With the largest rate of teens having sex in the country and the fifth-highest HIV/AIDS rate in that age group, Philadelphia has launched a campaign to reverse those trends with a website that offers mail-order condoms to children as young as 11.
A similar effort in Provincetown, Mass., last year stirred up vigorous protest from parents when the school board made condoms available to children of all ages, as long as they went to a school counselor and asked. After the uproar, officials limited access to fifth-graders and up -- or those 11 and older.
But so far in Philadelphia, the parental reaction has been minimal, according to city health department spokesman Jeff Moran.
Though not much data exists on sexual behavior among kids as young as 11, the 2009 CDC Youth Risk Behavior Survey shows that 15 percent of children under 13 have had their first sexual encounter.
"I haven't heard much in way of public outcry -- not yet -- but I anticipate it," said Gary Bell, executive director of Bebashi-Transition to Hope, a local nonprofit that works with teens on prevention of HIV and other sexually transmitted diseases.
"We hear from teachers and school counselors and sometimes the principals that kids are cutting school in the afternoon and leaving early to go have orgies -- and that's in middle school," said Bell.
"They get groups together with kids of different genders -- sometimes same-sex and sometimes mixed. The parents are not home and so they go there and have sex and trade partners."
He also reported that city teens use different colored lip stick to signal "how far they will go with oral sex with a guy," according to Bell. "We are hearing about them acting out in school in the bathrooms and the stairways. This is not entirely new, but we don't think of it in middle school."
And, he said, most teens have no idea that they are exposing themselves to the dangers of risky sex. The organization's 24/7 hotline gets questions like, "Can I get pregnant standing up?" or "Can I get pregnant with anal sex?"
"We had another kid kicked out for a ménage a trois -- three boys who were 10 and 11," he said "It's really apparent that many do not realize they can get sexually transmitted infection with oral or anal sex."
Take Control Philly Aimed at Sexually Active Teens
Health officials hope their new website can at least help disseminate information. City schools offer one year of health education and half of that is devoted to physical education. The other semester includes other topics, as well as sex.
The website, Take Control Philly, provides information on sexually transmitted disease and where to go for help, as well as straight talk and explicit illustrations on how to use a condom.
"And let's face it, sex is more fun when you're not worried about getting pregnant or getting an STD," says the website. "If you feel you and your partner are ready to have sex, it is important to use protection every time. That means using a condom -- and using it right.
The city also launched a custom-wrapped condom, called "The Freedom Condom" to bring attention to their campaign.
The 2009 CDC Youth Risk Behavior Survey reveals that the city has the highest number of sexually active teens and one of the lowest numbers of those who use condoms. A city health department report confirms this.
Centers for Disease Control and Prevention (CDC) also show Philadelphia has the fifth highest HIV/AIDS infection rate.
Condom availability for children as young as 11 is controversial, and Bell admits it's no "panacea."
But child development experts say introduction to sex education early on is important.
Dr. Eugene Beresin, a professor at Harvard University and director of training in child and adolescent psychiatry at Massachusetts General and McLean hospitals in Boston, said he was in favor of policies aimed at younger children.
"If kids are taught and have access to counseling, there's a better chance of abstinence being maintained and the risk of STDs is diminished," he said.
But, he said, condom distribution should not be the "flagship" of sex education.
"Let's face it," he said. "You can't stop kids from having sex if they want to. It would be great if they hold off, but we can't stop it. What we can do is improve responsibility. So while we have to be thoughtful about randomly distributing condoms in the first grades, sex behavior and its consequences are part of the lives of young teens through young adulthood."