"Let's talk about sex." Salt-N-Pepa told us this in the late 80s, urging African Americans to protect themselves from HIV/AIDS. Yet 20 years on, African American youth in Multnomah County don't seem to be talking about sex — or its consequences. At least not enough to keep themselves safe.
That's why Multnomah County last week launched a new Web site called www.knowsexpdx.com The site aims to reach Portland's Black youth and families by providing culturally specific information about sexual health.
The hard fact is African Americans in Portland suffer from higher rates of sexually transmitted infections than their White counterparts. That's part of a national trend. For example, seven times as many African Americans as Whites were infected with gonorrhea and five times as many contracted chlamydia, in Multnomah County statistics from 2000-2004. Both infections can be successfully treated, but should be caught as early as possible to avoid problems such as infertility. New cases of HIV are also higher in African Americans than in White non-Hispanics.
Yet African Americans are no more sexually active than Whites, says Tricia Tillman, program manager at the Multnomah County Health Department. "It's not because African Americans are having more sex or more sexual partners," she said.
"By having a lack of access to STD screening and treatment means more disease can be spread. … It doesn't mean they are using condoms less … among adolescents there are more untreated sexually transmitted diseases."
Tillman said many of the root causes of health disparities, including sexual health disparities, come down to lack of access to health services, lack of education, and lack of money. Another factor, Tillman said, could have to do with the way African American males view their future. With a lack of access to higher education, higher incarceration and homicide rates, many Black males may not protect themselves because they are fatalistic about the future.
The Web site itself has an urban flair designed to appeal to teens and young adults. Club scenes with dance music play in the background. The information on the site – gleaned from a number of different Web sites and information sources – is standard information about sexually transmitted infections, advice about relationships, safer sex practices, the emotional impact of sex, and links to other agencies.
Teens and young adults were also involved in creating the site. The Web developers used five different focus groups with people aged 13 to 25 to give input on the type of information they'd like to see in a sexual health information Web site. The Web site is part of an overall campaign to reduce sexual health disparities. The African American STD Disparities Elimination Program has been working since 2002 on the problem. Before that, traditional STD-prevention strategies targeted gay and White communities.
The campaign is also reaching out to faith-based groups as a means to reach out to African American youth. Tillman says churches have an important role in both safe sex and abstinence education.
"There's a lot biblically that promotes abstinence and health," she said. "And churches also realize not everyone is operating at that level. More and more, churches are willing to talk about people making healthier choices."
The site includes two options when entering the sex information section of the Web site: "No Sex" and "Know Sex." The abstinence-only pages provide basic information about what abstaining from sex is and why some people pledge to abstain. What it doesn't say, however, is that studies show many young people who pledge to abstain from sexual activity until marriage, will break that pledge. The Web site promotes abstinence as a "100 percent effective way" to prevent pregnancy and infection. While it's true that not having sex is the only way to be 100 percent safe, recent studies say abstinence-only education often fails, and teens are the casualties.
Two separate studies published in the American Journal of Sociology and the Journal of Adolescent Health in 2001 and 2005, showed that 60 percent of young people who pledged abstinence until marriage had broken that vow when researchers questioned them six years later. And although youth who pledged to abstain were more likely to put off having vaginal intercourse, they engaged earlier in anal and oral sex. They also were less likely to use condoms when they had sex. Abstinence pledgers also were less likely to know their STD status or to have undergone STD testing.
A 2007 study by Finer L. Trends, published in Public Health Reports, found that since the 1950s, 75 percent of Americans have had premarital sex by age 20 and 95 percent had had premarital sex before age 44.
The Skanner asked Tillman if the Web site should include on the abstinence Web pages, a mention of its high failure rate. Are teens who visit the Web Site being given a false sense of safety when they read that pledging abstinence is "100 percent effective," if the facts show otherwise?
"Comprehensive sexual education is not contrary to abstinence education, it's complementary," she said. "Our position at Multnomah County Health Department is that having both messages is critical."
Charlene McGee, health educator with the equity program who spearheaded the project acknowledged that correct information is vital.
"Abstinence is not effective," she said, but working with churches and other groups who support those programs presents a learning curve. She said they are working to make more people understand the failures and successes of sex education.
Part of that push is to also make people realize this is not a "them" issue, but an "us" issue. When discussing the Web site and campaign, McGee said the crowd was asked a number of questions such as "Did you have sex before marriage?" and "Have you ever known someone to become pregnant out-of-wedlock?"
Illustrating the complexity of the problem, she said one woman approached her privately. The woman said she wanted to raise her hand to almost every question, but still retained the expectation that her 15-year-old daughter would remain abstinent until her wedding night. "People have unrealistic expectations," McGee says.
