for protection against STDs is made difficult by the taboos that surround sex and sexuality. As Lear (1995:1313) notes, individuals rarely engage in explicit discussions about sex: ''The existing discourse on sex is marked by a lack of vocabulary. ... Sexual encounters, at least early in a relationship, often involve very little spoken communication; communication is rather non-verbal and coded." Barriers to open discussion include gender roles, modesty, and cultural, family or religious beliefs. For instance, the "good woman" or the "modest woman" is not supposed to know about sex, so it is inappropriate for her to bring up subjects like HIV and condoms. Many studies have shown that both adolescents and adult women who are uncomfortable about their sexuality and who have high levels of guilt regarding sexual behavior are less effective in their use of contraceptives than others (Herold et al., 1979; Gerrard, 1982, 1987). Narrow attitudes towards sexuality and sex roles can make it difficult to initiate a conversation regarding sex and safer sex strategies with



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