March 8, 2004 -- At 17, Yesenia Myasonee has seen five of her school friends get pregnant in the past two years — and that's not counting the six "acquaintances," as she calls them, who also had to take brief school breaks to have their babies.
An articulate, preternaturally bright senior at South High Community School, Worcester, Mass., Myasonee also volunteers at a local youth organization that attempts to raise awareness of safe sex issues.
And though she's conscious of the importance of safe sexual practices, she's also aware that many of her pals display alarming propensities to indulge in risky sexual behavior.
Recalling her failed attempts to get some of them to use contraception, Myasonee is characteristically blunt. "I call them dumb," she says, referring to her friends who use neither condoms nor birth control pills. "I can only push so far, but I can't hold their hands."
From school grades, college admissions and career choices to erratic dates, dwindling pocket money and stubborn acne, American teenagers have a lot to be anxious about. What they do not seem to be significantly concerned about though, is safe sex and the risks of sexually transmitted diseases.
According to a recent study by the Centers for Disease Control and Prevention, teenagers and young adults account for nearly half the cases of sexually transmitted diseases in the United States, although they make up just a quarter of the sexually active population.
In the first extensive national estimate of STDs, including HIV, among young Americans, the study found that of the 18.9 million new STD cases that occurred in 2000, 9.1 million were among persons aged 15-24.
Invulnerable And in Denial
On the one hand, the alarmingly high number of STD cases can be attributed to recent improvements in screening and detection methods. On the other, the disproportionately high rate of sexual infections among young Americans is a result of a complex stew of social, cultural and political forces that has been simmering in recent years.
"It's alarming, but it doesn't surprise me," says Laurie Ross, coordinator of HOPE Coalition (Healthy Options for Prevention and Education), a Worcester-based coalition working on youth sexual issues.
"I think adolescents don't think anything can happen to them. If a girl is afraid she's pregnant, she'll take a pregnancy test, but she won't take an HIV test. They tend to think they're invulnerable."
Like other Western countries, the United States has seen a drop in teen pregnancy and birth rates for more than a decade.
Studies also show a decline in teen sexual activity during the same period. A 2002 CDC study, for instance, found the percentage of high school students who ever had sex dipped from 54.1 percent in 1991 to 45.6 percent in 2001.
More Pills, More Oral Sex
But that, some experts say, does not necessarily mean the ones who are sexually active are listening to public health messages on the importance of safe sex.
While the 2002 CDC study did not address other types of sexual activity, such as oral sex, a number of experts working with American youth say oral sex is getting increasingly popular in the age group.
While STDs can be transmitted through oral sex, a study by the Kaiser Family Foundation last year concluded that a majority of American teens are not aware that STDs can indeed be transmitted through oral sex.
And while the fall in U.S. teen pregnancy rates are nowhere near the rapid decline in other Western countries, some experts say credit for the statistical drop lies more with the use of hormonal birth control pills and patches than condoms, which provide physical barriers against infections.
Guys Are ‘Cool,’ Girls Are ‘Easy’
Female empowerment and effective contraception have always been inextricably linked. And Ross believes the fact that women have more control over pills and patches than condoms is especially significant among youth.
"The whole attitude to condom use among young people should be viewed in terms of gender issues in sex and relationships," says Ross.
"A lot of girls feel that if they ask their partners to wear condoms, she'll be viewed as not trusting him. While pop culture messages are highly sexualized, the underlining attitudes [among youth] have not changed. It's still viewed as 'cool' for guys to have sex, but girls are talked about as 'easy' — there are plenty of double standards."
But condom use among youth is also a highly politically charged terrain in the United States.
For William Smith, director of public policy at the Sexuality Information and Education Council of the U.S. (SIECUS), a New York-based nonprofit organization, the high STD rates among American youth is a manifestation of a deeper malaise.
"This news is really shocking," says Smith, referring to the recent CDC study.
"It should be a wake-up call for policy makers that our policies are failing the young people in this country. This study should be a wake-up call for policy makers to stop funding abstinence-only programs and back comprehensive and medically accurate sex education," he adds.
Just Say No to Sex or Condoms?
Abstinence education has turned into a public health policy war of sorts. The battle-lines are drawn between "abstinence-only" program advocates on one side and promoters of comprehensive sex education — which includes information on abstinence and contraception — on the other.
With the Bush administration pledging $270 million on abstinence-only education this year, federal funding may have become the focal point of the acrimonious fight. But by all accounts, it is the condom that is the lightning rod as advocates on both sides battle for the hearts, minds and sexual lives of American youth.
According to Leslee Unruh, president of the Sioux Falls, S.D.-based Abstinence Clearinghouse, comprehensive sex ed advocates fail to inform youth about the dangers of the condom.
"Condoms break, condoms come off, the fact is condoms are not helpful and they lead kids to have a false sense of security," says Unruh. "What's more, condoms don't protect the heart. Breakups can be very painful and can lead to depression and suicide. Sexuality is not just a health issue, it's an emotional one as well."
The solution, according to Unruh, lies solely with abstinence-until-marriage programs, since she believes comprehensive sex education programs pay only "lip service" to abstinence while promoting "protection."
‘That’s So Old-Fashioned’
But Myasonee has little patience for abstinence-only programs. "That's so old-fashioned," she says with a dismissive sigh.
"Honestly, my friends say, 'everyone's doing it, so why shouldn't I?' " adds Myasonee. "I know a girl who was very dedicated to abstinence, she was very vocal about staying a virgin until she got married. And then she got a boyfriend in eighth grade and lost her virginity."
Although her school provides comprehensive sex education, the 17-year-old senior is hardly enthused by the program so far. "In two years, we've had two [sex ed] sessions," she explains. "They show you how births happen. After that, they don't want to go in depth. I think they feel that if they do, they're encouraging sex or something."
The solution, according to Myasonee — who says she attends church regularly, uses a condom with her boyfriend and is also on the pill — is to talk about such issues with adults.
But she's not blind to a tricky set of challenges. Not only do kids prefer not to discuss their sex lives with their adult relatives, but parents often don't make it easy, she says.
Recalling the way her best friend's family recently handled her pregnancy, Myasonee explains it was a bit like ostriches with their heads firmly stuck in the sand.
"Both her parents work and her boyfriend used to come home after school," she explains. "But her parents let her pretend she's an angel. Deep down inside, I think they had to know. People won't usually talk about things like safe sex. I think when people get infected, they just keep it to themselves — except in pregnancies, where beyond a point, you can't hide it."